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 CHAPTER 6
HEALTH-RELATED BEHAVIOR AND HEALTH PROMOTION
CHAPTER OUTLINE

I. Health and Behavior

A. Section Introduction
1. Greater attention is being given to people’s health behavior since health
habits are related to developing fatal and chronic diseases
a. illness and early death could be greatly reduced if people
changed their lifestyles
i. average life expectancy could increase to 85 years
B. Lifestyles, Risk Factors, and Health
1. Section introduction
a. the lifestyle of even typical people includes risk factors for illness
and injury
2. Health behavior
a. health behaviors = any activity people perform to maintain or
improve their health regardless of perceived health status or
whether the behavior achieves goal
b. well behavior = any activity undertaken to maintain or improve
current good health and avoid illness
i. when well, people may not have motivation to put forward
effort or make sacrifices for healthful behavior
ii. engaging in healthful behavior depends heavily on
1) perception of threat of disease
2) value in behavior reducing threat
3) attractiveness of unhealthful behavior
c. symptom-based behavior = when ill, any activity undertaken to
determine the problem and find a remedy
i. large variability in expression of symptom-based behavior
1) some people are fearful or stoic whereas others
are very likely to complain and/or seek help
d. sick-role behavior = any activity people undertake to get well
after determining they are ill
i. sick-role expectations
1) exemption from typical obligations and life tasks
2) an obligation to try to get well (although many don't
adhere to recommendations)
ii. sick-role behaviors may be influenced by learning and
cultural expectations

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 3. Practicing health behavior
a. health behavior practices
i. although shortcomings are noted in level of health behavior
performance, percentages still represent an improvement
over the past decade
b. gender, sociocultural, and age differences are observed in health
behaviors
i. example: women perform more health behaviors than men
ii. explanation: people perform behaviors that are salient to
them
c. consistency in health behaviors
i. conclusions regarding health behaviors
1) although health habits are fairly stable, they do
change over time
2) particular health behaviors are not strongly tied to
each other
3) health behaviors are not governed by a single set
of attitudes or response tendencies
ii. reasons for lack of consistency
1) at any given time in life, various factors may
differentially affect different behaviors
2) people change with experience
3) life circumstances change
C. Interdisciplinary Perspectives on Preventing Illness
1. Health advances occur through efforts to prevent disease and
improvements in diagnosis and treatment
a. 3 approaches to illness prevention
i. behavioral influence - encouraging/demonstrating health
behaviors
ii. environmental measures - changing the environment such
as adding flouride to water supply
iii. preventive medical efforts - examples include dental
checkups
b. there are 3 levels of prevention (primary, secondary, tertiary)
related to different levels of health status and with different
effects on health behaviors, social network, and health
professionals
2. Primary prevention
a. involves specific actions taken to avoid disease or injury
i. examples: using seat belts, genetic counseling,
immunizations
b. approaches health professionals may use for primary prevention
i. giving medical advice
ii. using a system of reminders
iii. constructing medical websites

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 3. Secondary prevention
a. involves actions taken to identify and treat an illness early in
effort to stop or reverse health problem
b. includes patient's symptom-based behavior (help seeking), a
physician prescribing medications or dietary changes, the patient
adhering to medical advice (sick role behavior)
c. examples
i. annual physical examinations
ii. cyclic scheduled laboratory tests to detect disease earlier
4. Tertiary prevention
a. involves actions to retard lasting damage, prevent disability, and
rehabilitate
b. examples
i. physical therapy
ii. taking medications to control pain or inflammation
c. in case of incurable diseases, goals may also be to keep patient
comfortable and the disease in remission for as long as possible
D. Problems in Promoting Wellness
1. Process of preventing illness and injury operates within a system of
interrelated factors
a. interrelated factors/problems can impair effectiveness of each
component in system
b. each component affects each other component
2. Factors within the individual (intrapersonal)
a. many healthy behaviors are less pleasurable than the unhealthy
alternatives
i. some people deal with this by setting limits on the amount
of unhealthy behaviors they do
b. often have little immediate incentive for changing health
behaviors
c. prevention requires a change in long-standing behaviors that
have become habitual, may involve addictions
d. people need to have cognitive resources, self-efficacy, and
motivation to engage in health behaviors
e. being sick or taking certain medications may affect mood and
energy levels therefore also affecting cognitive resources and
motivation
3. Interpersonal factors
a. social network consists of people with different individual
motivations
i. having friends or family who model healthful behavior and
who give social support/encouragement for behavioral
change increases likelihood of making changes
ii. interpersonal conflict may emerge due to different
motivations and have negative effect on health behaviors

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 4. Community factors
a. people are more likely to adopt health behaviors encouraged by
government and health care agencies
b. issues affecting advice given by health professionals
i. have inaccurate information about what patients’ health-
related behaviors
ii. traditionally have focused on treatment rather than
prevention although interest in prevention has increased
c. issues affecting large-scale community efforts
i. public health projects influenced by lack of funds
ii. need to consider programs for people of different ages
and sociocultural backgrounds
iii. health insurance may not cover prevention efforts
iv. need to balance public health with economic priorities

II. What Determines People's Health-Related Behavior?

A. General Factors in Health-Related Behavior
1. Although people can describe healthy behavior, heredity or genetics
appears to influence some health behaviors such as alcoholism
2. Learning
a. operant conditioning = acquiring behaviors through learning
consequences to a behavior
i. types of consequences
1) reinforcement = increases the likelihood a behavior
will occur again in the future
a) positive reinforcement = a pleasant
consequence follows the behavior
b) negative reinforcement = behavior removes
or ends an unpleasant consequence
2) extinction
a) occurs when the consequences maintaining
a behavior are eliminated
3) punishment
a) occurs when behavior is suppressed by an
aversive consequence or something
pleasant is removed
b. modeling = learning through observing the consequences a
model receives
1) affect the observer especially if the model is similar
and high status
c. role of habit
i. occurs when behavior is performed automatically and
without awareness
ii. habits are less dependent on consequences and more
dependent on antecedent cues

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 iii. since habitual behaviors are so difficult to change, “well”
behaviors need to be established early in life and
unhealthy behaviors eliminated as soon as they appear
3. Social, personality, and emotional factors
a. social factors
i. ways in which friends/family influence health behaviors
1) encouraging/discouraging health behaviors
2) providing consequences
3) modeling health behaviors
4) communicating values about health
ii. gender differences in health-related behaviors may be
influenced by parental perceptions of male v. female
children
b. personality
i. personality trait of conscientiousness is associated with
practicing health-protective behavior
c. role of emotions
i. distress over potential illness may interfere with getting
preventive screening
ii. high levels of stress are associated with unhealthy
behaviors such as poor diet, low exercise, smoking, and
drinking
4. Perception and cognition
a. perceived symptoms influence health-related behaviors
i. symptom severity influences help seeking
1) severe symptoms prompt most people to seek
medical care
2) moderate symptoms tend to lead people to change
health habits to meet needs of health problem
b. role of cognitive factors in health behaviors
i. people must have correct knowledge and ability to solve
problems to engage in healthful behaviors
ii. people make judgments that have impact on health
1) assess the condition of their health.
2) make decisions regarding needed changes in
health behavior
iii. misconceptions on health status can lead to harmful
health behaviors
1) example: hypertensives altering medication-taking
behavior when lack of symptoms present
c. impact of unrealistic optimism
i. concept involves peoples’ belief that they are less likely
than other people their age or sex to experience negative
health situations

