What influence does behavior have on health? - Chapter 17 (Health Psychology)

Good health is a personal and collective goal. That is why one must promote good health. This can be done through the media, through doctors and through the government that makes policy plans. It appears that promotion of health costs less and is more successful than disease prevention, which used to happen more. By teaching people good health habits, they will experience fewer illnesses.

HealthHealth

behaviorsbehaviors play a role in the development of diseases. Although in the past people mainly died of acute infectious diseases (flu, tuberculosis, measles and polio), there is now an increase in so-called 'preventive' diseases such as cardiovascular diseases, lung cancer, car accidents and alcohol and drug abuse. If more good health behaviors were to occur, the number of deaths due to these lifestyle diseases could decrease. In addition, people will die less quickly, increasing the life expectancy of the entire population. Third, people with good health behaviors will have more years of life without symptoms of chronic diseases. Finally, good health behaviors have a cost-saving effect.

Health behaviors are behaviors that people perform to increase or maintain their health. Poor health behaviors can easily turn into bad health habits and play a role in the development of diseases.

A health habit is a form of behavior that is related to health, and that one automatically exercises without being aware of it. Examples include wearing a safety belt, eating healthy food and brushing your teeth. These habits are often developed in childhood and stabilize at eleven to twelve years of age. Because a health habit can not easily be changed, it is important that one develops good health habits and the bad one learns.

Primary prevention has the task of developing good health habits and changing bad ones. This primary prevention is aimed at changing / removing the risk factors for a disease before the disease develops. This can be done by:

• behavioral change methods to change problematic health behaviors, and

• by preventing people from developing bad health habits.

Factors for healthy behavior

There are several factors that influence healthy behavior and health habits.

Demographic factors: people who have little stress, are highly educated, are young and people who have many sources of social support generally have better health habits than people with a lot of stress, little social support and people with fewer sources.

Age: health habits are good in childhood, become worse during adolescence and young adulthood. The health habits improve as people get older.

Values: the value society attaches to certain health habits influences the exercise of these health habits. An example of this is the value attached to the physical exercise of women. This differs between different cultures.

Personal control: people who see their health as something under their personal control will have better health habits than people who relate their health to chance factors.

Social influence: friends, family, colleagues and other social contacts can influence health behavior, both negative and positive.

Personal goals: the goals that a person has set have an influence on the exercise of healthy behavior. If the goal is 'being fit', then someone will have more physical activity.

Symptoms received: certain symptoms may induce people to engage in health behaviors.

Access to health care: if people have poor access to health care, they will have fewer regular checks (eg a mammogram), which may lead to fewer healthy habits. This group of people will also receive fewer lifestyle advice from doctors, as a result of which bad health habits will change less quickly.

Cognitive factors: people can believe that certain behaviors are beneficial and that, if they do not comply with certain health behaviors, they are more vulnerable to disease.

Why is it difficult to change bad health habits?

One reason is that researchers do not know much about when and how bad health habits develop. It is therefore difficult to determine the moment at which one must intervene to change a bad health habit.

In addition, poor health habits at the time of exercise have little effect on health. These habits develop in childhood and puberty, so when people are healthy. The cumulative effect of bad health habits, such as smoking, drinking and poor nutrition, is not noticed until later in life. Emotions also play a role. This way the change can be counteracted because the unhealthy behavior is an addiction, happens automatically and is enjoyable. To prevent stress, the behavior continues.

Unhealthy habits can be enjoyable so people are not motivated to change them. Unhealthy habits are not related to each other. Someone who sports a lot does not automatically wear a safety belt in the car.

A final reason that health habits are difficult to change is the instability of healthy behavior. This is because:

• different health habits are controlled by different factors (smoking can be stressful and little physical activity can be caused by a lack of access to the fitness school)

• different factors can control the same health habits for different people (people can eat from a 'social' point of view but also because they feel alone)

• factors that control a health habit can change during the course of the behavior (someone can start smoking under social pressure, but continue with it because it helps against stress)habit

• can change factors that control a healthduring the course of a person's life (during school hours someone moves a lot, but if someone works later, this can become less)

• health-care patterns, their development and the factors that influence this, can differ very much between individuals.

It means that health habits are dulled and remain under the influence of different factors for different people. These factors can change during the course of life and during the course of the health habit.

Children and adolescents

Early socialization is very important for the development of health habits. The influence of parents who are role models in particular plays a major role here. Parents teach their children that they have to wear a seat belt in the car and that they have to brush their teeth every day. As the children grow older, they can start to ignore these learned habits. Adolescents are very sensitive to all kinds of unhealthy behaviors (smoking, drinking, etc). It is important that parents supervise these adolescents well.

The development of good health habits also depends on when the habit is learned. A good educational moment must be chosen, because one moment is more suitable to learn a certain healthy behavior or to prevent a bad one than another.

Many educational moments occur during childhood. Others are present because the health system creates these moments. Doctors visit young parents and teach them certain basic skills and provide information about accident prevention.

Educational moments can also occur if someone is pregnant, which is a good reason to stop smoking and drinking.

Identifying the right educational moment is of great importance for primary prevention, because this is the moment that someone can learn good behavior, but bad behavior has not yet been developed.

Many health habits are developed at primary school. These are then choices with regard to eating, snacking and dieting. Adolescence is also compared with a window of vulnerability, because young people are exposed to the bad behavior of their friends and senior citizens.

Research shows that precautions taken during adolescence are a better predictor of diseases after the age of 45 than adult health habits. So it may be that for adults who are suddenly developing good habits, it is already too late, because they have already caused a chronic illness because of their behavior during their teenage years.

People who have a higher risk of certain diseases

In addition to children and adolescents, people who are at risk for certain illnesses are a vulnerable group that can promote health promotion / promotion. For example, a daughter of a woman with breast cancer can learn how to examine her own breasts on bumps. Health promotion in this group is becoming increasingly important because the genetic basis of many diseases is becoming known.

Working with people with a higher risk of certain diseases has a number of advantages. If these people are known, this can lead to prevention or elimination of bad health habits that contribute to the vulnerability. Even if nothing can be done about prevention, the knowledge and information for people can be an incentive to change their situation (eg women with breast cancer).

There is also a cost advantage. Because only people who are at higher risk get a health-care intervention, people without this risk do not have to get this intervention. This saves money. Due to the concentration on high-risk populations, other risk factors may be determined that also contribute to the risk factor mentioned in the development of an unfavorable outcome.

There are, however, also disadvantages. People who run a higher risk often can not correctly assess their risk. In general, people are unrealistically positive when it comes to their own vulnerability to diseases. It is possible that people who are identified as having a risk factor will behave excessively cautiously and impose all kinds of restrictions on themselves. Another extreme is that people do not care about the risk factor and do not seek the help they can possibly use.

Ethical issues are tied to working with risk-based populations. When should people be informed of their risk if their risk is low. If a young daughter of a woman with breast cancer is told that she has an increased risk of breast cancer, this can cause major psychological problems.

Many risk factors are genetic and therefore can not be changed. An intervention does not have to be of use. No clear interventions have been devised for many disorders. For example, alcoholism is partly caused by a genetic factor. However, it is not known how this fact should be handled by the children of an alcoholic. The disclosure of risk factors can have major consequences within a family, for example if the question is asked as to who is responsible for causing the increased risk.

Elderly

Health promotion in the elderly was first seen as a waste, but now more and more policymakers are finding out that a healthy elderly population brings fewer health costs. The promotion of the health of older people has therefore become increasingly important. Attention is focused on maintaining a healthy and balanced diet, taking steps to prevent accidents, regular exercise, smoking cessation, a controlled use of alcohol and reducing the misuse of medication.

Especially regular exercise is important because it keeps people mobile and ensures that they can continue to take care of themselves. In addition, it is important that older people remain active and that they continue to participate in activities.

Alcohol consumption is a priority because the risks of alcohol increase as people age; the alcohol tolerance decreases in the elderly. Alcohol consumption also increases the risk of accidents. Older people can also develop drinking problems, for example as a result of loneliness.

Gender differences and ethnic differences There

are differences in gender-based behavior and the performance of certain health behaviors between the sexes. For example, men generally drink more alcohol. Anglican men also smoke more on average than other groups. Some ethnic groups have a higher risk of certain health behaviors. There are also differences between the performance of certain health behaviors. Black and Spanish women have less physical exercise than Anglican women.

Changing health habits

The rest of the chapter will deal with the technology of changing bad health habits.

Changing attitudes

Changing attitudes towards healthy behavior can be achieved through education. This education assumes that people will change their health habits if they have the right information. Education as a way to change health behaviors works best when the following conditions are met:

• Communication must be lively and colorful. Use must be made of cases from the past.

• The speaker must be an expert who is reliable, friendly and equal to the public.

• The message must be short, clear and direct.

• Strong arguments must be reported in the beginning and at the end of the story, so not somewhere in the middle.

