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Pages 19-38

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From page 19...
... The 1982 report was influential in creating opportunities for research and was almost prescient in its statements about areas that have developed greatly since that time. For example, large-scale studies of social risk factors, such as social class or socioeconomic status, have contributed to our understanding of population health in many ways (Chapter 4~.
From page 20...
... It is now acknowlecigec3, for example, that cardiovascular disease is an important killer of women as well as of men, necessitating research anc3 improvements in practice. National concern about the public health consequences of tobacco use has led to a wide range of interventions anc3 the evaluation of approaches.
From page 21...
... From a medical perspective, people are healthy if they are uninjured and free of disease, but a person with risk factors for disease might be considered unhealthy. As increasing numbers of people are screened or as technology improves, more disease is revealed (Black and Welch, 19971.
From page 22...
... Typically, simple self-report measures of overall health status perform at least as well as physiological indicators c30. Contemporary definitions recognize that health is multidimensional.
From page 23...
... The failure to separate current health status from prognosis is a major conceptual obstacle to defining health. Both health anc3 severity of illness should be assessed with respect to the two inclepenclent constructs of current function anc3 prognosis (see NRC, 2000a)
From page 24...
... The magnitude of the effect of social isolation on the risk of cardiovascular disease is compa' table to that of elevated serum cholesterol or milc3 hypertension (Atkins et al., 1991~. Positive psychological states are associated with better cop' ing with severe stress attendant to acquired immune deficiency syndrome (AIDS)
From page 25...
... THE INTERSECTION OF HEALTH AND BEHAVIOR In 1974, the Lalonde report presented a framework of the health field that went beyond providing medical care and identified human biology, environment, lifestyle, and health care organization as major elements. That report initially led to a focus on lifestyle, or individual behavior, as both the locus of responsibility and the target of clinical and community interventions.
From page 26...
... 26 HEALTH AND BEHAVIOR cured primarily on providing health care. The model shows that factors that include social anc3 physical environment anc3 genetic endowment also influence incliviclual biological anc3 behavioral determinants of health.
From page 27...
... identify ancl review effective applications of behavioral anc3 psychosocial interventions in a variety of settings; (4) examine implementation of behavioral ancl psychosocial interventions, including guidelines ancl changes in provider behaviors;
From page 28...
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From page 30...
... Each committee member brought to the table their own perspective about what would be most effective, but the data were inac3equate to convince any of the experts of a best approach to shaping and maintaining behavior change. While conventional wisdom tells us that we need to c30 more exercise, eat less, avoid tobacco, wear seatbelts, anc3 be careful with firearms, clecicling what specific interventions produce these sustained changes presents a dilemma.
From page 31...
... INTRODUCTION 31 obstacle is that there are no rigorous evaluations of interventions. Evalua' Lions may assess short~term changes, but long~term effectiveness must en' ter the equation because maintaining behavior change has been shown to be difficult.
From page 32...
... Because the field of health anc3 behavior is so extensive, the committee was unable to provide an exhaustive review for all covered topics. This is true, for example, in the description of interventions for behavior change at the various levels.
From page 33...
... To emphasize the importance of reciprocal interactions among those factors in the determination of the health status of inclivicluals anc3 populations, without implying that "everything is related to everything else," the report groups biobehavioral linkages with physiological evidence in Chapter 2, behavioral risk factors in Chapter 3, anc3 social risk factors in Chapter 4. Part Two actresses research anc3 practice regarding interventions in health-relatec3 behavior.
From page 34...
... American Journal of Roerltgerlology, 168, 3-11. Carson, R.A.
From page 35...
... Health Education Quarterly, 15, 351-377. NHLBI (National Heart, Lung and Blood Institute)
From page 36...
... American Journal of Public Health, 75, 1402-1407.
From page 37...
... For example, tobacco use, alcohol consumption, inadequate physical activity, some sexual practices, anc3 high~fat or low fiber diets have all been recog' nizec3 as unhealthful. Less widely recognized, however, is the association between socioeconomic status anc3 health, or the influence of social net' works, current or anticipated employment status, anc3 personal beliefs.
From page 38...
... 38 HEALTH AND BEHAVIOR Part One reviews some of the most important developments on these topics. Chapter 2 actresses the interactions of biobehavioral factors in health, Chapter 3 reviews behavioral risk factors, and Chapter 4 describes the role of social risk factors.


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