Prevelance_of_Preventive_Health_Practices_Among_Young_Adult_Population_in_Mucg._(Long_Essay)

CHAPTER ONE INTRODUCTION 1.1 BACKGROUND OF THE STUDY Stone (1987), puts definitions of health into two categories: those that portray health as an ideal state and those that portray health as movement in a positive direction. The first definition implies that any disease or injury is a deviation from good health and that the ideal state can be restored by removing the disease or disability. Brannon & Feist (1992). The second definition, however, implies the multidimensional and continuous nature of health in a progressive direction. The second category of definitions simply speaks of health not just being an absence of disease but a conscious state of progressive wellness. One such is the definition of health by the World Health Organization. The World Health Organization (1948) defines health as a complete state of physical, mental and social well-being and not just the absence of disease or infirmity. These two categories of definitions bring two different conditions. One refers to an absence of disease and the other more aptly defining health in an extension. As to say that the continuous maintenance of that state where infirmity or disease is absent is what is best described as good health. However, the WHO definition is also so apt because of the fact that there may be people living with forms of infirmity who might be healthier in some sense than the able-bodied person. For instance, a person may find himself crippled and in a wheel chair but still maintain a superior level of health. Health, ultimately, is multifactorial. There are multifactorial contributors to one’s medical, physical health and also multifactorial dimensions of good health or wellness. Overall soundness involves mental, social, physical and emotional well-being of the individual. Focusing on physical, medical health, there are several contributors to what we will call good health. According to Gatchel, Baum & Krantz (1989), genetics have an effect on health and behavior. Darwin proposed the principle of natural selection. Behavioral genetics has proven genetics have an effect on health and behavior. Such factors are beyond our control. Our wellness or well-being health wise, however, is not just determined by such biological factors. Even within biological factors, apart from the action of genes, there are also the actions of neurotransmitters and other neurochemicals. These independent factors are strongly interdependent. The actions of genes go to affect the actions of various biological chemicals and both of these manifest physically in the individual. Both these factors are greatly influenced also most times by environmental factors. Environmental factors can either hinder or facilitate the physical manifestation of genetic and neurochemical information. This study focuses exclusively on these environmental factors. Within the various environmental factors that ostensibly affect our health and well-being, there are two further divisions. There are the grand, widespread factors which we have little control over. For example, every person in the world right now is exposed to different levels and kinds of pollution as a result our activities as a race over the years. These factors could well be influenced by human activity but as an individual there is very little one can do to avoid the influence of these factors. This compared, perhaps, to the personal hygiene conditions that one lives in. This brings us to the next group of factors which we can exercise a great deal of control over. In our current society, unfortunately, keeping personal hygiene may go a long way but may be woefully inadequate to keep one healthy. This is simply because the health problems of today have very little to do with parasitic and pathogenic infections that were very rampant some time ago. Worldwide, since the 19th century, the leading model of health and illness has been biomedical. (Brannon and Feist, 1992). The biomedical health model, deals with health problems by going through its core properties. This model is dualistic, mechanistic, reductionist and disease oriented. The model works on the principle that the body and mind are two separate entities. If a person was ill, it was because of a physical interference of the body’s normal mode of operation. A pathogen or germ intruded and as a result the individual was ill. The model targeted the pathogen and sought to destroy it to return the individual to their wellness state. The model had great advantages, the greatest, being the eradication of most infectious diseases and the development of medical technologies. With the success of the biomedical model and the rising quality of human life came the evolution of illness and disease. Enter the bio psychosocial model which incorporates psychological and social factors with the physical aspects of health and illness. With this system, the mind and the body are no more separate entities. The influences of the environment and the mind on an individual’s physical well-being are rightfully considered. (Gatchel, Baum & Krantz, 1989). Illnesses of our time are what are referred to as lifestyle diseases. Diseases that are as result of the kind of life choices we make, diet, exercise and substance use. Such diseases as diabetes, cardiovascular diseases, cancer, stroke, multiple sclerosis and the like. The problem with the bio