• Conclusions must be drawn explicitly. It must be clear what the public must do to change his / her situation.

• More extreme messages have greater effects, although the messages must not be too extreme.

• If a public is inclined to accept the message, only beneficial effects must be mentioned. If the public still has to be persuaded to accept a message, two sides must be highlighted. The beneficial effects must be mentioned, but also the pleasant consequences of carrying out the bad health behavior.

• If behavior is touted that is needed to detect a disease, the consequences of this disease must be mentioned. If the goal is that people develop health habits, the benefits of this behavior must be emphasized.

However, it is possible that the information that is transferred is misunderstood. Then people can start to believe that the problem is less, because apparently it is very common. People do this instead of changing health behavior.

Another way than education to change behavior is to use fear. If people fear that certain behavior is bad for their health, they will change this behavior to reduce their anxiety. The more afraid someone is, the more likely they will be to change their behavior. However, this does not always happen. It may be that only fear is not enough to change behavior. Often this fear must be linked to recommendations for taking action and information about the efficacy of healthy behavior.

Health psychologists have developed ideas for changing health habits that link educational and motivational factors to a more general model. The main model / theory about why people have health behaviors is the health belief model.

Health belief model

The health belief model assumes that there are two factors that determine whether someone has certain health habits:

• the extent to which someone experiences a certain health threat. This is again influenced by general values ​​about health, certain ideas about the vulnerability to a certain disease and certain ideas about the consequences of a disease.

• the extent to which someone believes that certain behavior will remedy this threat. Someone must then believe that the health habits will be effective and that the benefits of acting on the health habits exceed the disadvantages.

The health belief model can explain many types of behavior, for example AIDS-related risk behavior. The health belief model is not only suitable for explaining why people display certain behavior, but also for explaining why they change their behavior under certain circumstances. The health belief model is also used to design ways of communicating that encourage people to adopt different behaviors. Then the emphasis should be placed on the vulnerability of people and on the fact that healthy behavior can reduce the threat to the disease. The health belief model only does not address the idea of ​​whether someone can maintain healthy behavior.

People with a sense ofself-efficacyare better able to sustain certain behavior. Research has shown a strong relationship between a person's ideas about self-efficacy and both the changing of a health habit and the change in behavior in the longer term.

In summary: whether someone has a certain health behavior depends on many thoughts, ideas and attitudes.

The theory of planned behavior

This theory assumes that a health habit is the direct result of an intent to behavior. An intention to conduct consists of three things:

• The attitude towards the specific action (based on the probable outcomes of the action and the evaluation thereof)

• The subjective norms regarding the action (these are someone's ideas about what others think he / she thinks what he / she has to do)

• The expected behavioral control (the idea of ​​whether someone is capable of showing the required behavior and whether this behavior has the desired effect)

If these factors have ensured a behavioral intention, the behavior change automatically follows .

The planned behavior theory creates a model in which ideas are directly linked to behavior. In addition, it provides an extensive picture of a person's intentions in relation to a certain health habits.

With the theory of planned behavior, different health behaviors can be explained. Examples are: the use of a condom, the use of sun cream, the use of a contraceptive pill, physical exercise, smoking, AIDS-related risk behavior and self-examination of breasts in women.

The theory of self-determination

This theory states that individuals are actively motivated to achieve set goals. The autonomous motivation and own assessed competencies are central here. Research showed the importance of autonomous motivation and support for this theory.

Although the theories explain a lot, they are not very successful in explaining spontaneous behavioral changes and they do not predict very well long-term behavioral changes. When people are encouraged to change behavior, they can respond defensively or irritably. People may wrongly think that they are less vulnerable than other people. A health threat can also be perceived as less threatening than it really is. Thinking about illness makes people depressed. That is why they are going to explain ignoring or defensive.

Unrealistic images about a person's own health, illness and treatment block the possibility of changing health behavior through, for example, carefully composed messages. Only giving information is often not enough to change health habits. That is why health psychologists now also use techniques of certain forms of therapy.

Health habit change through cognitive-behavioral approach

Cognitive behavioral therapy can contribute to the change of a health habit. The approach of cognitive behavioral therapy changes the focus of the intended behavior. It concerns the conditions and factors that cause, maintain and strengthen it. Cognitive behavioral therapy can also influence someone's ideas about their ability to change behavior. With this therapy, the thoughts and behavior are dealt with together.

The thoughts that someone has, largely determine his / her behavior. For this reason it is important to change the behavior of someone, because someone's thoughts have to change.

Techniques of cognitive behavioral therapy

The first steps to behavioral change are self-observation and self-monitoring. By self-observation and self-monitoring, someone can analyze his / her own behavior. The frequency of the behavior, the factors that play a role in the behavior and the consequences of the behavior must be examined. By inciting a patient to self-observation, he is forced to make an effort to change health behavior. Someone must learn to recognize his / her behavior. Once this is successful, the behavior and situations in which it occurs and the feelings that come with it can be recorded. When this documentation is ready, a structured behavioral change program can be drawn up. Self-observation is the beginning of therapy, but in some cases this can also cause a change in behavior. However, this change through self-monitoring is often short-lived.

Another way to change behavior is classic conditioning. In classical conditioning, an unconditioned reflex is linked to a new stimulus, creating a conditioned reflex. Classical conditioning is one of the first methods used to change behavior. For example, it can be used in the treatment of alcoholism, smoking or other addictions. It is very important that the patient wants to work with it.

The opposite of classic conditioning is operant conditioning. With operant conditioning, voluntary behavior is linked to systematic consequences. The behavior is strengthened. Behavior is followed by positive reinforcement, making it more likely that the behavior will occur again. The other way around, if certain behavior is punished, it will happen less often. An example of an operant conditioning is a drinker who keeps on drinking, because his mood improves with the alcohol.

Operante conditioning is very suitable for changing health habits. First, people are rewarded when they perform an action that brings them closer to their goal. As the change gets closer, a larger change in behavior can be asked for the same reward each time.

Another technique is modeling. This is learning by looking at someone else's behavior. Observing first and then modeling can lead to behavioral changes. People will imitate someone faster who is equal to themselves. Equality is therefore an important principle in modeling.

Modeling can be important in a long-term behavioral change technique. An example is alcoholics who have a lot to talk to former addicts to exchange methods of stopping.

Modeling can also work in reducing anxiety (eg, for a jab) that can cause poor health habits. Someone can then see how and another person effectively deals with these fears and learn from them. In such cases it is better to look at someone who is afraid of the situation, but can deal with this than to look at someone who has no fear at all. An anxious person can identify himself better with another anxious person than with someone who has no fear. So modeling is most effective when you have to learn from a realistic picture of the situation and reflect the actions of a person.

Checking stimuli can be very useful in controlling behavior. Certain discriminatory stimuli can incite someone to certain behaviors, such as smoking, drinking or other bad health habits. If these stimuli can be controlled, the behavior does not have to occur anymore. First, someone has to get rid of the stimuli that cause problem behavior; subsequently, new discriminatory stimuli are needed instead of these stimuli, which will cause a new response.

Self-control

Cognitive behavioral therapy is increasingly working with a technique in which self-monitoring takes place. Someone must then, as his / her own therapist, learn to check the antecedents and consequences of the specific behavior that has to be changed. This self-monitoring can take place through self-reinforcement. Someone rewards themselves each time to let the specific behavior take place more or less. Someone can reward himself positively with something he / she would like to have after changing behavior. Research shows that people, for example, better lose weight when they reward themselves. Self-reward has proved very useful, also because people can be their own therapist and need not be controlled by someone else.

Punishing yourself can also work. Positive punishment (there is an unpleasant stimulus after the wrong behavior has occurred) works better than negative punishment (a pleasant stimulus is removed). Punishing yourself works best when coupled with self-reward.

Self-punishment only works if the person who has to change the behavior actually performs these punishments. There is a way of self-punishment that works well, this is contingency contracting. A contract is concluded with someone else, for example a therapist, who determines whether a reward or punishment is applied to the behavior of the person being treated.

With covered self-control , individuals learn to recognize the thoughts that precede certain behaviors. By changing these thoughts, the behavior can also change. These thoughts can also occur after the behavior. Then it is the intention that these "after" thoughts stimulate the right behavior and do not abort the right behavior. The internal dialogues (the thoughts) that people carry can be changed and then strengthened to change the behavior. The restructuring of these internal dialogues has proved very useful in dealing with stress disorders.

Through self-instruction and self-talk, people can change these thoughts and their behavior. These instructions can first be said out loud and later take place internally.

Another technique than self-instruction to involve people in their learning process is to give behavioral assignments to do at home. Both the patient and the therapist can get homework after the session to ensure that both parties stay involved in the process. It is useful to write down these assignments and not just make verbal agreements. By writing it down, the assignments become clear.

