Chapter 6 Notes PDF

CHAPTER 6 HEALTH-RELATED BEHAVIOR AND HEALTH PROMOTION CHAPTER OUTLINE I. Health and Behavior A. Section Introduction 1. Greater attention is being given to people’s health behavior since health habits are related to developing fatal...

CHAPTER 6 HEALTH-RELATED BEHAVIOR AND HEALTH PROMOTION CHAPTER OUTLINE I. Health and Behavior A. Section Introduction 1. Greater attention is being given to people’s health behavior since health habits are related to developing fatal and chronic diseases a. illness and early death could be greatly reduced if people changed their lifestyles i. average life expectancy could increase to 85 years B. Lifestyles, Risk Factors, and Health 1. Section introduction a. the lifestyle of even typical people includes risk factors for illness and injury 2. Health behavior a. health behaviors = any activity people perform to maintain or improve their health regardless of perceived health status or whether behavior achieves goal b. well behavior = any activity undertaken to maintain or improve current good health and avoid illness i. when well, people may not have motivation to put forward effort or make sacrifices for healthful behavior ii. engaging in healthful behavior depends heavily on 1) perception of threat of disease 2) value in behavior reducing threat 3) attractiveness of unhealthful behavior c. symptom-based behavior = when ill, any activity undertaken to determine the problem and find a remedy i. large variability in expression of symptom-based behavior 1) some people are fearful or stoic whereas others are very likely to complain and/or seek help d. sick-role behavior = any activity people undertake to get well after determining they are ill i. sick-role expectations 1) exemption from typical obligations and life tasks 2) an obligation to try to get well (although many don't adhere to recommendations) ii. sick-role behaviors may be influenced by learning and cultural expectations  3. Practicing health behavior a. health behavior practices i. although shortcomings are noted in level of health behavior performance, percentages still represent an improvement over the past decade b. gender, sociocultural, and age differences are observed in health behaviors i. example: women perform more health behaviors than men ii. explanation: people perform behaviors that are salient to them c. consistency in health behaviors i. conclusions regarding health behaviors 1) although health habits are fairly stable, they do change over time 2) particular health behaviors are not strongly tied to each other 3) health behaviors are not governed by a single set of attitudes or response tendencies ii. reasons for lack of consistency 1) at any given time in life, various factors may differentially affect different behaviors 2) people change with experience 3) life circumstances change C. Interdisciplinary Perspectives on Preventing Illness 1. Health advances occur through efforts to prevent disease and improvements in diagnosis and treatment a. 3 approaches to illness prevention i. behavioral influence - encouraging/demonstrating health behaviors ii. environmental measures - changing the environment such as adding flouride to water supply iii. preventive medical efforts - examples include dental checkups b. there are 3 levels of prevention (primary, secondary, tertiary) related to different levels of health status and with different effects on health behaviors, social network, and health professionals 2. Primary prevention a. involves specific actions taken to avoid disease or injury i. examples: using seat belts, genetic counseling, immunizations b. approaches health professionals may use for primary prevention i. giving medical advice ii. using a system of reminders iii. constructing medical websites  3. Secondary prevention a. involves actions taken to identify and treat an illness early in effort to stop or reverse health problem b. includes patient's symptom-based behavior (help seeking), a physician prescribing medications or dietary changes, the patient adhering to medical advice (sick role behavior) c. examples i. annual physical examinations ii. cyclic scheduled laboratory tests to detect disease earlier 4. Tertiary prevention a. involves actions to retard lasting damage, prevent disability, and rehabilitate b. examples i. physical therapy ii. taking medications to control pain or inflammation c. in case of incurable diseases, goals may also be to keep patient comfortable and the disease in remission for as long as possible D. Problems in Promoting Wellness 1. Process of preventing illness and injury operates within a system of interrelated factors a. interrelated factors/problems can impair effectiveness of each component in system b. each component affects each other component 2. Factors within the individual a. many healthy behaviors are less pleasurable than the unhealthy alternatives i. some people deal with this by setting limits on the amount of unhealthy behaviors they do b. often have little immediate incentive for changing health behaviors c. prevention requires a change in long-standing