psychosocial model apart from it being time and effort consuming is that it is quite expensive. Even more expensive is the cost of treatment and management of these lifestyle diseases. These diseases continue to take so many lives because of their ever increasing prevalence as a result of persistent bad lifestyle health choices. Especially within the emerging generations, lifestyle pressures and the pressures of the society predispose so many individuals into living unhealthy lifestyles. Due to the expensive nature of coping with these illnesses there is now preventive health. Preventive health seeks to prevent the disease from setting in, in the first place. This system is now being encouraged worldwide as it is very affordable for governments and the individuals involved. Even more important is the fact that most of these diseases cannot be cured and that their absolute avoidance is simply best for all involved. Life expectancy refers to the average length of life a person is expected to live according to statistics. (http://www.who.int/mediacentre/factsheets/fs172/en/index.html 5-10-09). In every country, economic factors, quality of life, quality of healthcare delivery and other factors are considered to calculate the life expectancy. The main factors considered are quality of life, the national economy, the quality of the healthcare delivery system and the health lifestyles of the people. Casual analysis of figures provided by the CIA FACTBOOK (2009), the World Health Organization and Wikipedia reveal a consistent trend in life expectancy worldwide. All across the world, life expectancy continues to increase. In the United States for instance, life expectancy has increased by more than 50% in the last century (Matarazzo, 1984b). Even in most under-developed countries which generally lack behind in life expectancy rankings, the persistent rise is very visible. One can then confidently conclude that people are living longer and longer. Increase in life expectancy is attributed to many factors including the successful eradication of most infectious diseases such as small pox and polio. The improving economic situation and standard of living in most countries, the new technologies and knowledge of the health sector are also contributing factors. This coupled with a host of other minute yet significant factors culminate to give our current world wide life expectancy situation. However, life expectancy figures seem to have peaked for most countries and their rise slowed down drastically. This due to the lifestyle diseases mentioned and this has warranted the promotion of preventive health all across the world. We are then presented with the peculiar case of Africa. Although life expectancy is rising in Africa, its pace cannot be compared in any way to other nations like France and the figures remain incredibly low. According to information provided by Wikipedia, Swaziland, for example has a life expectancy age of 39.8. This means the average person in Swaziland is expected not to live above age 40. Devastating fact, especially when compared to a country like France with its life expectancy at 80.98 years. Amazing difference, but not so far-fetched; the last four countries on the list of rankings for life expectancy are all African. Apart from the obvious poverty and low standards of living which our governments are, hopefully, doing their best to get rid of, there is what is called the double disease burden. Aikins (2007) speaks about this phenomenon with special reference to Ghana. It reflects the situation of many African countries still having to deal with infectious, parasitic diseases such as tuberculosis, malaria and the like and also now dealing with the lifestyle related diseases. Data from Ghana Med J. 2007 December; 41(4): 154–159, places stroke as the number one cause of death and malaria as the number two in the Volta region. The scenario is reversed in the Greater Accra region and this fairly illustrates the point of the double disease burden. The point is that we must begin from somewhere. In our urban areas in particular these lifestyle diseases are doing much damage. How do we expect our healthcare delivery system to improve in anyway if we keep bombarding it in such a manner with our illnesses' Infectious diseases are being dealt with very effectively in time. Various campaigns like the ones against malaria do volumes in terms of bringing down the incidence of the disease. With the continuous efforts of our health agencies and educated members of the society it can be said that in a few years we may catch up with the developed countries. We can prevent lifestyle related diseases by indulging in health enhancing behaviors. These are lifestyle habits that promote our health. For the purposes of this study, the major areas of lifestyle behaviors to be looked at will be diet and nutrition, exercise, smoking and alcohol use. Knowledge of one’s health status and further action to try to change it for the better is also very important. One deeply hindering factor to the promotion of preventive health is the absence of knowledge that we have about our own health status and health issues. Knowing about these issues and making no efforts is basically useless. But knowledge about health issues and one’s biofeedback is a positive indicator that one takes their health at least with some seriousness. Such a person is in a better position to take action than the individual ignorant of all these issues. In present urban societies, knowledge of health issues and one’s health status is quite common but only among the aging generation. As far as preventive health is concerned, action in the positive direction at this point in our lives does a lot more for our health than when we are aging and already showing symptoms of some of the conditions we talk about. Now, any significant change in a nation’s life expectancy figures will be visible when these changes take place within the emerging population. This is not to say that change in health behavior alone will change life expectancy figures but holding all other factors can life expectancy change considering the former only' This is the question the study seeks to answer. 