There are several basic factors that influence one’s health; some of the most important ones include nutrition, level of physical exercise, smoking and drinking behaviour, drug use, sleep regimen and even such things as wearing a seatbelt. These factors have a direct influence on many health problems. However, how a person behaves in these aspects of life is determined by other overarching factors – some of them are protective while some increase health risks. We decided to divide factors that influence our health behaviours into protective and risk factors. These factors can be biological or environmental in nature.

This chapter will introduce some of the key social and dispositional factors that play a role in health behaviours.  More information relevant to specific health problems may be found in the relevant chapters.

Social factors

One of the basic forms of learning is modeling or in other words, imitating what other people around us do. Every child and even every adult learns behavior in this way, mainly from one’s parents and later in life from one’s peers. Consequently, it becomes a very important health protective factor when one’s parents and peers have a healthy lifestyle; one is much more likely to eat healthy food, exercise, drink alcohol moderately, sleep well and fulfill other rules of healthy living once her parents and peers also behave in this way. Sadly, the same is true about the opposite; if one’s parents and friends smoke or eat junk food, there is a relatively high probability that one is also going to.

Mays et al (2014) carried out a study of 406 adolescents ages 12 to 17 to determine the effect of parental smoking behaviour. Interviews were carried out both with the adolescents and their parents.  The adolescents then had follow-up interviews one and five years later. The parental interviews focused on parental smoking history, current smoking, and nicotine dependence.

The researchers found that adolescents with parents who were nicotine-dependent smokers were more likely to be early regular smokers and early experimenters with each additional year of previous exposure to parental smoking. The researchers concluded that adolescents with nicotine-dependent parents are susceptible to more intense smoking patterns and this risk increases with longer duration of exposure.

Economic factors are extremely important as protective as well as risk factors in health behaviour. Poverty is one of the major risk factors when it comes to health. People living in poverty tend to have significantly higher levels of stress than financially secure individuals. Not only that, they also have less access to appropriate health care. They often live in insufficient housing conditions and are more likely to be malnourished and experience physical violence. As a result of this, people living in poverty have statistically more health problems.

Haan et al (1987) looked at the mortality rate of residents in a poor neighborhood in the US over a period of nine years.  All participants in the study were 35 years or older.  The members of the community were matched with the national averages based on several variables.  These included age, race, sex, income, employment status, access to medical care, health insurance coverage, smoking, alcohol consumption, physical activity, body mass index, sleep patterns, social isolation, marital status, and diagnosis of depression.

The findings were that the rate of mortality was 1.71 higher than the national average across all variables.  This means that the residents of the poor neighborhood in Oakland, California were almost twice as likely to die of health-related causes in the period of the study as residents of non-poverty neighborhoods. These results support the hypothesis that one's socioeconomic environment may be an important risk factor for poor health and early mortality - and that this may be independent of individual behaviours. 

Dispositional factors

Personal factors are also crucial to one’s health-related behaviour. Many aspects of one’s personality influence health such as risk-taking tendency or self-efficacy. One aspect of personality aspect that appears to have a direct effect on health is one's locus of control - an individual’s perception of personal agency. Some people tend to think they have control over events in their life and they believe that they determine their own fate; these people would have an internal locus of control. On the other end of the spectrum, there are people who believe they have minimal influence over their own lives and it is rather luck or some other external force that decides what is going to happen to them – these people have an external locus of control.

As could be inferred, having an internal locus of control is a protective factor in health behaviour while having an external one is a risk factor; individuals with an internal locus of control are more likely to lead a healthy lifestyle as they believe that by doing so they can influence their health situation. On the contrary, people with an external locus of control tend to think whatever they do, their health is predetermined and they cannot do anything about their situation, so “why bother?” The same principles also work in case a person becomes seriously ill; if she has an internal locus of control, she will work hard on trying to recover while if she has an external locus of control, she will feel helpless and that she cannot change her fate. She may be passive and demonstrate only limited health-promoting actions. 

Sangeeta et al (2015) researched the relationship between health-promoting behaviour and locus of control. Their sample consisted of 200 college students (50% males, 50% females). They found a significant positive relationship between internal locus of control and health responsibility, physical activity, good nutrition, spiritual growth, and even interpersonal relationships and stress management. This study confirms the suggestion that an internal locus of control is a good predictor of a healthy lifestyle.

 Teacher only box

When discussing the three behaviours most influential in controlling obesity, students need to be able to justify their choices.  This may be done by a process of elimination or through sound reasoning about the value of a cultural trait. Comments are included below which give my own opinion on this question.

1. People do not deprive themselves of the foods they love - they just eat smaller portions of those foods. This is the "all things in moderation" argument.  Many health professionals argue that smaller portions are really key to weight control; however, other researchers have shown that it is not as simple as "calories in/calories out."

2.  The French spend time preparing their meals. Processed and packaged foods are often avoided. This brings up the question of whether processed or packaged food is less healthy AND may lead to weight gain.  This argument is a bit problematic in that some packaged foods are bad for your weight, but not necessarily all. Whether they are healthy overall, however, is a different question.

3.  Meals are served in courses.  This gives the diner time between courses and slows down the eating process.  This may also mean that the diner is feeling full later in the meal and will eat less. Thus, the logic of having the high-calorie dessert last! However, it may also mean that there is a feeling of social pressure to consume all the courses, whereas in a culture where all food is available at once, an individual may make choices not to eat certain foods.

4.  The French eat when they are hungry.   There is a French saying, "Bon repas doit commencer par la faim" -   A good meal must begin with hunger.  It is questionable just how true this is.  But the cultural rule is that if you don't feel like eating, then you should wait to eat. The highly regimented "dinner time" in many cultures means that people eat - hungry or not. This means consuming unnecessary calories.

5.  Fresh fruit is often served as dessert. Although fruit also has sugar, it is not as caloric as other foods. This is definitely a healthy alternative and low in calories.

6.  The television is not on during meals.  Dinner is a time when people talk about their day and engage in friendly debate. This may be seen as very good "social hygiene", but it is not clear what role this would pay in obesity.

Checking for understanding