Sunday, December 10, 2006

The Benefits of Sociological and Psychological Theories in Obesity Related Public Health Initiatives in the Southern United States - Michelle Heinz

The prevalence of obesity in the United States increased rapidly during the 1990s. In particular, the South saw a 67% increase, making it the most affected area of the country (Hensley). National Center for Health Statistics Heart disease and stroke are two of the three main causes of death in the United States and are closely linked with obesity (National Center for Health Statistics). The severity of this epidemic calls into question the reasons why public health has failed to slow this growth. After looking at the general approach public health had been using, it is clear that failure is closely related to the lack of correctly used sociological and psychological theories such as McGuire’s Communication Persuasion Matrix, Ajzen’s Theory of Planned Behavior, and the Food Selection Paradigm. The correct use of these theories would have resulted in programs that adequately address the methods by which people receive and interpret messages, the influence of perceived self-efficacy on individuals’ choices, as well as the socioeconomic factors that impact individual choices.

Public health practitioners would greatly benefit from the use of McGuire’s Communication-Persuasion Matrix as it would ensure that the communication, a fundamental factor, is adequately implemented. McGuire organized the five classes of communication factors into a grid with the six main behavioral steps (Mcguire 223). The six behavioral steps of persuasive communications, according to McGuire, are presentation, attention, comprehension, yielding, retention, and overt behavior (220-223). In other words, the success of a public health program lies in the creator’s ability to deliver a message in a way that the intended audience pays attention to, understands, agrees with, retains, and carries out the behavior. If the program designers compared these six steps with the five classes of communication factors (source, message, channel, receiver, and destination) it would ensure that fundamental principals of communication are not overlooked (McGuire 224). Many public health initiatives have failed to address communication factors such as demographic and personality characteristics of the receiver, as well as the credibility and attractiveness of the source (McGuire 238-239).

For example, if the designers of the failed 5-a-day campaign had incorporated McGuire’s ideas into the design of this program, perhaps they would have seen that sometimes people simply cannot afford fresh fruits and vegetables. Also, the source of the message simply lacks the qualities needed to attract interest and stimulate the desired response. A more effective approach would entail the creation of a program designed to provide coupons to those who require assistance to purchase the desired foods. This plan would be particularly beneficial in the southern United States due to the fact that a greater percentage of the population is living in poverty (U.S. Census Bureau 16). It would be important that these coupons have no dollar value because, as is the case with food stamp programs that provide people with a debit card linked to food funds given to them by the state, the alternative provides no way to control what food items the person purchases. If coupons were provided for ‘5 apples’ or ‘1 carton eggs’ people would be free to purchase these particular items without a financial barrier.

Other factors rarely taken into consideration are the credibility and attractiveness of the source (McGuire 230-231). A person is more likely to be persuaded to perform a specific health behavior if the receiver perceives the source of the message as an expert who is enthusiastic about the communication of the message, likeable, and similar to him or herself (McGuire 230-232). The government has a long history of being dishonest with the public, and as a result “the public is extremely wary of certain government information programs that might attempt to influence their health behaviors” (Hochheimer 313). Instead of relying on public health officials to deliver the message of a healthier lifestyle, policy implementers should recruit a spokesperson to whom the audience can relate. Maybe if children saw advertisements of their favorite super heroes eating nutritious foods, they would try to emulate the behavior due to the likeability of the source. Or perhaps if a non-Caucasian were to see a health professional or community leader of his or her ethnicity delivering a message on the television, they would stop and pay attention instead of simply changing the channel. Again, this approach would be particularly useful in the southern United States due to the high percentage of non-Caucasians and the fact that many health professionals are Caucasian.

Ajzen’s Theory of Planned Behavior is another useful model of human behavior that is useful in the design of public health models. This model states that human action is guided by individual behavioral, normative, and control beliefs (Ajzen 665). Only after a person has determined their attitude toward the behavior, considered social norms, and determined their perceived behavioral control will they form an intention (Ajzen 665). This intention then leads directly to a behavior (Ajzen 665). Perceived behavioral control is perhaps the most significant of these three beliefs because even if society says it’s okay to perform a behavior, and the person has a good attitude toward the behavior, the person will not perform the behavior unless they believe they have the ability to do so. This is closely related to the idea of perceived self-efficacy, that is “people’s beliefs about their capabilities to exercise control over their own level of functioning and over events that affect their lives” (Bandura qtd. in Ajzen 667).

Because overweight and obese people are more likely to have low self-esteem, and therefore are less likely to believe they have the ability to change, this theory is of particular use when examining obesity-related public health initiatives. Many people may have already tried to lose weight and failed. For this reason, it is important to set realistic goals. It is not reasonable to say to a morbidly obese person, “go lose two hundred pounds.” Someone has a greater chance of believing they have the ability to do a behavior if the goal is attainable.

The Shape Up America! 10,000 steps campaign is an example of a program that could have benefited from use of this theory. This campaign sets unrealistic goals by telling people that in order to obtain the recommended amount of exercise per day, they must walk 10,000 steps. The program then urges people to buy a pedometer and continues on to say: “we found it was nearly impossible for us to get in 10,000 daily steps without intentionally going out for a walk” since most people walk about 2-3,000 steps each day (Shape Up America). A person who is already in poor health is not likely to believe they will be able to incorporate and extra 7,000 steps per day into their schedule. As many people will have already accepted defeat before they actually begin, this unattainable goal is the major downfall of this program.