behaviors that have become habitual, may involve addictions d. people need to have cognitive resources, self-efficacy, and motivation to engage in health behaviors e. being sick or taking certain medications may affect mood and energy levels therefore also affecting cognitive resources and motivation 3. Interpersonal factors a. social network consists of people with different individual motivations i. having friends or family who model healthful behavior and who give social support/encouragement for behavioral change increases likelihood of making changes ii. interpersonal conflict may emerge due to different motivations and have negative effect on health behaviors  4. Factors in the community a. people are more likely to adopt health behaviors encouraged by government and health care agencies b. issues affecting advice given by health professionals i. have inaccurate information about what patients’ health-related behaviors ii. traditionally have focused on treatment rather than prevention although interest in prevention has increased c. issues affecting large-scale community efforts i. public health projects influenced by lack of funds ii. need to consider programs for people of different ages and sociocultural backgrounds iii. health insurance may not cover prevention efforts iv. need to balance public health with economic priorities II. What Determines People's Health-Related Behavior? A. General Factors in Health-Related Behavior 1. Although people can describe healthy behavior, heredity or genetics appears to influence some health behaviors such as in alcoholism 2. Learning a. operant conditioning = acquiring behaviors through learning consequences to a behavior i. types of consequences 1) reinforcement = increases the likelihood a behavior will occur again in the future a) positive reinforcement = a pleasant consequence follows the behavior b) negative reinforcement = behavior removes or ends an unpleasant consequence 2) extinction a) occurs when the consequences maintaining a behavior are eliminated 3) punishment a) occurs when behavior is suppressed by an aversive consequence or something pleasant is removed b. modeling = learning through observing the consequences a model receives 1) affect the observer especially if the model is similar and high status c. role of habit i. occurs when behavior is performed automatically and without awareness ii. habits are less dependent on consequences and more dependent on antecedent cues  iii. since habitual behaviors are so difficult to change, “well” behaviors need to be established early in life and unhealthy behaviors eliminated as soon as they appear 3. Social, personality, and emotional factors a. social factors i. ways in which friends/family influence health behaviors 1) encouraging/discouraging health behaviors 2) providing consequences 3) modeling health behaviors 4) communicating values about health ii. gender differences in health-related behaviors may be influenced by parental perceptions of male v. female children b. personality i. personality trait of conscientiousness is associated with practicing health-protective behavior c. role of emotions i. distress over potential illness may interfere with getting preventive screening ii. high levels of stress are associated with unhealthy behaviors such as poor diet, low exercise, smoking, and drinking 4. Perception and cognition a. perceived symptoms influence health-related behaviors i. symptom severity influences help seeking 1) severe symptoms prompt most people to seek medical care 2) moderate symptoms tend to lead people to change health habits to meet needs of health problem b. role of cognitive factors in health behaviors i. people must have correct knowledge and ability to solve problems to engage in healthful behaviors ii. people make judgments that have impact on health 1) assess the condition of their health. 2) make decisions regarding needed changes in health behavior iii. misconceptions on health status can lead to harmful health behaviors 1) example: hypertensives altering medication-taking behavior when lack of symptoms present c. impact of unrealistic optimism i. concept involves peoples’ belief that they are less likely than other people their age or sex to experience negative health situations  1) belief is based on illogical ideas such as the health problem rarely occurring or not having occurred to them yet ii. when a person is sick or when a threat of illness is clear, people are affected by unrealistic pessimism regarding health iii. importance of findings about unrealistic optimism and unrealistic pessimism 1) revealed that feelings of invulnerability is not unique to adolescents 2) people who engage in health practices tend to feel they would be at risk for problems if they did not do so 3) health professionals can implement intervention designed to help people see risks more realistically B. The Role of Beliefs and Intentions 1. How people think may influence how they behave a. example: people who believe in alternative health models (e.g., reflexology) are apt to behave in ways that support those beliefs 2. The