Lifestyles and health behaviour by wuyunqing

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									Lifestyles and health behaviour

   determinants of health-enhancing
   What are health behaviours?

 Kasl and Cobb (1966) defined three types of
  health related behaviours. They suggested that;
      a health behaviour is a behaviour aimed at preventing
       disease (e.g. eating a healthy diet);
      an illness behaviour is a behaviour aimed at seeking a
       remedy (e.g. going to the doctor);
      a sick role behaviour is an activity aimed at getting
       well (e.g. taking prescribed medication or resting).
   What are health behaviours?

 Health behaviours have also being defined by
  Matarazzo (1984) in terms of either:
     Health impairing habits, which he called "behavioural
      pathogens" (for example smoking, eating a high fat
      diet), or
     Health protective behaviours, which he defined as
      "behavioural immunogens" (e.g. attending a health
              Behaviour and mortality

 50% of mortality from the 10 leading causes of death is
  due to behaviour.
 Doll and Peto (1981) estimated that 75% of cancer
  deaths were related to behaviour. 90% of all lung cancer
  mortality is attributable to cigarette smoking, which is also
  linked to other illnesses such as cancers of the bladder,
  pancreas, mouth, and oesophagus and coronary heart
  disease. Bowel cancer is linked to behaviours such as a
  diet high in total fat, high in meat and low in fibre.
         Lifestyle and
About 50% of premature deaths in western
 countries can be attributed to lifestyle
 (Hamburg et al., 1982). Smokers, on average,
 reduce their life expectancy by five years and
 individuals who lead a sedentary (i.e. none
 active) lifestyle by two to three years
 (Bennett and Murphy, 1997).
Lifestyle and
                    Holy Four

 Four behaviours in particular are associated with
  disease: smoking, alcohol misuse, poor nutrition
  and lower levels of exercise; these are called the
  “holy four”.
 Conversely, rarely eating between meals, sleeping
  for seven to eight hours each night, and eating
  breakfast nearly every day have been associated
  with good health and longevity (Breslow and
  Enstrom 1980). Recently high-risk sexual activity
  has been added to the risk factor list.
      Belloc and Breslow (1972)

 Belloc and Breslow (1972) conducted an
  epidemiological study asking a representative
  sample of 6928 residents of Almeida County,
  California whether they engaged in the
  following seven health practises:
      Belloc and Breslow (1972)

1.   sleeping seven to eight hours daily
2.   eating breakfast almost every day
3.   never or rarely eating between meals
4.   currently being at or near prescribed height
     adjusted weight
5.   never smoking cigarettes
6.   moderate or no use of alcohol
7.   regular physical activity.
     Positive attitude

 Having a positive attitude towards life
  has been found to increase longevity
  (Levy et al, 2002). The team used data
  gathered in 1975 in Oxford, Ohio, where
  almost everybody over 50 was
  questioned about their life and health. By
  tracing the deaths of participants over 23
  years, the team was able to match
  lifespan against attitudes towards ageing
  expressed at the start.
                Positive attitude

 Participants had been asked to agree or disagree
  with statements such as: “Things keep getting
  worse as I get older” or “I have as much pep as I
  did last year” or “I am as happy now as I was when
  I was younger.” The participants were scored on a
  scale of zero to five, in which five represented the
  most positive attitude towards growing older and
  zero the most negative.
              Positive attitude

 In the Journal of Personality and Social
  Psychology, the team says that the median
  survival for the most negative thinkers was
  15 years, while for the most positive it was
  22.5 years.
 Controlling for age, sex, wealth, health and
  loneliness did not alter the finding.
 There are several methodological criticisms that can
  be made of the original study by Belloc and
  Breslow and the follow-up studies. First, the sample
  is not particularly representative as all the
  participants came from the same area in the USA.
 Second, the study establishes a correlation between
  seven specific health preventive behaviours and
  longevity, but does not prove that these behaviours
  actually caused some of the participants to live
  longer. It is possible, although unlikely, that some
  other factor — personality, for example — affected
  both behaviour and lifespan.
 The „behavioural change‟ approach to promoting
  health raises a couple of ethical issues. First, it can
  lead to „victim-blaming‟. If we believe too strongly
  that individuals can prevent themselves from falling
  ill by choosing to carry out health preventive
  behaviours, then we may go on to blame those
  individuals for failing to protect their own health if
  they do fall ill.
 There have been cases where doctors have
  refused to treat certain patients because they
  felt that they had brought their illnesses on
  themselves. The greatest contributions to
  health have been through developments in
  medical science and through public health
  initiatives such as improved sanitation, and
  not through individual behavioural change.
 The second problem with the behavioural
  change approach is the narrow line that
  exists between persuading someone to
  change his or her behaviour and coercion.
  Do we have a right to assume that we
  know better than someone else what is
  best for their own health, and to force
  them to change their behaviour?
              Genetic theories

