Sample Health Behaviors Research Paper. Browse other research paper examples and check the list of research paper topics for more inspiration. If you need a research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our custom research paper writing service for professional assistance. We offer high-quality assignments for reasonable rates.
Interest in behaviors that have important impacts on our health and well being is based upon two assumptions; (a) that a signiﬁcant proportion of the mortality from the leading causes of death is caused by the behavior of individuals, and (b) that such behavior is modiﬁable (Conner and Norman 1996). Behavior is held to exert its inﬂuence on health in three basic ways: by producing direct biological changes, by conveying health risks or protecting against them, or by leading to the early detection or treatment of disease (Baum and Posluszny 1999).
Academic Writing, Editing, Proofreading, And Problem Solving Services
Get 10% OFF with FALL23 discount code
This research paper begins by oﬀering a deﬁnition of health behavior and the diﬀerent types of health behavior. The prevalence of key health behaviors and their relationship to morbidity and mortality is then examined. The chapter then considers who performs these diﬀerent behaviors, why they might do so, and how health enhancing behaviors might be encouraged and health impairing behaviors discouraged.
2. The Deﬁnition Of Health Behaviors
Health behaviors have been deﬁned in various ways. For example, Conner and Norman (1996) deﬁne them as any activity undertaken for the purpose of preventing or detecting disease or for improving health and well being. Gochman (1997) in the Handbook of Health Behavior Research deﬁnes them as ‘behavior patterns, actions and habits that relate to health maintenance, to health restoration and to health improvement’ (Vol. 1, p. 3). Behaviors within this deﬁnition include medical service usage (e.g., physician visits, vaccination, screening), compliance with medical regimens (e.g., dietary, diabetic, antihypertensive regimens), and self-directed health behaviors (e.g., diet, exercise, smoking, alcohol consumption). All have received considerable attention from social and behavioral researchers and we now have a good understanding of the factors inﬂuencing how and why individuals engage in such behaviors.
In describing health behaviors it is common to distinguish health enhancing from health impairing behaviors. Health impairing behaviors have harmful eﬀects on health or otherwise predispose individuals to disease. Such behaviors include smoking, excessive alcohol consumption, and high dietary fat consumption. In contrast, engagement in health enhancing behaviors convey health beneﬁts or otherwise protect individuals from disease. Such behaviors include exercise, fruit and vegetable consumption, and condom use in response to the threat of sexually transmitted diseases.
3. Key Health Behaviors
Numerous studies have examined the relationship between health behaviors and health outcomes (e.g., Blaxter 1990) and have demonstrated their role in both morbidity and mortality. One of the ﬁrst such studies identiﬁed seven features of lifestyle which were associated with lower morbidity and higher subsequent long-term survival: not smoking, moderate alcohol intake, sleeping 7–8 h per night, exercising regularly, maintaining a desirable body weight, avoiding snacks, and eating breakfast regularly (Belloc and Breslow 1972). Health behaviors also impact upon individuals’ quality of life, by delaying the onset of chronic disease and extending active lifespan. Smoking, alcohol consumption, diet, gaps in primary care services and low screening uptake are all signiﬁcant determinants of poor health, and changing such behaviors should lead to improved health. For example, in the USA, Healthy People 2000 (US Department of Health and Human Services [USDHHS] 1990) lists increased physical activity, changes in nutrition and reductions in tobacco, alcohol and drug use as important for health promotion and disease prevention.
Smoking is the health behavior most closely linked with long-term negative health outcomes. Morbidity and mortality from coronary heart disease (CHD) are increased among smokers (Doll et al. 1994). Moreover, there is a strong positive relationship between the number of cigarettes smoked per day and the incidence of CHD (Friedman et al. 1979). Smoking has also been linked to a number of cancers, including cancer of the lung, throat, stomach and bowel as well as a number of more immediate negative health eﬀects such as reduced lung capacity and bronchitis (Royal College of Physicians 1983). Despite the array of negative health outcomes, smokers often report positive mood eﬀects from smoking and the use of smoking as a strategy for coping with stress.
