Chapter 3

Health Promotion and Risk Reduction

Health Promotion and Community Health Nursing (1 of 3)

Health promotion:

● any combination of health education and related organizational, economic, and

environmental supports for behavior of individuals, groups, or communities conducive to
health
-Green and Kreuter (1991, p. 2)

● ... that which is motivated by the desire to increase well-being and to reach the best
possible health potential
-Parse (1990)

Health Promotion and Community Health Nursing (2 of 3)

Health protection:

● ... those behaviors in which one engages with the specific intent to prevent disease,
detect disease in the early stages, or maximize health within the constraints of disease
-Parse (1990)

● ... an important step in maintaining health

Health Promotion and Community Health Nursing (3 of 3)

Defining health:

● The way health is defined has shifted from a focus on the curative model, to a focus on
multidimensional aspects such as the social, cultural, and environmental facets of life
and health
-Benson (1996)

● "A state of complete physical, mental and social well-being, and not merely the absence
of disease"
-WHO (2009)
Healthy People 2020

● The health promotion initiative for the nation

● Broad goals
○ Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death.
○ Achieve high equity, eliminate disparities, and improve the health of all groups.
○ Create social and physical environments that promote good health for all.
○ Promote quality of life, healthy development, and healthy behaviors across all life
stages.

Determinants of Health

● Biology
● Behaviors
● Social environment
● Physical environment
● Policies and interventions
● Access to high-quality health care

Theories in Health Promotion (1 of 4)

● Community health nurses and their clients engage in health promotion activities
in:
○ Workplace settings
○ Schools,
○ Clinics and
○ Communities
Pender's Health Promotion Model (HPM)

● Explores biopsychosocial factors that influence individuals to pursue health promotion

activities

Theories in Health Promotion (2 of 4)

● Health Belief Model (HBM)

○ Provides the basis for much of the practice of health education and health
promotion today
○ How does the patient perceive his or her health?
■ Perceived seriousness
■ Perceived susceptibility
■ Perceived benefits of treatment
■ Perceived barriers to treatment
■ Cues to action
■ Self-efficacy
Transtheoretical Model (TTM)

● Combines several theories of intervention, constructs of the model includes:

○ Self-efficacy
○ The process of change
○ Based on assumption behavioral change takes place over time, progressing
through change.
○ Change is difficult, even for motivated individuals.
Theory of Reasoned Action (TRA)
● Assumption that all behavior is determined by one's behavioral intentions
-Montano and Kasprzyk (2008)

○ One's attitude is determined by one's belief about the outcomes of performing the
behavior, weighed by one's assessment of the outcomes.

Risk and Health

● Risk is "the probability that a specific event will occur in a given time frame"
-Oleckno (2002)
○ A risk factor is an exposure that is associated with a disease.
-Friis and Sellers (2004)

● Risk assessment is a systematic way of distinguishing the risks posed by potentially

harmful exposures
○ Hazard identification
○ Risk description
○ Exposure assessment
○ Risk estimation

Relationship of Risk to Health and Health Promotion Activities (1 of 3)

● Modifiable risk factors

○ Individual has control.
○ Examples: smoking, lifestyle, eating habits, activities

● Nonmodifiable risk factors

○ Individual has little or no control.
○ Examples: genetics, gender, age, environmental, exposure
Relationship of Risk to Health and Health Promotion Activities (2 of 3)

● U.S. Surgeon General provides a useful tool to help clients assess their family history for
health risks, which can be found on-line at: [Link]

Relationship of Risk to Health and Health Promotion Activities (3 of 3)

● Risk reduction
is a proactive process enables individuals to react to actual or potential threats to
their health
-Pender (1996)

● Risk communication
is the process of informing the public regarding threats is affected by perceptions,
process, and actions

-Finnigan and Vinswanath (2008)

Tobacco and Health Risk (1 of 3)

● Leading cause of preventable death

● Most common in less educated populations and those living below poverty level
● Smoking is a causal factor in cancers of the:
• Esophagus
• Bladder
• Stomach
• Oral cavity
• Pharynx
• Larynx
• Cervix
• Lung

Tobacco and Health Risk (2 of 3)

● More than 70% of current smokers report they would like to quit smoking.
● Nicotine addiction is the most common form of chemical dependence.
● Smokers who try to quit experience withdrawal symptoms such as:
• Anxiety
• Increased appetite
• Irritability
• Difficulty concentrating
Tobacco and Health Risk (3 of 3)

● Quitting
• Information on quitting can be accessed at the CDC website at:
[Link] smoking/[Link]
• Look for teachable moments
• Assess client's tobacco use
• Explore willingness to quit
• Refer to cessation programs
• Encourage attempts to quit

Alcohol Consumption and Health (1 of 3)

● Alcohol use is very common in our society.

● Binge drinking is an unrecognized problem among women and girls.
• One in five high school-aged girls
• One in eight adult women
● Similar in pregnant and nonpregnant women

Alcohol Consumption and Health (2 of 3)

● Dietary guidelines for Americans states that alcohol would be consumed in moderation
no more than one drink per day for women and two drinks per day for men.
● A drink is:
○ 12 ounces of beer or wine cooler
○ 8 ounces of malt liquor
○ 5 ounces of wine
○ 1.5 ounces of 80-proof distilled spirits or liquor

Alcohol Consumption and Health (3 of 3)

● Prevent underage drinking

● Identify individuals and groups at risk of abuse and dependence
● Education of both adults and youth regarding alcohol and risks posed by underage
alcohol consumptions must accompany enforcement efforts.
● "Too Smart to Start" program targets parents and caregivers of 9- to 13-year-olds.
● Requires a community-wide effort to address the problem on several fronts
Diet and Health (1 of 3)

● Diet is one of the most modifiable of risk factors.

● Healthy diet contributes to prevention of chronic disease such as:
○ Type 2 diabetes
○ Hypertension
○ Heart disease
○ Some cancers
○ Diet and Health (2 of 3)

Diet and Health (2 of 3)

● Obesity in the United States was unchanged from 2003 to 2004 and 2011 to 2012.
● No state met the Healthy People 2020 goal to reduce obesity prevalence to 15%.
● Educate clients about:
○ Balancing caloric intake and physical activity
○ Servings vs. portion control
○ Eating away from home affects "portion distortion"
○ Using social media and mobile applications to help

Diet and Health (3 of 3)

● USDA recommends that all Americans go to choose My Plate website to develop a

personalized eating plan based on individual needs and preferences:
[Link]

Physical Activity and Health (1 of 2)

● Community nurses are commonly asked, how much exercise do I need or what counts
as exercise?
● Answers can be found on the CDC website: [Link]
activitity/basics/inde [Link].
Physical Activity and Health (2 of 2)

● Walking has been found to be one of the most beneficial exercises.

○ Does not require expensive equipment O People with disabilities are able to
participate with assistive devices.
○ Easy form of physical activity to perform and maintain
○ Lower likelihood of injury than more vigorous forms of exercise
○ Good activity for those who are physically inactive
○ Can adapt to one's abilities, time, and circumstances

Sleep and Health (1 of 2)

● Sleep is an essential component of chronic disease prevention and health promotion.

● Requirements change with age and life circumstances.
● Regulated by waking time and circadian rhythms
● Hormones during sleep affect memory, blood pressure, and kidney function.
● Sleep assessment tool is found on the National Sleep Foundation's website at:
[Link]

Sleep and Health (2 of 2)

● Sleep assessment is important.

○ Identify disorders that may affect daily activities.
○ Keep sleep log.

● Practice sleep hygiene

○ Establish environment that promotes sleep.
○ Avoid food and activities that interfere with sleep.