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 1) belief is based on illogical ideas such as the health
problem rarely occurring or not having occurred to
them yet
ii. when a person is sick or when a threat of illness is clear,
people are affected by unrealistic pessimism regarding
health
iii. importance of findings about unrealistic optimism and
unrealistic pessimism
1) revealed that feelings of invulnerability is not
unique to adolescents
2) people who engage in health practices tend to feel
they would be at risk for problems if they did not do
so
3) health professionals can implement intervention
designed to help people see risks more realistically
B. The Role of Beliefs and Intentions
1. How people think may influence how they behave
a. example: people who believe in alternative health models (e.g.,
reflexology) are apt to behave in ways that support those beliefs
2. The Health Belief Model
a. theory based on the assumption that likelihood of taking
preventive action is dependent on analysis of threat the person
feels regarding a health problem and the pros/cons of taking the
action
b. perceived threat depends upon
i. perceived seriousness - severity of effects if problem is left
untreated
1) higher perception of seriousness linked to higher
perception of threat and taking preventive action
ii. perceived susceptibility - vulnerability to contracting the
problem
1) perception of higher risk linked to higher perception
of threat and taking preventive action
iii. cues to action - being reminded or alerted to the problem
1) being aware of cue increases sense of threat and
need for action
c. perceived benefits must exceed the perceived barriers or costs
for preventive behavior to occur
d. likelihood of preventive action is based on the combination of
perceived threat and the sum of the cost-benefit ratio
e. demographic, psychosocial, and structural variables influence
perceptions of benefits, barriers, and risks
i. includes age, sex, racial/ethnic background, social class,
personality traits, knowledge, or prior experience with
health problem

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 f. research supports much of the model
i. hundreds of studies have been performed testing different
elements of the model
ii. findings suggest perceived barriers and perceived
susceptibility are strong predictors of health behavior
1) some research also supports cues to action
g. theory shortcomings
i. does not account for habitual behaviors
ii. no standard way of measuring its components
3. The Theory of Planned Behavior
a. theory, actually an extension of theory of reasoned action, is
based on assumption that people decide on intentions prior to
action and intentions are best predictors of behavior
b. judgments that determine intention
i. attitude regarding the behavior - judgment of whether
behavior is a good thing to do based on likely outcome of
behavior and whether outcome is rewarding
ii. subjective norm - social pressure or appropriateness of
behavior based on others' opinions and motivation to
comply with that opinion
iii. perceived behavioral control - expectation of behavioral
success (similar to idea of self-efficacy)
c. how intentions are developed
i. judgments combine to produce intention that leads to
performance of the behavior
ii. self-efficacy is important component in development of
intention
1) self-efficacy based on analysis of following
a) complexity of task
b) effort required
c) availability of helping resources
d. research on theory
i. support found for theory assumptions in tests on various
health-related behaviors such as donating blood,
exercising, using condoms
ii. meta-analysis suggests that interventions can change the
factors and increase intentions
d. theory shortcomings
i. intentions and behavior are only moderately related
1) gap can be reduced by intervention that includes
careful, specific planning
ii. theory does not include prior experience

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 e. shortcomings in common with Health Belief model
i. both assume people think about health-related behavior in
a detailed way
ii. people know what illnesses are associated with particular
behaviors
iii. people know how to accurately estimate risks of illness
4. The Stages of Change model
a. model emphasizes readiness to change
i. people in one stage show different psychosocial
characteristics from people in other stages
ii. efforts to change behavior not likely until person has made
it to more advanced stages
iii. people may regress in stages
iv. it is possible to help people move across stages
1) have person describe in detail how they will change
2) develop intervention so that match strategies to
person’s needs
b. stages of the model (see Figure 6.3)
i. precontemplation - person hasn't thought about change or
may have been decided against it
ii. contemplation - person is aware problem exists and is
seriously considering change
iii. preparation - person is ready to try to change and plans to
pursue a behavioral goal
iv. action - person engages in active change efforts
v. maintenance - person works to maintain successful
behavioral changes
c. research support
i. findings indicate that people at higher stages of model are
more likely to succeed
ii. studies have also found processes that lead to regression
and value of matching interventions to stages in
increasing likelihood of success
d. model shortcomings
i. as with previously discussed cognitive theories, doesn't
account for irrational decisions, which appear to be result
of motivational or emotional processes not addressed in
model
C. The Role of Less Rational Processes
1. Motivational factors in beliefs
a. motivated reasoning
i. a process by which people's desires and preferences
influence the judgments they make about the validity and
utility of new information

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 ii. when people prefer to reach a particular conclusion, they
may use biased processes, such as accepting only
information that supports their conclusion, even if their
logic is clearly faulty
iii. studies demonstrating nonrational thought in health-
related decisions
1) people with chronic illness who use illogical thought
patterns tend to not follow medical advice
2) people who are at high risk for HIV infection and
use defense mechanisms deny their risk for AIDS
perhaps due to high feelings of threat
3) people use irrelevant information to judge risks in
having sex
4) smokers give lower risk ratings than nonsmokers
2. False hope and willingness
a. 2 features of health-related behaviors not accounted for well by
previous theories
i. people who fail to change a negative health behavior often
try to do so again in the future
ii. many risk behaviors occur spontaneously
b. false hopes serve as basis for try change again
i. false hopes = believing, without rational basis for belief,
that one will succeed in subsequent change efforts
ii. stem from observation that, for a while, they were
successful in previous attempt(s) and that is reinforcing
iii. misinterpret cause of previous failure as lack of effort
1) failure often due to expecting too large change of
behavior, too great an effect would occur, and
change would occur quickly and easily
c. risky behaviors often occur without thought
i. people find themselves in tempting situations they didn’t
expect
ii. issue isn’t that they didn’t intend to do a harmful behavior
but that they were willing to do it
1) factors influencing willingness
a) positive subjective norms
b) positive attitudes toward behavior
c) having engaged in behavior before
d) having a favorable social image of type of
person who does the behavior
3. Emotional factors in beliefs
a. stress has negative effects on cognitive processing
i. under high stress, people pay less attention to and
remember less information from health promotion literature

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 b. Conflict Theory model
i. model that accounts for both rational and irrational decision
making
ii. describes the cognitive sequence people use in decision
making
1) stages in model
a) appraising the challenge as threat or
opportunity
b) surveying alternatives to the challenge
iii. model proposes people experience stress in all major
decisions due to importance of decision and conflicts
about what to do behaviorally
iv. coping with decisional conflict depends on presence or
absence of risks, hope, and adequate time
1) different combinations of above produce different
coping patterns
a) hypervigilance - person sees serious risks
and believe that they may have alternatives,
but believe they are running out of time so
become frantic and make a hasty decision
b) vigilance - see serious risks and believe that
they have alternatives and time therefore
experience less stress and make more
rational choices
2) vigilance is most adaptive coping pattern
v. theory has not been tested enough to know its strengths
or weaknesses

III. Development, Gender, and Sociocultural Factors

A. Development and Health
1. As people age, the biopsychosocial factors affecting health change
a. preventive needs and goals change as a result
b. see Table 6.4 for excellent breakdown
2. During gestation and infancy
a. birth defects due to genetic abnormalities or harmful factors in
the fetal environment affect about 3 out of every 100 births in US
b. nourishment as well as hazardous microorganisms and
chemicals are passed to fetus from mother
c. three prenatal hazards affecting fetus
i. maternal malnourishment may lead to low birth weight,
poorly developed immune and central nervous systems,
and greater infant mortality
ii. infections may be passed