The number of people smoking in the USA and UK has shown a steady decline over the past twenty years. Data from the General Household Survey showed that 28 percent of people over the age of 16 smoke in the UK. Smoking is more common among men and among unskilled manual workers (General Household Survey 1994). A similar pattern is evident in the USA and other First World countries, with smoking more common among less educated, lower income and minority groups (Rigotti 1989). Those who quit smoking reduce the risk to their health, particularly if they quit before 35 years of age (Doll et al. 1994).
The impact of diet upon morbidity and mortality are well established (USDHHS 1988). In the Third World, the problems related to diet and health are ones of under-nutrition; in the First World, the problems are predominantly linked to overconsumption of food. In Western industrialized countries excessive fat consumption and insuﬃcient ﬁber, fruit and vegetable consumption are related to health problems. In addition, excess consumption of calories combined with insuﬃcient exercise has made obesity a major health problem. Diet has been implicated in cardiovascular diseases (CVDs), strokes and high blood pressure, cancer, diabetes, obesity, osteoporosis, and dental disease.
It is generally agreed that elevated blood cholesterol level is a major risk factor for the development of CVD (Consensus Development Conference on Lowering Blood Cholesterol to Prevent Heart Disease 1985). Nutbeam and Catford (1990) estimate that 26 percent of men and 25 percent of women in the UK have cholesterol levels greater than 6.5 mmol l-1(a level considered to be excessive). While in the USA, it is estimated that 50 percent of the adult population is at risk of CHD by virtue of elevated blood cholesterol levels (Sampos et al. 1989). The reduction of blood cholesterol via dietary change is now widely accepted as an important way of tackling CHD. Dietary recommendations include reducing fat in the diet and increasing soluble ﬁber intake. However, their impact upon cholesterol levels may be limited.
The potential health beneﬁts of engaging in regular exercise include reduced cardiovascular morbidity and mortality, lowered blood pressure, and the increased metabolism of carbohydrates and fats, as well as a range of psychological beneﬁts such as improved self-esteem, positive mood states, reduced life stress and anxiety. Nevertheless, a signiﬁcant proportion of the population lead a sedentary lifestyle. The General Household Survey (1989) indicated that only one in three men and one in ﬁve women in the UK participate in any sport or recreational physical activity. Moreover, the Allied Dunbar Fitness Survey (1992) of 6,000 English adults reported that one in six adults had done no exercise (i.e., for 20 minutes or more at a moderate or vigorous level) in the previous four weeks. Participation in regular exercise is strongly related to a number of sociodemographic variables. In particular, young people and males are more likely to engage in regular exercise. For example, the 1988 Welsh Heart Health Survey (HPAW 1990) reported that among 18–34 year olds, 61 percent of men engaged in moderately vigorous exercise at least two times a week compared with only 35 percent of women. For 35–64 year olds, the percentages drops to 37 percent for men and 17 percent for women. Overall, across First World countries the typical exerciser is likely to be young, well educated, aﬄuent and male.
3.4 Health Screening
Individuals may seek to protect their health by participating in various screening programs which attempt to detect disease at an early, or asymptomatic, stage. In the UK, screening programs have been set up for various diseases, including anemia, diabetes, bronchitis, cervical cancer, and breast cancer. Considering breast cancer, it has been estimated that breast screening programs which include mammograms can reduce breast cancer mortality by up to 40 percent among women aged 50 and over (Strax 1984). However, participation rates in breast screening programs show great variability across diﬀerent countries, ranging from 25 percent to 89 percent (Vernon et al. 1990). Participation tends to be negatively related to age, and positively related to education level and socio- economic status.