The advantages apart from the fact that the patient is involved in his / her treatment are:

• The patients make an analysis of their behavior, which can be useful in planning future interventions.

• The patients are involved in the process through a contractual arrangement that involves certain responsibilities.

• The responsibility for the behavioral change for a large part lies with the patient.

• The sense of self-control of the patient is increased by the homework assignments.

To change behavior or to ensure that it does not arise,can also social skills be taught. This is because the lack of social skills or having social fears can cause people to show certain behavior. For example, young people start to smoke because they want to be part of it. The aims of this therapy are to reduce the fears, to learn new skills for dealing with anxious situations and to learn alternative behaviors for the behavior that one normally showed in the anxious situation. By learning relaxation techniques it is possible that people are less likely to become socially anxious, as a result of which they will show poor health habits less quickly. In addition, more and more motivational interview techniques are used to get less motivated clients to move. Furthermore, it offers handles for dealing with resistance.

Falling back into behavior

A big problem when changing behavior is that people can fall back into their incorrect behavior after the change. This problem is especially relevant for addictive habits such as smoking, drinking and drug use. Falling back into the old habit can be very gradual. For example, smoking one cigarette at a party, which is the beginning of returning to normal smoking behavior. Why people fall back into old habits is not entirely clear. Rejuvenation symptoms that occur after stopping an addictive drug can be a reason. Vulnerable moments are also a reason that people fall back. If people used to smoke or drink at a party, it is difficult not to do so at a certain moment. If people are under stress, anxious or depressed, there is a greater chance that people will fall back into their old habits. Social support from friends and family can ensure that people fall back less quickly.

Once people have violated the rules they have set themselves, an 'abstinence violation effect' can occur. This is a sense of loss of control that arises when someone violates his own rules. If this has happened, a real relapse can occur more easily.

The consequences of a relapse are negative emotional effects, such as disappointment, frustration, anger and unhappiness. People get a reduced sense of self-motivation due to a relapse. If people make a new attempt to change their behavior after a relapse, this can cause difficulties. People will start less quickly with a new attempt. A paradoxical effect of a relapse can also occur. People become more convinced of their own control. It then seems as if several attempts are needed to finally achieve the goal, for example to stop smoking.

The possibility that relapse occurs can be reduced by giving a few 'spur' sessions a week before the end of the treatment. A few months after stopping the treatment some 'clearing' sessions can be given. A better way than these sessions is to add more behavior-changing elements, such as the relaxation exercises or training of assertiveness.

A third way to reduce relapse is to let the therapy go on for life. Disadvantages of this are that people keep feeling that they are very vulnerable to relapse. This also suggests the suggestion that people can not exercise control over their habit. A better option is to re-balance the client's lifestyle. This is how people keep control, but there is positive behavior change.

The change of unhealthy behavior does not happen at once. This requires several steps that can be presented in a transtheoretical model:

The stages of change are:

• Precontemplation

• Contemplation

• Preparation

• Action

• Maintenance

A behavioral change can be achieved in several places: under the treatment of a professional, with family, self-help groups, school, workplace interventions, community-based interventions, via media and / or internet. The relapse prevention must be integrated in the therapy. It appears that people who are very motivated at the beginning of the therapy have less chance of a relapse. That is why at the beginning of the therapy a great deal of attention is paid to increasing motivation and maintaining compliance. Another way is to do a screening and remove people who do not really want their behavior to change. However, this is ethically dubious, because people are turned away from a therapy, while it can be very good for their health. On the other hand, someone who is not very enthusiastic can reduce the motivation of others, reducing the chance of success of these others.

People can prevent a relapse by avoiding situations in which their incorrect health habits take place. For some people, such as smokers, it is impossible to avoid all situations in which their old behavior occurred. Then people have to learn skills to deal with these situations. This can increase the self-confidence of people.

How can you improve health with behavior? - Chapter 18 (Health Psychology)

Many of us know how to achieve health and what kind of behavior it requires. Intentions for a new year often include: eating healthy, exercising a lot and saving money. These good intentions are often difficult to sustain, but this health-promoting behavior is important. Health promoting behavior should be a high priority for all of us.

Exercise

researchers have in recent years focused on aerobic exercise. This is physical exercise that stimulates and strengthens the heart and lungs and improves the oxygen consumption of the body. Aerobic exercise has a long duration and high intensity for which people need a high stamina. Examples are swimming, jogging, cycling, running and jumping rope.

Women are physically less active than men. White people get more exercise than black people and Spaniards, older people are less active than young people. People with high incomes are also more active than people with lower incomes. Physical activity is the most important form of health behavior for the elderly.

Physical activity provides cardiovascular fitness and endurance. The chance of a heart attack is also reduced. Furthermore, it increases the efficiency of the cardio-respiratory system, improves physical work capacity, improves or maintains muscle tension and muscle strength, improves body weight, improves joint flexibility, reduces hypertension, improves movement of cholesterol and it can improve the possibilities of dealing with stress. In addition, it can reduce the effects of bad health habits, such as smoking, unhealthy eating and alcohol consumption. Regular physical exercise improves life expectancy and slows the mortality of, for example, cancer and cardiovascular disease.

The prescribed amount of physical exercise for a normal adult is 30 minutes of modest exercise on most (preferably every day) days of the week and 20 minutes or more intense exercise on at least three days a week.

During exercise, the same hormones (adrenaline) are released as when experiencing stress. Nevertheless, physical exercise does not have a beneficial effect on health and stress. This may be because adrenalin has a beneficial effect if it is released intermittently and as bad as if it is permanently present in the blood, such as during stress. It is also possible that adrenaline is metabolized differently during exercise than during stress. A final possibility is that the activation of the hypothalamic-pituitary-adrenocortical system is responsible for the harmful effects of stress and not the activation of the sympathetic nervous system such as during exercise and also during stress n.

Physical activity has a positive influence on depression, tensions, moods and fears. Immediately after physical exercise, mood and feelings of well-being can be improved. The effects of long-term regular effort can improve the overall mood, although this effect is slightly less than the direct effect. This influence on the mood is partly due to the social aspect of physical activity, the feeling that you are among others. Social support also ensures that people adhere to a body movement program. Physical activity also has a beneficial effect on the self-image, which is why it is often used in the treatment of depression and in menopausal symptoms. However, the effects of physical activity on people's well-being should not be exaggerated, because the effects are often small. An important factor seems to be whether people believe that physical exercise has a positive influence on mood.

Because physical exercise improves well-being, it can be a way to deal with stress. Research has shown that the negative effects of stressful events on health decrease as physical activity increases.

This positive effect of exercise on the stress perception can be due to the positive influence of physical exercise on the immune system. The activity of immunity would also be modulated by the release of endogenous opioids, which is stimulated by physical activity. By exercise, the concentration and attention-orientedness is increased. However, this cognitive effect can also spread to the other side because the muscles become too tired. Because of physical exercise, people would also be less absent from work and would be able to get a greater satisfaction from their work.

Factors that influence regular physical activity

Research has shown that half of the people who start a voluntary physical activity program are still participating in the program after six months. This is because many people find it difficult to make regular exercise a regular activity. A cause of this can be stress. But there are also other factors that influence doing physical exercise.

Individual factors are whether people come from a family where a lot of physical activity is being done, if people have a positive attitude towards physical activity, if people see themselves as types of physical exercise and if people believe that they are responsible for their own health. . However, these factors do not determine whether someone will participate in a physical program for a long time.

Sex is a factor; boys get more exercise than girls and especially middle and older women get little physical activity. People who are overweight are less inclined to move than people with a slimmer body.

No clear relationship has been found between health status and loyalty to participation in a physical activity program. However, research has shown that people with an increased risk of cardiovascular disease are more loyal to exercise programs than those without an increased risk.

People with a high self-esteem with respect to physical activity do more exercise. These people also believe more strongly that they can benefit from physical exercise than people with less self-confidence on this front.

Positive emotions during physical exercise determine, among other things, whether people continue to exercise regularly. Self-confidence appears to be a very important factor for physical activity for older men and women. Older men and women may still have the motivation for physical exercise, but self-confidence in their own strengths and possibilities can have fallen sharply due to old age. If this self-confidence were to be worked, more older people would probably start exercising.

There are also aspects related to the setting in which physical activity is offered, which contribute to the extent to which people engage in physical exercise. Easily accessible physical exercise ensures that more people participate. This means that people can easily reach the place where physical exercise is given. Research shows that if people have to perform physical exercise that results in a high heart rate (90% of the maximum heart rate), this will negatively affect the faith with which people come. This is because exercise with this heartbeat demands too much of the body if this has to take place on a regular basis.

Research also shows that when physical activity is a habit for people, this is an important predictor for whether people continue with physical activity. If people participate in physical exercise for 3-6 months, chances are that they will continue to do so. This is because the physical exercise takes place automatically, because it has become a habit. But the habit of physical exercise requires planning and organization, something that many other habits do not ask. That is why physical exercise requires a will, the sense of personal responsibility and the recognition that hard work is needed.