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 iii. presence of addictive or harmful substances (cocaine,
cigarette smoke, alcohol) is related to low birth weight,
impaired cognitive functioning, higher infant mortality
d. health education is advisable for pregnant women
e. breast feeding and childhood immunizations improves immune
functioning in infants and children
3. Childhood and adolescence
a. increased motor development places children at risk for injuries
due to accidents
i. ways to reduce likelihood of accidents
1) teaching children safety behaviors
2) providing appropriate supervision
3) decreasing access to dangerous situations
ii. cognitive processes in young children are immature
b. during adolescence, teenagers have cognitive abilities to make
logical decisions but peer pressure may exert a negative,
immediate influence
i. engaging in multiple interrelated risky behaviors occurs
ii. also learning to drive during this time period which
contributes to likelihood of accidents
4. Adulthood and aging
a. adults are less likely to adopt new behavioral risks to health
i. older and younger adults may have similar beliefs about
effectiveness of behaviors in preventing illness
1) older adults engage in more healthy behaviors
2) older adults may perceive themselves to be more
at risk for disease than younger adults and
therefore be more likely to engage in preventive
behavior as a result
b. living in an industrialized country is associated with living longer
and being in better physical and financial condition
c. engaging in regular substantial exercise tends to decline with age
i. exaggerate dangers of exertion on health
ii. underestimating physical capabilities
iii. embarrassment regarding performance of physical
activities
B. Gender and Health
1. Life span expectancy is longer for women depending on the country
and age group studied
a. factors influencing short life span for males
i. males have greater physiological reactivity when under
stress contributes to greater likelihood of developing CHD
ii. estrogen levels in women delay heart disease by reducing
blood cholesterol levels and platelet clotting
iii. men smoke and drink more increasing risk for
cardiovascular and respiratory disease, cancer, cirrhosis
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 iv. men have higher levels of drug use, unhealthy diets, risky
driving and sexual activity
v. males less likely to seek medical care
vi. work environments of men are more hazardous
b. men engage in more strenuous exercise - a behavioral
advantage
2. Trends in health problems
a. women have higher rates of acute illnesses and nonfatal chronic
disease
b. women use more medical drugs and services even when
pregnancy and reproductive conditions are controlled for
C. Sociocultural Factors and Health
1. Section introduction
a. study of health in Americans v. British demonstrates 2 trends
i. health differs between different countries
ii. health differs across different populations of people within
a country
2. Social class and minority group background
a. health correlates with social class
i. people in lower social class are more likely to be born with
low birth weight, die in infancy, die before 65, have poorer
overall health and longstanding illness in adulthood, or
experience more days of restricted activity due to illness
b. lower class members have poorer health habits, behaviors and
knowledge
c. infant mortality and development of chronic illness is much higher
among African-Americans
d. African-Americans, American Indians, and Hispanics have the
highest health problems and risks
i. live in environments that don’t encourage practicing
positive health behaviors
ii. increased vulnerability for 3 health problems
1) substance abuse
2) exposure to HIV
3) higher likelihood of injury or death from violence
3. Promoting health with diverse populations
a. solutions to health problems in diverse populations
i. reducing poverty
ii. creating effective approaches to present health
information at low literacy levels
b. professionals who are trying to prevent and treat illnesses need
to consider:
i. biological factors - differing physiological processes
ii. cognitive and linguistic factors - differing ideas about
illness, body sensation, and symptom interpretation;
language differences between professional and patient
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 iii. social and emotional factors - differing levels and coping
reactions to stress; differing types and use of social
support
c. grassroots, culturally relevant health-promotion programs have
been developed in some areas
i. example: Por La Vita involves increased breast and
cervical cancer testing in Hispanic women

IV. Programs for Health Promotion

A. Methods for promoting health
1. Motivating people to change is an important step in interventions
a. people need to want to change and that requires modifying
health beliefs and attitudes
2. Providing information
a. people need to know what to do, when, where, and how to do it
b. sources of information to promote health
i. mass media – television, radio, newspapers, magazines
1) simply supplying information on the negative
consequences of an activity has had limited
success
a) people don't want to change the behavior
ii. the Internet - databases and detailed information on
specific illness or support groups are increasingly located
here
iii. medical settings - information provided at the doctor's
office
1) advantages: most people visit the doctor annually
and respect their doctor
2) disadvantages: offices are busy; personnel may not
feel they have expertise to help or feel they are
intruding in personal lives of patients
3) office system should be structured in such a way to
promote giving information
a) 5- to 10-minute counseling sessions done in
person or over the phone
b) developing a system of cues
4) physicians can give personal risk estimates on
disease and opportunities to undergo tests
a) even when opportunity is available, patients
are hesitant to have tests due to anxiety or
conflict with other family members who don’t
wish to know the risk

