Introduction to Health Promotion E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Understand the foundations and applications of health promotion
Introduction to Health Promotion gives students a working knowledge of health promotion concepts and methods and their application to health and health behaviors, with a special emphasis on the philosophical and theoretical foundations of health promotion. The textbook also identifies and discusses the innovative health campaigns, strategies, and policies being implemented and enacted to improve health behaviors and practices that ultimately improve quality of life. Written by a professor with more than two decades of experience teaching and researching health promotion, this comprehensive resource goes beyond the basics, delving into issues such as the application of behavior change theories, planning models, and current wellness topics like nutrition, physical activity, and emotional well-being, among others.
- Provides a clear introduction to the most essential topics in health promotion and education
- Explains behavior change theories and program planning models
- Explores health promotion's role tackling issues of stress, tobacco use, eating behaviors, and physical activity
- Includes chapters dedicated to professions, settings, and credentials available in the health promotion field
- Looks at future trends of health promotion
Ideal for students in health promotion, health education, and public health fields, Introduction to Health Promotion prepares students with a comprehensive overview of the foundations, history, and current perspectives of health promotion, as well as its key methods and applications.
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Veröffentlichungsjahr: 2014
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CONTENTS
Cover
Title Page
Copyright
Tables and Figures
Foreword
Preface
The Editor
The Contributors
Part One: The Foundation of Health Promotion
Chapter 1: Health Promotion
Brief Overview of Health in the Twentieth Century
Health Promotion: An Emerging Field
Determinants of Health
Important Health Promotion Concepts
Health Promotion Meets the Health Care System
Positions in the Health Promotion Field
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 2: Health Behavior Change Theories and Models
Health Behavior Theories
Historical Perspective
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 3: Program Planning Models
Effective Health Promotion Planning
Social Ecological Model
Consumer-Based Planning Models for Health Communication
Health Promotion Planning Model for Community-Level Programs
Connecting Health Behavior Theories to Program Planning Models
Summary
Key Terms
Review Questions
Student Activities
References
Part Two: Health Behaviors
Chapter 4: Tobacco Use
Tobacco Use
Smokeless Tobacco and Chronic Disease
Secondhand Smoke Exposure and Chronic Disease
Political and Cultural History of Tobacco Use
1998 Master Settlement Agreement
Recent Efforts to Reduce Tobacco Use
Effective Programs That Discourage Tobacco Use
Challenges to Reducing Smoking
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 5: Eating Behaviors
Eating Behaviors
Nutrition, Eating Habits, and Health
Benefits of Healthy Eating Habits
Recommended Nutrition and Dietary Intake
History of Nutrition and Dietary Patterns
Changes to the American Food Environment
Recent Efforts to Promote Healthy Eating
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 6: Physical Activity Behaviors
Physical Activity
Recommended Physical Activity Levels
Benefits of Physical Activity
Sedentary Behavior
Physical Activity Patterns
Physical Activity Behaviors and Barriers
Efforts and Initiatives to Increase Physical Activity
Policies That Promote Increasing Physical Activity
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 7: Stress, Emotional Well-Being, and Mental Health
The Origins of the Term Stress
The Fight-or-Flight Response
Stress Physiology
Eustress and Distress
Life Stress and Illness
Coping: Stress Management Techniques
Stress at Work
Mental Health in Communities
Mental Health Disparities
Stress Management with Children
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 8: Clinical Preventive Services
Benefits of Evidence-Based Clinical Preventive Services
Recommended Levels of Preventive Services
Patient Protection and Affordable Care Act
History of Preventive Services
The US Preventive Services Task Force
The Advisory Committee on Immunization Practices
Promoting the Use of Preventive Services
Challenges to Increasing the Use of Evidence-Based Preventive Services
Summary
Key Terms
Review Questions
Student Activities
References
Part Three: Health Promotion in Action
Chapter 9: National and State Initiatives to Promote Health and Well-Being
Healthy People: 1979–2020
Healthy People 2020
US Department of Health and Human Services (HHS)
US Department of Agriculture (USDA)
Monitoring the Nation's Health
State Initiatives
Local Programs
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 10: Settings for Health Promotion
The Home
Communities
Early Childhood Centers
Schools
Colleges and Universities
The Work Site
Health Care Providers
Faith-Based Centers
The Internet
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 11: Health Promotion-Related Organizations, Associations, and Certifications
Nonprofit Health Associations
Professional Health Associations
Certifications
Summary
Key Terms
Review Questions
Student Activities
References
Chapter 12: Trends in Health Promotion
Trend 1: The Population Will Get Much Older in the Next Three Decades
Trend 2: The Health Status of Aging Adults Will Decline Steadily If We Don't Do Things Differently
Trend 3: Adults Won't Be the Only Ones Who Are Losing Their Health Status
Trend 4: Health Care Costs Will Remain an Issue of Significant Concern Far into the Future
Trend 5: Prevention Will Become a National Priority
Trend 6: Medical Self-Care Will Gain Rapid Popularity
Trend 7: Physical Activity Will Become the Most Commonly Prescribed Medicine
Trend 8: Financial Incentives and Disincentives Will Go Mainstream
Trend 9: Physical Environments Will Be Altered Radically
Trend 10: Efforts to Curb Obesity Will Intensify Greatly
Trend 11: The Need for Talented Health Promotion Professionals Will Skyrocket
Summary
Key Terms
Review Questions
Student Activities
References
Weblinks
Index
End User License Agreement
List of Tables
Table P.1
Table 1.1
Table 1.2
Table 1.3
Table 1.4
Table 2.1
Table 2.2
Table 2.3
Table 2.4
Table 3.1
Table 3.2
Table 3.3
Table 3.4
Table 4.1
Table 4.2
Table 4.3
Table 5.1
Table 5.2
Table 5.3
Table 5.4
Table 6.1
Table 6.2
Table 6.3
Table 6.4
Table 6.5
Table 6.6
Table 6.7
Table 6.8
Table 6.9
Table 6.10
Table 8.1
Table 8.2
Table 9.1
Table 9.2
Table 9.3
Table 11.1
Table 11.2
Table 11.3
Table 11.4
Table 11.5
List of Illustrations
Figure 1.1
Figure 2.1
Figure 2.2
Figure 2.3
Figure 2.4
Figure 3.1
Figure 3.2
Figure 3.3
Figure 3.4
Figure 4.1
Figure 4.2
Figure 4.3
Figure 5.1
Figure 5.2
Figure 5.3
Figure 5.4
Figure 5.5
Figure 6.1
Figure 7.1
Figure 7.2
Figure 7.3
Figure 7.4
Figure 7.5
Figure 7.6
Figure 7.7
Figure 8.1
Figure 9.1
Figure 9.2
Figure 9.3
Figure 9.4
Figure 9.5
Figure 9.6
Figure 9.7
Figure 9.8
Figure 9.9
Guide
Cover
Table of Contents
Begin Reading
Begin Reading
Part 1
Chapter 1
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Introduction to Health Promotion
Anastasia Snelling, Editor
Cover design: Wiley
Cover image: Sporty Couple © jupiter55 | Thinkstock
Organic Vegetables © monticelllo | Thinkstock
Meditation © deeepblue | Thinkstock
Copyright © 2014 by John Wiley & Sons, Inc. All rights reserved.