Health Belief Model a. theory based on the assumption that likelihood of taking preventive action is dependent on analysis of threat the person feels regarding a health problem and the pros/cons of taking the action b. perceived threat depends upon i. perceived seriousness - severity of effects if problem is left untreated 1) higher perception of seriousness linked to higher perception of threat and taking preventive action ii. perceived susceptibility - vulnerability to contracting the problem 1) perception of higher risk linked to higher perception of threat and taking preventive action iii. cues to action - being reminded or alerted to the problem 1) being aware of cue increases sense of threat and need for action c. perceived benefits must exceed the perceived barriers or costs for preventive behavior to occur d. likelihood of preventive action is based on the combination of perceived threat and the sum of the cost-benefit ratio e. demographic, psychosocial, and structural variables influence perceptions of benefits, barriers, and risks i. includes age, sex, racial/ethnic background, social class, personality traits, knowledge, or prior  experience with health problem f. research supports much of the model i. hundreds of studies have been performed testing different elements of the model ii. findings suggest perceived barriers and perceived susceptibility are strong predictors of health behavior 1) some research also supports cues to action g. theory shortcomings i. does not account for habitual behaviors ii. no standard way of measuring its components 3. The Theory of Planned Behavior a. theory, actually an extension of theory of reasoned action, is based on assumption that people decide on intentions prior to action and intentions are best predictors of behavior b. judgments that determine intention i. attitude regarding the behavior - judgment of whether behavior is a good thing to do based on likely outcome of behavior and whether outcome is rewarding ii. subjective norm - social pressure or appropriateness of behavior based on others' opinions and motivation to comply with that opinion iii. perceived behavioral control - expectation of behavioral success (similar to idea of self- efficacy) c. how intentions are developed i. judgments combine to produce intention that leads to performance of the behavior ii. self-efficacy is important component in development of intention 1) self-efficacy based on analysis of following a) complexity of task b) effort required c) availability of helping resources d. research on theory i. support found for theory assumptions in tests on various health-related behaviors such as donating blood, exercising, using condoms ii. meta-analysis suggests that interventions can change the factors and increase intentions d. theory shortcomings i. intentions and behavior are only moderately related 1) gap can be reduced by intervention that  includes careful, specific planning ii. theory does not include prior experience e. shortcomings in common with Health Belief model i. both assume people think about health-related behavior in a detailed way ii. people know what illnesses are associated with particular behaviors iii. people know how to accurately estimate risks of illness 4. The Stages of Change model a. model emphasizes readiness to change i. people in one stage show different psychosocial characteristics from people in other stages ii. efforts to change behavior not likely until person has made it to more advanced stages iii. people may regress in stages iv. it is possible to help people move across stages 1) have person describe in detail how they will change 2) develop intervention so that match strategies to person’s needs b. stages of the model (see Figure 6.3) i. precontemplation - person hasn't thought about change or may have been decided against it ii. contemplation - person is aware problem exists and is seriously considering change iii. preparation - person is ready to try to change and plans to pursue a behavioral goal iv. action - person engages in active change efforts v. maintenance - person works to maintain successful behavioral changes c. research support i. findings indicate that people at higher stages of model are more likely to succeed ii. studies have also found processes that lead to regression and value of matching interventions to stages in increasing likelihood of success d. model shortcomings i. as with previously discussed cognitive theories, doesn't account for irrational decisions, which appear to be result of motivational or emotional processes not addressed in model C. The Role of Less Rational Processes 1. Motivational factors in beliefs a. motivated reasoning i. a process by which people's desires and preferences influence the judgments they make about the validity and utility of new information  ii. when people prefer to reach a particular conclusion, they may use biased processes, such as accepting only information that supports their conclusion, even if their logic is clearly faulty iii. studies demonstrating nonrational thought in health-related decisions 1) people