3.5 Sexual Behaviors
Sexual behaviors are considered health behaviors because of their impact upon the spread of sexually transmitted diseases (STDs) such as gonorrhea and syphilis. More recently, the role of sexual behaviors in the spread of human immunodeﬁciency virus (HIV) has been a focus of attention. While early health education campaigns emphasized the need to reduce the number of sexual partners or avoid particular sexual practices (e.g., anal sex, penetrative sex), more recently the focus has been upon the use of condoms during penetrative sex to reduce the risk of HIV transmission. Condom use is particularly recommended for those with multiple partners or those who do not know their partners’ sexual history. For these reasons, much of the health advice concerning condom use has been focused on young people.
There seems to be considerable variation in the use of condoms in response to the threat of HIV AIDS. For example, studies in the UK and USA report rates of between 24 and 58 percent (Fife-Schaw and Breakwell 1992, Gerrard et al. 1996). The General Household Survey (1993) in the UK reported changes by age group in the use of condoms for the period 1983 to 1991. Among 16–24 year olds, condom use increased from around 6 percent to around 12 percent during this period, while among 40–49 year olds it dropped from around 18 percent to around 12 percent over the same period.
3.6 Alcohol Use
Moderate alcohol consumption has been linked to positive health outcomes. However, high alcohol consumption has been linked to a range of negative health outcomes including high blood pressure, heart disease and cirrhosis of the liver. High levels of alcohol consumption have also been associated with accidents, injuries, suicides, crime, domestic violence, rape, murder and unsafe sex (British Medical Journal 1982). While many of the adverse eﬀects of high alcohol consumption are due to continued heavy drinking (e.g., cirrhosis of the liver, heart disease), others are more speciﬁcally related to excessive alcohol consumption in a single drinking session (e.g., accidents, violence).
The General Household Survey (1992) reported that the average weekly consumption of alcohol in the UK was 15.9 units (1 unit =1 glass of wine, 1 measure of spirits, or 0.5 pints of beer) for men and 5.4 for women. In addition, 27 percent of men and 11 percent of women were drinking more than the recommended weekly sensible limits (21 units for men, 14 units for women). Heavy drinking is also more likely among younger age groups. In a survey of 12,000 Welsh adults, Moore et al. (1994) reported that 31.1 percent of drinkers aged 18–24 engaged in binge drinking (i.e., drinking half the recommended weekly consumption of alcohol in a single session) at least once a week.
4. Relationship Of Health Behaviors To Sociodemographic Factors
A clearer understanding of why individuals perform health behaviors might assist in the development of interventions to help individuals gain health beneﬁts. A variety of factors have been found to account for individual diﬀerences in the performance of health behaviors. Demographic variables show reliable associations with the performance of health behaviors. For example, there is a curvilinear relationship between many health behaviors and age, with high incidences of many health risking behaviors such as smoking in young adults and much lower incidences in children and older adults (Blaxter 1990). Such behaviors also vary by gender, with females being generally less likely to smoke, consume large amounts of alcohol, engage in regular exercise, but more likely to monitor their diet, take vitamins and engage in dental care (Waldron 1988). Diﬀerences by socioeconomic status and ethnic group are also apparent for behaviors such as diet, exercise, alcohol consumption and smoking (e.g., Blaxter 1990).
Generally speaking, younger, wealthier, better educated individuals, under low levels of stress, with high levels of social support are more likely to practice health protective behaviors. Higher levels of stress and/or fewer resources are associated with health risking behaviors such as smoking and alcohol abuse (Adler and Matthews 1994). Social factors seem to be important in instilling health behaviors in childhood. Parent, sibling and peer inﬂuences are important, for example in the initiation of smoking. Cultural values also have a major impact, for instance in determining the number of women exercising in a particular culture. For example, Steptoe and Wardle (1992) report that between 34 and 95 percent of women in their European student sample had exercised in the past 14 days.