 Is it possible, however, for a person‟s genetic
  inheritance to directly affect their health-
  related behaviour? It may be, for example,
  that alcoholism is partly hereditary. In his
  book on this topic, Sher (1991) describes
  evidence that the children of alcoholics are
  more likely to become alcoholic themselves.
    Genetic theories

 Although it is notoriously
  difficult to determine whether
  a correlation such as this is
  due to genetic factors or arises
  as a result of social learning,
  some psychologists argue that,
  although there probably is no
  such thing as an „alcoholism
  gene‟, certain genetically
  inherited personality traits
  may pre-dispose an individual
  towards alcohol abuse.
Family genetics and history of
    dietary risk factors.
    Several studies have provided evidence
     that family history of dietary risk factors
     may be related to adolescents‟ food
     preferences. Fischer and Dyer (1981)
     reported that family history of obesity was
     related to increased intake of sweets, dairy
     products, and fatty foods in a sample of
     116 high school girls. Their results also
     indicated that having a family history of
     heart problems was related to decreased
     consumption of milk, eggs, and salty
Family genetics and history of
    dietary risk factors.
     Levine, Lewy, and New (1976) found a
      family history of hypertension to be
      associated with a greater prevalence of
      obesity among African American
      adolescents. Some investigators have
      also analyzed dietary intake among twin
      populations as evidence of a genetic
      variance for nutrient intake. In one of
      these studies, De Castro (1993) found
      significant heritabilities for identical and
      fraternal twins with regard to the
      amount      of     food      energy      and
      macronutrients eaten daily.
   Family genetics and history of
       dietary risk factors.
 In contrast, Fabsitz, Garrison, Feinleib, and
  Hjortland (1978) demonstrated that, in addition to a
  genetic variance, environmental effects (e.g., how
  frequently twins saw each other) were important in
  accounting for similarities in twins‟ nutrient
  intakes. These results suggest that there may be an
  interaction between genetic and environmental
  factors that influence eating behaviors among
        Genetic theories

 Genetic theories suggest that there may be a
  genetic predisposition to becoming an
  alcoholic or a smoker. To examine the
  influences of genetics, researchers have
  examined either identical twins reared apart
  or the relationship between adoptees and
  their      biological    parents.     These
  methodologies tease apart the separate
  effects of environment and genetics.
                Genetic theories

 In an early study on genetics and smoking, Sheilds
  (1962) reported that of 42 twins reared apart, only 9
  were discordant (showed different smoking
  behaviour). He reported that 18 pairs were both
  non-smokers and 15 pairs were both smokers. This
  is a much higher rate of concordance than predicted
  by chance. Evidence for a genetic factor in smoking
  has also been reported by Eysenck (1990) and in an
  Australian study examining the role of genetics in
  both the uptake of smoking (initiation) and
  committed smoking (maintenance) (Murray et al.
 Genetic theories

 Research into the role of genetics in
  alcoholism has been more extensive
  and reviews of this literature can be
  found elsewhere (Peele 1984;
  Schuckit 1985). However, it has been
  estimated that a male child may be
  up to four times more likely to
  develop alcoholism if he has a
  biological parent who is an alcoholic.
         Behaviourist learning
 Classical conditioning is a process in which
  the individual associates an automatic
  response with a neutral stimulus. Ivan Pavlov
  (1849—1936) described this process after he
  noticed that laboratory dogs would salivate
  when he turned a light on because they had
  learnt to associate the light with the presence
  of food.
Behaviourist learning
           Behaviourist learning
 Classical conditioning could explain certain health-
  related behaviours such as „comfort eating‟, for
  example. If a parent regularly offers a child sweets
  or chocolate at the same time as physical and
  emotional affection, then the child may learn to
  associate sweet foods with the reassuring feelings
  that arise out of parental love. In later life, the child
  may try to recreate these pleasant feelings by eating
  chocolate when he or she is stressed or depressed.
Behaviourist learning
           Operant conditioning