Programs developed to get people to exercise

Programs have been developed in which techniques of cognitive behavioral therapy, such as contingency contracting, self-reinforcement, self-monitoring and setting goals, are linked to encourage people to exercise. Techniques that are used to maintain a changed habit are also useful here. In addition, techniques to prevent relapse are also important. For example, people can be trained to cope with the temptation not to engage in physical exercise. Because people change their behavior in different phases, the techniques must respond to these different phases. People who just start exercising can be persuaded to solve practical issues. People who are already exercising have more to do with successful techniques that prevent the stopping of sports.

It is probably best to match exercise programs to an individual. If one understands what one's motivations and ideas about sports are, an exercise program can be set up that suits them. The chances of people continuing to exercise are greater when they do something they like, for which they can develop their own goals, for which they are motivated to continue and when it is a sport that suits them. Through the interventions in the physical exercise of people, the whole lifestyle of people can change. By participating in a program, for example, people suddenly absorb fewer calories.

Prevention of accidents

Many accidents can be prevented by the prevention of accidents. This concerns traffic accidents, but also poisonings and accidents at work. The biggest cause of death and cause of accidents among children younger than 5 years are accidents in the house. Parents usually take measures to prevent this as well as possible; after all, they have control over the environment in which the child is. Many GPs teach parents skills in taking these measures. Parents can be informed about the most common toxic substances through parent classes. Nevertheless, elderly people in particular are at greater risk of an accident. In addition, about 25% of the elderly remain dependent on hospital care for at least a year after an accident.

Better safety measures have reduced accidents at home and at work in recent years. An example are safety caps on medicines. The strict rules regarding work safety also contributed to this decrease in the number of accidents in the workplace. The interventions that have been done to reduce these accidents have thus been successful.

Car accidents are the biggest cause of death when it comes to death from accidents. Little research has been done into ways to prevent people from learning traffic accidents. There are many measures that can be taken to prevent accidents. Obvious measures are: reducing the maximum speed, wearing a seat belt and putting children in a child seat. However, it is difficult to encourage people to comply with these measures. To achieve this, information about health, psychological interventions and social awareness are necessary. These interventions may not be as effective to really learn the right behavior. Legal solutions are better for this, such as fines.

Health behavior related to cancercancer

BreastBreast

cancer is more common in women at a younger age. That is why it is important that women who have an increased risk of breast cancer regularly examine their own breasts. 90% of all cases of breast cancer are detected through self-examination. In self-breast examination the underlying tissue of the breast is examined for changes in this tissue. The breasts should then be examined once a month in a standing and lying position. Examining their own breasts should become something normal for women, so that this becomes a health habit.

The health belief model (see previous chapter) determines in part whether women examine their own breasts. People who have few obstacles to examine their breasts and worry about their health are more inclined to examine their breasts than other women. The planned behavior theory also predicts whether women perform self-breast examination or not. Especially factors that ensure a favorable attitude towards self-breast examination are important. Having social norms to support self-breast research also puts women to this health habit.

Only 35% of women do self-breast research and a large proportion of these do not do it in the right way. Factors that contribute to not doing self-examination are fear of discovering a bump, finding it difficult to determine change in the tissue or not being sure that you are doing well. It is also difficult to remember to do it on the good day of the month. It can be useful to do self-reward if the self-breast examination takes place at the right time and in the right way. It can also be useful to increase the frequency of the study, so that women think more about it and therefore forget it less quickly.

For older women (over 40) it is useful to have a mammogram every year. This is important because the incidence of breast cancer has risen sharply in the last 20 years. Most breast cancers are detected in women over 40. The survival rates can improve through early detection by means of mammograms. The mortality of breast cancer is reduced by these screening programs.

The loyalty with which women come to do a mammogram is low despite the important value it has. The causes for this can be shame about the procedure, fears, nervousness, and anticipatory pain. In America, concerns about costs are also important. A lack of time can also play a role. By changing the attitudes of women to a mammogram, more women will have a mammogram made. Here the health belief model and the planned behavior theory can be used. The health belief model is about the expected advantages and disadvantages of a mammogram for women. The benefits must then be increased. For the theory of planned behavior, the own thoughts and thoughts of the surroundings of the woman play a role in whether or not to make a mammogram.

The health system also needs to change in order to have more women make a mammogram. Women often have to make an appointment with several doctors to get all the necessary tests. This should be accommodated with one doctor so that women are more likely to make an appointment.

The use of sunscreen

The last 30 years there has been an increase in the number of people with skin cancer. This is due to excessive exposure to ultraviolet radiation. To reduce the risk of skin cancer, psychologists try to encourage people to use sunscreen. Here only education is not enough. This is because having a tanned skin is found to be very attractive and people simply do not want to give up by using sunscreen. If people do use sunscreen, the strength is often not sufficient. The type of skin that someone has, determines to a large extent whether someone will use sunscreen. Someone who burns quickly will use sunscreen faster than someone who does not burn quickly. Furthermore, someone's thoughts about the effectiveness of sunscreen are important. In addition, the social standards that apply to the use of sunscreen also play a role.

When communicating about this to adolescents and young adults, it is important that the gains (free from skin cancers) and the direct risks of ultraviolet radiation are emphasized. More types of self-examination and prevention measures will be discovered in the development of knowledge about cancer.

Nutrition

Healthy eating should be a goal for everyone. Eating is a risk factor for many causes of death and also for the development of many diseases. A healthy diet is therefore very important. Dietary factors are related to the cholesterol level and especially to the LDL content. High cholesterol and LDL levels are risk factors for cardiovascular disease. Salt affects hypertension and can also contribute to cardiovascular disease in some individuals. Eating habits would also contribute to different types of cancer, such as breast, stomach, pancreatic and colon cancer. Poor nutrition combined with other risk factors, such as stress, is very dangerous. This can, for example, result in a changed fat reactivity. Changing health can improve a person's health. For example, dietary changes can lower blood cholesterol levels, reducing the risk of arteriosclerosis.

Difficulty in changing food

When people have to change their diet, this is usually an adjustment that must be sustained throughout life. This is often a difficult adjustment. People tend to eat healthier more often because they want a better appearance than they do for their health.

When people actually reduce the salt and fat in their diet, in many cases they consume more of other types of food. This does not reach the goal of the diet. However, it is doubtful whether a low-fat diet causes weight reduction and prolongation of life.

It is therefore difficult to start people on a diet, but it is also difficult for people to sustain this diet. One reason for this may be that there is too little attention for the reasons why the diet should be sustained longer. It is also possible that insufficient attention is paid to relapse prevention techniques. People are responsible for their own diet. Doctors and other health care providers can only influence this from a distance. If people have a strong sense of self-motivation (they believe they can change their diet), have a lot of social support and have the idea that a different diet brings benefits for health, then chances are that people will also have the diet full to hold. A permanent change in the diet is then possible.

Poor dietary habits can be the result of a weak feeling of self-motivation, a low level of health awareness, a preference for meat or little knowledge of the relationship between eating habits and illnesses.

Some dietary patterns change the mood or personality of someone. Low cholesterol in the diet can result in a bleak mood. Another study suggests that low cholesterol levels reduce the number of heart attacks, but increases the number of deaths caused by behavioral causes (suicides, accidents and murders). This could be because a low cholesterol leads to lower serotonin levels in the brain.

Ways to change diet

Interventions to change dietary patterns are usually done on an individual level, so that the diet can be adapted directly to the individual. Every way that is used to change dietary patterns starts with education and training of self-monitoring. This is to make people clear how much of everything is in their food and how much they may have. After that, various cognitive behavioral therapy techniques can be used. These are stimulus control, contingency contracting, etc. If these techniques are linked to relapse prevention techniques, chances are that people will be able to change their dietary pattern. Furthermore, it is more effective to set short-term goals to combat overweight than to set a long-term goal.

It may be useful not to focus the intervention on one individual but on a whole family. It is easier for those who have to change their diet to keep this up when the other family members also stick to this adapted diet. The family members meet the therapist who must make clear to them the importance of changing the family's dietary pattern. The specific changes that have to be made are discussed. With other families, who also had to change their diet, recipes can be exchanged and experiences discussed.

In the social field, there are also ways that can affect the dietary pattern of people. However, these ways do not guarantee a long-term change. There are training campaigns about nutrition that can have some success. A modern way is to tackle a certain group and to design interventions for this. This is then a group for whom it is very important that the diet changes with respect to health. An example of such a group is people with a low income who live in the city.

Sleep

Sufficient sleep, rest and renewal are also important healthy behaviors. Many people do not make good use of sleeping hours or suffer from insomnia (not being able to sleep). There are different techniques to incorporate more relaxation in the day.