5. Understanding The Distribution Prevalence Of Health Behaviors
Perceived symptoms control health behaviors when, for example, a smoker regulates his her smoking on the basis of sensations in the throat. Access to medical care has been found to inﬂuence the use of such health services (e.g., Black Report 1988). Personality factors have also been associated with health behaviors (Adler and Matthews 1994). Cognitive factors also determine whether or not an individual practices health behaviors and may explain how other factors inﬂuence behavior. Knowledge about behavior–health links is an important factor in an informed choice concerning health behaviors. Various cognitive variables have been studied including perceptions of health risk, eﬃcacy of behaviors in inﬂuencing this risk, social pressures to perform the behavior, and control over performance of the behavior. The relative importance of various cognitive factors in determining who performs various health behaviors constitutes the basis of diﬀerent models. Such models have been labeled social cognition models (SCMs) because of their focus on cognitive variables as the primary determinant of individual social behaviors. These SCMs provide a basis for understanding the determinants of behavior and behavior change. Each of these models emphasize the rationality of human behavior and assume that behavior is based upon elaborate, but subjective, cost–beneﬁt analysis of the likely outcomes of diﬀering courses of action. It is assumed that individuals generally aim to maximize beneﬁts and minimize costs in selecting a behavior.
5.1 Health Belief Model
The Health Belief Model (HBM) attempts to conceptualize two types of health beliefs that make a behavior in response to illness more or less attractive (Sheeran and Abraham 1996): perceptions of the threat of illness and evaluation of the eﬀectiveness of behaviors to counteract this threat. Threat perceptions depend upon the perceived susceptibility to the illness and the perceived severity of the consequences of the illness. Together these variables determine the likelihood of the individual following a health-related action, although their eﬀect is modiﬁed by demographic variables, social pressure and personality. The particular action undertaken is determined by the evaluation of the possible alternatives. This behavioral evaluation depends upon beliefs concerning the beneﬁts or eﬃcacy of the health behavior and the perceived costs or barriers to performing the behavior. Hence, individuals are likely to follow a particular health behavior if they believe themselves to be susceptible to a particular condition or illness which they consider to be serious, and believe the beneﬁts of the behavior undertaken to counteract the condition or illness outweigh the costs. It is assumed that this whole process is set in motion by cues to action. Cues to action include a diverse range of triggers to the individual taking action and are commonly divided into factors that are internal (e.g., physical symptoms) or external (e.g., mass media campaigns, advice from others) to the individual. Other inﬂuences upon the performance of health behaviors, such as demographic factors or psychological characteristics (e.g. personality, peer pressure, perceived control over behavior) are assumed to exert their eﬀect via changes in the components of the HBM.
5.2 Theory Of Planned Behavior
The Theory of Planned Behavior (TPB) was developed by social psychologists and has been widely employed as a tool to aid our understanding of a variety of behaviors including health behaviors (Ajzen 1991, Godin and Kok 1996). The TPB details how the inﬂuences upon an individual determine that individual’s decision to follow a particular behavior. Within the TPB, the determinants of behavior are intentions to engage in that behavior and perceived behavioral control (PBC) over that behavior. Intentions represent a person’s motivation. The construct is conceptualized as an individual’s conscious plan or decision to exert eﬀort in order to engage in a particular behavior. Perceived behavioral control is a person’s expectancy that performance of the behavior is within his her control. Intentions are determined by three variables. The ﬁrst is attitudes, which are an individual’s overall evaluation of the behavior. The second is subjective norms, which consist of a person’s beliefs about whether signiﬁcant others think he she should engage in the behavior. The third measures the extent to which the individual perceives that the behavior is under their personal control and is labeled PBC.
The attitude, subjective norm and PBC components are determined by underlying beliefs. Attitude is a function of a person’s salient behavioral beliefs; which represent perceived likely consequences of the behavior (e.g., taking exercise will reduce my risk of heart disease). Subjective norm is a function of normative beliefs, which represent perceptions of speciﬁc salient others’ preferences about whether one should or should not engage in a behavior (e.g., my family think I should take exercise). PBC is based on beliefs concerning access to the necessary resources and opportunities to perform the behavior successfully (e.g., I have easy access to a place where I can exercise).
So, according to the TPB, individuals are likely to engage in a health behavior if they believe that the behavior will lead to particular outcomes which they value, if they believe that people whose views they value think they should carry out the behavior, and if they feel that they have the necessary resources and opportunities to perform the behavior.
