Early Habit Formation and Health Outcomes

Much of our health is determined by daily habits and behaviors.  These habits have developed over the years, most without thought. Socialization has a great influence on our behaviors and habits. Socialization is the process of learning to behave based on influences in our environment.  The earliest significant influences are of those caring for us in infancy and as we grow.  We are greatly impacted by the values and attitudes of our caregivers. These influences help determine our behaviors and the habits that we develop.  Some are healthy and some are not. Some habits improve our health and some do not.  Brushing our teeth is a habit that enhances our health. Having a candy bar and soda pop every night before bed is a habit that, over time, would likely be harmful to our health.

Health Risk Behaviors that Contribute Significantly to Chronic Disease

Health risk behaviors are unhealthy behaviors you can change. There are many aspects of health that can contribute to overall health and wellness. The Center for Disease Control has identified that most illness, suffering, and death are related to four individual behaviors:

1) Lack of Physical Activity,

2) Poor Nutrition,

3) Excessive Alcohol Consumption,

4) Tobacco Use.  

The Determinants of Health – What Contributes to Our Health Status?

The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health fall under several broad categories:

1. Biology and Genetics (ex: gender, age, family history)
2. Individual Behavior (ex: substance use, unprotected sex, smoking, dietary choices)
3. Health Services/Medical Care (ex: access to quality healthcare and health insurance status)
4. Environment/Policymaking (ex: regulations that support or hinder health status)
5. Social Circumstances (ex: discrimination, income, gender, availability of resources)

Detailed examples of Social Factors that can contribute to poor health outcomes include:

• Availability of resources to meet daily needs (ie. educational, job opportunities, living wages, or healthful foods)
• Social norms and attitudes, such as discrimination
• Exposure to crime, violence, and social disorder, such as the presence of trash
• Social support and social interactions
• Exposure to mass media
• Socioeconomic conditions
• Housing, homes, and neighborhoods
• Exposure to toxic substances, environmental or other physical hazards

It is the interrelationships among the above factors that determine individual and population health. Therefore, interventions that target multiple determinants of health are most likely to be more effective from a public health standpoint.2

Individual Behavior is the Most Significant Contributor in Most Cases

Many people think that the most influential aspect of our health is biology and genetics, but it is not.  Although family history does have play a part in our level of risk, individual behavior outweighs that aspect in most every case, and is the largest contributor to health status.

In addition to the individual behavior category, take a look at some of the other categories that individuals may be able to modify. Adding those components together increases the level of control we have.  We must keep in mind, however, that children have less control over their decisions than an adult.  For example, if a child is living with an adult who is smoking in the house, the child can’t simply choose to move out of the house. Children also have little influence on the household grocery purchases, in many cases. Regardless, the fact that individuals can modify their individual behavior allows it to be a most significant influence on individual health status.

 

 

Adults as Role Models for Decision Making

Adults can serve as positive or negative role models.  As part of the process of development, children imitate others.  Their values, attitudes and behaviors are greatly influenced by those around them, particularly their parents or caregivers.  If adults are choosing healthy behaviors, this will have a positive impact on youth.

Adults can also assist children in making healthy decisions. We can teach them strategies for decision making.  First, we want to encourage them to stop and think instead of making snap decisions. We can model this for children at a very young age.  Discuss decision making at the grocery store.  Describe the process when you are deciding what food to buy. Demonstrate how to consider the pros and cons and discuss potential outcomes.  As a child gets older, allow them to help with the decision making process.

Health Behavior Theories and Models

Health Behavior Theories and Models can help to explain why humans behave in the ways that they do. If we know that certain behaviors are healthy, then why don’t we just do them?  Part of the issue is that healthy outcomes of behaviors are usually long term.  It is more difficult to be motivated toward behavior when we won’t see the benefits right away.  However, the benefits of developing healthy habits early in life will be very beneficial for the lifespan.

K-A-B:  (Knowledge, Attitude, and Behavior)

The KAB concept is at the foundation of understanding health behavior change.

We can have all of the reliable knowledge in the world about health risk (we know that many people have died horrible deaths as a result of smoking cigarettes), but if our attitude (belief that it could happen to us and desire to make change) is not in alignment, we are unlikely to make a healthy behavior change.  The result is a gap between knowledge and behavior that keeps the individual from changing their behavior. More knowledge can certainly be helpful, but if there is not an attitude or desire for change, it will not happen.  Both knowledge and attitude are needed in order to move us toward healthy behavior.  You will find that this aligns with some of the models in this chapter.

Health Behavior Theories and Models attempt to explain why people behave in certain ways.  Utilizing these theories or models can be helpful with interventions for encouraging positive changes in health behavior.

Example #1:  According to the Internal and External Locus of Control (LOC) models, if we feel that something outside of ourselves is responsible for our health (external locus of control), then we are less likely to carry out healthy behaviors.  For example, with external locus of control, if a person who smokes believes that their smoking behavior will not influence their health, they are not likely to make a change. Their perception that other external forces will determine their health and lifespan deters them from healthy behavior. On the opposite end, having an Internal Locus of Control (believing that our actions DO make a difference) allows us to be in the driver’s seat and take action for positive results.  If an individual believes that their decision to smoke or not to smoke contributes to their health status, then they are more likely to quit.