In theory, an individual needs only a knowledge of simple math to prevent obesity. If the number of Kcalories eaten is greater than those required by the body, weight gain will occur. De Garine’s Food Selection Paradigm outlines all the factors that influence food selection; culture, availability, economics, acceptability, religion, sociophychological factors, and individual choice impact the decision making process (Fieldhouse 26). Simply put, the cultural and economic background of a person determines his or her food choice. If public health professionals wish to change the eating habits of the population, they must understand and address each of these factors.

As different cultural groups immigrated to America, people tended to settle areas where they felt most comfortable and with others who shared similar ancestry. Food became one of the easiest ways of preserving cultural identity “for it permits him to insert himself daily into this own past and to believe in a certain culinary ‘being’” (Barthes 24).
It is important for public health practitioners to acknowledge the societal influences on food selection in order to create effective programs because “our social background is the source of many of the details of the mental processes in our habitual choices among foods and drinks and of when, where and how to consume them” (Booth 70).

These cultural communities resulted in the association of particular areas with types of food. For example, almost everyone is familiar with the “soul foods” indicative of Southern culture: “The essence of Black culture has been handed down through oral history, generation after generation in the African tradition, through the selection and preparation of soul food” (Hughes 272). A typical breakfast prepared according to “soul food” tradition would be comprised of any combination of the following: grits, homemade biscuits, ham or bacon, fresh milk and eggs, fried chicken, country-smothered steak or pork-chops (Hughes 278). These foods are not exactly known for their health benefits, but to avoid them simply because they are “unhealthy” would deny the importance of their culture. Given the importance of food to one’s cultural identity, careful consideration is needed when advising people as to proper dietary practices. Programs designed to change the eating habits on a cultural level must tailor their programs so they address every concern of the audience. Instead of telling people they may no longer eat their favorite foods, perhaps simple substitutions of one food for another healthier food would be an acceptable compromise.

The economic factors that influence food choice, availability and affordability, seem to be constantly overlooked when designing public health initiatives, especially when the focus of such initiatives is to persuade people to spend their money on more nutritious (often more expensive) foods. Instructing someone to eat more nutritious foods does not mean they have access to such foods or even be able to afford them.

Diets of the poor are “excessive in starches, fats, and sugars while being deficient in any or all of meats and other proteins, vegetables and fruits, and milk products” (Fitchen 390). This makes sense since starches, fats, and sugars are among the more inexpensive forms of nutrition and therefore are the more likely sources of such for the poor. Additionally, parents who are unable to provide adequate food for their children often respond to complaints of hunger by giving them “a food item that is not only filling but desired and liked” (Fitchen 383). Again, a food stamp program that provides “healthy” food vouchers without regard as to price would eliminate the financial barrier to healthy foods while enabling the purchaser the freedom to pick foods without financial consideration.

The Southern United States is an area of the country with very a distinct culture; it is also the area of the country most plagued by obesity. Public health practitioners must learn that programs cannot be designed for the population as a whole, but must be customized to address the specific needs of subset populations. Only after public health professionals gain a better understanding of the cultural differences present in the United States population will they be able to design and implement effective programs. This paper touches upon a few of many sociological and psychological theories, the ideas of which ensure that naive public health professionals do not overlook these fundamental needs. Incorporation of these ideas into public health programs would greatly benefit the current methods of addressing obesity in the Southern United States.

Works Cited

Ajzen, Icek. “Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory
of Planned Behavior.” Journal of Applied Social Psychology 32 (2002): 665-83.

Barthes, Roland. “Toward a Psychosociology of Contemporary Food Consumption.”
Food and Culture: a Reader. Ed. Carole Counihan and Penny Van Esterik. New
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Booth, D. A. Psychology of Nutrition. London: Taylor & Francis: 1994.

Fieldhouse, Paul. Food and Nutrition: Customs and Culture. New York: Chapman & Hall,
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Fitchen, Janet M., “Hunger, Malnutrition, and Poverty in the Contemporary United States.”
Food and Culture: a Reader. Ed. Carole Counihan ad Penny Van Esterik. New
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Hensley, Tim. “Obesity Epidemic Increases Dramatically in the United States: CDC
Director Calls for National Prevention Effort.” Editorial. 26 Oct. 1999. 3 Dec. 2006
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Hochheimer, John L., “Reducing Alcohol Abuse: A Critical Review of Educational
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Hughes, Marvalene H., “Soul, Black Women, and Food.” Food and Culture: a Reader. Ed.
Carole Counihan ad Penny Van Esterik. New York: Routledge, 1997. 272-80.

McGuire, William J., “Persuasion, Resistance, and Attitude Change.” Handbook of
Communication. Ed. Ithiel de Sola Pool & Wilbur Schramm. Chicago: Rand
McNally College Publishing Company, 1973. 216-52.

National Center for Health Statistics. “Health, United States, 2006.” Hyattsville, MD:
2006. 3 Dec. 2006 < http://www.cdc.gov/nchs/data/hus/hus06.pdf>.

Shape Up America. “10,000 Steps a Day.” 2006. 2 Nov. 2006
<http://www.shapeup.org/shape/10000steps_2006fs.pdf>.

U.S. Census Bureau. “Income, Earnings, and Poverty Data From the 2005 American
Community Survey.” Washington D.C. 2006. 10 Nov. 2006.
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