By what behavior does health deteriorate? - Chapter 19 (Health Psychology)

Health-damaging behaviors are behaviors of people who reduce their current or future health or cause harm. Because many of these behaviors are habits and also addictive, they are difficult to change. However, if the right attitude, motivation and help are available, every habit can be changed. If someone has changed one health habit, such as quitting smoking, there will often be other lifestyle changes, for example healthy eating.

The characteristics of health-damaging behavior

Health-damaging behaviors have addictive characteristics. For example, there is a high vulnerability in adolescence for the development of these behaviors. This involves smoking, excessive drinking, use of drugs, unsafe sex and risk behavior that can lead to accidents.

Adolescence is not the only vulnerable age. For example, alcoholism can also occur later in life, while obesity can develop at a young age. These health-reducing behaviors are influenced by the environment, such as friends. Children and adolescents imitate their friends and learn from them. In addition, adolescents and young adults want to feel cool, developed or cool about their social environment. These behaviors can then be developed as part of the self-presentation. A third similarity between all these behaviors is that they are enjoyable. They also increase the ability of adolescents to deal with stressful situations. Any health-reducing behavior is dangerous and they are all risk factors for diseases or death, for example smoking.

The development of this type of behavior is gradual. An individual first learns about the behavior, then experiments with it and then uses it regularly. Abuse of various means, such as drink, smoking and drugs, are determined by the same factors as the development of this health-reducing behavior.

If adolescents have a tendency to deviant behavior, have a weak self-confidence and a complicated family situation, they will rather develop the health-deteriorating behaviors. This also applies to the misuse of certain resources. This abuse will therefore occur earlier in the adolescents who fit the situation described above. The health-reducing behavior (problem behavior) is related to the larger social structure in which this behavior takes place. This way more problem behavior occurs in the lower social classes. It may be that this problematic behavior is the reason for the fact that social class is so strongly related to diseases and death.

Obesity: a health risk

Obesity is a surplus of body fat; fat accumulation in the body. Obesity is becoming a bigger problem. It almost replaces malnutrition as the most important contributor to poor health worldwide. Causes of this are genetic predisposition, too little physical activity and a large amount of fat and energy-rich food in developed countries.

Obesity is a risk factor for many other disorders. This can be a direct risk factor, but also indirectly because obesity affects other risk factors, such as high blood pressure. Disorders related to obesity are diabetes, arteriosclerosis, heart disease, hypertension, some forms of cancer, gallbladder disease and arthritis.

Obesity can cause problems during operations, during anesthesia and during deliveries. People die sooner because of obesity.

Other risk factors for obesity are social class and culture. For example, women with a low SES are often heavier than women with a high SES. This applies in rich countries, while in developing countries the opposite applies. There the prevalence of obesity is higher as people have a higher SES and therefore have more prosperity.

The culture factor has to do with the image of what one likes. In developed countries one finds women who are thinly beautiful, so there is a great emphasis on physical exercise and dieting.

Someone who has diabetes also has a greater risk of obesity. This is because these people have a high insulin content which makes them more hungry and therefore eat more. People with obesity can also easily store fat because they have very large fat cells.

Diets are also a risk factor for obesity. Successive periods of diets and weight gain provide greater efficiency in the use of food in the body and lower metabolism. When people start eating normally after a diet, the metabolism is still low, which means they will arrive sooner. This is called the yo-yo effect.

The link between food and stress

There are people who eat more when they are under stress, but also people who start to eat less. In people who are not dieting or who are overweight, stress can suppress the physiological signs that cause hunger, resulting in less nutrition. Someone who follows a diet, however, can lose control due to stress, which means that the brake on food will disappear. This leads to an increase in food intake. People who start eating when they are under stress often eat salty food and food that is low in calories. This while when they are not under stress they eat just high calorie foods.

'Stresseters' have more fluctuations in fears and depression than 'non-stress eaters'. People who are overweight have the same thing; they too have more fluctuations of anxiety, hostility and depression than other individuals.

It is not clear whether eating due to stress can cause excess weight. This probably depends on the experience of psychological problems and the assessment of stress. These would then be markers of the physiology that causes the weight to recover to the set point.

Most weight loss programs start with diets. People then learn how they can control their food intake, what is in their food and how many calories they can eat per day. The results of diets are often small and not lengthy in nature. The dropouts are often not satisfied with the result, which increases the chance that the lost weight will come back. Low-fat diets are best to lose weight with, but these are also the diets that people are least likely to maintain and where there is a high risk of a relapse. Diets can lead to reduced psychological functioning, concentration problems, an obsession with food, psychological problems and food for socializing. According to experts, dieting is a good way to treat obesity, but it must be applied in combination with other treatment options.

A second way of treating is fasting. In the case of fasting, food intake stops for a few days, with the exception of low-calorie liquids. Fasting means that people can lose a lot of weight very quickly. But people can not insist infinitely because it is bad for health. When people immediately pick up their normal eating habits after fasting, the lost weight quickly returns. Therefore, the treatment option of fasting techniques are added that ensure that people can stay on their new weight.

A radical way to deal with obesity is through operations. Especially stomach surgery is popular. Here the stomach is reduced so that it has a smaller capacity for food. As a result, the person undergoing surgery has to limit his food intake. Because there are risks associated with surgery, this way is actually only used in people who are over 100% overweight, who have to lose weight because their health deteriorates and they themselves are unable to lose weight in a different way.

People can also medicines getthat inhibit their appetite. This should reduce food intake. These medicines can be prescribed or purchased yourself. If taking these medications is combined with cognitive behavioral interventions, there is a big chance of weight loss. Instead of medicine, food supplements can also be swallowed. When people attribute the weight loss to the pills and not to their own efforts, there is a greater chance that the weight will come back.

Many current interventions in people with obesity use a multimodal approach. This may look like this: people with obesity are taught to do self-monitoring . They have to learn to keep track of what they eat, when they eat, how much they eat, where they eat and other dimensions of the food. This makes these obese patients more aware of their eating habits. Then the stimuli that contribute to eating behavior are analyzed. Patients must then learn to change these stimuli. For example, they can facilitate access to raw vegetables while reducing the presence of high-calorie food in the home. It turns out to be effective when people who participate in such a program receive individual guidance and feedback.

The next step is self-control. Patients must gain control over their eating behavior. For example, by teaching people to eat slowly by placing the eating utensils after a certain number of bites, the intake of food decreases. People are also encouraged to enjoy their food, because the goal is to eat less and enjoy more. People also need to know the consequences of their eating behavior. In addition, they have to reward themselves if they have done something successfully. Developing self-monitoring is very important for the treatment of the behavior of people with obesity.

Techniques are added to this treatment. Exercise is a very important addition. A lot of physical activity ensures a faster weight loss at the beginning of the program and contributes to maintaining the weight achieved after losing weight. This applies to both adults and children.

Participants of the weight loss program are instructed to keep their negative thoughts about weight loss and weight and to focus on positive self-talk.

A factor that contributes to successful weight loss and maintaining this weight loss is the presence of social support. Because people with a lot of social support are more successful in weight loss, the participants are taught methods to get effective social support from family members and friends.

In the multimodal technology, elements of relapse prevention techniques are also present. Situations can then be practiced where the risk of relapse is high for which coping strategies are then developed. These relapse prevention techniques are not only important for controlling the diet, but also for people who are not successful in losing weight and therefore want to stop. Women are not successful due to a lack of self-discipline, while men are more inclined to seek an external reason.

Where are weight loss programs given?

Many programs are given from work. It turns out that it works very well when two teams compete for the most weight loss. This could be due to very effective social support that arises when there is competition. The competition element would also stimulate and motivate people to drop out. There are also commercial companies offering weight loss programs, for example the Weight Watchers. The quality of these programs must be monitored.

Do cognitive behavioral therapies work when losing weight?

The newer cognitive behavioral techniques work better than the older ones. They lead to more weight loss in a shorter time. This could be because the new programs are longer and better because they emphasize self-management and physical activity and contain relapse prevention techniques. Nevertheless, the results differ per individual. With one the weight goes off and remains off, with others it comes as quickly as it goes off. In general, the treatment of obesity is only to a certain extent successful. Constant diets can make the problem worse. Health psychologists encourage people to live as healthy as possible, with sensible eating and sufficient physical activity.

Approach via public health

Because obesity is a very big problem, a public health model has to be drawn up. Weight loss programs are not sufficient in the treatment of obesity and overweight. An important strategy is prevention in families whose children are at high risk of becoming obese. Parents must then be taught that they give healthy eating habits to their children. As a result, the incidence of obesity could decrease. Behavioral therapy in children can be very successful because children learn habits more easily than adults. A lot of physical exercise is an important component of the programs in children. Because parents make food for children, the problem of self-control in children is not present.

What also needs to be considered is prevention of weight gain in adults with a healthy weight that age. If adults have a healthy lifestyle, the weight gain as they get older will be better.