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3. Features of information to enhance motivation
a. using tailored content
i. give information delivered in person, in print, or over the
telephone should be specific to the listener and based on
characteristics of that person
b. message framing
i. information emphasizes benefits or costs of behavior or
decision
1) gain-framed message - focus on attaining desirable
consequences or avoiding negative consequences
a) best for motivating behaviors that serve to
prevent or recover from illness or injury
2) loss-framed message - focus on getting
undesirable consequence and avoiding positive
consequences
a) best for behaviors that serve to detect a
health problem early
ii. effectiveness of frame depends on type of health behavior
iii. fear appeals are a special type of loss-frame message
1) linked to health belief model concept that people
who believe they are more susceptible to risk
(threat) when they do not engage in preventive
behavior are motivated by fear to engage in the
behavior
2) effects of fear appeals are transient
3) ways to make fear appeals more effective
a) emphasize organic and social
consequences of developing health problem
b) provide specific instructions/training for
performing behavior
c) help bolster self-confidence or self-efficacy
for behavior
4. Motivational interviewing
a. motivational interviewing is a counseling style designed to help
individuals explore and resolve ambivalence to changing
behavior
i. “client-centered” approach where client has control over
conversation and counselor uses reflective listening and
directive questioning to determine person’s internal
motivation for behavior change is used
ii. decisional balance = client lists reasons for and against
changing behavior so these can be discussed and
weighed
iii. interview may involve single or multiple sessions
iv. session(s) lead patient to identify benefits and problems
and then work through identified problems
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 v. research has found this is a promising method
vi. decisional balance is identified has critical component of
process
5. Behavioral methods
a. techniques that focus on enhancing performance of the
preventive act itself by altering antecedents and consequences
b. altering antecedents
i. providing specific instructions or training
ii. creating calendars to indicate when to perform behavior
iii. developing reminders of appointments
c. altering consequences
i. providing rewards when behavior occurs
1) effectiveness depends on type of reward, age of
person, person’s interest in performing behavior
d. for programs to be effective, they need to consider the viewpoint
of the person regarding preventive action and consequences of
behavior
6. Maintaining healthy behaviors
a. after new behaviors have been developed some lapse or relapse
may occur
i. lapse - a momentary backsliding
ii. relapse - returning to original behavior pattern
1) more common when person tries to change long-
standing behavior
b. abstinence-violation effect
i. when experiencing a lapse destroys confidence in
remaining abstinent and precipitates a full relapse
1) can be reduced by training to cope with lapses,
maintaining self-efficacy about behavior, and
providing “booster” sessions or contacts
a) need to provide counseling about dealing
with difficult situations that could lead to
relapse
B. Promoting Health in the Schools and Religious Organizations
1. School-based and religious organization health education may teach
children to avoid harmful practices and acquire beneficial behavior
2. Effectiveness of school and religious organization programs
a. have demonstrated improvement in blood pressure and
cholesterol levels
b. have shown improvements in health behavior and physical
condition
c. characteristics of effective school and religious organization
programs
i. comprehensive programming
ii. program involves children’s parents and community over a
long period
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C. Worksite Wellness Programs
1. Wellness programs are increasing rapidly in workplaces in industrialized
countries
a. national survey results
i. 90% of responding employers had some kind of health
promotion activity
ii. 1/3 of small worksites and 1/2 of large worksites had
comprehensive programs
b. impact of employee health on workplace
i. poor employee health costs employers in terms of health
benefits and absenteeism
ii. costs of running wellness programs is offset by savings in
health benefits and less cost due to absenteeism
2. Aims of programs
a. reducing risk factors such as hypertension, cigarette smoking,
diet & weight, physical fitness, alcohol abuse, and stress
3. Advantages of worksite programs
a. convenient to attend
b. inexpensive for employees
c. provides employees with reinforcement
d. can structure environment to encourage healthful behavior
4. Johnson & Johnson's "Live for Life" program
a. one of the most effective worksite programs developed
b. components of the program
i. a health screening
ii. lifestyle seminar
iii. action groups focus on specific problems
iv. follow-up contacts
v. work environment changes
c. evaluation results found improvements in health indicators,
absenteeism, and health care costs in program participants
D. Community-Wide Wellness Programs
1. Programs designed to reach large numbers of people with intention of
improving knowledge and performance on preventive behaviors
a. programs often use media to provide information and advice on
risk factors
b. incentives may also be provided
2. The Three Community Study
a. purpose was to change behavior and reduce risk for
cardiovascular disease
b. three California communities selected for the study
i. two communities were given media information on
smoking, diet and exercise whereas the third was treated
as the control
c. results indicate overall cardiac risk increased in the control
community and decreased in experimental communities
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 i. best results in older populations and worst results in
younger populations, participants with less education, and
participants with lower socioeconomic status
3. Other similar programs have demonstrated similar success
a. overall impact of programs tend to be modest but significant
when population impact is considered
E. Electronic Interventions for Health Promotion
1. Internet-based programs
2. Computer-based programs
F. Prevention With Specific Targets: Focusing on AIDS
1. HIV infection
a. magnitude of AIDS threat
i. tens of millions have died around the world
ii. over 33 million currently infected
iii. millions newly infected each year
b. demographics of infection
i. largest concentration of infection in sub-Saharan Africa
ii. growing incidence in Asia and Eastern Europe
iii. declines seen in industrialized countries
1) development of new medical treatments has
affected infection process in developed countries
c. modes of HIV transmission
i. contact between body fluids of infected and uninfected
persons through sexual activity or use of shared needles
ii. transmission of virus from mother to baby during
gestation, delivery or breast-feeding
d. risk factors for HIV infection
i. in US, male-to-male anal intercourse still major risk factor
ii. in US, risk of exposure is growing in low-income and
minority groups
iii. in other parts of world, major modes of infection include
sharing needles and unprotected heterosexual vaginal
intercourse
iv. females are becoming increasingly at risk
v. uncircumsized males are at greater risk
vi. unsafe sexual behavior remains major risk
1) prevention efforts have focused on fear messages
and providing information to promote safer-sex
practices
e. factors influencing unsafe sexual behaviors
i. ignorance
ii. lack of availability of protection
iii. promiscuity
iv. having sex under influence of alcohol or drugs
1) related to increased negative attitudes and
decreased self-efficacy about condom use
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 2) increases willingness to have unsafe sex
v. beliefs about the closeness or seriousness of the
relationship related to reduced condom use
vi. using denial or wishful thinking during decision making in
sexual situations
vii. beliefs of low self-efficacy about using condoms and
decrease in sexual pleasure if one is used
viii. embarrassment over buying condoms and errors in
using them
ix. medical treatments that lower viral load and their link to
over-optimistic beliefs
f. maladaptive beliefs are demonstrated when behavior contradicts
expert information and qualifiers are added to statements
2. Basic messages to prevent HIV infection
a. information on basic behaviors, much of which has been
designed to arouse fear
i. avoid or reduce sex outside of long-term monogamous
relationship
ii. people who have HIV may not know it and some who do
know do not report it to sexual partners
iii. drug users shouldn’t share needles unless sterilized
iv. women should be tested for HIV before becoming
pregnant and, if positive, avoid becoming pregnant
b. impact of information on HIV-related knowledge and behavior
i. information has been directed toward adolescents and
young people, intravenous drug users and their sexual
partners, and gays and bisexuals
ii. although information increases knowledge, sexually
experienced persons don’t follow recommendations for
behavior change
iii. virginity pledges are commonly broken within a year
1) promoting condom use is more effective in sexually
active youth
iv. information has reduced risk behaviors in drug users but
only so far as it relates to drug behaviors
1) sexual behaviors are not affected
c. best organized efforts have been present in gay communities
who were already organized through social, political, and
religious groups prior to HIV pandemic
i. groups became mobilized to address HIV public health
campaigns
ii. results of efforts in gay community reflect most profound
behavioral changes in health-related behaviors ever
recorded
3. Focusing on sociocultural groups and women
a. intervention efforts must be increased with heterosexual women
197
 and disadvantaged sociocultural groups
i. some minority groups may be at risk due to less
knowledge or distrust of medical system
ii. factors placing women at risk for HIV
1) male partner who resists using condoms
2) being socially/economically dependent on male
partner
3) having less power in their relationship
4) violence within the relationship
5) partner who interprets request to use condom as
sign she doesn’t care for him or suspects him of
infidelity
iii. interventions with Hispanic and African American women
1) sessions were designed to increase motivation and
interpersonal skills for adopting safer sex practices
2) results: more likely to report using safer sex
practices & obtaining condoms; less likely to
develop STDs
4. Making HIV prevention more effective
a. individual counseling (motivational interviewing) has had best
success with those already infected
b. uninfected people often do not reduce risky behaviors
c. well-designed programs should include:
i. tailoring the program to sociocultural group needs
ii. training in actual skills
iii. using methods to reduce behaviors that increase risk of
unsafe sex
iv. bolstering self-efficacy and advancing people through
stages of change
v. using respected or popular individuals to lead program
vi. encouraging infected person to disclose HIV status
vii. reducing nonrational influences on sexual decisions

198
DISCUSSION TOPICS

1. The Precaution Adoption Process:

The precaution adoption process is a model of preventive behavior not discussed
in this chapter but clearly applicable. This model proposes that preventive behaviors
occur in stages ranging essentially from uninformed bliss to actively taking precautions
against a health hazard. Particularly interesting is Weinstein’s suggestion that people at
different stages will think and behave in qualitatively different ways and that intervention
strategists need to consider that different kinds of interventions and information will be
needed to move people through these stages.
Source:
Weinstein, N.D. (1988). The precaution adoption process. Health Psychology,
7(4), 355-386.

2. Private Passions and Public Health:

This is an interesting article you may wish to have students read regarding
HIV/AIDS. In reviewing the lives of people, it addresses tough personal and
interpersonal needs and motivations that underlie what on the surface may appear to be
illogical behavior with respect to HIV-testing and risk exposure. For example, the author
describes cases of HIV-positive patients who actively try to infect their partners in an
attempt to make that person stay with them. Another perspective involves AIDS
infection as one of many problems in the lives of some people. A rich article for
discussion.
Source:
Krajick, K. (1988). Private passions and public health. Psychology Today, 22,
50-58.

3. The Effect of the Environment on Women's Health:

Sarafino notes that men’s occupational and recreational experiences have
historically put them at risk for illness and injury. VanDusen’s chapter explores a rich
set of issues to be considered when evaluating the environmental risks to which women
have historically been exposed. She explores environmental agents and situations
within the home, neighborhood, and work settings that put women at risk. For example,
over a million women working in the clothing and textile industry may be exposed to
formaldehyde, flame-retardants, solvents, benzidine-type dyes, noise, vibration, and
cotton dust. Nearly half a million hairdressers and cosmetologists are exposed to
bleaches, nail varnishes, and hair dye. Household workers are at risk for exposure to
chemicals such as solvents, pesticides, and disinfectants and injury due to falls. This
author discusses the impact of these environmental hazards on the lives of women and
the effects on children during gestation.
Source:
VanDusen, K. (1982). The effect of the environment on women's health. In
Hongladarom, G.C., McCorkle, R., & Woods, N.F. (Eds.), The complete book of
women's health. (pp.163-178).

199
4. A Worksite Health Promotion Model for Public Schools:
This chapter addresses health promotion/prevention programs in both worksite
and school settings. As such, this article may be of interest since it merges principles
across both settings. The authors provide a very helpful table comparing general
program characteristics for school health education, school health promotion programs,
and worksite health promotion. In particular, they suggest that rather than having
improved knowledge, attitudes, and behaviors as the outcome goals for health
education classes, the goals might be more similar to those of worksite settings:
improving student morale, increasing productivity (i.e., grades), and reducing student
absenteeism.

Source:
Eddy, J.M., Fitzhugh,E., Gold, R.S., & Wojtowicz, G.G. (1996). A worksite health
promotion model for public schools. Journal of Health Education, January/February, 48-
50.

5. Workplace Wellness Program.

According to Cohen (1985), the advantages of a health promotion program at the
workplace are:
a. most employees go to the workplace on a regular schedule, facilitating regular
participation in programs;
b. contact with co-workers can provide reinforcing social support, which is
believed by many to be a primary force in sustaining a life-style change;
c. workplaces offer many opportunities for environmental supports, such as
healthy food in cafeterias and office policies regarding smoking;
d. opportunities abound for positive reinforcement for program participants;
e. programs in the workplace are generally less expensive for the employee than
comparable programs in the community; and
f. programs in the workplace are convenient.