Published by Jossey-Bass
A Wiley Brand
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No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at www.wiley.com/go/permissions.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Readers should be aware that Internet Web sites offered as citations and/or sources for further information may have changed or disappeared between the time this was written and when it is read.
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Library of Congress Cataloging-in-Publication Data
Introduction to health promotion/Anastasia Snelling, editor.
p.; cm.
Includes bibliographical references and index.
ISBN 978-1-118-45529-6 (paperback) – ISBN 978-1-118-45528-9 (pdf) – ISBN 978-1-118-45530-2 (epub)
I. Snelling, Anastasia, 1957- editor.
[DNLM: 1. Health Promotion–methods–United States. 2. Health Behavior–United States. 3. Health Planning–methods–United States. 4. Health Promotion–trends–United States. 5. Preventive Health Services–methods–United States. WA 590]
RA427.8
362.1–dc23
2014010406
Tables and Figures
Tables
P.1.
Disciplines and the Relationship with Health Fields
1.1.
Life Expectancy at Birth, at Sixty-Five Years of Age, and at Seventy-Five Years of Age
1.2.
Leading Causes of Death in the United States and Related Risk Factors
1.3.
Lifestyle Behaviors Related to Disease
1.4.
Number of Deaths for Leading Causes of Death
2.1.
Social Change Theory and Application of Constructs
2.2.
Processes of Change
2.3.
Constructs of the Health Belief Model
2.4.
Presented Theories and Their Constructs
3.1.
PRECEDE-PROCEED Model
3.2.
MATCH Phases and Steps
3.3.
CDCynergy Program Planning Model
3.4.
Key Questions for Each Stage of MAP-IT
4.1.
Provisions of the Master Settle Agreement
4.2.
List of Harmful and Potentially Harmful Constituents (HPHCs) in Cigarette Smoke and Smokeless Tobacco
4.3.
Healthy People 2020 Objectives Related to Tobacco Use
5.1.
Leading Causes of Death: Number of Deaths (United States, 2010)
5.2.
Different Dietary Patterns, Their Characteristics, and Disease Risk Impact
5.3.
Food Availability in Pounds per Person
5.4.
A Comparison of the 2010 Dietary Guidelines and the Average American Diet
6.1.
The 2008 Physical Activity Guidelines for Americans Recommendations
6.2.
Examples of Activities at Various Levels of Intensity
6.3.
Benefits of Physical Activity
6.4.
Comparison of Healthy People 2020 Activity Criteria and 2008 Physical Activity Guidelines for Americans
6.5.
Key Points of Quality Physical Education
6.6.
Community Transformation Grants (CTG)
6.7.
Strategies for Increasing Physical Activity in the Community
6.8.
Local Strategies to Prevent Obesity
6.9.
Community Actions to Promote Physical Activity
6.10.
YMCA Physical Activity Community Initiatives
8.1.
Select Preventive Screenings Examinations
8.2.
US Preventive Services Task Force (USPSTF) Grading System
9.1.
Healthy People 2020 Leading Health Indicators
9.2.
Key Recommendations from the Dietary Guidelines for Americans, 2010
9.3.
NHANES Health Exam Tests
11.1.
Nonprofit Health Associations
11.2.
Select Health Professional Associations
11.3.
Select Scholarly Journals
11.4.
Fitness-Based Certification Organizations
11.5.
Health Coaching Certification Organizations
Figures
1.1.
Social Ecological Model
2.1.
Theories, Concepts, and Constructs
2.2.
Transtheoretical Model: Stages of Change
2.3.
Health Belief Model in Summary
2.4.
Theory of Reasoned Action and Theory of Planned Behavior
3.1.
A Social Ecological Framework for Nutrition and Physical Activity Decisions
3.2.
PRECEDE-PROCEED Model
3.3.
MATCH Model
3.4.
Health Communication Program Cycle
4.1.
The Health Consequences Causally Linked to Smoking and Exposure to Secondhand Smoke
4.2.
How Cigarette Smoking Causes Cancer
4.3.
Proposed Warning Labels for Cigarettes
5.1.
Trends in Overweight, Obesity, and Extreme Obesity among Adults Aged Twenty to Seventy-Four Years: United States, 1960–2008
5.2.
MyPlate Icon
5.3.
Comparison of Americans' Usual Dietary Intake to the 2010 Dietary Guidelines for Americans
5.4.
Comparison of Food Availability and Dietary Recommendations
5.5.
Food Subsidies
6.1.
Ecological Approach to Physical Activity
7.1.
Stress Response
7.2.
Protective Adaptations
7.3.
Effects of Stress on Health
7.4.