Eating disorders

Some people continue to lose weight. This may be because they are influenced too much by the image of the 'perfect body' (slim and thin). Many people have the incorrect idea that if you are thin then you are healthy. Some people are so obsessed with weight and food that they have an eating disorder. In recent years there has been an increase in the number of people with eating disorders.

Anorexia Nervosa

Anorexia Nervosa is an obsessive disorder where an individual starves himself, and in which an individual diets and a lot of sports, to the point where the body weight is far below the optimum level. Most people with anorexia nervosa are female adolescents.

Several factors have been determined that contribute to the development of anorexia.

Physiological explanations are that stopping the menstrual cycle (amenorrhea) is a sign for weight loss. In girls with anorexia, the steroids that regulate the food would be present in the body to an increased degree. There seems to be a connection between Turner syndrome and having anorexia nervosa.

Women with eating disorders and women who are predisposed to this often have elevated blood pressure, increased heart rate, increased reactivity to stress and high levels of cortisol in the urine. This indicates that these women are constantly reactive to stress. Women with eating disorders quickly become depressed, anxious and often have weak self-esteem.

Anorexia is thought to have a genetic component because it is common in certain families. Girls with anorexia would lack a sense of control coupled with the need for confirmation. These girls exhibit very perfectionistic behavior. There is a very wrong body image, of which one does not know whether this is the cause or the result of the anorexia.

Family factors also play a role. Girls with anorexia often come from problem families or from a very close family in which there is no good communication about emotions and quarrels. The mother-daughter relationship can affect the disorder.

Research now focuses on the conditions under which anorexia can occur in people with an increased risk of this.

Treatment of anorexia

The first goal of treating an anorexic patient is to bring the weight back to the normal level. This can be done, for example, by means of operant conditioning that causes positive reinforcement of the behavior. However, if anorexic patients learn this in a hospital, the question is whether they can keep this up in the home situation.

If the weight is restored, other therapies can be given. An example of this is family therapy in which families learn to communicate better about conflicts and emotions. Psychotherapy may be necessary to improve self-image and self-confidence. Coping skills can also be learned with stress.

Because anorexia has major health consequences, attention is now focused on prevention. The most important thing is that the health risks of anorexia are clearly told. Women with symptoms of anorexia can also be encouraged to seek treatment.

Bulimia

bulimia is a syndrome characterized by alternating cycles of abnormal eating and removing food from the body, for example by surrender. Eating large amounts of food usually happens when the individual is alone. This excessive eating can be caused by negative emotions. Someone then starts eating and can not stop. Although this food is unpleasant, the check is gone and the person can not stop it. Many people with anorexia are also bulimic.

People with bulimia usually have a normal weight, or even some obesity, especially on the hips. The phase in which these people eat is a phase in which the control is gone. The control must then be obtained by removing the food from the body by, for example, surrendering. Food can become a constant thought. The normal control of food through internal sensations is no longer there. This has changed in decisions about what to eat when. This is a cognitively based regulation system.

Families in which there is a lot of attention for appearance and being thin get children with bulimia faster. Bulimia patients often have low self-esteem and eating to control their negative emotions. Girls and women with bulimia are not only obsessed with food, but also with weight and body. There may be a history of depression or other psychopathology, abuse of alcohol and drugs and difficulties with organizing work and social moments. Stress can induce an abnormal eating moment, especially when it comes to conflict with others. Physiological consequences of the disorder are hormonal disorders, disorders in the hypothalamus, food allergies, altered taste, neurological disorders and a disorder of the endogenous opioid system.

The treatment of bulimia

One difficulty in treating bulimia is that many women do not want treatment. One of the first things that needs to be done is convince these women of the health risks they run and the importance of therapy.

A combination of medicinal and cognitive behavioral therapy is the most effective treatment for bulimia. Patients must have a diary in which they keep track of their eating habits. Self-monitoring can reduce the number of abnormal eating moments.

Other more specific techniques that are used are increasing the regularity of eating, making a greater variety of food and delaying as far as possible the moment at which to be surrendered. Through these techniques the patterns that the women have built up can be broken down. The treatment also includes relapse prevention techniques.

Being substance-

dependent Some people depend on a certain substance. This is the case if the individual has administered the drug several times, which has led to tolerance, withdrawal and compulsive (compulsive) behavior.

There are different forms of means dependency. Someone can be physically dependent. Then the body is adapted to the presence of the means it uses the drug in the normal functions of the body. This also has to do with tolerance where a larger dose is always needed to achieve the same effect. Someone can also crave or crave to express a certain behavior or consume a certain substance. This can be the result of physical dependence or a conditioning process.

Someone is addicted when, as a result of the use of a substance, he has become physically or psychologically dependent on this substance over a certain period of time.

Withdrawal refers to the unpleasant symptoms that people experience when they stop using a substance to which they have been addicted. Examples of these symptoms are headache, nausea, anxiety and hallucinations.

Alcoholism and problem drinking

Alcoholism is the biggest cause of death in America after smoking, a poor diet and little physical activity. The consumption of alcohol is related to various conditions such as increased blood pressure, liver cirrhosis, stroke, some forms of cancer, developmental delay and physiological abnormalities in the children of heavily drinking mothers. Excessive drinking can cause cognitive problems.

Many people have died by drinking and driving.

Alcohol consumption thus contributes to illnesses and accidents. In addition, it involves many economic costs and other health risks arise. An example of this is aggressiveness, whereby more murders and robberies are committed under the influence of alcohol. Alcohol consumption can lead to unsafe sex. Alcoholism is therefore a big problem.

What is alcoholism and problem drinking?

Alcoholism and problem drinking include a number of specific patterns. An alcoholic is someone who is physically addicted to alcohol. Alcoholics have withdrawal symptoms when they try to stop drinking. In addition, they have a very high tolerance for alcohol and can not control their drinking habits.

A problem drinker does not have to have all these characteristics, but they usually have social, psychological and medical problems as a result of the alcohol. Behaviors that are associated with heavy alcohol consumption are: the daily need of alcohol, repeatedly trying to stop alcohol consumption without result, suddenly drinking a lot, not being able to stop drinking, losing memory during intoxication, continuing to drink while health problems are known and drinking non-alcoholic beverages.

That some heavy alcohol users are physiologically dependent on alcohol is suggested because there are stereotype drinking patterns. By drinking, the alcohol content in the blood remains the same, and heavy alcohol users can function at an alcohol level that is much higher than among less tolerant drinkers. There is also a feeling that there is no control over the consumption of alcohol and there is a subjective urge for alcohol. Symptoms of alcohol abuse are difficult to perform daily work, inability to function normally in the social field without alcohol and difficulties encountered while drinking, such as convictions while driving under the influence.

What causes alcoholism and problem drinking?

The causes of alcoholism and problem drinking are very complex. There are genetic factors associated with it. Men also appear to have a greater risk of alcoholism than women. Social demographic factors, for example low income, can predict alcoholism. The development of alcoholism is a gradual process in which physiological behavior and socio-cultural variables play a role.

The use of alcohol is a waythe effects of stress to buffer. People with many chronic stressors, many negative big events and little social support are more likely to become problem drinkers or alcoholics than people without these problems. If people have little autonomy in their work, are not allowed to take decisions or are allowed to do so, and are unable to use their own qualities, these people will become heavy alcohol users sooner. In addition, financial tensions may play a role. Drink people to reduce their negative emotions and to increase their positive emotions.

Alcoholism also depends on the social and cultural environment of an individual. Parents and friends are role models for adolescents and can thus influence attitudes towards adolescent alcohol consumption. Many people who become alcoholics have associated alcohol consumption in their former life with pleasant events.

When people get married and have children, their risk of alcohol abuse becomes smaller, because they will then go to pubs and parties where alcohol use is prominent. Risk ages for alcohol abuse are between 12-21 years and middle-age if it is a way to deal with stress.

The treatment of alcohol abuse

In recent years alcohol abuse has been a habit that can be changed. Some alcohol users can do this alone and others need help with this. Alcoholism can be successfully treated with cognitive behavioral change programs.

However, a large part of the participants can not leave the alcohol after following these programs and fall back into their old habit. This may be because those who participate in such programs are also those who have serious drinking problems. Otherwise they would not need help. The social class in which people find themselves is a factor that is important for the success with which alcoholics conclude treatment programs. People in a higher social class and with stable social environments (regular job, group of friends and an intact family) are more successful than people with a low SES and an unstable social environment. These backgrounds should be taken into consideration during the treatment of alcoholics.

Treatment programs for alcoholics

One way that is widely used in the treatment of alcoholics is self-help groups. A known is the AA (Alcoholics Anonymous). The treatment programs often use cognitive behavioral therapy in a broad spectrum to address biological and environmental factors related to alcoholism. The goals of the treatment are the weighting of the strengthening effect of alcohol (so that patients must have more and more), the learning of new behaviors that do not encourage alcohol abuse and the changing of the environment so that stimuli are present that lead to behavior other than alcohol abuse. Stress coping techniques can also be taught so that there is a greater chance of sustaining in the longer term.