1.2 PROBLEM STATEMENT Preventive health entails healthy lifestyle practices which must be encouraged. Given the fact that life expectancy is expected to rise, it is important that all factors are held in check. Given that the health care system will continue to improve the question is will the lifestyle behaviors of the approaching generations promote health or not' If lifestyle behaviors of the younger generation are health deteriorating then it can be expected that life expectancy at least for the next ten years cannot rise. Ghana has a double disease burden and our ability rise out of our predicament will depend very heavily on the success of preventive health. Are the youth taking preventive health seriously' Is preventive health making an impact in the emerging generation' Are the youth indulging in healthy lifestyles' The study will focus on a section of the youth faced with a lot of the pressures of our current civilization. University students are faced with the greatest lifestyle health problem brought about by their circumstances of living and aggravated by their often sedentary lifestyles. Are these members of the population, who are most at risk, being impacted in any way by our preventive health efforts' 1.3 PURPOSE OF STUDY The study seeks to find out if the preventive health agenda affects the young adult population in any way. It will seek to find out if the youth population in danger of lifestyle diseases have important knowledge of and indulge in healthy lifestyle practices. This information will be sought as an indicator of the success of our preventive health system so far and a possible predictor of life expectancy within the country in the next few years. 1.4 SPECIFIC OBJECTIVES The study will find out the extent of knowledge on health issues possessed by the youth. The study will also find out the kind of health lifestyle practices that individuals among the target population are indulging in. The information gained will be put in analysis to determine the direction of preventive health lifestyle practices among the emerging generation. The study will further try to predict what the information means in terms of life expectancy and the direction of the preventive health care system. 1.5 RELEVANCE OF THE STUDY Information gathered by the study will be extremely useful to the Ghanaian society. It will provide fair knowledge on the health lifestyles of the youth. This information will be extremely useful in the formulation of health policy. Government institutions related to the determination of quality of life and life expectancy will also find the information gathered by the study extremely useful. The information may also aid economic policy formation. The study will also point out the weaknesses of the preventive healthcare delivery system in Ghana. This will help the system make appropriate adjustments. It will show to great depth where preventive health education should be directed. The study may also be a reminder and an eye opener for participants who will realize the need to indulge in healthy lifestyle practices. CHAPTER TWO REVIEW OF RELATED LITERATURE 2.1 INTRODUCTION The chapter examines the theoretical aspects and existing literature on the subject of health practices among youth and how these practices affect our health. World Health Organization (WHO), in 1948, health was defined as being "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". Wellness is an expanded idea of health as for instance individuals with serious illness rise above the physical or mental limitations to live rich, meaningful and vital lives. Some factors of our health are beyond our control but others are well within our control. Health is the level of functional and/or metabolic efficiency of an organism at both the micro (cellular) and macro (social) level. (en.wikipedia.org/wiki/Health). The definitions of health as previously mentioned are in two types, one expressing a positive progression and the other negative, expressing the absence of disease or impaired functioning. 