Optimal Stress Zone
7.5.
Holmes and Rahe Stress Scale
7.6.
Demand-Control Support Model
7.7.
World Health Organization's Optimal Mix of Mental Health Services
8.1.
USPSTF Recommendation Process
9.1.
HHS Organizational Chart
9.2.
CDC FluView Webpage: ILI Activity Indicator Map
9.3.
STATE System Interactive Map: Behaviors—Cigarette Use—Adult Current Smokers—BRFSS
9.4.
STATE System Toolkit
9.5.
BRFSS Map Showing 2010 Data for Alcohol Consumption
9.6.
Sample YRBSS Report
9.7.
Legalization of “Medical” Marijuana Map
9.8.
Newborn Screening: Critical Congenital Heart Defects (CCHD), Current Status
9.9.
State Indoor Tanning Laws for Minors
Foreword
This introductory text will be a perfect fit for many of the rapidly emerging professional degree programs in health promotion and allied professions that regard health promotion as a core responsibility. The convergence of focus on health promotion in recent years has been spurred by the inescapable reality that behavior is the primary pathway through which society can have a positive influence on the prevailing health problems of today's world. Professor Snelling and her collaborating authors have represented that reality in the first part of the book with a chapter on each of the leading behavioral determinants of chronic health conditions. Then they have shown how state-of-the-art theories, models, and experience-based strategies for health promotion can be applied in systematic ways to address those problems.
One feature that makes this book stand out among many others is the selection of a balanced roster of authors from academia and practice. The role of practicing health professionals who lead important organizations and programs in health promotion should help bring the theories and research evidence of academics to life for students. Indeed, it has been my lament that too many evidence-based guidelines for practice in health promotion have been produced by academic research without sufficient attention to the context in which the evidence would be applied. My argument to those who sponsor health promotion research and those who fund health promotion programs is that if we want more evidence-based practice, we need more practice-based evidence. This book will help point the way and inspire some students to plan, implement, and evaluate theory-based and evidence-based health promotion interventions and programs that will, in turn, produce the complementary practice-based evidence we desperately need in this field.
Lawrence W. Green, DrPh, Scd (Hon.)
Professor, Department of Epidemiology and Biostatistics
School of Medicine
University of California at San Francisco
Preface
The health promotion field emerged during the second half of the twentieth century as medicine and science became successful treating infectious diseases with antibiotics, advancing maternal and child health, and improving sanitation practices. These gains significantly improved the quality and quantity of life for all. Yet, now we face the next medical crisis: chronic disease. Medicine and science research have continued to manage disease conditions through a number of procedures, surgeries, and pharmaceuticals. All of these approaches come with a very high cost to the individual through reduced quality of life and economic cost to organizations and the federal government responsible for providing health insurance. At this time, health care costs account for 17.6% of the gross domestic product. This means that the United States spends almost seventeen cents of every dollar on providing health care to Americans. Controlling these health care costs is a continuing priority for the nation. Consider that over 70% of all health care costs are related to chronic disease and that many risk factors for chronic disease are considered modifiable, such as tobacco use, physical inactivity, food choices, and managing stress. These modifiable risk factors are the core behaviors that the field of health promotion focuses on to improve the quality of people's lives and to manage rising health care costs.
Changing individual and societal health behavior is a very complex process. Since the 1980s, more research has shown that for individuals to successfully adopt healthy behaviors, social, behavioral, and environmental factors also must be part of the process of change. The healthy choice must be the easy choice in our homes, schools, work sites, and communities. The vision is to live in a country where a culture of health is seen, practiced, and supported throughout the life span.
The unique contribution of this book is to introduce students to the individual and societal forces that have transformed the factors that influence one's health, including social and physical environments, medical advances, personal lifestyle choices, and legislation. The book identifies and discusses the innovative health campaigns, strategies, and policies that are being implemented and enacted to improve health behaviors and practices that ultimately improve the quality of life.
It is my sincere desire that the writings in this book inspire you to either embark on a career in health promotion or, at the very least, provide you with an understanding of the ways in which many disciplines intersect with health promotion, so that whatever discipline you study, you will better understand how your work interacts with the promotion of health. Almost every discipline intersects with the field of health promotion. Further, health promotion professionals do not work in isolation. The nature of health promotion is to work across multiple disciplines to design and develop strategies that use the best knowledge we know and apply it to health behaviors. Table P.1 lists diverse areas of study and identifies the related work of health promotion, whether you study exercise or nutrition science to understand how to advise consumers on health behaviors to improve their health status or if you study communication or marketing to design health campaigns that inform the general public about health risks associated with smoking or drinking and driving or public policy to understand or evaluate how public health policy decreases health disparities by providing consumers with healthful foods or access to affordable health care.
Table P.1 Disciplines and the Relationship with Health Fields
Discipline
Contribution
Example
Communication and marketing
Social marketing campaigns
Campaigns to reduce smoking or promote physical activity
Public policy
Local, state, and national policy promoting health
Affordable Care Act
Human resources
Health benefits offered through employers
Work site health
Biology
Understanding the changes in the body from food and exercise
Healthy behavior identification
Psychology
Understanding why people make the choices they do and how to facilitate behavior change
Health promotion models
Sociology
Understanding how human society functions and influences behavior
Health promotion models
Medicine and allied health
Monitoring health, identifying risk factors, and restoring health
Annual physicals; clinical preventive services
Economics
Behavioral economics
Encouraging healthy food choices
This introductory textbook for health promotion students is designed and written to be distinctly different from other textbooks. It provides readers with an in-depth examination of the forces that have changed our lifestyles and environments over the past century, which in turn have resulted in changes in individual health behaviors that affect the onset of chronic conditions. During this same time frame, there were also considerable medical advances, improving early detection of disease and developing progressive treatments for chronic conditions. These changes are ones that health promoters must understand and address. Ultimately, the framework for the development of social and physical environments that support healthy lifestyle choices will guide the transformation of communities where people are empowered to make healthy choices, so they can live longer lives free of preventable disease, disability, and premature death.