 Operant conditioning is when people respond to
  reward or punishment by either repeating a
  particular behaviour, or else stopping it. If an
  individual carries out a behaviour that clearly seems
  to be bad for his or her health, such as smoking
  cigarettes, a deeper look may well reveal benefits
  for the individual, such as social approval, the
  nicotine buzz and so on.
           Operant conditioning

 A striking example of how operant conditioning can
  affect health behaviour is the study by Gil et al
  (1988). They conducted research on children
  suffering from a chronic skin disorder that causes
  severe itching. They videotaped the children with
  their parents in the hospital and observed that when
  parents tried to stop their children scratching (in
  order to prevent peeling and infection) this actually
  increased the scratching behaviour by rewarding it
  with attention.
           Operant conditioning

 When they asked parents to ignore their children
  when they scratched and give them positive
  attention when they did not scratch, the amount of
  scratching was significantly reduced.
 Drinking, eating, smoking, drug and sexual
  addictions all have the „irrational‟ characteristic that
  the total amount of pleasure gained from the
  addiction seems much less than the suffering caused
  by it. According to learning theorists, the reason for
  this lies in the nature of the gradient of
         Operant conditioning

 Addictive behaviours are typically those in
  which pleasurable effects occur rapidly after
  the addictive behaviour while unpleasant
  consequences occur after a delay. The simple
  mechanism of operant conditioning and the
  gradient of reinforcement is able, as it were,
  to over-power the mind‟s capacity for
  rational calculation.
              Social learning

 Social learning occurs when an individual
  observes and imitates another person‟s
  behaviour, either because the individual
  looks up to that person as a role model or
  else through vicarious reinforcement —
  that is, .the individual sees the person being
  rewarded for his or her actions.
               Social learning

 Social learning can clearly be very influential
  in encouraging people to do things that are
  bad for their health (for example, a teenager
  may take up smoking because he or she has
  an admired elder brother who smokes, or
  may try illegal drugs because he or she sees
  other people taking them and having a good
                   Social learning

 Another example of how vicarious reinforcement can lead to
  unhealthy behaviour concerns young women with eating
  disorders, who see images of very thin models in magazines
  being rewarded with success, money, glamour and fame. On
  the other hand, many health promotion campaigns use
  positive role models to try to get people to lead healthier
  lifestyles. The advertising industry, whose reason for
  existing is to persuade people to change their behaviour,
  often depicts successful, good-looking and happy people
  using a certain product in the hope that this will make others
  want to use the product as well.
Social learning

 Bandura (1977) has been particularly influential in
  emphasising the importance of learning by
  imitation in linking it to his concept of self-efficacy,
  personality traits consisting of having confidence in
  one‟s ability to carry out one‟s plans successfully.
  People with lower self-efficacy are much more
  likely to imitate undesirable behaviours than those
  with higher self-efficacy.

 Heather and Robertson (1997) give a useful
  discussion of the application of these principles to
  drinking. Patterns of drinking by parents are
  observed by children who may then imitate them in
  later life, especially the behaviour of the same sex
  parents. In adolescence, the drinking behaviour of
  respected older peers may also be imitated, and
  subsequently that of higher status colleagues at
  work, a phenomena, which may explain the
  prevalence of heavy drinking in certain professions
  such as medicine and journalism.

 Many psychologists criticize behaviourist-
  learning theories on the grounds that they are
  too mechanistic. In other words, they
  assume that human beings respond
  automatically to specific situations. Not only
  does this imply a lack of freewill, but also it
  also ignores the effect on behaviour of
  cognitive factors.
       Social and environmental
 There are many different social and environmental
  factors contributing to people‟s health behaviour.
  For example, a common explanation for young
  people taking drugs or smoking cigarettes is „peer
  pressure‟. It may be that people imitate their peers
  because of the explanation given above — that is,
  vicarious reinforcement; they see others getting a
  reward for a certain behaviour, so they copy it.
      Social and environmental
 Social factors such as culture influence
  dietary behaviour.      Culture affects an
  individual‟s food selection, preparation, and
  eating patterns. Certain tastes or food are
  associated with specific feelings and
  meanings within a culture (for example, soul
  food may denote fried and barbecue meats
  within the African American community).
      Social and environmental
 Mexican American women often feel
  uncomfortable with focusing on themselves
  as individuals therefore a successful
  approach to losing weight would target the
  whole family rather than the individual
  woman (Foreyt et al, 1991).
       Social and environmental
 Television advertising also exerts a larger influence
  over dietary behaviour. Advertisers often target
  adolescents by promoting fast foods high in fat,
  cholesterol, sodium, and sugar. It has been found
  that children‟s television viewing positively
  correlates with smoking behaviour and attempts to
  influence parents shopping selections (Dietz and
  Gortmaker, 1985). Television viewing is also
  highly correlated with obesity in children (Bowen et
  al, 1991).