The first phase with serious drinkers consists of detoxification. This must be done in a protected medical setting, because a lot of health problems can arise during this process. If the alcoholic is already partially detoxified and has not drunk alcohol for a while, the therapy can start. The alcoholic will then receive intensive and internal therapy for a short period, followed later by a period of external therapy.

The cognitive behavioral techniques that are used include self-monitoring. This often happens to let the alcoholic or problem drinker understand the situations in which drinking occurs and continues. Contingency contracting is also often used. It is agreed that if, for example, something goes wrong in the future, this will result in psychological or financial costs.

Motivation techniques are used because the responsibility and possibility of change lie entirely with the patient / alcoholic. In some programs, the participants take medication to reduce the interactions in the brain with the alcohol that contribute to alcoholism.

In many programs participants are taught stress management techniques that can serve as a substitute for drinking. This is because alcoholics or problem drinkers often use drinking as a coping way for stress. It is also the case that these techniques ensure less waste in the programs. It has been proven that a stressful event within the first 90 days after treatment is a good predictor for a relapse in seemingly 'cured' alcoholics. Relaxation techniques can also be effective for alcoholics to deal with situations in which they would otherwise go to drink. In some cases family therapy is given, which makes the return to the family easier for the alcoholic.

The relapse after treatment is a major problem in the treatment of alcohol abuse. Prevention can be used by practicing coping skills and social skills in 'situations with a high risk of relapse'. A chance relapse can occur. This helps the problem drinker realize that an opportunity drop is not the end of the check and a sign of failure. People must learn skills to reduce drinking. They can also choose to drink non-alcoholic beverages in risky social situations.

Success of alcohol abuse treatment programs

Within alcohol abuse treatment programs, there are several factors that contribute to success. The drinker must be able to identify, change or develop ways of dealing with these factors from the environment that determine drinking. The participation in a program lasts an average of 6-8 weeks, followed by a period of aftercare where the patient is back home. Other factors that contribute to success are the use of weather-therapy and the interference of family and employers in the program.

The question now is whether internal hospitalization of the patient is needed per se to guarantee success. It turns out that alcoholics with stable jobs, relationships and few other problems do just as well in treatment programs in which the patient does not have to work internally. This could save costs. Of all alcoholics out there, only a small percentage (about 15%) is treated.

Can you drink again after treatment?

The question is whether treated alcoholics can still use alcohol in their normal life. The idea that alcoholics can stay away from the drink better after treatment is for the most part true. However, it appears that some problem drinkers can drink again as long as they can check this themselves. These are mainly young people who have not been problem drinkers for a long time, have a job and live in an environment that supports them. By drinking controlled drinking, someone can show normal social behavior. This is sometimes a more realistic goal than total abstinence, because some people (such as students) often come into situations where a lot is drunk. In addition, controlled drinking would be a way to prevent the large relapse in total abstinence.

Special skills must be learned in order to be able to drink. The point is that people learn to determine the amount they want to drink, to monitor their alcohol consumption themselves, to check the amount they drink, to apply self-reinforcement for controlled drinking and to learn alternatives for alcohol abuse. Due to the success of programs that alcoholics learn these skills, it is proven that heavy drinkers can learn to drink controlled. Also, these programs do not seem to be as intense and comprehensive as other broad-spectrum programs against alcohol abuse.

Prevention of alcohol abuse

Because alcoholism is a big problem, health psychologists have come up with the idea to make young people clear early on that they can better keep their drinks off or that they should only drink controlled. Young people are taught techniques that allow them to refuse drinks or to handle risky situations in which the pressure to drink is high.

Because adolescents learn and apply these skills they get a better self-awareness. Through the curricula, the social norms that ensure that young people drink alcohol can be replaced by standards that emphasize the abstinence of drink or controlled drinking. Because these programs are not expensive to give, low-income areas can be reached. In these areas people who are otherwise the most difficult to reach are living.

Prevention of alcohol abuse can also be done by increasing the taxes on alcohol, applying stricter rules to advertising alcoholic beverages, drawing the attention of governments to the big drinking problem among young people and the misleading health benefits of drinking Push the button.

Driving under the influence

An important problem as a result of alcohol use is the accidents that occur as a result of driving under the influence. The general public also considers this a matter that needs attention. The pressure on governments to carry out stricter alcohol control is increasing. Attention is also shifted to hosts and hostesses who allow their guests to drive under the influence and to friends who do not recognize that their friends are getting drunk behind the wheel. However, this can be a difficult task. It can help if the rider is someone you know well, you think that the person really needs help and you can give him / her that help and if you've had conversations with the rider in the past about what to do in such situations.

The intervention of hosts and friends with drunken riders goes against the principle of personal responsibility and individual freedom. As a result, many drunken people are still on the road.

Because nowadays more attention is paid to drunken drivers, many drinkers are going to develop self-regulating techniques that ensure that they avoid drunken driving. This can be done by drinking less if there is still to be driven, by arranging a taxi or by slowing or stopping driving until the effect of the drink has dropped. Prevention of drinking in the whole is difficult to achieve. Because many people now regulate themselves to avoid drunken driving, some of them can come up with a solution to the problem of accidents.

Modest drinking can be healthy because it reduces the risk of cardiovascular disease. This could be because alcohol increases the HDL content slightly. HDL removes cholesterol and helps to lower the LDL content. This reduces the risk of cardiovascular disease.

Smoking

Smoking is the cause of many preventable deaths. Smoking increases the risk of cardiovascular disease, chronic bronchitis, emphysema, respiratory diseases, damage due to accidents and burns, lower birth weight of the children and subordinate fetal development.

It appears that smokers are less aware of their health than non-smokers. Therefore, they will fall into other bad health habits earlier. Especially the combination of smoking and drinking is common. Smokers take more sick leave, have more accidents at work and make more use of health care than non-smokers.

The dangers of smoking are not limited to the smokers themselves, but also the friends, family members and colleagues run a greater risk of different diseases.

Smoking has a synergistic effect

Smoking increases the influence of other risk factors on health. This is a synergistic effect. For example, the combination of smoking and cholesterol causes greater morbidity and mortality in cardiovascular diseases. Nicotine can namely reduce the HDL content, because nicotine releases fatty acids, resulting in more triglycerides being synthesized. The latter ensures the decrease of HDL (HDL clears up cholesterol).

Smoking has a relationship with stress. For example, it has been proven that nicotine in men increases the size of heart rate reactivity under stress. In women, nicotine reduces heart rhythm, but blood pressure is increased. Because of the stimulating effects of nicotine, smokers have a greater risk of a sudden heart attack. There is a physiological link between smoking and hyperresponsiveness to stressful events, which leads to a higher risk of cardiovascular disease. The combination of low weight and smoking also leads to higher mortality. Very thin people who smoke have a higher mortality than smokers with a normal weight. Non-smokers who are thin do not have this increased mortality.

Smokers have less physical exercise if they continue to smoke. If they stop smoking, they will get a more active level of physical activity. Smoking therefore provides less physical exercise than normal. Too little exercise is a risk factor for many diseases and death.

If women smoke, they have a four times higher risk of breast cancer.

People who are depressed and smoke have a greater risk of cancer than non-smokers who are depressed. This could be because natural killer cell activity increases due to the combination of smoking and depression. Nowadays people think that smoking could be a cause of depression. Smoking is related to anxiety in adolescence. Whether fears and smoking have a synergistic effect on health is not known.

The synergistic health effects of smoking could be the cause of the deaths related to smoking. Although the direct health effects of smoking are known to the general public, the synergistic effects are less known. Stopping smoking has health-promoting effects. The risk of cardiovascular disease and lung disease decreases considerably if someone stops smoking.

History of the problem of smoking

Smoking was a normal habit for years. In the beginning this was especially true for men. In 1955 53% of adult men smoked in the US. Women started smoking later than men. In 1964 the first official article was published with the message that smoking can have harmful consequences.

A large public campaign followed in which the dangers of smoking were emphasized. Despite this campaign, women and young people started to smoke more. The number of smokers among men dropped to 39%. There were then alternatives for smoking, such as the 'healthy' cigarette. Many people switched from heavy cigarettes to light cigarettes with less strong nicotine. It was believed that they went in the direction of good health by that step. However, follow-up studies showed that these assumptions were wrong, because people start to smoke more of these lighter cigarettes to compensate for nicotine loss.

Since 1979, the number of adults smoking has dropped by more than 25%. Nevertheless, smoking remains a big problem. The number of smokers is especially high among groups of minorities and teenagers. Tobacco industries are shifting their markets to developing countries where smoking is a rising problem. This is because in developed countries the pressure to reduce smoking among children and adolescents is very high. In China, smoking behavior is taking on epidemic proportions.