The book is divided into three parts. Part 1, “The Foundation of Health Promotion,” introduces the framework of health promotion and provides the student to a number of key terms, models, and trends related to the field. Chapter 2 introduces health behavior change theories that offer constructs on how individuals approach personal behavior change, that is, the essence of health promotion—engaging individuals to actively promote their own health through daily actions such as being physically active or selecting healthy foods to eat. Program planning models (chapter 3) are essential tools to successfully reaching large groups of people through social marketing campaigns to interventions to enacting policies to create environments in which people can practice healthy behaviors.
Part 2, “Health Behaviors,” describes those actions that promote health and prevent disease. These chapters introduce the short history of how tobacco use, eating, physical activity, and emotional health have evolved as a result of the changes in our social and physical environments. These chapters provide a comprehensive discussion of the health behaviors that influence the onset of chronic disease in our country and how and why these behaviors have changed over time. Chapter 8 highlights the important role clinical preventive services also have on promoting health by monitoring chronic disease development and overall health status. Health promotion professionals are promoting healthful living, hence, the inclusion of preventive services (immunizations and age-appropriate screenings) available through the medical community need to be understood and promoted.
These health behavior chapters examine how changes in our environment and society over the past several decades have affected behaviors and how those changed behaviors affect health and disease. By understanding the historical perspective of each of these behaviors, health promotion professionals will possess a richer context for their work, understanding that multiple forces have shaped, and continue to affect, the health of individuals and our society. Health behavior change is complex; in order to advance innovative solutions, it is critical that health promoters fully understand the history of these behaviors. Within each chapter, examples of policies and programs that exemplify health promotion in action are provided.
Part 3, “Health Promotion in Action,” presents how state and federal governments engage in promoting healthful living for their consumers, what associations and certifications support the health promotion profession, where health promotion is taking place and the job opportunities available for this profession, and closing out with future trends in health promotion as we move through the twenty-first century. There are a plethora of national activities that promote health and prevent disease. The federal agencies monitor health status, provide broad guidelines, conduct research, and fund programs to promote health. Collectively, there are thousands of federal employees who work across disciplines to study or implement new approaches to improve the health of our society.
Chapter 10 discusses the setting where health promotion takes place, which further exemplifies that health promotion is beginning to be seen everywhere such as in day care centers, schools, colleges, work sites, food stores, retirement homes, and communities. Again, thousands of professionals believe in the vision of a country in which people are practicing healthy behaviors every day because the healthy choice is the easy choice. Staying current within the discipline will be important after you graduate. Chapter 11 discusses associations, journals, and certifications that provide important information for your life beyond the borders of an academic institution. In time, reading a textbook or listening to a professor's lecture will be in the past. But as a professional, you will need to stay current and this chapter is full of associations and journals that will facilitate your continued professional development. The final chapter is a look into the future predicting some trends that will help to create a culture of health to ensure that the Healthy People 2020 goals to “attain high-quality, longer lives free of preventable disease, to improve the health of all groups, to create social and physical environments that promote good health for all, and to promote healthy behaviors across all life stages” will be achieved.
At the end of each chapter, the student will find a brief summary and list of key terms of the information presented in the chapter. After the summary and key terms are a list of student questions and activities. Both the questions and activities are written to extend the learning and understanding of the material presented in the chapter. By completing the questions and activities, students will gain a deeper understanding of the breadth and depth of the health promotion field. All references used in each chapter are at the end and students are encouraged to seek out these articles, book chapters, and books for additional information.
My goal for this textbook is to enhance the academic preparation of students who are pursuing degrees in health promotion, public health, health education, and other degrees that address or affect the health status of individuals, communities, and societies nationally as well as around the world. Although this textbook focuses on behaviors, trends, and resources in the United States to promote health, many of them are applicable to cultures and settings around the world. There is a universal desire to live a healthful life, and this desire can be found in people of every age, gender, race, and ethnicity.
The book provides a foundation of knowledge for the health promotion professional. Many students are excited to learn such a field exists and ask where they can begin. My response is always with themselves! Being a role model and learning to practice what health promotion professionals teach is a great starting point. I do not expect that you will set a perfect example of health every day, but by practicing health-promoting behaviors you will personally experience the process and the benefits and become healthy as a result.
An instructor's supplement is available at www.josseybass.com/go/snelling. Additional materials such as videos, podcasts, and readings can be found at www.josseybasspublichealth.com. Comments about this book are invited and can be sent to [email protected].
Acknowledgments
I would like to first thank all of the contributing authors of this book whose expertise in their respective areas has enhanced the content in this book. Many of the contributing authors have spent time at American University, and the health promotion programs have been enriched as a result of their work. Also, I would like to thank all the faculty, staff, and students in the School of Education, Teaching, and Health at American University for their encouragement and support along this journey. A special recognition to my team of graduate assistants, especially Michelle Kalicki and Stephanie Sunderlin, who are always willing to work with me on this and the many projects I accept. Last, I want to thank Laura Aden Caldwell, whose editorial and organizational work has enhanced this book.
I would also like to thank Jossey-Bass for producing this book with me. The entire team has been valuable in making this a reality, and I would like to acknowledge especially Andy Pasternack, Seth Schwartz, Susan Geraghty, and Justin Frahm.
Reviewers Lori Francis, Christina R. Johnson, and Steve McClaran provided thoughtful and constructive comments on the complete draft manuscript.
Finally, this book is dedicated to my family who inspire me to make a difference in people's lives through my work. My husband, Roger; my children, Trevor, Anastasia, and Amelia; my parents, John and Amelia Mustone; my siblings, John, Lisa, Paul, Mary Ellen, and Jessica; and my extended Mustone and Snelling family members. May we all live a life full of love, happiness, and good health.
“To laugh often and much; to win the respect of intelligent people and the affection of children; to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find the best in others; to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to know even one life has breathed easier because you have lived. This is to have succeeded.”
