Developmental differences in health behaviours Health Psychology
Illness cognitions among children • Several researchers have used the cognitive perspective to explore the development of illness concepts among children. Bibace and Walsh (1980) interviewed children of different ages about their concepts of illness. They then coded the children’s replies into Piaget’s (1930) stages of cognitive development. Children between the ages of 2 and 6 years provided more pre-logical explanations. At this age the most common explanation for illness was contagion. People became ill because they were close to certain contagious objects or persons.
Illness cognitions among children • Between 7 and 10 years children offer more concrete-logical explanations. At this age the children explain illness in terms of internalisation and contamination. The person is required to come into physical contact with the source of the illness and possibly to ingest it.
Illness cognitions among children • Finally, 11-year-olds’ explanations were more formal-logical. The children offer a more physiological explanation referring to internal physiological processes. Kister and Patterson (1980) also referred to Piagetian concepts and suggested that young children explain illness in terms of ‘immanent justice’ — a form of punishment for a transgression.
Illness cognitions among children • Several commentators (e.g. Burbach and Peterson, 1986) have questioned the methodological adequacy of these and comparable studies. Siegal et al. (1990) found that young children were reluctant to use contagion to explain toothache but correctly used it to explain getting a cold. They suggested that in previous work ‘rather than lacking knowledge of the causes of illness, [the children] may simply have misunderstood the procedural requirements of the interview.
Illness cognitions among children • They also found no evidence that illness is described in terms of immanent justice. They suggested that in previous research the children may have attempted to comply with the suggestion of an adult interviewer that adults may be so powerful that children who are naughty will be inevitably punished’ (p. 160).
EXERCISE AMONG CHILDREN • There are substantial variations in the extent of participation of children in physical activity. Sex, socio-economic and ethnic variations are apparent from an early age. Simons-Morton et al. (1997) conducted a large survey of over 2,400 third grade (8- to 9-year-old) children in four US states. They found that not only did boys participate significantly more in moderate to vigorous physical activity but they also participated more in sedentary activities. Specifically, boys spent more time than girls watching television and playing video games.
EXERCISE AMONG CHILDREN • The ethnic differences in physical activity were not significant after controlling for other demographic variables.
EXERCISE AMONG CHILDREN • Gottlieb and Chen (1985) considered the character of physical activity among a sample of 2,695 seventh and eight grade students (12—14 year olds) in Texas. They found that the female students were more likely than the males to participate in running, swimming, dancing, skipping, tennis, roller-skating and volleyball. These activities were largely classified by sporting experts as individual, non-competitive and potentially aerobic activities. The male students preferred team, competitive, non-aerobic activities.
EXERCISE AMONG CHILDREN • Gottlieb and Chen also found evidence of ethnic differences. After controlling for father’s occupation, Anglos were more likely to engage in individual, non-competitive, aerobic type activities (bicycling, swimming, tennis, Frisbees, roller skating and golf). Blacks favoured competitive team sports such as basketball and also dancing, while Mexican-Americans preferred baseball. Gottlieb and Chen suggest that children choose sports that older members of their own race (role models) have been successful in.
Predictors of children’s participation • Initial attempts to explain children’s participation in sporting activities focused on parental modelling. Moore et at. (1991) found that more active parents are more likely to have more active preschool children. SimonsMorton et at. (1997) found that a generalized measure of support for physical activity from parents, teachers and peers predicted extent of physical activity among the children.
Predictors of children’s participation • In an attempt to distinguish between parental influence and children’s attributes Stucky-Ropp and DiLorenzo (1993) conducted a study in a Midwestern American town which involved structured interviews with over 200 10- to 12-year-old children and their mothers. Statistical analysis of their findings showed that the children’s reported enjoyment of physical activity was the most salient predictor of exercise behaviour. In addition, the mothers’ perceptions of barriers to exercise (e.g. lack of time) and mothers’ reports of family support were important.