with chronic illness who use illogical thought patterns tend to not follow medical advice 2) people who are at high risk for HIV infection and use defense mechanisms deny their risk for AIDS perhaps due to high feelings of threat 3) people use irrelevant information to judge risks in having sex 4) smokers give lower risk ratings than nonsmokers 2. False hope and willingness a. 2 features of health-related behaviors not accounted for well by previous theories i. people who fail to change a negative health behavior often try to do so again in the future ii. many risk behaviors occur spontaneously b. false hopes serve as basis for try change again i. false hopes = believing, without rational basis for belief, that one will succeed in subsequent change efforts ii. stem from observation that, for a while, they were successful in previous attempt(s) and that is reinforcing iii. misinterpret cause of previous failure as lack of effort 1) failure often due to expecting too large change of behavior, too great an effect would occur, and change would occur quickly and easily c. risky behaviors often occur without thought i. people find themselves in tempting situations they didn’t expect ii. issue isn’t that they didn’t intend to do a harmful behavior but that they were willing to do it 1) factors influencing willingness a) positive subjective norms b) positive attitudes toward behavior c) having engaged in behavior before d) having a favorable social image of type of person who does the behavior 3. Emotional factors in beliefs a. stress has negative effects on cognitive processing  i. under high stress, people pay less attention to and remember less information from health promotion literature b. Conflict Theory model i. model that accounts for both rational and irrational decision making ii. describes the cognitive sequence people use in decision making 1) stages in model a) appraising the challenge as threat or opportunity b) surveying alternatives to the challenge iii. model proposes people experience stress in all major decisions due to importance of decision and conflicts about what to do behaviorally iv. coping with decisional conflict depends on presence or absence of risks, hope, and adequate time 1) different combinations of above produce different coping patterns a) hypervigilance - person sees serious risks and believe that they may have alternatives, but believe they are running out of time so become frantic and make a hasty decision b) vigilance - see serious risks and believe that they have alternatives and time therefore experience less stress and make more rational choices 2) vigilance is most adaptive coping pattern v. theory has not been tested enough to know its strengths or weaknesses III. Development, Gender, and Sociocultural Factors A. Development and Health 1. As people age, the biopsychosocial factors that contribute to health change a. preventive needs and goals change as a result b. see Table 6.4 for excellent breakdown 2. During gestation and infancy a. birth defects due to genetic abnormalities or harmful factors in the fetal environment affect about 3 out of every 100 births in US b. nourishment as well as hazardous microorganisms and chemicals are passed to fetus from mother c. three prenatal hazards affecting fetus i. maternal malnourishment may lead to low birth  weight, poorly developed immune and central nervous systems, and greater infant mortality ii. infections may be passed iii. presence of addictive or harmful substances (cocaine, cigarette smoke, alcohol) is related to low birth weight, impaired cognitive functioning, higher infant mortality d. health education is advisable for pregnant women e. breast feeding and childhood immunizations improves immune functioning in infants and children 3. Childhood and adolescence a. increased motor development places children at risk for injuries due to accidents i. ways to reduce likelihood of accidents 1) teaching children safety behaviors 2) providing appropriate supervision 3) decreasing access to dangerous situations ii. cognitive processes in young children are immature b. during adolescence, teenagers have cognitive abilities to make logical decisions but peer pressure may exert a negative, immediate influence i. engaging in multiple interrelated risky behaviors occurs ii. also learning to drive during this time period which contributes to likelihood of accidents 4. Adulthood and aging a. adults are less likely to adopt new behavioral risks to health i. older and younger adults may have similar beliefs about effectiveness of behaviors in preventing illness 1) older adults engage in more healthy behaviors 2) older adults may perceive themselves to be more at risk for disease than younger adults and therefore be more likely to engage in preventive behavior as a result b. living in an industrialized country is associated with living longer and being in better physical and financial condition c. engaging in regular substantial exercise tends to decline with age i. exaggerate dangers of exertion on health ii. underestimating physical capabilities iii. embarrassment