2.2 HEALTH AND BEHAVIOR The Health Belief Model Rosenstock, Strecher and Becker (1988) propose the health belief model as being one’s perceived susceptibility to disease or disability, perceived severity of disease and disability, perceived benefits of health enhancing behaviors and perceived barriers to health enhancing behaviors. The perception that a particular health practice will be effective in reducing that threat also falls within the context of the health belief model. Susceptibility to disease expresses the belief that people are more likely to take action when they feel vulnerable to a disease. Although feelings of invulnerability to disease are not reasonable in most circumstances, research has shown that unreasonably optimistic perceptions to disease are widespread. (Weinstein, 1984). In practical terms, once a person feels they may not get sick they do little to keep themselves from the illness. Since most symptoms of lifestyle related disease appear in later adulthood, young adults seem to feel the danger of lifestyle diseases is only real to that age group. It is often common for people in later years to take their health more seriously than when they were younger. If a patient does not believe an illness is severe and that he/she has a good chance of becoming ill, readiness to act will be low. (Gatcel, Baum & Krantz, 1989).   Health behaviors and attitudes formed during childhood lay a strong foundation for lifetime health related behavior. It has further been shown in various studies that prevalence of risk factors for Non Communicable Diseases in childhood and adolescence bears a significant tendency towards development of disease in adulthood. Such research has documented that adolescence is the appropriate time period for appropriate intervention. During adolescence, teenagers start to make individual choices and develop risky behaviors that can result in disease outcomes such as cancer, obesity, hypertension and other cardiovascular diseases, type 2 diabetes and HIV infection, which are among the leading causes of death in developing and developed countries. It is easier to inculcate healthy behavior at a young age rather than to modify behaviors at later ages or after the onset of disease. (http://www.ispub.com/journal/the_internet_journal_of_health/volume_9_number_2_13/article/life-style-related-risk-factors-for-cardiovascular-diseases-in-indian-adolescents.html). The concept transcends into young adulthood. According to a study by USDHEW, 1978, 94% of teenagers in America at the time who participated in a study, believed that smoking was dangerous to their health. The study further realized that among these 90% of smoking teenagers also believed the same. However, the study registers a widespread belief that most young smokers have towards smoking. Most believe that in the next five years or so, at least by the time they are out of college, they would have stopped smoking. This for them meant that they were not at risk of the hazards they themselves confessed to. (Brannon and Feist, 1992). So although the danger of most of these lifestyle behaviors are clear to most young people, the threat is not as real to them as it will be when they get older, or at least that is what they believe. Further considering the health belief model, the fact that the future is always uncertain creates attitudes within detrimental to positive life behaviors among young people. Perceived severity also relates directly to compliance to health advice and positive lifestyle behavior. Rosenstock, Strecher and Becker (1988), argue that the benefits of acts that lead to good health should outweigh the costs for subjects to comply especially in instances where the subjects are already ill. Leventhal and Cleary (1980), claim that young adults who smoke usually do so in response to social pressure and the fact that they have friends who smoke. Drinking young adults are also at their best when drinking in groups. The social cost of being isolated and not having fun most of the time seems to be too high a price compared to danger which young adults perceive to be very far away and uncertain. McCoy (1992) in a study to test Neil Weinstein’s seven stage model for health behavior change, discovered that people adopt a precaution only after they perceive personal susceptibility. They further evaluate the precaution as being personally effective and appraise the benefits of the precautions over the risk of taking them. Many young people fear the risk of being isolated and ostracized than the risk of possible disease in their later, very uncertain years. For instance, Beliefs about alcohol are established very early in life, even before the child begins elementary school. An adolescent who expects drinking to be a pleasurable experience is more likely to drink than one who does not. How people view alcohol and its effects also influences their drinking behavior, including whether they begin to drink and how much. With this premise, young adults take to drinking after drinking is portrayed on television and by friends as the ultimate entertainer. A research study in India about adolescent lifestyle decisions and their subsequent effects on coronary heart disease in 2009 proposed attitudes formed in earlier years determined lifestyle in later years. Background and Objectives: Cardiovascular disease is the prevailing non-communicable cause of death and disability in the Indian subcontinent. Health behaviors and attitudes formed during childhood lay a strong foundation for lifetime health related behavior. Methodology: The present study was carried in 866 adolescents aged 11-16 years. CDC recommended GSHS questionnaire was administered to these students. The statistical analysis was done using SPSS version 13.0. To see the effect of risk factors on BMI and DBP, multivariate regression analysis was done. Results: In this study, 8.2% and 6.3% of boys had smoked and taken alcohol at least once in the last month, respectively. 13.6% of the subjects felt that there were no benefits of eating fruits and vegetables. 