Ralph Waldo Emerson
The Editor
Dr. Anastasia Snelling is a professor and the Associate Dean in the School of Education, Teaching, and Health at American University. She has been a member of the Academy of Nutrition and Dietetics as a registered dietitian for over thirty years and a fellow in the American College of Nutrition. Dr. Snelling teaches courses including nutrition, health promotion, and health communication at both the undergraduate and graduate level.
Her research focuses on methods of behavior change in nutrition education to manage risk factors related to chronic disease. Specifically, her research focuses on using the school environment to improve the health status of children. Grounded in the Social Ecological Model, her work in school health examines different levels of influence that can improve the health and food environment, leading to improved health and weight status. By addressing the needs of the child within the social, economic, and cultural contexts where they live, the research aligns health and education to enable students to reach their full potential. Reliable evidence indicates that healthy students are better learners, and, consequently, good health is fundamental to ensuring an effective education.
Dr. Snelling regularly presents her research at national and international conferences. Her research is published in many highly-regarded journals focusing on nutrition, health promotion, and school health. She has appeared on C-Span to discuss food labeling regulation and her opinions and expertise have appeared in such media outlets as Education Week, the Washington Post, US World and News Report, and Fox Business News.
The Contributors
Jennifer Childress is the owner of Patina Esprit Wellness, LLC, where she provides health coaching, personal training, and consulting services to her clients. In addition to her training and coaching practice, Jen also serves as an independent consultant to the Alliance to Make US Healthiest, where she works on implementing and advancing the HealthLead Workplace Accreditation Program. Jen has a master's degree in health promotion management (American University, Washington, DC) and holds certificates in personal fitness training (Aerobics and Fitness Association of America [AFAA]), coaching (Coach Training Alliance), and health education (National Commission for Health Education Credentialing [NCHEC]).
She has been an author on articles published in the American Journal of Public Health, the North Carolina Medical Journal, and the Wellness Councils of America (WELCOA) Absolute Advantage. Jen has taught as an adjunct professor in the Department of Health and Physical Education at Grand View University in Des Moines, Iowa. She is involved within the business community and has served on the National Board of the American Business Women's Association (ABWA).
Laurie DiRosa is a faculty member of the Department of Health and Exercise Science at Rowan University, teaching undergraduate and graduate health promotion courses. She also serves as the research and nutrition consultant for a grant-funded program titled GetFIT, which is a fitness and nutrition program that serves individuals with disabilities and their caregivers. For this program, Dr. DiRosa trains community members and undergraduate students in the counseling techniques of motivational interviewing using the training program she developed specifically for this population. Dr. DiRosa holds an EdD from Wilmington University, an MS in health promotion management from American University, and a BS in exercise and sport science from Ursinus College.
Jill Dombrowski is a clinical assistant professor at The Catholic University of America in the School of Nursing. Dr. Dombrowski holds a BSN from Georgetown University and an MSN and PhD from The Catholic University of America, as well as an MS from American University in health and fitness management. She teaches undergraduate- and graduate-level health promotion courses and coordinates interprofessional wellness committees in the university and DC communities. Dr. Dombrowski's research interests include work site health promotion interventions, physical activity in working mothers, self-efficacy, and time management.
David Hunnicutt has been the president of the Wellness Council of America (WELCOA), one of the largest and most respected work site wellness organizations in the United States since 1995. With more than five thousand corporate members, WELCOA is the industry leader when it comes to keeping the nation's employers up-to-date on issues related to improving health, enhancing productivity, and containing health care costs.
A gifted teacher and writer, David travels extensively and has keynoted many of the most important business and health events in the country. With more than five hundred national keynote addresses since 2000, David has presented to such audiences as the National Chamber of Commerce, the United Nations, the National Institutes of Health, the Centers for Disease Control and Prevention, the US Department of Defense, as well as many of the major Fortune 500 companies.
Dr. Hunnicutt has written, edited, and produced more than a dozen books, including a best-selling medical self-care book that has sold more than six hundred thousand copies. Dr. Hunnicutt's opinions, expertise, and work have appeared in such media as the Wall Street Journal, MSN, CBS News, CBS MarketWatch, Business Week, CIO Magazine, Business and Health, American Medical News, Workforce Magazine, and numerous local and national newspapers.
Michelle Kalicki received her BS in sport management from the University of Florida and her MS in health promotion management from American University. Thanks to funding from the USDA's Economic Research Service, she has been part of a research team focused on childhood obesity and, in particular, vegetable consumption in low-income elementary schools. Her areas of interest in health promotion include physical activity, nutrition education, and health policy.
Casey Korba is director of prevention and population health at America's Health Insurance Plans (AHIP). Casey works with AHIP member health plans and health care stakeholder partners to support and advance health insurance plans' initiatives and partnerships in the areas of clinical and community preventive services, wellness, and disease management activities and programs. Casey's key areas of interest include promoting physical activity and healthy eating initiatives, tobacco cessation, and work site and community health programs. Casey received a BA in English literature from Dickinson College and an MS in health promotion management at American University.
Marty Loy is professor of health promotion and dean of the College of Professional Studies at the University of Wisconsin–Stevens Point. Prior to becoming dean, Marty served as the associate dean of the School of Health Promotion and Human Development. His teaching and research are in the areas of stress management, including mindfulness meditation, grief, and loss. He has published extensively in these areas, authoring two books: Childhood Stress: A Handbook for Parents, Teachers and Therapists (Whole Person Associates, 2010) and with Amy Boelk, Losing a Parent to Suicide: Using Lived Experiences to Inform Bereavement Counseling (Routledge, 2013).
Marty won the University Excellence in Teaching Award in 2001. He is past president and currently serves on the board of directors for the National Wellness Institute. He and his wife, Becky, are cofounders of Camp Hope, a camp for grieving children that has served as a model for similar camps around the country.