 • Conformity does not exert an equally
  strong influence in all situations and with
  all individuals, It is likely to be more
  powerful in ambiguous situations, when
  others are perceived as having more
  expertise, or when the individual has low
  self-confidence, poor self-esteem and a
  weak sense of self-efficacy.
       High-risk sexual behaviour

 Hawkins et al. (1995) reported that the most
  frequent safer sex behaviour amongst well-educated
  heterosexual students was the use of the
  contraceptive pill. The least frequent sexual
  practice, reported by only 24% of the sample, was
  the use of condoms. An important factor is that the
  majority of young persons do not see themselves as
  at risk of HIV infection or have feelings of
  invulnerability towards the disease.

Those who are physically active throughout the adult
  life live longer than those who are sedentary.
  Paffenburger et al (1986) monitored leisure time
  activity in a cohort of 17000 Harvard graduates
  dating back to 1916. Using questionnaires it was
  found that those who were least active after
  graduation had a 64% increased risk of heart attack
  compared with their more energetic classmates.
  Those who expended more than 2000 calories of
  energy in active leisure activities per week lived, on
  average, two and a half years longer than those
  classified as inactive.

About a quarter of the UK population engage in health
 promoting levels of exercise, with a similar picture
 in the USA. In recent years these levels have
 dramatically increased. For example in Wales 20%
 of men and 2% of women took sufficient exercise
 in 1985 but by 1990 this had increased to 27% of
 the population. Those who engage in exercise are
 more likely to be young, male and well-educated
 adults, members of higher socio-economic groups,
 and those who have exercised in the past.

Those least likely to exercise tend to be in the lower
  socio-economic groups, older individuals, and those
  whose health is likely to be at risk as a consequence
  of being overweight and smoking cigarettes
  (Dishman 1982). Obstacles to exercise include not
  having enough time, lack of support from family or
  friends and perceived incapacity due to ageing.
    five different types of exercise.

 Brannon & Feist (1997) describe five
  different types of exercise.
1.Isometric exercise involves pushing the
  muscles hard against each other or against an
  immovable object. The exercise strengthens
  muscle groups but is not effective for overall
   five different types of exercise.

2. Isotonic exercise involves the contraction
   of muscles and the movement of joints, as
   in weight lifting. Muscle strength and
   endurance may be improved but the general
   improvement is in body appearance rather
   than improving fitness and health.
    five different types of exercise.

3. Isokinetic exercise uses specialised
   equipment that requires exertion for lifting
   and additional effort to return to the starting
   position. This exercise is more effective
   than both isometric and isotonic exercise
   and promotes muscle strength and muscle
   endurance (Pipes and Wilmore, 1975).
    five different types of exercise.

4. Anaerobic exercise involves short, intensive
   bursts of energy without an increased amount of
   oxygen such as in short distance running. Such
   exercises improve speed and endurance but do not
   increase the fitness of the coronary and
   respiratory systems and indeed may be dangerous
   for people with coronary heart disease.
    five different types of exercise.

5. Aerobic exercise requires dramatically increased
   oxygen consumption over an extended period of
   time such as in jogging, walking, dancing, rope
   skipping, swimming and cycling. The heart rate
   must be in a certain range which is computed
   from a formula based on age and the maximum
   possible heart rate. The heart rate should stay at
   this elevated level for at least 12 minutes, and
   preferably 15 to 30 minutes. This exercise
   improves the respiratory system and the coronary
     Organic & Dynamic Fitness

 Kuntzleman (1978)
Organic fitness-our capacity for action and
  movement determined by inherent factors
  such as genes, age and health status.
Dynamic fitness-determined by our
London bus crews

        Maurice et al. (1953)
         studied London double
         decker bus drivers and
         their conductors. The
         more active conductors
         had significantly less
         incidence of C. H. D.
         than did the sedentary
         drivers. Can you think
         of any confounding
         factors in this study?