regarding performance of physical activities B. Gender and Health 1. Life span expectancy is longer for women depending on the country and age group studied  a. factors influencing short life span for males i. males have greater physiological reactivity when under stress contributes to greater likelihood of developing CHD ii. estrogen levels in women delay heart disease by reducing blood cholesterol levels and platelet clotting iii. men smoke and drink more increasing risk for cardiovascular and respiratory disease, cancer, cirrhosis iv. men have higher levels of drug use, unhealthy diets, risky driving and sexual activity v. males less likely to seek medical care vi. work environments of men are more hazardous b. men engage in more strenuous exercise - a behavioral advantage 2. Trends in health problems a. women have higher rates of acute illnesses and nonfatal chronic disease b. women use more medical drugs and services even when pregnancy and reproductive conditions are controlled for C. Sociocultural Factors and Health 1. Section introduction a. study of health in Americans v. British demonstrates 2 trends i. health differs between different countries ii. health differs across different populations of people within a country 2. Social class and minority group background a. health correlates with social class i. people in lower social class are more likely to be born with low birth weight, die in infancy, die before 65, have poorer overall health and longstanding illness in adulthood, or experience more days of restricted activity due to illness b. lower class members have poorer health habits, behaviors and knowledge c. infant mortality and development of chronic illness is much higher among African-Americans d. African-Americans, American Indians, and Hispanics have the highest health problems and risks i. live in environments that don’t encourage practicing positive health behaviors ii. increased vulnerability for 3 health problems 1) substance abuse 2) exposure to HIV 3) higher likelihood of injury or death from violence 3. Promoting health with diverse populations a. solutions to health problems in diverse populations  i. reducing poverty ii. creating effective approaches to present health information at low literacy levels b. professionals who are trying to prevent and treat illnesses need to consider: i. biological factors - differing physiological processes ii. cognitive and linguistic factors - differing ideas about illness, body sensation, and symptom interpretation; language differences between professional and patient iii. social and emotional factors - differing levels and coping reactions to stress; differing types and use of social support c. grassroots, culturally relevant health-promotion programs have been developed in some areas i. example: Por La Vita involves increased breast and cervical cancer testing in Hispanic women IV. Programs for Health Promotion A. Methods for promoting health 1. Motivating people to change is an important step in interventions a. people need to want to change and that requires modifying health beliefs and attitudes 2. Providing information a. people need to know what to do, when, where, and how to do it b. sources of information to promote health i. mass media – television, radio, newspapers, magazines 1) simply supplying information on the negative consequences of an activity has had limited success a) people don't want to change the behavior ii. the Internet - databases and detailed information on specific illness or support groups are increasingly located here iii. medical settings - information provided at the doctor's office 1) advantages: most people visit the doctor annually and respect their doctor 2) disadvantages: offices are busy; personnel may not feel they have expertise to help or feel they are intruding in personal lives of patients 3) office system should be structured in such a way to promote giving information a) 5- to 10-minute counseling sessions  done in person or over the phone b) developing a system of cues 4) physicians can give personal risk estimates on disease and opportunities to undergo tests a) even when opportunity is available, patients are hesitant to have tests due to anxiety or conflict with other family members who don’t wish to know the risk 3. Features of information to enhance motivation a. using tailored content i. give information delivered in person, in print, or over the telephone should be specific to the listener and based on characteristics of that person b. message framing i. information emphasizes benefits or costs of behavior or decision 1) gain-framed message - focus on attaining desirable consequences or avoiding negative consequences a) best for motivating behaviors that serve to prevent or recover from illness or injury 2) loss-framed message - focus on getting undesirable consequence and avoiding positive consequences a) best for behaviors that serve to detect a health problem early ii. effectiveness of frame depends on type of health behavior iii. fear appeals are a special type of loss-frame message 1) linked to health belief