What are factors that encourage employers to institute such programs? What factors
discourage them? Are there workplace factors that serve to increase health risks?

6. Cross-cultural Differences in Reporting Symptoms.

Richard Brislin, in his book on cultural influences on behavior, notes that
research instruments (i.e., questionnaires) are frequently difficult to use since the
connotative meaning of terminology can vary across cultures. As an example, health or
good health can mean different things depending on cultural understandings of the
nature of the body and disease etiology. His basic suggestion is that people involved in
health care delivery need to be sensitive to cross-cultural variation in symptom
reporting, as people tend to report symptoms in culturally-acceptable ways. For
example, somatization may be more likely to occur in cultures where signs of weakness,
anxiety, or worry are less tolerated. Complaints of gastrointestinal problems, nausea, or
tightness in the head/chest may be indicative of homesickness or other stressing life
situations. Brislin contends that practitioner knowledge of the bases for somatization
within various cultural groups can provide an important context for understanding
200
symptom reporting, can contribute to patients' feeling of acceptance within the medical
setting, and ultimately influence positive outcomes in health services delivery.

Source:
Brislin, R. (1993). Understanding culture's influence on behavior. (pp. 329 - 334).
Fort Worth, TX: Harcourt Brace Jovanovich.

201
ACTIVITIES

1. Assess Yourself: Your Knowledge about AIDS. Students' knowledge regarding

AIDS is measured in this self-assessment, reproduced in handout #1.

2. Health Promotion. Have each student choose a problem addressed by public

health departments such as cancer, heart disease, drinking, smoking, drugs, or AIDS.
Monitor magazines, newspapers, television and radio programs as well as billboards
and promotional activities for prevention efforts. Classify the efforts so identified as
primary, secondary or tertiary in nature. Are the efforts fear-arousing,
information-providing, or skill-building?

3. Health Risk Appraisal. A generous number of health risk appraisals (HRAs) can
now be completed on-line. HRAs can be easily found by entering the key phrase
"Health Risk Appraisal" on most major search engines. An example site is
http://www.nmfn.com/tn/learnctr--lifeevents--longevity .If you did not do this exercise in
connection to chapter 1, you may wish to include it here since this chapter speaks
directly to using health risk appraisals. As noted before, you may wish to extend this
exercise by having students select 1-2 identified risk areas and develop a plan to
address these areas.

4. Health Quest activities. A CD-ROM entitled HealthQuest: An interactive

exploration of your health and well-being by Gold, R.S., Atkinson, N., Mullen Conley, K.,
and McDermott, R.J. is available through McGraw-Hill. Three modules include activities
and information regarding tobacco, alcohol, and other drugs. Wellness exercises are
also integrated into the activities provided.

202
Handout #1

Assess Yourself: Your Knowledge about AIDS.

Instructions: Answer the following true-false items by circling the T or F.

T F 1. All people who develop AIDS die from its complications.

T F 2. Blood tests can usually tell within a week after infection whether
someone has the AIDS virus.

T F 3. People do not get AIDS from using swimming pools or restrooms

also used by someone with AIDS.

T F 4. Some people have contracted AIDS from insects, such as

mosquitoes, that have previously bitten someone with AIDS.

T F 5. AIDS can now be prevented with a vaccine and cured if treated

early.

T F 6. People who have the AIDS virus can look and feel well.

T F 7. Gay women (lesbians) contract AIDS much more often than

heterosexual women but not as often as gay men.

T F 8. Health workers have a high risk of getting AIDS from or spreading

the virus to their patients.

T F 9. Kissing or touching someone who has AIDS can give you the
disease.

T F 10. AIDS is less contagious than measles.

203
RESOURCES

Suggested Readings:
Health and Behavior
Ajzen, I., Albarraci, D., & Hornik, R. (2007). Prediction and change of health behavior:
Applying the reasoned action approach. Mahwah, NJ: Erlbaum Associates.
Brown, J.D., Steele, J.R., Walsh-Childers, K. (2002). Sexual teens, sexual media:
Investigating media’s influence on adolescent sexuality. Mahwah, NJ: US
Lawrence Erlbaum Associates.
Skelton, J.A., & Croyle, R.T. (1991). Mental representations in health and illness.
New York: Spring-Verlag.
Woolf, S.H., Jonas, S., & Lawrence, R.S. (1996). Health promotion and disease.
Prevention in clinical practice. Baltimore, MD: Williams & Wilkins.

What Determines Health Behavior?

Glanz, K., Lewis, F., & Rimer, B. (1997). Health behavior and health education: theory,
research, and practice. San Francisco: Jossey-Bass.
Gochman, D. (1997). Handbook of health behavior research. New York: Plenum Press.
James, A & Hockey, J. (2007). Embodying health identities. New York: Palgrave
Macmillan.
Miller, D., Green, J. (2002). The psychology of sexual health. Oxford: Blackwell
Science Ltd.
Orbell, S, Perugini, M, & Rakow, T. (2004) Individual differences in sensitivity to
health communications: Consideration of future consequences. Health
Psychology, 23(4) 388-396.
Raczynski, J.M., Leviton, L.C. (2004). Handbook of clinical health psychology:
Volume 2. Disorders of behavior and health. Washington D.C.: American
Psychological Association.
Rifkin, E., & Bouwer, E. (2007). The illusion of certainty: health benefits and risks. New
York: Springer.

Development, Gender, and Sociocultural Factors

Campbell, C.A. (1999). Women, families, and HIV/AIDS: A sociological perspective on
the epidemic in America. Cambridge: Cambridge University Press.
Daniels, N. (2008). Just health: meeting health needs fairly. New York: Cambridge
University Press.
Parks, D., Morrell, R., & Shifren, K. (1999). Processing of medical information in aging
patients: cognitive and human factors perspectives. Mahwah, NJ: Lawrence
Erlbaum.
Pearlberg, G. (1991). Women, AIDS, & communities: A guide for action. New York:
Women's Action Alliance.
Soares, R. (2007). On the determinants of mortality reductions in the developing world.
Cambridge, MA: National Bureau of Economic Research.
US Government Accountability Office. (2007). Poverty in America: economic research
shows adverse impacts on health status and other social conditions as well as
the economic growth rate. Washington, DC: US-GAO.
204
Van Vugt, J.P. (Ed.) (1994). AIDS prevention and services: community based
research. Westport, CN: Bergin & Garvey.

Health & Wellness Promotion

Brownson, R.C., Baker, E.A., & Novick, L.F. (1999). Community-based prevention:
Programs that work. Gaithersburg, MD: Aspen Publ.
Cottrell, R., Girvan, J., & McKenzie, J. (1999). Principles and foundations of health
promotion and education. Boston: Allyn and Bacon.
Downie, R., Tannahill, C., & Tannahill, A. (1996). Health promotion: models and
values. New York: Oxford University Press.
Evers, A., Farrant, W., & Trojan, A. (Eds.). (1990). Healthy public policy at the local
level. Boulder, CO: Westview Press.
Fazio, L. (2008). Developing occupation-centered programs for the community. Upper
Saddle River, NJ: Pearson/Prentice Hall.
Grant, C., & Brisbin, R. (1992). Workplace wellness: the key to higher productivity and
lower health costs. New York: Van Nostrand Reinhold.
Hoeger, W. & Hoeger, S. (1996). Fitness & wellness. Englewood, CA: Morton.
Howatt, W. (2001). Creating wellness at home and in school. Bloomington, ID: Phi
Delta Kappa Educational Foundation.
Kerber, B. (1999). Wellness program management yearbook. Manasquan, NJ:
American Business Publishing.
Miller, D.F. (1995). Dimensions of community health. Madison, WI: Brown &
Benchmark.
Raczynski, J., & DiClemente, R. (1999). Handbook of health promotion and disease
prevention. New York: Kluwer Academic.
Schust, C.S. (1996). Community health: Education and promotion manual.
Gaithersburg, MD: Aspen Publ.
Wilson, B., & Glaros, T. (1994). Managing health promotion programs. Champaign, IL:
Human Kinetics.
Woolf, S., Jonas, S., & Kaplan-Liss, E. (2008). Health promotion and disease
prevention in clinical practice. Philadelphia: Wolters Kluwer Health.