 Exercise has been found to lower depressive
  moods in a variety of people, including
  young pregnant women from ethnically
  diverse backgrounds (Koniak-Griffin, 1994)
  and nursing home residents aged 66 to 97
  (Ruuskanen and Parkatti, 1994). These
  findings could be due to the release of
  endogenous Opiates during exercise.

 Exercise is a buffer against stress. This could be
  because of the positive effect on the immune
  system. Exercise produces a rise in natural killer
  cell activity and an increase in the percentage of T-
  cells (lymphocytes) that bear natural killer cell
  markers (indicating the sites where killer cells are
  produced). This warns off invading cells before
  they have the chance to harm the body.

 Both exercise and stress reduce adrenaline and
  other hormones yet exercise has a beneficial effect
  on heart functioning whereas stress may produce
  lesions in heart tissue. In exercise adrenaline
  metabolises differently and is released infrequently
  and gradually under conditions for which it was
  intended (e.g. jogging). In conditions of stress
  adrenaline is discharged in a chronic and enhanced
             Dietary habits

 The MRFIT study (Stamler et al. 1986), was a
  longitudinal study over six years of three hundred
  and fifty thousand adults. A linear relationship was
  found between blood cholesterol level and the
  incidence of coronary heart disease (CHD) or
  stroke. The risk for individuals within the top third
  of cholesterol levels was three and a half times
  greater than those in the lowest third.
          Dietary habits

 A 24 year longitudinal study of American
  men working for western electricity found
  that men who consumed high levels of
  cholesterol were twice as likely to develop
  lung cancer compared with men who
  consumed low levels of cholesterol. Much of
  the cholesterol came from eggs (Shekelle et
  al, 1991).
           Dietary habits

 High fibre diets protect men and women
  from cancer of the colon and the rectum.
  Fibre from fruits and vegetables offer more
  protection against colon cancer than that
  from cereals and other grains. Fruit
  consumption offers protection against lung
  cancer and we should be eating fruit 3 to 7
  times per week (Fraser et al, 1991).
     Obesity and eating disorders

 More than a quarter of children in English
  secondary schools are clinically obese,
  almost double the proportion a decade
  ago, and an official survey released in
  April 2006 also showed that girls were
  suffering more than boys from a crisp
  and chocolate-fuelled life of too much
  eating and too little exercise.
     Obesity and eating disorders

 Researchers measured the height and
  weight of 11-15 year olds, and found
  26.7% of girls and 24.2% of boys
  qualified as obese - nearly double the
  rate in 1995. Among children aged 2-10,
  12.8% of girls and 15.9% of boys
  weighed above the obesity threshold -
  also well up on 10 years before.
     Obesity and eating disorders

 The increase in obesity accelerated
  sharply in 2004, especially among girls,
  the survey said. Figures for the 11-15
  age group showed the proportion of
  obese girls grew from 15.4% in 1995 to
  22.1% in 2003. But in 2004 it shot up to
     Obesity and eating disorders

 The survey also found that the obesity
  rate among adults had risen to 24%, in
  spite of people exercising more and
  eating more fruit and vegetables.
 However, more men gave up smoking
  than women, and in 2004 there were for
  the first time more women smokers
  (23%) than there were men (22%).
     Obesity and eating disorders

 Obesity is defined in terms of the percentage
  and distribution of an individual's body fat.
  Techniques used to assess the body fat range
  from using computer tomography (e.g.
  ultrasound waves) to magnetic resonance
  imaging (MRI). Obesity may also be defined in
  terms of body mass index (B. M. I.) which is
  calculated by dividing a person's weight by
  their height squared using metric units (i.e.
  kilogrammes and metres squared).
     Obesity and eating disorders

 Stunkarda (1984) suggested that obesity
  should be categorised as either mild (20
  to 40% overweight), moderate (41 to
  100% overweight) or severe (more than
  100% overweight). This would suggest
  that 24% of American men and 27% of
  American women are at least mildly
  obese (Kuczmarski, 1992).