Are you more Internal or External?  How much of a difference do you believe your behaviors make relative to your health?

Have you ever said or heard someone say, “Well, it’s in my family, so there’s nothing I can do about it” or “If I’m going to get sick, I’m going to get sick and there’s nothing I can do about it”?  Those perceptions would show that a person has an “External Locus of Control”.

While there is a genetic component for our health status, it is a very small component in comparison with the influence of our individual behaviors.  The good news is that our individual behaviors can positively influence our health and we can make positive change through our decisions. An internal locus of control is helpful in moving an individual toward healthy behaviors.

Example #2:  The Health Belief Model  is related to our Locus of Control and contains critical components that may explain why people choose certain behaviors.  The core components of this model are “perceived susceptibility and perceived severity“. If a person believes (perceives) that they are susceptible (or vulnerable) to negative consequences and that those consequences are severe, they are more likely to carry out a health behavior.  If the person truly believes that their smoking behavior will have negative consequences and that those consequences will be severe and it could happen to them, the person is more likely to take action.  An example would be, in determining whether a sexually active person will utilize a condom, a script may run inside their mind saying, “I won’t catch anything having sex just this one time without protection”.  This person perceives that they are not susceptible.  The script goes on to say, “If I catch something, I can just go get a prescription for it”.  These perceptions demonstrate a lack of knowledge and an attitude that the behavior isn’t that important.  Perceived benefits and barriers also come into play when an individual perceives that the barriers are more influential than the benefits. (Trying to get a condom and using it in the moment are very large barriers that may seem larger than the benefits of protection.) The individual may also lack self-efficacy or confidence in their ability to carry out the condom usage and may not receive a cue to action, such as advice or encouragement from a friend to carry out the health behavior. In reality, this one decision could change the person’s life.  Someone could contract an infection with just one unprotected encounter, and there are many sexually transmitted infections that are not curable.  There could also be a life-changing pregnancy.  However, if the person does not perceive it as serious or something they are susceptible to, then they are not likely to carry out healthy behavior.

The Bad Example(s)

A “bad example” can influence our perceptions and can be applied to the Health Belief Model.  This can be particularly problematic for youth. When someone you know participates in a risky behavior with no (apparent) negative outcomes it sends a message that nothing bad will happen as a result of the behavior.  Ex:  Your Grandfather smoked unfiltered cigarettes until he was 90 without ever getting sick.  Your friend had unprotected sex multiple times without an unintended pregnancy, STI or HIV (that you know of). Your uncle ate only the healthiest foods and dropped dead.  Can you think of another example like this?  These are the examples that really throw us for a loop.  We WANT to believe in these examples because it helps us to justify unhealthy behavior.  In reality, there are other factors that make up a person’s total health that can influence their health status.  Maybe your uncle was suffering from stress and mental anguish in his other dimensions, while Grandpa was extremely healthy in those areas.  We are happy for Grandpa even if he was a bad example, however, we have to remember that these cases are rare and are not representative of how behavior is likely to impact our quality and length of life.

Example #3: Stages of Change

The Stages of Change (Transtheoretical) Model is also commonly referenced when it comes to health behavior.  This model basically says that if you are not ready to change, you are not going to change.  Can you relate to this?  Have you ever had someone on your case to quit smoking, lose weight, exercise, or eat vegetables and all you heard was “Blah, blah, blah, blah”?  If we are in the “pre-contemplation” stage, it means that we aren’t ready to even think about change.  Although the people in our lives can be very influential and supportive with our positive behavior changes, sometimes their nagging can be less than effective if we are not ready to hear it. “Contemplation” is the stage in which we are thinking about change.  In the “preparation” stage, we are researching and making plans regarding the change.  “Action” is when we actually implement the change, and “maintenance” involves continuing the behavior over the long term.  Some resources list “termination” as the final stage, others keep the last stage as maintenance.

Example #4:  Theory of Planned Behavior – This theory is an adaptation of the theory of reasoned action based on the assumption that humans are usually quite rational and make systematic use of the information available to them. The theory states that people assess certain factors before deciding to engage or not engage in a behavior. According to this theory, intention will help predict future behavior. The difference in intention is composed of three constructs: (a) attitude toward the behavior, (b) subjective norms, and (c) control. A number of studies have found an association with the intention-behavior relationship. It also has been found that intentions have a substantial causal effect on behavior.

Other Critical Influences on Individual Behavior

The Impact of Self-Control and Delayed Gratification

Delayed gratification, or deferred gratification, is the ability to resist the temptation for an immediate reward and wait for a later reward. On the other hand, human beings are certainly drawn toward behavior involving instant gratification, meaning that we do things that make us feel good right away instead of waiting. Generally, delayed gratification is associated with resisting a smaller but more immediate reward in order to receive a better reward later. We practice it every time we consciously delay immediate rewards to earn the benefits of a more distant goal. Waiting to eat a piece of candy, or choosing to save up our money for something are examples of how we choose delayed gratification and utilize self-control. Studies have shown that delay of gratification is an observable measure of self-control, and that self-control predicts future success better than measures like IQ and standardized test performance. Research shows that students from countries emphasizing the value of delayed gratification did better than students from countries without that emphasis. The benefits are long-lasting, and get stronger over time. These students also had fewer absences and fewer disciplinary problems.