Predictors of children’s participation • There were also some sex differences. Boys’ activity was also predicted by their perception of modelling and support of exercise behaviour by family and friends, whereas girls’ activity was more predicted by presence of exercise-related equipment at home and parental modelling. These results confirm the central role of family environment in establishing an interest in physical activity among children.
Predictors of children’s participation • As children move into adolescence it would be expected that the influence of parents would decline. Reynolds et at. (1990) explored this issue with longitudinal data on 743 14- to 16-year-old students from the control condition of the Stanford Adolescent Heart Health Program. They collected baseline data on these teenagers and then followed them up four and 16 months later. At four months the best predictor of physical activity for both males and females was baseline activity.
Predictors of children’s participation • For boys, self-efficacy (confidence that they could exercise despite obstacles) was a nonsignificant predictor but not social influence, which included the activity levels of family and friends. This would suggest the development of a more independent lifestyle. For girls social influence was important as was perceived stress and intention. At 16 months baseline activity remained important for boys but not self-efficacy, perhaps another indicator of their changing lifestyle and the conflicting influences. For girls, self-efficacy was important.
Social meaning of sport for young people • Much psychological research into the development of physical activity has adopted a deterministic model such that it is assumed that participation is ‘caused’ by a combination of social and psychological variables. This approach ignores the active role of the young person in deciding whether or not to become involved and the social context within which physical activity occurs. A limited number of studies have adopted this more social perspective.
Social meaning of sport for young people • Kunesh et at. (1992) conducted a detailed investigation of the school play activities of a sample of 11- to 12-year-old girls in central USA. In interviews the girls reported that they found physically active games at home and at school enjoyable. However, in the school playground the girls preferred to stand in a group and talk while the boys participated in various games. When the girls did participate in games the boys often criticized them for their supposed inferior skill performance.
Social meaning of sport for young people • To avoid this negative treatment the girls excluded themselves. The girls reported that when playing at school they felt nervous and embarrassed. These findings would suggest that while at an early age boys and girls both enjoy physical activities by the time they reach puberty the girls feel that they are being excluded.
Young people’s decisions about sport participation (based on Coakley and White, 1992) • ·Consideration of the future, especially the transition to adulthood: certain sports are accepted and others rejected depending upon their perceived adultness. Teenagers reject those games, which they perceive as childish. Young women in particular become less involved in sporting activities, which they perceive as having little connection with the female role.
Young people’s decisions about sport participation (based on Coakley and White, 1992) • Desire to display and extend personal competence and autonomy: young people become involved in sporting activities to the extent to which it extends their feeling of competence and autonomy. Again, there are gender differences with the young women being less likely to define themselves as sportspersons even if they are actively involved in physical activities. For them, sport is often perceived as a more masculine activity.
Young people’s decisions about sport participation (based on Coakley and White, 1992) • ·Constraints related to money, parents and opposite-sex friends: access to material resources is an important factor in explaining whether young people participate in certain sporting activities. In addition, the young women emphasize the importance of parents who seem to adopt a much more controlling influence on their general social lives.
Young people’s decisions about sport participation (based on Coakley and White, 1992) • ·Further, the extent of participation in sporting activities is affected by whether or not the young women have a boyfriend. It is often the boyfriend who initiates leisure activity and restricts or encourages participation in sporting activities. Indeed, the young women seem to give their own interests a low priority in order to maintain their relationships with their boyfriends.
Young people’s decisions about sport participation (based on Coakley and White, 1992) • ·Support and encouragement from parents, relatives, and/or peers: young people report that they are often actively encouraged by family or friends to participate in certain physical activities. The young women in particular note the importance of having a friend to accompany them to sporting activities.
Young people’s decisions about sport participation (based on Coakley and White, 1992) • ·Past experiences in school sports and physical education: many young people report certain negative school experiences, which colour their attitudes to physical activities. In particular, young women comment on how school physical education was associated with feelings of discomfort and embarrassment. Young men seem to have more pleasant memories of school sport.