81.3% of the study subjects were eating fast food (Samosa, patties, noodles, etc.) in the past 7 days, out of which 5.1 % were eating out on all seven days. 36.8 % were taking carbonated drink ≥ 1 time/ day. (http://www. ISPUB - Life Style Related Risk Factors for Cardiovascular Diseases in Indian Adolescents files.) 2.3 EXERCISE AND ACTIVITY Roth and Holmes (1985), investigated high-stress and low-stress college students over a nine-week period to determine whether regular exercise could buffer the negative effects of stress. They found that physically fit subjects reported fewer stress related problems and also fewer symptoms of depression over a subsequent two month period than did less active students. The combination of high stress and low activity predisposed college students to sickness, according to the study. Brown and Lawton (1986) also found that, under conditions of high stress adolescents who exercised regularly had fewer physical illness than those who regularly exercised. The San Francisco longshoreman study by Paffenbarger and associates found that, coronary heart disease (CHD) death rates were more than 80% higher for lower activity workers than for highly active ones. From this and other studies, Paffenbarger concluded that high intensity exercise produces a training effect that provides protection against coronary heart disease. (Brannon and Feist, 1992). Regular physical activity provides enormous health benefits. It helps reduce heart disease, cancer, type 2 diabetes and many other diseases and metabolic conditions. Regular fitness exercise is also highly beneficial for weight reduction and weight maintenance, and may improve brain chemistry to reduce depression. By contrast, health studies that have monitored the well-being of large groups of people over many years clearly show that inactivity significantly increases the risk of overweight, obesity and chronic diseases. (http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx'p=240&np=297&id=2120). Research study The tracking of physical activity and its influence on selected coronary heart disease risk factors were studied in a 6-year (original survey in 1980, with follow-ups in 1983 and 1986) study of Finnish adolescents and young adults as part of the Cardiovascular Risk in Young Finns Study. The subjects in this analysis were aged 12, 15, and 18 years at baseline. Physical activity was assessed with a standardized questionnaire, and a sum index was derived from the product of intensity, frequency, and duration of leisure time physical activity. Complete data on physical activity index from each study year were available on 961 participants. Significant tracking of physical activity was observed with 3-year correlations of the index ranging from 0.35 to 0.54 in boys and from 0.33 to 0 39 in girls. Tracking was better in older age groups. Two groups of adolescents (active and sedentary groups) were formed at baseline according to high and low values of the index, respectively. Approximately 57% of those classified as inactive remained inactive after a 6-year follow-up. The corresponding value for active subjects was 44% (p < 0 01, active vs. inactive). The long-term effects of physically active and sedentary life-styles were studied by comparing groups of young adults who had remained active or inactive in every three examinations. Serum insulin and serum TN glyceride concentrations were significantly lower in active young men. They had a more beneficial high density lipoprotein to total cholesterol ratio and thinner subscapular skinfolds. The authors conclude that the level of physical activity tracks significantly from adolescence to young adulthood. Physical inactivity shows better tracking than those physical activity, and subjects who are constantly inactive express a less beneficial coronary risk profile compared with those who are constantly active. (http://aje.oxfordjournals.org/cgi/content/abstract/140/3/195). 2.4 DIET AND NUTRITION Global energy imbalances and related obesity levels are rapidly increasing. The world is rapidly shifting from a dietary period in which the higher-income countries are dominated by patterns of degenerative diseases whereas the lower- and middle-income countries are dominated by receding famine to one in which the world is increasingly being dominated by degenerative diseases. Dietary changes appear to be shifting universally toward a diet dominated by higher intakes of animal and partially hydrogenated fats and lower intakes of fiber. Activity patterns at work, at leisure, during travel, and in the home are equally shifting rapidly toward reduced energy expenditure. Large-scale decreases in food prices (e.g., beef prices) have increased access to supermarkets, and the urbanization of both urban and rural areas is a key underlying factor. Limited documentation of the extent of the increased effects of the fast food and bottled soft drink industries on this nutrition shift is available, but some examples of the heterogeneity of the underlying changes are presented. (http://pediatrics.aappublications.org/cgi/content/full/101/3/S1/518). The problem of eating and dieting has to do with overeating, obesity and eating the wrong kinds of food in terms of preparation, fat and cholesterol content and additive chemicals as well as deficient nutrients. Uncontrolled eating is now a main problem in health risk management. When weight is 40% above the ideal, the