Maya Maroto is the academic director of the nutrition program at the Maryland University of Integrative Health. Maya's instructional focus includes nutrition education, holistic nutrition, public health nutrition, and health policy. Her research areas include food insecurity, school nutrition policies, and school-based food pantries. Maya holds a BS in nutrition and food science from Auburn University, an MPH in nutrition from the University of North Carolina at Chapel Hill, an EdD in community college leadership from Morgan State University, and is also a registered dietitian nutritionist (RDN).
David Stevenson serves as the president and CEO of the Central Connecticut Coast YMCA, one of the largest Ys in the United States. As part of a worldwide movement, each Y serves unique community needs with a special focus on youth development, healthy living, and social responsibility. In 2013, 2,400 Central Connecticut Coast Y volunteers and staff served 87,000 children and families through twelve branches and fifty program sites. Dr. Stevenson began his Y career in Ohio and has also served at Ys in Washington, DC; Baltimore, Maryland; Pittsburgh, Pennsylvania; and most recently in Connecticut. Dr. Stevenson holds a BS in recreation management from Ithaca College, an MS in health and fitness management from American University, and a PhD in educational administration from American University.
Maura Stevenson is currently an associate professor of biological sciences at Quinnipiac University in Hamden, Connecticut, where she teaches and serves as academic coordinator for anatomy and physiology. She has a BS degree from Ithaca College, an MS degree from the University of Wisconsin–LaCrosse, and her PhD was earned at American University. She was previously involved in work site health promotion research at American University. She is a coauthor of “Using Theories and Models to Support Program Planning” in ACSM's Worksite Health Promotion Manual: A Guide to Building and Sustaining Healthy Worksites and “The Weight Management Triad: Dietary Intervention, Behavior Change, and Daily Activity” in Journal of the American Association of Physician Assistants. She has presented “Past and Future Trends of Health Promotion” at the Association for Worksite Health Promotion Conference and “Trends in School-based Health Promotion” at the Keystone Health Promotion Conference. Dr. Stevenson had previous academic appointments at Community College of Allegheny County and Robert Morris University in Pittsburgh, Pennsylvania, and at McDaniel College in Westminster, Maryland.
Introduction to Health Promotion
Part OneThe Foundation of Health Promotion
Health promotion is a relatively new field and works in conjunction with the fields of health education and public health to improve the health and well-being of individuals, communities, and society. Collectively, professionals in these fields take a leadership role in collaborating with public health departments, communities, work sites, health care organizations, schools, and other entities to deliver programs and create healthful environments that lead to an improved health status of individuals. The chapters in this part provide an overview of the changes in our environment that have prompted more attention to the prevention of disease and the promotion of health. To accomplish this, key terminology and, most important, select theories and models used to promote behavior change and how to design, implement, and evaluate programs are discussed. In many academic programs, you may have additional course work to study behavior change theories and models as well as a program planning class.
Chapter 1 is a broad overview of select environmental changes occurring after World War II that significantly changed the way people lived, moved, worked, and obtained food. These changes in our society were aligned with shifts in the causes of death and disability in the United States. As medical treatment for infectious diseases were being discovered, personal health choices emerged as an important part to support healthful living. You will find an introduction to many key terms and concepts that are part of the language of health promotion and other related fields. The chapter ends with how the Patient Protection and Affordable Care Act is galvanizing the field of health promotion because the act prioritizes prevention of disease and promotion of healthful lifestyles.
Chapter 2 introduces health behavior change theories and models that offer constructs on how individuals approach personal behavior change, that is, the essence of health promotion—engaging individuals to actively promote their own health through daily actions such as being physically active or selecting healthy foods to eat. These models and theories will assist you in understanding the motivation that drives individuals to engage in behavior change. Tapping into key behavior change theories enables you to deliver theory-based programs to a target audience that will result in people successfully making the changes they set out to make.
Chapter 3 introduces you to program planning models, which incorporate behavior change theories within the intervention. Again, as a health promotion professional, the use of program planning models will set you apart from other practitioners. These models are essential tools to successfully reaching large groups of people through social marketing campaigns to creating effective interventions to enacting policies to create environments where people can practice healthy behaviors.
Collectively, these three chapters introduce you to the foundation of the field of health promotion, and you will study and use this information many times both in your academic work and in your professional life.
Chapter 1Health PromotionAn Emerging Field
Anastasia Snelling
Learning Objectives
After reading this chapter, the student will be able to:
Identify health trends related to chronic disease during the second half of the twentieth century.
Explain primary, secondary, and tertiary care.
Explain modifiable and nonmodifiable risk factors.
Identify the leading causes of death in the United States.
Describe how the Affordable Care Act is working to improve healthy lifestyles.
Explain the determinants of health.
The field of health promotion has a relatively short history compared to public health or medicine. However, it is clear that promoting health is an important component of public health and the medical field. Over the past century, US society has changed dramatically in the ways we work, live, and study. In recent decades, these societal changes have affected individual health choices and disease patterns, and as a result the field of health promotion has emerged as a distinct discipline to work in synergy with the fields of public health and health education. The purpose of this textbook is to familiarize students with the history of health patterns, with an emphasis on personal health behaviors, and to identify the social and environmental forces that can create a culture of health to promote a citizenry with longer, healthier lives that are free of disability and disease.
Brief Overview of Health in the Twentieth Century
A critical examination of the history of health issues related to death and disability in the United States provides us with an appreciation of how social and environmental factors influence disease patterns (see US Department of Health and Human Services, National Center for Health Statistics, 2010). This section briefly examines US health in the first half of the twentieth century and provides a more in-depth investigation of US health in the second half of the twentieth century.
1900–1950s
During the first half of the twentieth century (1900–1950s), the topic of health in the nation focused on developing the medical profession and establishing hospitals to treat patients. Public health departments focused on sanitation, disease control, and health education. During this time, public health functions included child immunization programs, community health services, substance abuse programs, and sexually transmitted disease control.
