Demographic variables show reliable associations with the performance of various
health behaviours. Age, for example, shows a curvilinear relationship with many health
behaviours, with higher incidences of health-risk behaviours such as smoking in young
adults and much lower incidences in children and older adults (Blaxter, 1990). Health
behaviours also vary between genders, with women being generally less likely to smoke,
consume large amounts of alcohol or engage in regular exercise and more likely to
monitor their diet, take vitamins and engage in dental care, although such patterns can
change over time (Waldron, 1988). Differences predicted by economic and ethnic status
are also apparent for behaviours such as diet, exercise, alcohol consumption and smoking
(e.g. Blaxter, 1990). Generally, younger, wealthier, better-educated individuals are more
likely to practise health-enhancing behaviours and less likely to engage in health-risking
behaviours. Socio-economic status (SES) differences are particularly apparent with ‘social
class gradients’ (i.e. increased longevity, better health and improved health behaviours
as we move from lower to higher SES groups) apparent in most Western countries
(Mackenbach, 2006). Social factors, such as parental models, are important in instilling
health behaviours early in life. Peer influences are also important, for example, in the
initiation of smoking (e.g. McNeil et al., 1988). Cultural values also appear to be influ -
ential, for instance in determining the exercise behaviour of women across cultural
groups (e.g. Wardle and Steptoe, 1991). We noted in Chapter 6 that personality traits
are fundamental determinants of behaviour and that there is now considerable evidence
linking personality and health behaviours (see Vollrath, 2006). For example, Friedman
et al.(1993, 1995) found that childhood conscientiousness predicted longevity and that
this was partly accounted for by conscientious individuals being less likely to engage
in smoking and alcohol use.
None of the correlates of health behaviours mentioned above can be easily modified
and therefore they do not represent useful targets for interventions designed to change
health behaviours. This is not the case for the cognitive antecedents of behaviour. A
variety of cognitive factors distinguish between those who do and do not perform
various health behaviours. For example, knowledge about behaviour–health links (or
risk awareness) is an essential factor in an informed choice concerning a healthy lifestyle
(see Chapter 8). The reduction of smoking over the past 20–30 years in the Western
world can be largely attributed to a growing awareness of the serious health risks posed
by tobacco use brought about by widespread publicity. However, the fact that tobacco
continues to be widely used among lower socio-economic status groups and the
growing uptake of smoking among adolescent girls in some countries, illustrate that
knowledge of health risks is not a sufficient condition for avoidance of smoking by all
individuals.
Knowledge is just one of a number of cognitive correlates of health behaviours.
Others include perceptions of health risk, potential efficacy of behaviours in reducing
this risk, perceived social pressures to perform a behaviour and control over
performance of the behaviour. The relative importance of individual cognitive factors
in predicting performance of health behaviours has been the focus of numerous studies.
For example, Cummings, Becker and Maile (1980) had experts sort 109 variables
associated with performing health behaviours and derived 6 distinguishable factors:
1 accessibility of health care services;
2 attitudes to health care (beliefs about quality and benefits of treatment);
HEALTH COGNITIONS AND BEHAVIOURS 141