 There are three different types of theories that
  attempt to explain obesity; they are:
   1.   Physiological theories suggesting that there are genetic
   2.   Metabolic rate theories proposing that obese people
        have a lower resting metabolic rate, burn up less calories
        when resting and therefore require less food. They also
        tend to have more fat cells which are genetically
   3.   Behavioural theories suggest that obese people tend to
        be less physically active and eat more food than required.
             Eating disorders

 The two main eating disorders are anorexia
  nervosa and bulimia.

 Individuals are diagnosed as anorexic only if they weigh at
  least 15% less than their minimal normal weight and have
  stopped menstruating. In extreme cases, anorexics may
  weight less than 50% of their normal weight. Weight loss
  leads to a number of potentially dangerous side-effects,
  including emaciation (wasting of the body), susceptibility to
  infection and other symptoms of under nourishment.
  Females are 20 times more likely to develop anorexia than
  males. But horseracing Jockeys, who are usually male, are
  susceptible to anorexia. Anorexia particularly affects white,
  Western, middle to upper class, teenage women.

 Another characteristic of anorexia nervosa is that of
  distortion of body image. Anorexics think that they are too
  fat. This was investigated by Garfinkel and Garner (1982).
  Participants used a device that could adjust pictures of
  themselves and others up to 20 per cent above or below their
  actual body size. An anorexic was more likely to adjust the
  picture of herself so that it was larger than the actual size.
  They did not do the same for photographs of other people.

 American undergraduates were shown figures of
  their own sex and asked to indicate the figure that
  looked most like their own shape, their ideal figure
  and the figure they found would be most attractive
  to the opposite sex. Men selected very similar
  figures for all three body shapes! Women chose
  ideal and attractive body shapes that were much
  thinner than the shape that was indicated as
  representing their current shape. Women tended to
  choose thinner body shapes for all three choices
  (ideal, attractive and current) compared to the men
  (Fallon and Rozin, 1985).

 The perfect figure has changed over the
  years. In the 1950s female sex symbols had
  much larger bodies compared with present-
  day female sex symbols.

 The hypothalamus is implicated in anorexia.
  The hypothalamus controls both eating and
  hormonal functions (which may also explain
  irregularities in menstruation).

 Personality factors and family dynamics could also
  play a part in anorexia. The anorexic lacks self-
  confidence, needs approval, is conscientious, is a
  perfectionist and feels the pressure to succeed
  (Taylor, 1995).
 Parental psychopathology or alcoholism also plays
  a part as does being in an extremely close or
  interdependent family with poor skills for
  communicating emotion or dealing with conflict
  (Rakoff, 1983).

 The mother daughter relationship has been
  implicated. Mothers of anorexic daughters tend to
  be dissatisfied with their daughter's appearance and
  tend to be vulnerable to eating disorders themselves
  (Pike and Rodin, 1991).
 Genetics could explain this result as De Castro
  (2001) has found that identical twins have similar
  eating patterns compared with fraternal twins

 Bulimia is characterised by recurrent episodes of
  binge eating followed by attempts to purge the
  excess eating by vomiting or using laxatives. The
  binges occur at least once a day usually in the
  evening and when alone. Vomiting and the use of
  laxatives disrupts the balance of the electrolyte
  potassium resulting in dehydration, cardiac
  arrhythmias and urinary infections.

 This disorder mainly affects young women and is
  more common than anorexia affecting five to ten%
  of American women. Bulimia is not confined to
  middle or upper-class females and transcends racial,
  ethnic and socioeconomic boundaries. Like
  anorexia explanations encompass biological,
  personality and social factors. Bulimics often suffer
  from other disorders such as alcohol or drug abuse,
  impulsivity and kleptomania.

 It may be triggered by life events such as feeling
  guilty or feeling depressed. There is a stronger link
  between depression and bulimia compared with
  depression and anorexia. The depression seems to
  be linked to a deficit in the neurotransmitter
  substance serotonin. Bulimics may report lacking
  self-confidence and use food to fulfil their feelings
  of longing and emptiness. The binge eating and
  vomiting is justified in terms of needing to have a
  high calorie intake of food and a desire to stay slim.