risks of disease elevate rapidly. (Brannon and Feist, 1992). For example, men more than 40% above average are 1.7 times more likely to die from coronary heart disease and at least 5 times more likely to die from complications involved with diabetes than those of average weight. Research study on the effects of obesity on United States children and its subsequent effects in later life posted on http://www.ajcn.org/cgi/content/abstract/84/2/289 by William Hertz of Tufts University School of Medicine and the Floating Hospital, Boston, Massachusetts. Obesity now affects one in five children in the United States. Discrimination against overweight children begins early in childhood and becomes progressively institutionalized. Because obese children tend to be taller than their non-overweight peers, they are apt to be viewed as more mature. The inappropriate expectations that result may have an adverse effect on their socialization. Many of the cardiovascular consequences that characterize adult-onset obesity are preceded by abnormalities that begin in childhood. Hyperlipidemia, hypertension, and abnormal glucose tolerance occur with increased frequency in obese children and adolescents. The relationship of cardiovascular risk factors to visceral fat independent of total body fat remains unclear. Sleep apnea, pseudo tumor cerebri, and Blount's disease represent major sources of morbidity for which rapid and sustained weight reduction is essential. Although several periods of increased risk appear in childhood, it is not clear whether obesity with onset early in childhood carries a greater risk of adult morbidity and mortality. Obesity is now the most prevalent nutritional disease of children and adolescents in the United States. Although obesity-associated morbidities occur more frequently in adults, significant consequences of obesity as well as the antecedents of adult disease occur in obese children and adolescents. 2.5 SMOKING AND ALCOHOL In recent years psychologists have accepted social learning theory as the most useful explanation for why people begin to drink in moderation or in a harmful manner. (Abrams & Niaura, 1987). According to this, people begin to drink for at least one of three reasons; the immediate after effects of alcohol drinking, pleasure or feeling of relaxation. There is also cognitive mediation; a person may decide earlier that drinking is consistent with his/her personal standards. Finally, the person may learn to drink simply by observing others. This is similar for smoking, especially for modeling or learning from observing others. When introduced to the behavior, young adults begin to evaluate the immediate effects. The absence of harsh immediate effects then encourages the behavior. Alcohol, the most widely used and abused drug among youth, causes serious and potentially life-threatening problems for this population. Although alcohol is sometimes referred to as a "gateway drug" for youth because its use often precedes the use of other illicit substances, this terminology is counterproductive; youth drinking requires significant attention, not because of what it leads to but because of the extensive human and economic impact of alcohol use by this vulnerable population. For some youth, alcohol use alone is the primary problem. For others, drinking may be only one of a constellation of high-risk behaviors. For these individuals, interventions designed to modify high-risk behavior likely would be more successful in preventing alcohol problems than those designed solely to prevent the initiation of drinking. Determining which influences are involved in specific youth drinking patterns will permit the design of more potent interventions. (http://pubs.niaaa.nih.gov/publications/aa67/aa67.htm). Research study Research on the Relationship between Early Age of Onset of Initial Substance Use and Engaging in Multiple Health Risk Behaviors among Young Adolescents. Background: Previous research based on problem-behavior theory has found that early age of onset of substance use is associated with engaging in multiple health risk behaviors among high school students. It is unknown whether these relationships begin during early adolescence. Objective: To examine the relationships between early age of onset of cigarette, alcohol, marijuana, and cocaine use and engaging in multiple risk behaviors among middle school students. Method: A modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 sixth through eighth grade students attending 53 randomly selected middle schools in North Carolina. A Health Risk Behavior Scale was constructed from 16 behaviors, including indicators of violence and weapon carrying; current substance use; nonuse of helmets when biking, in-line skating or skateboarding; not wearing a seat belt; riding with a driver who had been drinking; and suicide plans. Among this sample of middle school students, the scale had a mean (SD) of 4.1 (2.7) (range=0-15), and had a high internal reliability coefficient (=0.74). The independent variables included first time use of cigarettes, alcohol, marijuana, and cocaine at age 11 years or earlier; actual age of onset of each substance; race and ethnicity; family composition; sex; school grade; academic ranking; and older age for school grade. These data were analyzed with analysis of variance, Spearman r, and multiple linear regressions. Results: All the independent variables were found to be associated (P