1. Chapter 16

2. Top 10 Public Health Achievements in the 20th Century 1. Vaccinations 2. Motor vehicle safety 3. Safer workplaces 4. Control of infectious disease 5. Decline in deaths from coronary heart disease and stroke 6. Healthier mothers and babies 7. Safer and healthier foods 8. Family planning 9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard

3. Challenges to Wellness Obesity epidemic According to the Centers for Disease Control and Prevention (CDC), in 2004 approximately 34% of U.S. adults over age 20 were obese (CDC 2008). Obesity increases the risks of developing certain chronic diseases such as hypertension, cardiovascular disease, and diabetes. Reemergence of infectious diseases Rise of antibiotic-resistant bacteria More global travelers, both humans and animals Crowded living conditions (continued)

4. Challenges to Wellness: Access to Health Insurance Nearly 46.5 million nonelderly Americans didn’t have health insurance in 2006. Low-income people are at the highest risk of being uninsured. The uninsured are more likely to be hospitalized for medical conditions that could have been avoided if proper medical care had been received initially. The uninsured don’t receive basic preventive care such as Pap smears, mammograms, annual physicals, or blood glucose screenings.

5. Six Dimensions of Wellness Developed by Bill Hettler, cofounder and president of the board of directors of the National Wellness Institute: Physical Intellectual Emotional Social Spiritual Occupational

6. Reaching and Maintaining Wellness Find your current health status and identify areas you want to change or improve. Behavior change models help understand why it’s hard to change behavior: Transtheoretical model Self-efficacy and social cognitive theory Health belief model Locus of control Set realistic goals.

7. Transtheoretical Model Focuses on the decision-making process. Stages of change Behavior change is not a one-step process. Other concepts include processes of change and decision balance.

8. Stages of Change Precontemplation Contemplation Preparation Action Maintenance

9. Self-Efficacy Refers to people’s belief in their ability to succeed in specific situations. People with high self-efficacy believe they can master difficult tasks and don’t avoid those kinds of challenges. It’s vital to changing or adopting a health behavior because it helps determine your confidence in your ability to change.

10. Social Cognitive Theory Developed by psychologist Albert Bandura. People behave in a certain way because of interaction among personal factors, behavior, and the existing environment. Helps explain behavior change. Helps explain how people develop and maintain behavioral patterns. Helps in designing interventions.

11. Five Principles of Social Cognitive Theory 1. People learn from watching others. 2. Learning is an internal process that may or may not change behavior. 3. Behaviors are targeted toward specific goals. 4. Behavior eventually becomes self-regulated. 5. Reinforcement and punishment have both direct and indirect effects.

12. Health Belief Model People will engage in a health-related action if 1. they have an interest in health matters (health motivation), 2. they think they are susceptible to a particular illness (perceived vulnerability), 3. they think the benefits of the treatment outweigh the barriers to it (perceived barriers and benefits), and 4. they think a particular illness could be severe (perceived seriousness).

13. Locus of Control Locus of control is an important aspect of personality that depends on your view about the main causes of events. External control: Belief that outside circumstances guide behavior Lack confidence to obtain or overcome health habits Internal control: Belief that personal decisions affect actions More confident in your ability to change a behavior

14. How to Set Realistic Goals Set small goals to help you achieve your overall goal. Write down your goal. Make your goals specific and measurable. Write down when and where you’ll try to change your behavior. Reward yourself whenever you reach a goal. Find social support.