 Treatment involves medication and cognitive
  behavioural therapy. Antidepressants drugs are used
  in combination with psychotherapy. Treatment for
  bulimia tends to be more successful because
  bulimics recognise that they have a problem
  whereas anorexics don't.
           Health and Poverty

 It is important to point out that the most
  damaging lifestyles for our health are those
  associated with low incomes. Throughout the
  Western world, the most consistent predictor
  of illness and early death is income. People
  who are unemployed, homeless, or on low
  incomes have higher rates of all the major
  causes of premature death (Fitzpatrick and
  Dollamore, 1999).
            Health and Poverty

 The reasons for this are not clear although
  there are two main lines of argument. First, it
  is possible that people with low incomes
  engage in risky behaviours more frequently,
  so they might smoke more cigarettes and
  drink more alcohol. This argument probably
  owes more to negative stereotypes of
  working-class people than it does to any
  systematic research.
            Health and Poverty

 The second line of argument is that poor
  people are exposed to greater health risks in
  the environment in the form of hazardous
  jobs and poor living accommodation. Also,
  people on low incomes will probably buy
  cheaper foods which have a higher content of
  fat (regarded as a risk factor for coronary
  heart disease).
            Health and Poverty

 All this means that psychological
  interventions on behaviour can only have a
  limited effect, since it is economic
  circumstances that most affect the health of
  the nation.
            Health and Poverty

 The effects of poverty are long lasting and
  far-reaching. A remarkable study by Dorling
  et al. (2000) compared late 20th century
  death rates in London with modern patterns
  of poverty, and also with patterns of poverty
  from the late 19th century.
           Health and Poverty

 The researchers used information from
  Charles Booth‟s survey of inner London
  carried out in 1896, and matched it to
  modern local government records.
            Health and Poverty

 When they looked at the recent mortality
  (death) rates from diseases that are
  commonly associated with poverty (such as
  stomach cancer, stroke and lung cancer), they
  found that the measures of deprivation from
  1896 were even more strongly related to
  them than the deprivation measures from the
  1990s. They concluded that patterns of
  disease must have their roots in the past.
            Health and Poverty

 It is remarkable, but true, that geographical
  patterns of social deprivation and disease are
  so strong that a century of change in inner
  London has not disrupted them.
            Health and Poverty

 Another study by Dorling et al. (2001)
  plotted the mortality ratio (rate of deaths
  compared to the national average) against
  voting patterns in the 1997 general election.
  They divided the constituencies into ten
  categories, ranging from those who had the
  highest Labour vote to those who had the
            Health and Poverty

 The analysis found that the constituencies
  with the highest Labour vote (72 per cent on
  average) had the highest mortality ratio
  (127), and that this ratio decreased in line
  with the proportion of people voting Labour,
  down to the lower Labour vote (22 per cent
  on average) where there was a much lower
  mortality ratio (84).
            Health and Poverty

 This means that early death, and presumably
  poor health, was more common in areas that
  chose to vote Labour. If we take Labour
  voting as still being influenced by class and
  social status then this study gives us another
  measure of the effects of wealth on health.
            Health and Poverty

 The influence of poverty shows up in a
  number of ways. Glaucoma is a damaging
  eye disease that can cause blindness if
  untreated. A study by Fraser et al. (2001)
  looked at the differences between people
  who sought medical help early (early
  presenters) and those who sought help for the
  first time when the disease was already quite
  advanced (late presenters).
            Health and Poverty

 The late presenters were more likely to be in
  lower occupational classes, more likely to
  have left full-time education at age 14 or
  younger, more likely to be tenants than
  owner occupiers, and less likely to have
  access to a car.
             Health and Poverty

 It showed that a persons personal
  circumstances and the area they lived in had
  an effect on their decision to seek help with
  their vision. It also appeared that the disease
  developed more quickly in people with low
            Health and Poverty

 One uncomfortable explanation of the
  differences in mortality rates for rich and
  poor might be that the poor receive worse
  treatment from the NHS. Affluent women
  have a higher incidence of breast cancer than
  women who are socially deprived, but they
  have a better chance of survival.
            Health and Poverty

 A study to investigate the care of the breast
  cancer patients from the most and least well-
  off areas in Glasgow was carried out by
  Macleod et al. (2000). They looked at
  records from hospital and general practice to
  evaluate the treatment that was given, the
  delay between consultation and treatment,
  and the type and frequency of follow-up care.
            Health and Poverty