More Factors that Can Help Explain Behavior 

Predisposing Factors: Individuals will be “predisposed” to certain behaviors or be more likely to participate in certain behaviors if they have been exposed to it previously.  For example, if your parents drink alcohol, smoke cigarettes, or do other drugs, you will be predisposed.  If you’ve grown up in a household with depression or unhealthy communication you will be predisposed to those things.  If a good amount of sleep, healthy nutrition, and exercise weren’t part of your routine growing up, this would be a predisposing barrier to health as well.  On the other hand, if you grew up with healthy influences, you will be predisposed to some healthy behaviors.

Enabling Factors:  Enabling factors are skills or physical factors such as accessibility of resources or services that facilitate achievement of motivation to change behavior.  If you have a farmer’s market right down the road, this would enable you to eat many healthy vegetables and fruits.  If you have many sidewalks in your neighborhood, you may be more likely to be physically active. We may have negative enabling factors as well, such as a spouse or peers that behave in unhealthy ways.

Reinforcing Factors:  Reinforcing factors include factors that reward or reinforce the desired behavior change, including social support, economic rewards, and changing social norms. You could be positively reinforced by having a friend or relative who wants to plan activities that promote physical activity, or a contest that gives a prize to the people who quit smoking.  There can be negative reinforcements as well, so deliberately choosing to be in places and around people who reinforce healthy behavior is a smart move.

Helping Youth Reach Goals for Healthy Behavior

You would think that taking care of ourselves would be instinctive and always a top priority.  After all, we only have one body and we are much more productive and happy if our minds and bodies are healthy.  However, no one is born knowing what behaviors will contribute to a good quality and quantity of life.  Adults need to guide children in making healthy decisions.

For the sake of our health and wellness and for the sake of the children who will be watching our behavior and likely imitating us, we need to be sure that we are utilizing sound information to inform our choices.  We will also need to help them prioritize in order to support their success.  In addition to Healthy People goals and CDC recommendations, there are more specific recommendations for children, such as the 5-2-1-0 goals.

5-2-1-0 Goals

Have you heard of 5-2-1-0?  5-2-1-0 is a nationally recognized program that includes four core goals that promote health and wellness for children.

5 – Eat at least 5 servings of vegetables and fruits per day.

2 – Limit screen time to no more than 2 hours of recreational screen time per day.

1 – Be physically active for at least one hour (60 minutes) per day.

0 – Consume zero sugary drinks, replace with water.

SMART Goals

Using goals that are specific and measurable will help us to be more accountable and, therefore, more successful.  It is recommended that individuals begin with one behavior change goal at a time and then move to another once the first one has become habit. 

S- Specific – The more specific, the better.  What will you do, when and for how long? 

M- Measurable – You must be able to measure whether or not you are successful.  Ex:  If I just say “I will eat healthier”, that is not measurable because you must define “healthier” specifically.  I will eat three servings of vegetables per day five days per week is measurable.  You can determine whether or not you actually did it.

A-Actionable/Attainable – It must be something that you can actually do.

R- Realistic – The goal must be realistic for you.  If it is not realistic for you to exercise for one hour per day, do not set that as an overall goal.

T- Time-bound – Timeframes must be set.  If we don’t state when we will do things, they will never happen!  Example of overall goal:  I will eliminate cigarettes from my life by X date.  As noted below, you will also set smaller time bound goals to gradually get you to your goal.

EXAMPLES of SMART Health Behavior Change Goals:
Use the examples below as models to assist in creating health behavior change goals that support success.

Good Examples:

*I will eat five servings of vegetables per day, at least five days per week.  (Example of outlining smaller steps:  I will begin with two servings of vegetables per day for the first two weeks, increase to three servings per day for the next three weeks, etc.)

*I will take a 60 minute walk every day at 3pm.

*I will limit my (non-school related) screen time to less than 2 hours per day.

*I will drink water with meals and snacks.

In addition:  To make all of the above time bound, add a target date for reaching your goal.  It could be “by the end of the year”, “by the end of the semester”, “by the end of next month” or whatever you choose. 

Poor Examples – Do NOT use – Not specific or measurable: I will eat healthier, or I will exercise more. These are too vague and we are less likely to carry out the behavior if goals are not specific and measurable. You need to add more detail such as how many servings of vegetables you will each per day or how many minutes of what type of exercise you will do at what days and times.

IMPORTANT:  Do not use:  I will lose weight or I will lose X pounds by X date.  Weight loss is not a behavior. If you want to lose weight, then you would want to choose a behavior that will move you toward that outcome (such as increasing intake to X servings of vegetables, increasing activity to X minutes per day, decreasing intake of processed foods to X serving per X, drinking X ounces of water).