model concept that people who believe they are more susceptible to risk (threat) when they do not engage in preventive behavior are motivated by fear to engage in the behavior 2) effects of fear appeals are transient 3) ways to make fear appeals more effective a) emphasize organic and social consequences of developing health problem b) provide specific instructions/training for performing behavior c) help bolster self-confidence or self- efficacy for behavior 4. Motivational interviewing a. motivational interviewing is a counseling style designed to help individuals explore and resolve ambivalence to  changing behavior i. “client-centered” approach where client has control over conversation and counselor uses reflective listening and directive questioning to determine person’s internal motivation for behavior change is used ii. decisional balance = client lists reasons for and against changing behavior so these can be discussed and weighed iii. interview may involve single or multiple sessions iv. session(s) lead patient to identify benefits and problems and then work through identified problems v. research has found this is a promising method vi. decisional balance is identified has critical component of process 5. Behavioral methods a. techniques that focus on enhancing performance of the preventive act itself by altering antecedents and consequences b. altering antecedents i. providing specific instructions or training ii. creating calendars to indicate when to perform behavior iii. developing reminders of appointments c. altering consequences i. providing rewards when behavior occurs 1) effectiveness depends on type of reward, age of person, person’s interest in performing behavior d. for programs to be effective, they need to consider the viewpoint of the person regarding preventive action and consequences of behavior 6. Maintaining healthy behaviors a. after new behaviors have been developed some lapse or relapse may occur i. lapse - a momentary backsliding ii. relapse - returning to original behavior pattern 1) more common when person tries to change long- standing behavior b. abstinence-violation effect i. when experiencing a lapse destroys confidence in remaining abstinent and precipitates a full relapse 1) can be reduced by training to cope with lapses, maintaining self-efficacy about behavior, and providing “booster” sessions or contacts a) need to provide counseling about dealing with difficult situations that  could lead to relapse B. Promoting Health in the Schools 1. School-based health education may teach children to avoid harmful practices and acquire beneficial behavior 2. Effectiveness of school programs a. have demonstrated improvement in blood pressure and cholesterol levels b. have shown improvements in health behavior and physical condition c. characteristics of effective school programs i. comprehensive programming ii. program involves children’s parents and community over a long period C. Worksite Wellness Programs 1. Wellness programs are increasing rapidly in workplaces in industrialized countries a. national survey results i. 90% of responding employers had some kind of health promotion activity ii. 1/3 of small worksites and 1/2 of large worksites had comprehensive programs b. impact of employee health on workplace i. poor employee health costs employers in terms of health benefits and absenteeism ii. costs of running wellness programs is offset by savings in health benefits and less cost due to absenteeism 2. Aims of programs a. reducing risk factors such as hypertension, cigarette smoking, diet & weight, physical fitness, alcohol abuse, and stress 3. Advantages of worksite programs a. convenient to attend b. inexpensive for employees c. provides employees with reinforcement d. can structure environment to encourage healthful behavior 4. Johnson & Johnson's "Live for Life" program a. one of the most effective worksite programs developed b. components of the program i. a health screening ii. lifestyle seminar iii. action groups focus on specific problems iv. follow-up contacts v. work environment changes c. evaluation results found improvements in health indicators, absenteeism, and health care costs in program participants D. Community-Wide Wellness Programs  1. Programs designed to reach large numbers of people with intention of improving knowledge and performance on preventive behaviors a. programs often use media to provide information and advice on risk factors b. incentives may also be provided 2. The Three Community Study a. purpose was to change behavior and reduce risk for cardiovascular disease b. three California communities selected for the study i. two communities were given media information on smoking, diet and exercise whereas the third was treated as the control c. results indicate overall cardiac risk increased in the control community and decreased in experimental communities i. best results in older populations and worst results in younger populations, participants with less education, and participants with lower socioeconomic status 3. Other similar programs have demonstrated similar