 The data showed that women from the
  affluent areas did not receive better care from
  the NHS. The women from the deprived
  areas received similar treatment, were
  admitted to hospital more often for other
  conditions than the cancer, and had more
  consultations after the treatment than the
  women from the affluent areas.
            Health and Poverty

 Perhaps the reasons for the worse survival
  rate of women from deprived areas are not
  related to the quality of care, but to the
  number and severity of other diseases that
  they have alongside the cancer.
 Do some lifestyles make people more vulnerable to
  disease? Are we justified, for example, in
  associating high stress behaviour with certain health
  problems such as heart disease? Friedman and
  Rosenman (1959) investigated this and created a
  description of behaviour patterns that has generated
  a large amount of research and also become part of
  the general discussions on health in popular
 Before we look at the work of Friedman and
  Rosenman, it is worth making a
  psychological distinction between behaviour
  patterns and personality. Textbooks and
  articles often refer to the Type A personality,
  though, at least in the original paper, the
  authors describe it as a behaviour pattern
  rather than a personality type.
 The difference between these two is that a
  personality type is what you are, whereas a
  behaviour pattern is what you do. The importance
  of this distinction comes in our analysis of why we
  behave in a particular way („I was made this way‟
  or „I learnt to be this way‟), and what can be done
  about it. It is easier to change a person‟s pattern of
  learnt behaviour than it is to change their nature.
 Friedman and Rosenman devised a
  description of Pattern A behaviour that they
  expected to be associated with high levels of
  blood cholesterol and hence coronary heart
  disease. This description was based on their
  previous research and their clinical
  experience with patients.
 A summary of Pattern A behaviour is given
     (1) an intense, sustained drive to achieve
      personal (and often poorly defined) goals
     (2) a profound tendency and eagerness to
      compete in all situations
     (3) a persistent desire for recognition and
   (4) continuous involvement in several activities
    at the same time that are constantly subject to
   (5) an habitual tendency to rush to finish
   (6) extraordinary mental and physical alertness.
 Pattern B behaviour, on the other hand, is the
  opposite of Pattern A, characterised by the
  relative absence of drive, ambition, urgency,
  desire to compete, or involvement in
         Research into type A
 The classic study of Type A and Type B
  behaviour patterns was a twelve-year
  longitudinal study of over 3,500 healthy
  middle-aged men reported by Friedman and
  Rosenman in 1974. They found that,
  compared to people with the Type B
  behaviour pattern, people with the Type A
  behaviour pattern were twice as likely to
  develop coronary heart disease.
          Research into type A
 Other researchers found that differences in
  the kinds of Type A behaviour correlated
  with different kinds of heart disease: angina
  sufferers tended to be impatient and
  intolerant with others, while those with heart
  failure tended to be hurried and rushed,
  inflicting the pressures on themselves.
          Research into type A
 Recent reviews of Type A behaviour suggest
  that it is not a useful measure for predicting
  whether someone will have a heart attack or
  not. Myrtek (2001), for example, looked at a
  wide range of studies on this issue and
  concluded that measures of Type A and of
  hostility were so weakly associated with
  coronary heart disease as to make them no
  use for prevention or prediction.
          Research into type A
 The lasting appeal of the Type A behaviour
  pattern is its simplicity and plausibility.
  Unfortunately, health is rarely that simple
  and the interaction of stress with
  physiological, psychological, social and
  cultural factors cannot be reduced to two
  simple behaviour patterns.
 In 1921 Lewis Terman started the Terman
  Life-Cycle Study looking at the lives of over
  1500 people. The sample was recruited from
  schools in California after the teachers
  identified children who were gifted and had
  an IQ of 135 and above. The average year of
  birth was 1910 so their age at the start of the
  study was 11 years.
 It was not a very diverse sample, as they
  were mostly selected from white middle-
  class families, but this apparent weakness is
  a strength if we want to look at the effect of
  selected variables that do not include
  ethnicity and class.
 Data was collected over the years and in
  1950 (when the participants were aged about
  40) they were asked about their religiosity on
  a four-point scale (not at all: little: moderate:
  strong). Forty years later the researchers
  were able to compare this data against the
  mortality of the sample.
 To cut to the chase, once the researchers had
  accounted for all the other variables they
  were able to say that people who were more
  religious lived longer (Clark et al. 1999).
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