Limited Improvements in Health Behaviors Suggest Need to Review Approaches to Health Promotion: A Repeated, Cross-Sectional Study (original) (raw)
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A framework for health promotion and disease prevention programs
American Psychologist, 1995
There is a disquieting sense that many theoretically based health behavior change programs have been only minimally effective. Part of the problem may be that most current theories have considerable overlap, primarily focus on intraindividual and other individual-level variables, and tend to neglect the environment and issues related to program implementation. A framework is developed for health promotion and disease prevention programs that makes use of epidemiological and health indicator data and Healthy People 2000 goals to prioritize efforts, provides a schema to formulate programs on the basis of timing (prevention) and level of intervention, and addresses the marketing approach to target and implement programs. The framework integrates current theories to guide marketing and phases of research. Cheryl B. Travis served as action editor for this article. Work on this article was partially supported by grants from the National Cancer Institute, the National Institute of Mental Health, and the American Cancer Society. Special thanks go to Deborah Tate and Robert Stephens for their feedback and comments on drafts of the article.
International Journal of Behavioral Medicine, 2012
Background Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer. Purpose To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors. Method Relationships across stages for different behaviors were assessed in three studies with N=3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses. Results Consistently stronger correlations were found between nutrition and physical activity (r=0.16-0.26, p< 0.01) than between non-smoking and nutrition (r=0.08-0.16, p<0.03), or non-smoking and physical activity (r= 0.01-0.21). Principal component analyses of investigated behaviors indicated two factors: a "health-promoting" factor and a "health-risk" factor. Three distinct behavioral patterns were found in the cluster analyses. Conclusion Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors-especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors.
The search for evidence of effective health promotion
BMJ, 1997
A conceptually sound evidence base for interventions that aim to promote health is urgently required. However, the current search for evidence of effective health promotion is unlikely to succeed and may result in drawing false conclusions about health promotion practice to the long term detriment of public health. The reasons for this are threefold: lack of consensus about the nature of health promotion activity; lack of agreement over what evidence to use to assess effectiveness; and divergent views on appropriate methods for reviewing effectiveness. As a consequence health promotion may be designated "not effective" because it is being assessed with inappropriate tools.
The Challenge of Behaviour Change and Health Promotion
Challenges, 2017
The evidence about the effectiveness of behaviour change approaches-what works and what does not work-is unclear. What we do know is that single interventions that target a specific behavioural risk have little impact on the determinants that actually cause poor health, especially for vulnerable people. This has not prevented health promoters from continuing to invest in behaviour change interventions which are widely used in a range of programs. The future of behaviour change and health promotion is through the application of a comprehensive strategy with three core components: (1) a behaviour change approach; (2) a strong policy framework that creates a supportive environment and (3) the empowerment of people to gain more control over making healthy lifestyle decisions. This will require the better planning of policy interventions and the coordination of agencies involved in behaviour change and empowerment activities at the community level, with government to help develop policy at the national level.
Changing Patterns in Health Behaviors and Risk Factors Related to Chronic Diseases, 1990–2000
American Journal of Health Promotion, 2004
Purpose. Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. Design. Stratified cross-sectional design. Setting. United States. Subjects. 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. Measures. Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. Results. Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%–36% current smokers among white women and men), the largest increases in smoking (10%–12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%–9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high level...
Lifestyle Behaviors and Self-Rated Health: The Living for Health Program
Journal of Environmental and Public Health, 2014
Background. Lack of adherence to dietary and physical activity guidelines has been linked to an increase in chronic diseases in the United States (US). The aim of this study was to assess the association of lifestyle behaviors with self-rated health (SRH). Methods. This cross-sectional study used self-reported data from Living for Health Program ( = 1,701) which was conducted from 2008 to 2012 in 190 health fair events in South Florida, US. Results. Significantly higher percent of females as compared to males were classified as obese (35.4% versus 27.0%), reported poor/fair SRH (23.4% versus 15.0%), and were less physically active (33.9% versus 25.4%). Adjusted logistic regression models indicated that both females and males were more likely to report poor/fair SRH if they consumed ≤2 servings of fruits and vegetables per day (OR = 2.14, 95% CI 1.30-3.54; OR = 2.86, 95% CI 1.12-7.35, resp.) and consumed mostly high fat foods (OR = 1.58, 95% CI 1.03-2.43; OR = 3.37, 95% CI 1.67-2.43, resp.). The association of SRH with less physical activity was only significant in females (OR = 1.66, 95% CI 1.17-2.35). Conclusion. Gender differences in health behaviors should be considered in designing and monitoring lifestyle interventions to prevent cardiovascular diseases.
Strategies for promoting healthier food choices
2009
Between 1960 and 2004, the proportion of Americans meeting standard criteria for obe sity increased from 13 percent to 31 percent (KatherineM. Flegal et al. 2002), and it has been proposed that, if this trend is not reversed, obe sity may soon overtake smoking as the leading preventable cause of death (Ali H. Mokdad et al. 2004). Consequently, obesity is now one of the majorcauses of rising health care costs (Eric A. Finkelstein, Christopher J. Ruhm, and Katherine M. Kosa 2005).
Chronic Disease Prevention and Health Promotion
Public Health Ethics Analysis, 2016
Chronic diseases include conditions such as heart disease, stroke, cancer, diabetes , respiratory conditions, and arthritis. In high-income countries, chronic diseases have long been the leading causes of death and disability. Globally, more than 70 % of deaths are due to chronic diseases, in the United States , more than 87 % (World Health Organization [WHO] 2011). Almost one in two Americans has at least one chronic condition (Wu and Green 2000). Aside from the cost in terms of human welfare, treatment of chronic disease accounts for an estimated three quarters of U.S. health care spending (Centers for Disease Control and Prevention [CDC] 2012). Chronic diseases directly affect overall health care budgets, employee productivity, and economies. Globally, noncommunicable diseases account for twothirds of the overall disease burden in middle-income countries and are expected to rise to three-quarters by 2030, typically in parallel to economic development (World Bank 2011). Of particular concern to many low-and middle-income countries is that threats to population health occur on two fronts simultaneously: "In the slums of today's megacities, we are seeing noncommunicable diseases caused by unhealthy diets and habits, side by side with undernutrition" (WHO 2002). Four modifi able risk factors are principal contributors to chronic disease , associated disability, and premature death: lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption (CDC 2012). One in three adult Americans is overweight , another third is obese, and almost one-fi fth of young people between The opinions , fi ndings , and conclusions of the author do not necessarily refl ect the offi cial position , views , or policies of the editors , the editors ' host institutions , or the author ' s host institution .