HIV/AIDS
Global HIV Prevention Working Group. (2003). Access to HIV prevention: closing the
gap. United States: Global HIV Prevention Working Group.
Haacker, M. (2004). The macroeconomics of HIV/AIDS. Washington, DC: International
Monetary Fund.
Leviton, L., Hegedus, A., & Kubrin, A. (1990). Evaluating AIDS prevention: contributions
of multiple disciplines. San Francisco: Jossey-Bass.
National Institutes on Drug Abuse. (2000). The NIDA community-based outreach
model: A manual to reduce the risk of HIV and other blood-borne infections in
drug users. Bethesda, MD: NIDA.
Seckinelgin, H. (2008). International politics of HIV/AIDS: global disease – local pain.
New York: Routledge.
Tillman, P.S. & Pequegnat, W. (1996). Interventions to prevent HIV risk behaviors:
January 1991 through November 1996. Bethesda, MD: NIH.
205
Suggested Films and Videos:
Health and Behavior
1. AIDS: No nonsense answers. (1994, Films for the Humanities, 10 min).
Demonstrates prevention behaviors and lifestyle modifications to prevent AIDS
infection.
2. Cancer prevention. (1994, The Institute, 10 min). Discusses what causes cancer
and how to protect oneself from the disease.
3. Health hazards: What you don't know. (2000, Edudex, 30 min). Focuses on health
hazards in the environment.
4. HeartSafe: Healthy choices to protect your heart. (1993, Milner-Fenwick, 50 min). A
look at prevention and control of heart disease.
5. Living with cancer. (2000, Edudex, 30 min). Video covers advances in cancer
treatment and discusses social support as a factor in living with cancer.

What Determines Health Behavior?

6. If AIDS is so bad, how come we don't know anybody who has it? (1990, Metropost,
23 min). Demonstrates faulty beliefs that contribute to the spread of AIDS.
7. In human terms. (2000, Edudex, 30 min) Program analyzes disease throughout the
world community.

Development, Gender, and Sociocultural Factors

8. Breast health: Complete series. (1999, Edudex, 24 min). Provides a complete
breast health curriculum.
9. Conceiving the future. (1993, PBS Video, 57 min). Discusses how genetics
provides powerful ways to predict health and determine the future of an embryo.
10. Fetal alcohol syndrome: A focus on prevention. (1997, Edudex, 20 min). Offers
advice on prevention of FAS.
11. Pandemic. (1993, PBS Video, 57 min). Describes how some doctors are leaving the
hospital to prevent AIDS at its source.

Programs for Health Promotion

12. Avoiding Infectious and Sexually Transmitted diseases. (1998, Films for the
Humanities and sciences, 29 min). Profiles STDs such as HIV, symptoms, and risk
factors.
13. B.S.E. for teens: with Jennie Garth. (1999, Edudex, 7 min). Program encourages
teens to adopt the use of BSE.
14. Preventing skin cancer. (2001, Edudex, 25 min). Reviews the various kinds of skin
cancers and shows how to protect against them.
15. Testicular self-examination. (1995, Edudex, 5 min). Self-examination of the testes
is demonstrated.
16. Planning healthy lifestyles. (2002, Human Kinetics, 30 min). Students are given
guidelines for maintaining health and promoting wellness.
17. Introduction to wellness. (2002, Human Kinetics, 25 min). Maintaining health and
wellness and a healthy lifestyle is discussed.
206
Journals of interest
American journal of health behavior – PNG Publications

Internet sites of interest:

Workplace Wellness
1. http://www.wellnessjunction.com/ - A commercial website oriented to workplace
wellness.
2. http://www.corporatewellness.com/ - Corporate Wellness webpage (worksite
wellness programs).

Prevention
3. http://www.welcoa.org/ - Wellness Councils of America webpage
4. http://www.md-phc.com/index.html - Preventive Health Center
5. http://www.tht.org.uk/ - HIV infection information
6. http://www.health.org/ - The National Clearinghouse for Alcohol and Drug
Information (links to prevention programs).
7. http://hivinsite.ucsf.edu/ - HIV InSite Gateway to HIV and AIDS knowledge
8. http://www.livingto100.com/ - Living to 100 life expectancy calculator – gives detailed
prevention and health behavior change information.

Other Sites of Interest

9. http://www.healthypeople.gov - Healthy People 2010 website
10. http://www.nachc.com/ - National Association of Community Health Centers
11. http://www.cancer.org/ - American Cancer Society homepage
12. http://www.healthyself.org/healthyselfhome.htm - Site for health living resources
13. http://www.americanpregnancy.org - American Pregnancy Association – Site
promoting reproductive and pregnancy wellness
14. http://www.healthysex.com - Sexual risk knowledge checklist of facts
15. http://www.who.int/topics/health_promotion/en/ – World Health Organization health
promotion page
16. http://odphp.osophs.dhhs.gov/ - Office of Disease Prevention and Health Promotion

207
TEST QUESTIONS

True or False

F 1. Changing health habits is likely to reduce mortality rates only partially.

(142)

T 2. Sick role behavior as defined in the text would describe an individual

(143) who seeks out treatment for the purpose of getting well.

F 3. People’s health habits are extremely stable and do not change over
(144) time.

F 4. Dan is caught smoking by his parents, who are psychologists. His parents
(149) decide to make Dan stay in his room so that the behavior will stop. This
is an example of negative reinforcement.

T 5. The Health Belief Model proposes that people will take some
(151) health-related action if a threat is perceived and if the perceived benefits
of acting outweigh the perceived costs.

T 6. John has just begun thinking about quitting smoking cigarettes. Although
(154) he is thinking about changing, according to the stages of change model, if
he were to actually attempt a quit effort at this point his chances of
success are slim.

F 7. Across their life span, people’s preventive needs and goals tend to remain
(157) fairly constant.

F 8. Biological factors and poverty have only a small impact on health

(161) promotion programs with diverse populations.

T 9. Fear-arousing warnings, such as those found on packs of cigarettes,

(164) are a special case of loss-framed messages.

T 10. Worksite wellness programs such as the Live for Life program have
(167) been shown to reduce health risk behaviors, job stress, absenteeism,
and medical claims.

The Health Belief Model and Planned Behavior model are considered stage based models
while the Transtheoretical model is a continuum model.
a. True
b. False

208
Matching

Match one of the following with the examples in numbers 1-5.

a. positive reinforcement
b. negative reinforcement
c. extinction
d. punishment
e. modeling

b 1. When Bob is under stress he experiences heartburn, which he relieves

through the
(148) use of antacids.

a 2. Dr. Peterson gives his patients a new toothbrush and tasty mouthwash for
(148) attending regular dental checkups.

e 3. Frank took up golf because his fellow executives all played, and his wife
(149) Cheryl started taking walks because her friends in the neighborhood go on walks.

d 4. Sharon got sick the first time she tried a cigarette and never smoked
(149) again.

c 5. Sylvia was placed on medication to control her high blood pressure. After
(148) several weeks, she could feel no difference so she stopped taking her pills.

Match the following with a characteristic found in 6-10.

a. theory of planned behavior
b. conflict theory
c. health belief model
d. stages of change model
e. motivated reasoning

d 6. Involves spiraling toward successful change.

(154)

e 7. When desires and preferences influence judgments about new information.

(155)

a 8. As applied to health behaviors, interested in studying intentions

(152) that are determined by attitudes regarding the behavior, the influence of
beliefs of others, and ability to control a behavior.

c 9. Health behaviors are determined by the perceived seriousness of the threat

(151) and perceived cost of the behavior.

b 10. The view that health challenges may be perceived as

(156) either a threat or opportunity.