5.3 Perceived Self-eﬃcacy
Self-eﬃcacy is one of the most powerful predictors of health behavior (Bandura 1997, Schwarzer and Fuchs 1996). It has its origins in Bandura’s social cognitive theory, which states that behavior is a function of both incentives (i.e., reinforcements) and expectancies. Three kinds of expectancies can be identiﬁed, these being: situation–outcome expectancies, which refer to beliefs about how events are connected; outcome expectancies, which refer to beliefs about the consequences of performing a behavior; and self-eﬃcacy expectancies, which refer to beliefs about one’s ability to perform the behavior. Thus, in order to perform a health behavior, individuals must value their health (i.e., have an incentive), believe that their current lifestyle poses a threat to their health (i.e., situation– outcome expectancy), believe that adopting the new behavior will reduce the threat to their health (i.e., outcome expectancy), and believe that they are capable of performing the behavior (i.e., self-eﬃcacy expectancy). While all these beliefs are seen to be important in the initiation and maintenance of health behavior, perceived self-eﬃcacy is seen to be the most important. Individuals with a strong sense of self-eﬃcacy are believed to develop stronger intentions to act, to expend more eﬀort to achieve their goals and to persist longer in the face of barriers and impediments. Perceived self-eﬃcacy is therefore believed to play a crucial role in the determination of health behavior. According to Bandura (1997), self-eﬃcacy can be conceptualized and measured in terms of three parameters; magnitude, strength and generality, with strength being the key parameter. This is reﬂected in its measurement (e.g., ‘I am conﬁdent that I can refrain from smoking, even if someone oﬀers me a cigarette’).
5.4 Stage Models Of Health Behavior
A number of researchers have suggested that there may be qualitatively diﬀerent stages in the initiation and maintenance of health behavior, and that to obtain a full understanding of the determinants of health behavior it is necessary to conduct a detailed analysis of the nature of these stages. One of the ﬁrst stage models was put forward by Prochaska and DiClemente in their transtheoretical model of change (TTM). Their model has been widely applied to analyze the process of change in alcoholism treatment, smoking cessation, and psychotherapy. In its most widely applied form, Prochaska et al. (1992) identify ﬁve stages of change: precontemplation, contemplation, preparation, action, and maintenance. Individuals are seen to progress through each stage to achieve successful maintenance of a new behavior. Taking the example of smoking cessation, it is argued that in the precontemplation stage the smoker is unaware that his her behavior constitutes a problem and has no intention to quit. In the contemplation stage, the smoker starts to think about changing his her behavior, but is not committed to try to quit. In the preparation stage, the smoker has an intention to quit and starts to make plans about how to quit. The action stage is characterized by active attempts to quit, and after six months of successful abstinence the individual moves into the maintenance stage characterized by attempts to prevent relapse and to consolidate the newly acquired nonsmoking status.
6. Changing Health Behaviors
The above models detail the key cognitive determinants of health behavior. To the extent that these models outline the key social cognitive determinants of health behavior, interventions which target these variables should lead to associated changes in behavior. For example, the HBM would suggest that encouraging health behaviors is best achieved by increasing individuals’ perceived susceptibility to negative health outcomes and making individuals aware of the severity of such outcomes. Such approaches have been commonly employed in health promotion messages. In addition, the HBM might suggest the need to focus on the beneﬁts of health behaviors and the fact that barriers to action are easily overcome. However, there has been little systematic evaluation of their eﬀectiveness, perhaps due to the common sense appeal of these approaches.
Relatively few studies have used the TPB as a framework for developing interventions, despite the fact that the theory would suggest a number of interventions focusing on diﬀerent components of the model. Brubaker and Fowler (1990) did examine the eﬀect of persuasive messages tackling behavioral beliefs upon men’s intentions to perform testicular self-examination in response to the threat of cancer. A persuasive message was found to increase intentions to perform testicular self-examination compared to a no message control. The TPB would also suggest the need to tackle normative beliefs and control beliefs in any attempt to change behavior. A number of studies have attempted to use persuasive messages aimed at tackling normative pressures. For example, in relation to preventing adolescent smoking, prevention programs commonly attempt to tackle the perceived pressure from teenage peers who smoke. Tackling control beliefs has been seen to bear many similarities to changing perceptions of self-eﬃcacy (see below).