Foetal alcohol syndrome • Health issues for children start before they are born. It is important for the developing child to have a good level of nutrition and be relatively free from drugs and alcohol. An example of the consequences of early disadvantage is foetal alcohol syndrome (FAS). The symptoms of FAS are head and facial abnormalities, brain damage, low birth weight, hearing problems and impairment of growth.
Foetal alcohol syndrome • The syndrome is commonly associated with the children of alcoholic mothers, and there may well be other issues as well as alcohol that create the problems. For example, the alcoholic mother might not be eating well, sleeping well, or attending antenatal clinics. Research studies with animals, however, can use controlled experiments to estimate the effect of alcohol on the young.
Foetal alcohol syndrome • Studies on rats have found that one binge-drinking episode early in pregnancy is enough to create a measurable effect in 50 per cent of births (Sulik et al., 1981), and also measurable differences in brain structure in the regions associated with long-term memory (Dumas, 1994).
Child survival • An application of psychology outside the Western world has been in the UNICEF strategy to improve the rates of child survival. The strategy is called GOBI which is an acronym of the first words of the four points listed below (Harkness at al., 1988);
Child survival • 1. Growth monitoring to identify early cases of malnutrition and failure to grow. • 2. Oral re-hydration therapy for infants and children with severe diarrhoea. Diarrhoea is a major cause of death in poor countries, and was in fact the major cause of infant death in British cities until the turn of the 20th century. The therapy reduces the high rate of death from fluid loss.
Child survival • 3. Breast-feeding promotion, because breast milk is high in nutrition, and also helps to immunise the baby from some common diseases. Breast-feeding also reduces the chances of infection from un-sterilised bottles. • 4. Immunisation against the major childhood infectious diseases.
Child survival • Psychology can make a major contribution to this programme, especially in the promotion of breast-feeding. This behaviour is full of social meanings and it is not enough to present a direct message in the terminology of Western medicine. Fernandez and Guthrie (1983, cited in Berry at al., 1992) suggest that it is important to take account of lay beliefs about health when education programmes are designed. If the programme describes traditional behaviours and beliefs as harmful, then it is unlikely that local people will respond to the message.
Child survival • There is also the counter pressure from multinational companies who encourage women to buy their baby milk, despite the lack of available money and the health risks of bottle-feeding in poor communities. Fernandez at al. (1983, cited in Berry at al., 1992) were able to make a successful intervention to encourage breast-feeding in the Philippines. Their success was based on the behavioural idea of rewards, and they offered women praise, health coupons and lottery tickets as incentives to breast-feed, plant leafy vegetables and visit the health centre every month.
Bullying • A modern concern for children’s health, although it is probably an old problem, is the experience of bullying. Many children experience bullying at school and this may well have an effect on their general health. Natvig et al. (2001) surveyed 850 schoolchildren between 13 and 15 in Norway and asked about their general symptoms of health.
Bullying • They found that some symptoms such as irritability, headache, backache (boys), and nervousness and sleep disturbance (girls) were more common in children who had some recent experience of bullying. It appears that children who experience frequent bullying report substantially more symptoms, some of which might have a long-term negative effect on their health.
The health of older people • The proportion of older people in the European population is higher than it has ever been and it is expected to grow further (Walters et al., 1999). People over 65 made up 9 per cent of the population in the 1950s and are likely to make up 18 per cent of the population in 2020. These figures can be used to spread alarm about the ability of the welfare state to support older people, but what is sometimes overlooked is the level of good health and independence that older people might well enjoy.
The health of older people • If our society promotes good health in older people, they will remain fit and active for longer. In the UK, research suggests that physical activity declines sharply at 55 with a third of people over 55 doing no exercise at all, compared with a tenth of people aged 33—54 (Walters et al., 1999). A reasonable target for health promotion, then, is to increase the level of activity in older people.
The health of older people • One of the issues to consider when designing a health promotion for a group of people is that they will have a range of individual needs. Older people are as diverse as any other group in the population — the main feature they share is the length of time they have survived. So it you wanted to promote healthy eating in older people it would not be appropriate to use a simple message like ‘reduce the intake of calories and fat’ because some older people need to deal with dietary deficiencies.