209
Multiple Choice

c 1. The current trend of raising health consciousness is

(141) a. unprecedented in history.
b. unlikely to affect mortality rates.
c. similar to another such movement in the mid-1800s.
d. no different than the way people have always behaved.

d 2. If people adopted lifestyles that promoted wellness, how would the rate
(142) of illness and early death be affected?
a. Neither would not be affected in any way.
b. Rates of illness would be affected but not rates of early death.
c. Rates of early death would be affected but not rates of illness.
d. Both would be reduced.

b 3. Even if people adopted all recommended health behaviors and cures were
(142) found for major diseases, the upper limit of the average life expectancy of people
in technologically advanced countries is likely not to exceed:
a. 75 years.
b. 85 years.
c. 90 years.
d. 95 years.

a 4. How have the ten leading causes of death changed from the late 1960's to
(142) today?
a. Deaths from diseases of early infancy are no longer in the top ten.
b. Deaths from cancer and lung disease have decreased.
c. Deaths from heart disease and stroke have increased.
d. AIDS has become one of the top ten leading causes of death today.

d 5. Ted complains to his friends about recurring pain in his shoulder and
(143) has been looking up information on the Internet about possible causes for his
pain. Ted's behavior is an example of _____ behavior.
a. well
b. sick-role
c. irrational
d. symptom-based

210
b 6. You call your boss to let her know you won't be in today because you have
(144) the flu. You stay home where you take the appropriate medicines, rest, and
drink plenty of fluids. Your behaviors are examples of _____ behaviors.
a. rational
b. sick-role
c. symptom-based
d. cognitive

a 7. According to the research on cultural differences in response to symptoms

(144) and health behaviors, which of the following persons is most likely to be affected
by their family’s culture of origin?
a. James, a recent immigrant.
b. Frank, a fifth generation immigrant whose ancestors came from China.
c. Both are affected equally.
d. Neither are affected.

b 8. The greatest percentage of adults engage in which of the following health-

(144) related behaviors?
a. Rarely snack.
b. Eat breakfast almost every day.
c. Exercise regularly.
d. Average two or more drinks per day.

a 9. Which of the following statements about health habits/behaviors

(144) is supported by research?
a. Health habits tend not to be linked to one another.
b. Health habits always remain stable over time.
c. One single set of attitudes tends to govern our health behaviors.
d. Very few people practice health habits on a regular basis.

d 10. Which of the following statements about testicular cancer is not accurate?
(145) a. It affects mostly younger men.
b. It has a high cure rate if treated early.
c. It can be detected early by monthly testicular self-examinations.
d. It is more prevalent than breast cancer.

d 11. Which of the following statements about breast self-examination (BSE) is

(145) not accurate?
a. Most American women know about BSE but don't practice it on a
monthly basis.
b. The low practice of BSE may be due to low confidence, fear,
embarrassment, and lack of knowledge about its importance.
c. Simple reminders could increase the frequency of BSE practice.
d. BSE results in only a modest level of breast cancer detection.

211
d 12. Which is an example of an environmental preventive approach to tooth
(145) decay?
a. repairing cavities
b. demonstrating good brushing technique
c. reinforcing children for brushing their teeth
d. fluoridation of local water supplies

c 13. Showing your children how to drive a car safely is an example of a(n) _____
(145) approach to prevention.
a. environmental measure
b. tertiary
c. behavioral influence
d. precontemplation

a 14. A local physician encourages his patients to eat an appropriate diet,

(146) exercise, not smoke, use seat belts, and get plenty of sleep. This doctor is
encouraging
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. behavior modification.

d 15. Which of the following is NOT an example of primary prevention?

(146) a. using a condom
b. engaging in regular exercise
c. pre-conception genetic counseling
d. taking a prescribed blood pressure medicine

b 16. After finding a lump during her monthly BSE, Maggie is on her way to
(146) receive a mammogram. Maggie's trip to the lab is an example of
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. behavior modification.

d 17. Which of the following is NOT an example of secondary prevention?

(146) a. following a prescribed diet to control blood pressure
b. school hearing or vision tests
c. an annual physical examination
d. physical therapy following a stroke

212
c 18. Actions taken to reduce the damage of a disease or rehabilitate a patient are
(147) generally referred to as
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. cognitive restructuring.

a 19. Which is an example of tertiary prevention?

(147) a. a cardiac rehabilitation program for people who have recently had a
heart attack
b. regular dental checkups for children with healthy teeth
c. going to the doctor when you have a sore throat
d. being in a monogamous sexual relationship

d 20. Which of the following people is engaging in tertiary prevention?

(147) a. David, who schedules and attends annual physical checkups with his
physician
b. Linda, a healthy woman who works out at the gym 4-5 times per week
c. Frank, who has just tested negative for HIV
d. Amy, who receives chemotherapy for breast cancer

d 21. Which is an important factor in determining whether a person will adopt a

(147) wellness lifestyle?
a. encountering few barriers to changing behaviors
b. motivation to engage in the new behaviors
c. knowledge and skills to change an existing behavior
d. all of the above

b 22. Woo is attempting to lose weight. Which of the following interpersonal factors
(147) will support his effort?
a. His girlfriend doesn’t agree with the diet he has chosen.
b. He has a close friend who supports his new diet and weight loss goals.
c. His coworkers don’t understand why he’s so concerned about his
weight.
d. His lack of a strong social network

d 23. When a community attempts to reduce illness and injury, it may need to
(148) address which of the following problems?
a. diversity of age and sociocultural background of its citizens
b. funding for public health programs
c. creating a balance between the health and economic needs of the
community
d. all of the above

213
a 24. Which of the following statements is true regarding the relationship
(148) between heredity and health behaviors?
a. Heredity may influence some health-related behaviors.
b. Heredity has little to no influence on health-related behaviors.
c. Heredity is the best predictor of health-related behaviors.
d. Little to no research exists on this relationship.

b 25. Wendy says she smokes because it makes her less nervous. Her
(148) smoking behavior is being maintained through
a. positive reinforcement.
b. negative reinforcement.
c. punishment.
d. extinction.

c 26. Sam's parents punish him when he doesn't wear his bike helmet while
(149) riding his bike. What best predicts if this punishment will affect Sam's future
helmet-wearing behavior?
a. The type of punishment he receives.
b. The severity of the punishment.
c. Sam's expectation that the punishment will be repeated if he doesn't
wear the helmet.
d. The quality of accompanying explanations made by Sam's parents.

d 27. Observing a model is most likely to affect our behavior when the model is
(149) a. an older person.
b. a high status person.
c. a person similar to us.
d. b & c

c 28. Anna, a habitual smoker, lights up a cigarette after eating dinner. When the
(149) phone rings in the other room, she answers it and lights up another cigarette
from the pack by the phone. She is surprised later that she didn't realize she
had two cigarettes going at once. It appears her smoking behaviors are
governed by the _____ of her behavior.
a. consequences
b. social approval
c. antecedents
d. genetic influence

d 29. You want your children to grow into healthy adults. Which of the following
(149) practices will facilitate that?
a. changing bad health habits in your children as early as possible
b. engaging in healthy practices yourself
c. telling your children that having good health is important to you
d. all of the above

214
b 30. Results from a study of hypertensive patients' perceptions of symptoms
(150) found that these patients
a. make accurate estimates of their blood pressure levels.
b. are poor estimators of their own blood pressure.
c. estimate their blood pressure well, but not as well as normotensives.
d. rarely change their medication-taking behaviors in light of the
symptoms they experience.

a 31. Weinstein's research on beliefs about individuals' future health found that
(150) people tend to
a. be overly optimistic about future health.
b. be overly pessimistic about future health.
c. exaggerate the severity of health risks.
d. seldom think about their future health.

b 32. Manuel has just experienced a severe health scare regarding his heart.
(151) According to Weinstein, Manuel is likely to
a. display unrealistic optimism about his future health.
b. show unrealistic pessimism about his future health.
c. show no change in attitudes.
d. become very realistic about his health.

d 33. Which of the following is NOT a factor in people's perceived threat of illness
(151) or injury?
a. perceived seriousness of the health problem
b. perceived susceptibility of the health problem
c. reminders or alerts regarding a health problem
d. unrealistic optimism

d 34. Applying the health belief model, women who do regular breast
(151) self-examinations (BSEs)
a. believe they are susceptible to breast cancer.
b. believe developing breast cancer would have serious effects.
c. believe the benefits of BSE's outweigh the costs.
d. all of the above

a 35. Which of the following statements regarding research on the health belief
(152) model is true?
a. Research supports the major theoretical components of the model.
b. The model has received support for a very limited scope of health
behaviors.
c. The “cues to action” component has received no support.
d. Very little research has been done on the model.