Another interesting approach has focused directly on the immediate determinant of behavior in the TPB: intentions. Where individuals do have an intention to engage in a health behavior (goal intentions), but are having trouble implementing their intention, forming a speciﬁc plan about where and when to act has been found to help (Gollwitzer 1993). For example, Orbell et al. (1997) gave out a questionnaire about breast self-examination in response to the threat of cancer. Half the women were asked to indicate when and where in the next month they intended to perform breast self-examination (a speciﬁc plan or implementation intention). A one month follow-up found that 64 percent of these women had performed breast self-examination that month compared with only 16 percent of women who hadn’t made an implementation intention, despite having similar goal intentions.
Several studies have focused on enhancing feelings of self-eﬃcacy as a means for encouraging health behavior change. As Bandura (1997) outlines, there are four main sources of self-eﬃcacy, each of which could be addressed in interventions. First, individuals can develop feelings of self-eﬃcacy from personal mastery experience (e.g., it may be possible to split a behavior into various subgoals, such that the easiest subgoals are achieved before more diﬃcult tasks are attempted). Second, individuals may develop feelings of self-eﬃcacy through observing other people succeed on a task (i.e., vicarious experience). Third, it is possible to use standard persuasive techniques to try to instill feelings of self-eﬃcacy. Finally, one’s physiological state may be used as a source of information, such that high levels of arousal or anxiety may indicate to the individual that he or she is not capable of performing a given action (e.g., relaxation techniques may be employed to help maintain feelings of self-eﬃcacy).
Stage models have also been used as the basis for designing interventions. The main distinction from the approaches already presented is that this approach suggests that interventions need to be matched to the needs of each individual. So, for example, an individual at the pre-contemplation stage in relation to exercise needs to be made aware of the health problems associated with a lack of exercise. A diﬀerent individual in the contemplation stage needs information about the pros of changing their exercise behavior and the cons of not changing. While an individual in the preparation or action stage needs helps with acting on their plans to engage in exercise. Whilst these ideas appear entirely plausible, to date relatively few studies have managed to demonstrate that such stagematched interventions are more eﬀective than presenting the same intervention to all individuals.
Health behaviors have important consequences for both the quality and length of life by inﬂuencing disease outcomes. Nevertheless, there is still considerable variation in those individuals who perform these behaviors. Social cognition models provide one approach to understanding the variation in who performs health behaviors. These models are also useful because they suggest ways in order to change health behaviors in order to improve health. Perhaps the greatest challenge for social and behavioral research on health behaviors is the demonstration that such theory-based interventions can produce eﬀective and long-lasting behavior change that will lead to real health beneﬁts for all individuals.