Life Expectancy
By examining the life expectancy of men and women in the United States over time (see table 1.1), one can understand how medical and health advances have affected the health of a population. Life expectancy is a measure of the health status of a given population and is defined as “the average number of years a person from a specific cohort is projected to live from a given point of time” (McKenzie, Pinger, & Kotecki, 1999). At the beginning of the twentieth century, the life expectancies of men and women were 46.3 and 48.3 years, respectively. Infectious diseases such as influenza, pneumonia, tuberculosis, and gastrointestinal infections were the leading causes of death in the United States. The discovery of antibiotics and improved sanitation practices significantly contributed to increasing life expectancies by the 1950s, reaching sixty-five and seventy-one years for men and women, respectively.
Table 1.1 Life Expectancy at Birth, at Sixty-Five Years of Age, and at Seventy-Five Years of Age
At Birth
At Sixty-Five Years
At Seventy-Five Years
Year
Both sexes
Male
Female
Both sexes
Male
Female
Both Sexes
Male
Female
1900
47.3
46.3
48.3
11.9
11.5
12.2
*
*
*
1950
68.2
65.6
71.1
13.9
12.8
15.0
*
*
*
1960
69.7
66.6
73.1
14.3
12.8
15.8
*
*
*
1970
70.8
67.1
74.7
15.2
13.1
17.0
*
*
*
1980
73.7
70.7
77.4
16.4
14.1
18.4
10.4
8.8
11.5
1990
75.4
71.8
78.8
17.2
15.1
18.9
10.9
9.4
12.0
1995
75.8
72.5
78.9
17.4
15.6
18.9
11.0
9.7
11.9
2000
77.0
74.3
79.7
18.0
16.2
19.3
11.4
10.1
12.3
Source:
US Department of Health and Human Services, National Center for Health Statistics (2010).
Chronic Disease
As a result of the advances of immunizations, antibiotics, maternal and child health, and improved sanitation practices, life expectancy increased. Extending years of life was a positive advancement. However, one result of a longer life expectancy is the more significant impact that personal health choices and environmental factors have on the development of chronic conditions, sometimes referred to as noncommunicable diseases, which are not infectious or transferable from one person to another. Chronic disease is defined as a health condition or disease that lasts for a long period of time, usually for longer than three months. Chronic diseases also tend to take a long period to develop. Chronic conditions such as high cholesterol have developed over years of consuming high saturated fat and cholesterol foods, which leads to high blood cholesterol levels and is a risk factor for cardiovascular disease. These chronic conditions are usually managed with lifestyle changes, medication, or surgical approaches, depending on the disease.
One of the first studies conducted to measure the impact of personal health choices on cardiovascular disease was the Seven Countries Studies conducted by Ancel Keys in the 1950s (Keys et al., 1986). Keys recruited researchers in seven countries to launch the first cross-cultural comparison of heart attack risk in populations of men engaged in traditional occupations, comparing their diet and fat intake. The Seven Countries Study indicated that the risk and rates of heart attack and cardiovascular risk at the population and individual levels were directly and independently related to the level of total serum cholesterol. It demonstrated that the association between blood cholesterol level and coronary heart disease risk in the five- to forty-year follow-up was found consistently across different cultures. Cholesterol and overweight or obesity was also associated with increased mortality from cancer. The Seven Countries Study, along with other important large studies such as the Framingham Heart Study, the Nurses' Health Study, and the Women's Health Initiative, confirmed not only the importance of healthy diet but also identified weight status and regular physical activity as important factors for maintaining good general health. These studies were conducted in the mid-1950s and begin to establish the influence of personal health choices on disease patterns. Since that time, hundreds of studies have been done and are now being conducted to improve our understandings of the influence of lifestyle behaviors on chronic disease.
1960s–2000s
During the second half of the twentieth century, a number of social and environmental changes occurred that influenced consumer health choices and behaviors. Changes in the way we live are inevitable; however, health promotion professionals must examine how these changes influence health status and respond to these changes to maintain and improve health for individuals and society.
Employment
Americans were prosperous after World War II; the end of the war generated enormous advances in technology, medicine, and communications that led to new job opportunities for returning soldiers and for all citizens. Starting in the 1950s, for the first time in American history, a majority of US workers were white-collar rather than blue-collar workers (McColloch, 1983). White-collar workers tended to be involved in positions that required less physical activity than workers in blue-collar positions. People working in white-collar positions are typically sedentary for most of their day; there is a need to build physical activity back into their daily routines.
A blue-collar worker is someone who performs manual labor. Blue-collar work may involve skilled or unskilled labor, such as mining, mechanical, construction, or manufacturing jobs. A white-collar worker is someone who performs professional, managerial, or administrative work; examples include teachers, managers, and secretaries.
Suburbs and Cars
The housing industry boomed and shifted families into new suburban neighborhoods; the explosion of the automobile industry accompanied this shift. As people moved from urban to suburban areas, cars became more popular and necessary. Between 1945 and 1947, car production increased from 70,000 to 3.5 million (Weiner, 1992). As people moved out of the city and started owning cars, the reliance on transportation negatively influenced their daily physical activity.
Supermarkets, Food Choices, and Eating Patterns
As suburban neighborhoods were built, supermarkets and the food industry began to develop and shift to meet this new demand. In 1958, there were approximately fifteen thousand supermarkets; this number roughly doubled by the 1980s (Ellickson, 2011). In the 1960s, women began to enter the workforce, which shifted their role of preparing daily meals for the family. Then, frozen foods became more readily available at the retail level and the fast food industry was born. In 1968, McDonalds operated approximately one thousand restaurants; by 2012 there were thirty thousand McDonalds around the world. Along with the emergence of fast food restaurants, the microwave was introduced into the family kitchen. The shift from eating what one grew during the growing season to being able to purchase large quantities of foods at any time promoted increased calorie consumption. The food environment, from the prevalence and size of supermarkets to the growth of the fast food industry, underwent significant changes during this period.