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c 36. One of the shortcomings with the health belief model is
(152) a. the lack of research designed to test the model.
b. that it only accounts for habitual behaviors.
c. that there is no standard way of measuring its components.
d. that more recent models suggest it is simply wrong.

d 37. The theory of planned behavior is based on the fundamental notion that
(152) a. people develop behavioral intentions before engaging in voluntary
behavior.
b. behavioral intentions are the best predictors of actual behavior.
c. expectations of success influence behavior.
d. all of the above.

b 38. Annie’s parents strongly disapprove of her smoking habit. Which component
(153) of the theory of planned behavior is reflected in this variable?
a. Annie's personal attitude
b. subjective norms
c. perceived personal control
d. perceived severity

c 39. Jason says he would like to exercise more but simply doesn't have the
(153) money to pay for a gym membership. His behavioral intention is being most
affected by
a. personal attitude.
b. attitudes of important others.
c. low personal control.
d. low motivation to comply with the wishes of others.

a 40. According to the stages of change model, people go through five stages of
(154) intentional behavior change in the following order:
a. precontemplation, contemplation, preparation, action, maintenance
b. preparation, precontemplation, contemplation, action, maintenance
c. preparation, action, precontemplation, contemplation, maintenance
d. precontemplation, contemplation, preparation, maintenance, action
e. maintenance, precontemplation, contemplation, preparation, action

c 41. Which of the following represents an effort to move a person from one
(154) stage of change to another?
a. describing in general terms how they will change their behavior
b. having them stay in the precontemplation stage
c. matching the change strategy to the stage they are in
d. if they are in the precontemplation stage, having them talk with
someone who has successfully changed their own behavior

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d 42. JillAnn believes it unlikely that she could contract a sexually transmitted
(155) disease from her new boyfriend because he’s so nice to her. JillAnn's reliance
on irrelevant information in making sexual health decisions is a form of
a. precontemplation.
b. reasoned action.
c. rational thinking.
d. motivated reasoning.

d 43. Willy has been drinking and finds himself in a situation where he can have
(156) sex with someone he just met at a bar. Which of the following predicts if he will
engage in sexual actions with this virtual stranger?
a. If he has friends who have had sex under similar circumstances.
b. If he thinks having sex will reflect positively on how sexually attractive
he is to others.
c. If he done this before.
d. all of the above

a 44. Conflict theory emphasizes the impact of ___________ on all major

(156) decisions.
a. stress
b. irrational thinking
c. emotional stability
d. complete information

b 45. According to conflict theory, the only consistently adaptive decision-making

(156) pattern in the face of health risks is
a. hypervigilance.
b. vigilant coping.
c. unconflicted change.
d. defensive avoidance.

a 46. Health goals during gestation and infancy tend to include which of the
(158) following?
a. helping the parents to achieve the knowledge and capacity for the
physical, emotional, and social needs of the baby
b. establishing healthy behavioral patterns for nutrition, exercise,
recreation, and family life
c. anticipating and guarding against the onset of chronic disease
d. prolonging the period of effective activity and ability to live
independently

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d 47. Which of the following has been referred to as "nature's vaccine"?
(158) a. penicillin
b. exercise
c. a good heredity
d. breast milk

a 48. The leading cause of death during childhood and adolescence is

(159) a. accidents.
b. impaired immune functioning.
c. childhood diseases.
d. birth defects.

d 50. Which of the following health-related cognitions or behaviors is less likely

(159) in older adults than in younger adults?
a. starting new health risk activities since they don’t have long to live and
want to enjoy themselves
b. practicing fewer health behaviors
c. getting regular medical checkups
d. getting regular exercise

a 51. Research on gender and health has shown that women

(160) a. tend to live longer than men.
b. have fewer health problems than men.
c. tend to get more exercise than men.
d. (excluding pregnancies) use medical services less than men.

b 53. Research on social class, ethnicity, and health shows

(161) a. social class is not related to health status.
b. higher disease incidence in African-Americans, American Indians, and
Hispanics as compared to European Americans.
c. equal knowledge of risk factors for disease regardless of social class.
d. all of the above

d 54. According to the text, which of the following would significantly increase
(161) health in diverse populations?
a. reducing poverty
b. creating information approaches to reach populations with low literacy
rates
c. making health-promotion services culturally sensitive
d. all of the above

b 55. A common approach in mass-media health promotion campaigns includes

(162) a. information about using the Internet.
b. communication of negative consequences of unhealthy behaviors.
c. self-help clinics.
d. both b and c
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d 55. Using fear-arousing messages can be most effective under which of the
(165) following conditions?
a. when the seriousness of the health problem is emphasized
b. when combined with messages that indicate people can perform
healthful behaviors
c. when used in combination with gain-framed messages
d. both a and b

d 56. Which of the following factors influence the effectiveness of

(166) reinforcers for increasing health behaviors?
a. type of reward
b. income level of the person
c. sociocultural background of the recipient
d. the person’s gender

c 57. Thelma is upset with herself because she’s just eaten a piece of chocolate
(166) cake and thinks she’s completely “blown” her diet plan. She decides that she just
isn’t cut out for diets and eats the rest of the cake. This is an example of _____
(if Thelma believed she shouldn’t eat any cake at all while on her diet).
a. lapse
b. relapse
c. abstinence-violation effect
d. motivated reasoning

c 58. Which of the following represents a benefit of school health programs?

(166) a. They can be used in place of physical education programs that are
more costly.
b. They can easily be taught by even beginning school teachers.
c. They help children establish healthy behaviors early.
d. They are more effective in developing countries than in industrialized
countries.

d 58. According to the textbook, worksite health programs

(167) a. take advantage of peer and employer support for motivational
purposes.
b. are cost effective for businesses and employees.
c. can create environmental support to foster behavior change.
d. all of the above

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d 60. Overall, evidence on the effectiveness of community-based wellness
(168) programs suggests that:
a. such programs tend to produce modest changes.
b. any program that produces modest change in the health behavior of a
population is likely to have a large impact on disease.
c. such programs work best in older populations.
d. all of the above

1. Which of the following is one of the important elements in determining preventive health
behaviors, according to the Health Belief Model?
A. perceived threat
B. subjective norms
C. perceived efficiency
D. behavioral intention
E. stage of readiness

2. The primary outcome variable being explained/predicted in the Health Belief Model is …
A. outcome-efficacy
B. self-efficacy
C. perceived disability
D. likelihood of getting sick
E. none of these

3. According to the Transtheoretical Model of change, when a person is almost ready to instigate
change, and spends time thinking about how to implement a new behavior, s/he is in the
____________ stage.
A. maintenance
B. precontemplation
C. action
D. contemplation
E. preparation

Short Answer Questions

1. Compare and contrast primary, secondary, and teritary prevention. Given an

example of each approach to prevention.

2. Discuss the similarities and differences between the Health Belief model and the
Theory of Planned Behavior.

3. Briefly describe conflict theory and discuss how it incorporates stress into its model.

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Test Bank for Health Psychology Biopsychosocial Interactions 8th Edition Edward P Sarafino D

Essay Questions

1. Jeff has just had a heart attack. Using one of the cognitive theories of change,
describe how cognition will affect Jeff’s efforts to make lifestyle changes.

2. Suppose you want to develop a health promotion program at your school to reduce
alcohol consumption. Using information from this chapter, what factors would you
attempt to incorporate into your promotion program?

3. Review and discuss the prevention programs developed to provide effective

intervention regarding HIV exposure.

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