- Adler N, Matthews K 1994 Health psychology: why do some people get sick and some stay well? Annual Review of Psychology 45: 229–59
- Ajzen I 1991 The theory of planned behavior. Organizational Behavior and Human Decision Processes 50: 179–211
- Allied Dunbar Fitness Survey 1992 Health Education Authority, London
- Bandura A 1997 Self-eﬃcacy: The Exercise of Control. W. H. Freeman, New York
- Baum A, Posluszny D M 1999 Health psychology: mapping biobehavioral contributions to health and illness. Annual Review of Psychology 50: 137–63
- Belloc N B, Breslow L 1972 Relationship of physical health status and health practices. Preventive Medicine 9: 409–421
- Black Report 1988 Inequalities in Health: The Black Report and the Health Di ide. DHSS, London
- Blaxter M 1990 Health and Lifestyles. Routledge, London
- British Medical Journal 1982 Alcohol Problems. BMJ Publications, London
- Brubaker R G, Fowler C 1990 Encouraging college males to perform testicular self-examination: evaluation of a persuasive message based on the revised theory of action. Journal of Applied Social Psychology 20(17): 1411–22
- Conner M, Norman P 1996 (eds.) Predicting Health Behaviour. Open University Press, Buckingham, UK
- Consensus Development Conference on Lowering Blood Cholesterol to Prevent Heart Disease 1985 Lowering blood cholesterol to prevent heart disease. J. of the Australian Medical Association 253: 2080–6
- Doll R, Peto R, Wheatley K, Gray R, Sutherland I 1994 Mortality in relation to smoking: 40 years’ observations on male British doctors. British Medical Journal 309: 901–11
- Fife-Schaw C R, Breakwell G M 1992 Estimating sexual behaviour parameters in the light of AIDS: a review of recent UK studies of young people. AIDS Care 4: 187–201
- Friedman G D, Dales L G, Ury H K 1979 Mortality in middleaged smokers and non-smokers. New England Journal of Medicine 300: 213–7
- General Household Survey 1989 OPCS, London General Household Survey 1992 OPCS, London
- General Household Survey 1993 OPCS, London General Household Survey 1994 OPCS, London
- Gerrard M, Gibbons F X, Bushman B J 1996 Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin 119: 390–409
- Gochman D S (ed.) 1997 Handbook of Health Behavior Research. Plenum, New York, Vols. 1–4
- Godin G, Kok G 1996 The theory of planned behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion 11: 87–98
- Gollwitzer P M 1993 Goal achievement: the role of intentions. In: Stroebe W, Hewstone M (eds.) European Review of Social Psychology. Wiley, Chichester, UK, Vol. 4, pp. 141–85
- Health Promotion Authority for Wales 1990 Health in Wales. Health Promotion, Cardiﬀ, UK
- Moore L, Smith C, Catford J 1994 Binge drinking: prevalence, patterns and policy. Health Education Research 9: 497–505
- Nutbeam D, Catford J 1990 Modiﬁable risks for cardiovascular disease among general practitioners in Wales. Public Health 104: 353–61
- Orbell S, Hodgkins S, Sheeran P 1997 Implementation intentions and the theory of planned behavior. Personality and Social Psychology Bulletin 23: 945–54
- Prochaska J O, DiClemente C C, Norcross J C 1992 In search of how people change: applications to addictive behaviors. American Psychologist 47: 1102–14
- Rigotti N A 1989 Cigarette smoking and body weight. New England Journal of Medicine 320: 931–3
- Royal College of Physicians 1983 Health or Smoking: Follow-Up Report. Pitman, London
- Sampos C, Fulwood R, Haines C et al. 1989 The prevalence of high blood cholesterol levels among adults in the United States. Journal of the American Medical Association 262: 45–52
- Schwarzer R, Fuchs R 1996 Self-eﬃcacy and health behaviors. In: Conner M, Norman P (eds.) Predicting Health Behaviour. Open University Press, Buckingham, UK, pp. 163–196
- Sheeran P, Abraham S C S 1996 The health belief model. In: Conner M, Norman P (eds.) Predicting Health Behaviour. Open University Press, Buckingham, UK, pp. 23–61
- Steptoe A, Wardle J 1992 Cognitive predictors of health behaviour in contrasting regions of Europe. British Journal of Clinical Psychology 31: 485–502
- Strax P 1984 Mass screening for control of breast cancer. Cancer 53: 665–70
- US Department of Health and Human Services 1988 The Surgeon General’s Report on Nutrition and Health. US Department of Health and Human Services, Public Health Service, Washington, DC
- US Department of Health and Human Services 1990 Health People 2000: National Health Promotion and Disease Prevention Objectives. US Department of Health and Human Services, Public Health Service, Washington, DC
- Vernon S W, Laville E A, Jackson G L 1990 Participation in breast screening programs: a review. Social Science and Medicine 30: 1107–18
- Waldron I 1988 Why do women live longer than men? Journal of Human Stress 2: 2–13