Entertainment and Leisure Time
A shift in the physical activity patterns of adults and children also occurred. Advancing technology brought televisions into American living rooms. In 1950, less than 1% of homes had televisions. In 2012, over 83% of homes had at least one television. Between 1975 and 1985, video games such as Atari and Nintendo became available and IBM introduced the first personal computer. People of all ages are entertained with televisions, computers, and video games, again decreasing our daily physical activity time.
Tobacco Use
Although Americans had been smoking throughout the entire twentieth century, by 1950 more women were smoking than ever before and approximately 42% of all Americans smoked. Smoking was permitted everywhere, in office buildings, schools, restaurants, and airplanes. However, research started to suggest dangers associated with smoking. In 1964, the first surgeon general's report was written that clearly documented the effects of smoking on health. Early into the 1970s, concerns regarding secondhand smoke were validated and the negative effects of smoking became clear. As a result, clean indoor air legislation and higher cigarette taxes were put into effect in an attempt to reduce the prevalence of smoking. As a nation, we continue to limit where people can smoke and require higher taxes on tobacco. Some companies and college campuses are going smoke free. Because these actions have shown decreased rates of smoking in the United States, many advocates suggest applying similar strategies to other health behaviors.
By the end of the twentieth century, life expectancy for men and women was 74.3 and 79.7 years, respectively. Advances in medicine and drug therapy for managing chronic conditions were largely responsible for the increase in life expectancy in the late twentieth century.
Although life expectancy continued to increase, causes of death shifted from infectious diseases in the early half of the century to chronic diseases in the late 1900s and early 2000s. These chronic diseases are the focus of the health promotion field today. Now, the leading causes of death in the United States are primarily chronic disease influenced by risk factors that include personal health choices. Table 1.2 shows the leading causes of death and all related risk factors. Table 1.3 presents the actual causes of death from lifestyle behaviors, comparing 1990 and 2000, specifically the risk factors that advance chronic disease development, and Table 1.4 presents the leading causes of death in the United States.
Table 1.2 Leading Causes of Death in the United States and Related Risk Factors
Rank
Cause
Risk Factors
1
Diseases of the heart
Tobacco use, high blood pressure, elevated serum cholesterol, diet, diabetes, obesity, lack of exercise, alcohol abuse, genetics
2
Malignant neoplasms (cancer)
Tobacco use, alcohol misuse, diet, solar radiation, ionizing radiation, work site hazards, environmental pollution, genetics
3
Chronic lower respiratory disease
Tobacco use
4
Cerebrovascular diseases (stroke)
Tobacco use, high blood pressure, elevated serum cholesterol, diabetes, obesity, genetics
5
Accidents (unintentional injuries)
Alcohol misuse, tobacco use (fires), product design, home hazards, handgun availability, lack of safety restraints, excessive speed, automobile design, roadway design
6
Alzheimer's disease
Age, family history, genetics, head injury, heart health, general healthy aging
7
Diabetes mellitus
Obesity (for type 2 diabetes), diet, lack of exercise, genetics
8
Nephritis, nephritic syndrome, and nephrosis
Infectious agents, drug hypersensitivity, genetics, trauma
9
Pneumonia and influenza
Tobacco use, infectious agents, biological factors
10
Intentional self-harm
Table 1.3 Lifestyle Behaviors Related to Disease
1990
2000
Actual Cause
Number
%
Number
%
Tobacco
400,000
19
435,000
18.1
Poor diet and physical inactivity
300,000
14
365,000
15.2
Alcohol consumption
100,000
5
85,000
3.5
Microbial agents
90,000
4
75,000
3.1
Toxic agents
60,000
3
55,000
2.3
Motor vehicle
25,000
1
43,000
1.8
Firearms
35,000
2
29,000
1.2
Sexual behavior
30,000
1
20,000
0.8
Illicit drug use
20,000
1
17,000
0.7
Total
1,060,000
50
1,124,000
46.7
Sources:
For 1990 data, McGinnis & Foege (1993). For 2000 data, Mokdad et al. (2005).
Table 1.4 Number of Deaths for Leading Causes of Death
Heart disease
597,689
Cancer
574,743
Chronic lower respiratory diseases
138,080
Stroke
129,476
Accidents
120,859
Alzheimer's disease
83,494
Diabetes
69,071
Nephritis, nephrotic syndrome, nephrosis
50,476
Influenza and pneumonia
50,097
Intentional self-harm
38,364
Source:
Centers for Disease Control (2010).
Health Promotion: An Emerging Field
Health promotion, as a field of study, has a shorter history than public health and health education. The emergence of health promotion was a direct response to the changes in disease patterns in the United States, particularly the rise of chronic disease rates beginning in the mid-twentieth century. This rise is attributed primarily to two reasons: the discovery of antibiotics and vaccinations to prevent and treat infectious diseases and the adoption of lifestyle behaviors that increase risk for conditions that lead to chronic diseases.
Although health promotion, public health, and health education overlap to some degree, each is a distinct field of study in and of itself. It is important to understand the distinctions among these three fields, as shown in the following definitions. According to the World Health Organization (WHO Centre for Health Development, 2004), health promotion is
the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. (p. 30)
Dr. Michael O'Donnell (2002), a leading scholar in the field of work site health promotion, offers this definition of health promotion:
The art and science of helping people discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them in changing their lifestyle to move toward a state of optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most important, through the creation of opportunities that open access to environments that make positive health practices the easiest choice. (p. xx)
Health Education
Health education is defined by the World Health Organization (WHO Centre for Health Development, 2004) as
any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes. (p. 29)
Public Health
Public health, as defined by the World Health Organization (WHO Centre for Health Development, 2004),
is concerned with the health of the community as a whole. The three core public health functions are: the assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; the formulation of public policies designed to solve identified local and national health problems and priorities; and ensuring that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care. (p. 48)
Discussion
These definitions clearly indicate that public health, health education, and health promotion are all working toward the common goal of improving health for individuals and society. However, distinctly different in each definition are the strategies used to address health issues. Green and Kreuter (1999) suggest that