success a. overall impact of programs tend to be modest but significant when population impact is considered E. Prevention With Specific Targets: Focusing on AIDS 1. HIV infection a. magnitude of AIDS threat i. tens of millions have died around the world ii. nearly 40 million currently infected iii. millions newly infected each year b. demographics of infection i. largest concentration of infection in sub-Saharan Africa ii. growing incidence in Asia and Eastern Europe iii. declines seen in industrialized countries 1) development of new medical treatments has affected infection process in developed countries c. modes of HIV transmission i. contact between body fluids of infected and uninfected persons through sexual activity or use of shared needles ii. transmission of virus from mother to baby during gestation, delivery or breast-feeding d. risk factors for HIV infection i. in US, male-to-male anal intercourse still major risk factor ii. in US, risk of exposure is growing in low-income and minority groups iii. in other parts of world, major modes of infection include sharing needles and unprotected  heterosexual vaginal intercourse iv. females are becoming increasingly at risk v. uncircumsized males are at greater risk vi. unsafe sexual behavior remains major risk 1) prevention efforts have focused on fear messages and providing information to promote safer-sex practices e. factors influencing unsafe sexual behaviors i. ignorance ii. lack of availability of protection iii. promiscuity iv. having sex under influence of alcohol or drugs 1) related to increased negative attitudes and decreased self-efficacy about condom use 2) increases willingness to have unsafe sex v. beliefs about the closeness or seriousness of the relationship related to reduced condom use vi. using denial or wishful thinking during decision making in sexual situations vii. beliefs of low self-efficacy about using condoms and decrease in sexual pleasure if one is used viii. embarrassment over buying condoms and errors in using them ix. medical treatments that lower viral load and their link to over-optimistic beliefs f. maladaptive beliefs are demonstrated when behavior contradicts expert information and qualifiers are added to statements 2. Basic messages to prevent HIV infection a. information on basic behaviors, much of which has been designed to arouse fear i. avoid or reduce sex outside of long-term monogamous relationship ii. people who have HIV may not know it and some who do know do not report it to sexual partners iii. drug users shouldn’t share needles unless sterilized iv. women should be tested for HIV before becoming pregnant and, if positive, avoid becoming pregnant b. impact of information on HIV-related knowledge and behavior i. information has been directed toward adolescents and young people, intravenous drug users and their sexual partners, and gays and bisexuals ii. although information increases knowledge, sexually experienced persons don’t follow recommendations for behavior change iii. virginity pledges are commonly broken within a year  1) promoting condom use is more effective in sexually active youth iv. information has reduced risk behaviors in drug users but only so far as it relates to drug behaviors 1) sexual behaviors are not affected c. best organized efforts have been present in gay communities who were already organized through social, political, and religious groups prior to HIV pandemic i. groups became mobilized to address HIV public health campaigns ii. results of efforts in gay community reflect most profound behavioral changes in health-related behaviors ever recorded 3. Focusing on sociocultural groups and women a. intervention efforts must be increased with heterosexual women and disadvantaged sociocultural groups i. some minority groups may be at risk due to less knowledge or distrust of medical system ii. factors placing women at risk for HIV 1) male partner who resists using condoms 2) being socially/economically dependent on male partner 3) having less power in their relationship 4) violence within the relationship 5) partner who interprets request to use condom as sign she doesn’t care for him or suspects him of infidelity iii. interventions with Hispanic and African American women 1) sessions were designed to increase motivation and interpersonal skills for adopting safer sex practices 2) results: more likely to report using safer sex practices & obtaining condoms; less likely to develop STDs 4. Making HIV prevention more effective a. individual counseling (motivational interviewing) has had best success with those already infected b. uninfected people often do not reduce risky behaviors c. well-designed programs should include: i. tailoring the program to sociocultural group needs ii. training in actual skills iii. using methods to reduce behaviors that increase risk of unsafe sex iv. bolstering self-efficacy and advancing people through stages of change v. using respected or popular individuals to lead program vi. encouraging infected person to disclose HIV status vii. reducing nonrational influences on sexual decisions