Why do people smoke?

Smoking is determined by various physiological, psychological and social factors. Family and twin studies have shown that there are genetic influences on smoking behavior. Because of genetic feedback, some smokers have difficulty stopping smoking. It probably does not have much added value to give this information to smokers. Many people who smoke do not depend on it. Some people become calmer because of the nicotine, others are stimulated and others become depressed.

Factors in adolescents play an important role in developing the habit of smoking. Smoking starts with a period of experimentation in which the adolescent feels pressure from his friends and tries out cigarettes. Then the adolescent develops his attitude in smoking. After the experimental phase, a small proportion of adolescents become heavy smokers.

The influence of friends is one of the most important factors that causes young people to start smoking. More than 70% of cigarettes smoked by adolescents are smoked in the presence of a friend. Early smoking behavior is often part of a syndrome of problem behavior, including alcohol consumption, drug use and irresponsible sex. Smoking can be an attempt to reduce a negative mood. It can also be associated with an increased testosterone function.

Adolescents will smoke earlier if their parents smoke, if they come from a low social class or if they feel environmental pressure to start smoking.

The image of a smoker can also be a factor in which adolescents start smoking. Adolescents may have the image of a smoker that is tough, mature and rebellious. Uncertain young people can then smoke, because they then radiate the image they want. Other young people can of themselves have the image that fits the image of a smoker. These will therefore be more inclined to smoke. Other factors that contribute to a greater chance of smoking are little self-confidence, dependence, powerlessness and social isolation. Male students are less likely to smoke than female students.

Why is smoking addictive?

Smoking is addictive. A small group of smokers is able to do it occasionally and therefore not build up an addiction. Nicotine is a highly addictive drug. However, the mechanisms by which nicotine has an addictive effect are unknown.

The theory that explains the role of nicotine in not stopping smoking assumes that a person keeps his nicotine blood levels up by smoking and thus prevents withdrawal symptoms. These withdrawal symptoms occur when someone stops smoking.

It comes down to the fact that the nicotine levels in the blood change when someone starts to smoke. However, there are studies that have changed the nicotine level in the blood in humans, after which these people did not show any other smoking behavior. Another argument against this theory is that smoking strongly depends on situations in the environment and therefore can not change the nicotine level in the blood so quickly. Even if smokers are stopped and their nicotine content is zero, many smokers cease to fall back into their old habit. According to nicotine theory, there would be no reason for this.

Another theory is the theory of Pomerleau. He assumes that smoking works as a neuroregulator. Nicotine would then be a means by which reactions and attitudes are regulated. Nicotine changes the levels of normal neuro-regulators, such as norepinephrine, acetylcholine, dopamine, vasopressin and endogenous opioids. Smoking would then provide a temporary improvement of reactions. Thus, acetylcholine, noradrenaline and vasopressin can make the memory better. Acetylcholine and beta endorphins reduce anxiety and tension. The changes in these neurotransmitters can also improve the mood.

Smoking therefore increases concentration, alertness, responsiveness and the ability to eliminate irrelevant stimuli. When smokers stop smoking their concentration decreases, they have trouble remembering things and they experience more fears, tensions and mood swings. Because nicotine solves these problems, many smokers return to their old habit. As people smoke longer, they adjust their nicotine intake in such a way that they increase the beneficial effects of nicotine. This could be a reason that smoking is so good for coping with stress.

Other theories assume that smoking is maintained through social learning. Smoking is linked to rewarding experiences. For example, a young, insecure adolescent smokes because he is insecure. Once the cigarette is out, he / she becomes insecure again so he only lights up a cigarette to lower his fears. Because smoking is very addictive, it is difficult to treat.

What can be done to reduce smoking?

One way to reduce the number of smokers is to try and change the attitudes to smoking. Because many risks of smoking are emphasized via the media, people's attitudes to smoking change. The media can be very effective in providing information about health habits. The media also create anti-smoking attitudes and other social norms with regard to smoking within society. These attitudes also ensure that adults start smoking less quickly and are persuaded to remain non-smokers. The anti-smoking messages from the media ensure that people want to make an effort to stop smoking.

Therapeutic treatment of the smoking problem

Another way to reduce the number of smokers is a therapeutic treatment. Psychologists have developed ways to tackle the smoking problem, because only a change in attitude does not appear to be enough to encourage people to quit smoking. Many therapies start with nicotine replacement therapy. This can be done by nicotine gum or nicotine patches that deliver nicotine in the blood.

After the nicotine replacement therapy has started,is also operant conditioningdiscussed . Because smoking is a habit that is integrated into daily life, there are various stimuli that cause someone to smoke and continue to smoke. The operant conditioning must ensure that the smoking behavior is disconnected from these stimuli. Someone can carry a buzzer that beeps when smoking is required. This means that smoking behavior is independent of other stimuli such as drinking a cup of coffee with colleagues. Operant conditioning appears to be very useful at the beginning of the therapy, but it does not have much effect in the longer term.

The therapy for smoking can be described as a multimodal intervention. This means that different interventions are applied at different times in the process of quitting smoking. An individual must have a sense of self-control for multimodal intervention and must focus on active participation in the intervention process. In the beginning, the dangers of smoking and the negative attitudes that most people have towards smoking must be emphasized. Afterwards, the smoker must make a timetable for smoking cessation and make a program that states how he will stop. The smoker must also become aware of the difficulties that smoking cessation entails. In the next phase, different cognitive behavioral techniques can be used, which are also used when changing other health habits. Self-monitoring and self-observation can be considered, as well as reward techniques. Changing the environment can make an important contribution to stopping smoking.

Smokers who want to quit are encouraged to receive support from their partner, friends, relatives and colleagues in their decision to quit. Social support is very important for the success of quitting smoking. A group of friends can be very supportive, but also a barrier to smoking cessation because many people in the group of friends are smokers. Because smoking can be very relaxing, in therapy should also relaxation be taughtexercises.These relaxation exercises are useful in situations where an ex-smoker used to have caught a cigarette. It is also an alternative method to deal with stress and anxiety. A lifestyle restructuring can also help stop smoking. People can change their diet or do more physical activity.

The action to stop is quickly made. Continuing to stop smoking is more difficult. The prevention of a relapse therefore has an important part in the programs for smoking cessation. In most addictive acts, a single relapse immediately reduces self-esteem, increases a negative mood, and the thoughts that someone will be successful in stopping the habit disappear. This is also the case with smoking, a relapse of one accidental cigarette can cause this effect. Someone with a positive self-esteem, after a failure, focuses more quickly on other matters.

Smokers who want to stop must therefore try to understand that a single relapse is very normal and that it is not very important. Buddy systems or telephone counseling can be useful here.

The prevention-relapse techniques start with preparing people for the withdrawal symptoms. These are changes in hunger, cardiovascular changes, increased coughing and variations in the craving for a cigarette. Prevention-reversal techniques should also focus on teaching coping techniques to deal with stressful situations. The technique of contingency contracting can also be used, whereby the smoker pays a certain amount of money and only receives this money if he or she succeeds in stopping.

Factors that predict smoking cessation are:

• Whether people have alternative methods to deal with stress and anxiety.

• Whether people have enough social support and environmental support.

• Whether people have enough self-confidence.

These are the most important factors, but there are more to come up with.

Multimodal interventions evaluated

The success of stop-smoking programs is limited. Almost every combination of therapies has been tried and after a certain success in the beginning 90% of the participants fall back into the old habit. These are often young people, with a high nicotine dependency and a weak sense of self-confidence, who have more often tried to stop and whose attempts have failed more often.

No relapse prevention technique has yet been discovered that is really effective against a decline in smoking behavior. Relapse is most unlikely if the interventions are intensive, if pharmacotherapy is used and if telephone counseling is available.

By telling people that a single relapse is not bad, the disappointment they feel in such a relapse can be reduced. Although the programs to stop smoking are not so successful, there is some cumulative success. Approximately 20% of the participants stop at each program. The more attempts people make, the more people will stop. There is therefore no need to look at a single program.

Who can best try to make people stop smoking?

It turns out that people who, for example, look for psychotherapy to stop smoking do not do better than people who look for other therapies. If doctors give advice, this can lead to greater success. Especially if these recommendations contain an intervention or a reference to a specific stop program, they are successful.

It could be useful to set up stop programs via work. There is then great social support. However, it has been shown that stop programs do not work better than other programs through work. Continuing to stop smoking also does not work better in the workplace.

There are commercial programs that promise people that they can help them with smoking. The real statistics usually show a different success result than the advertisements.

The commercial programs are also in the form of self-help. These are then nicotine patches or television programs that the smoker can follow and instructions on how he / she can stop smoking. It turns out that this self-help means fewer people stop smoking in the beginning, but the people who quit keep this up as well as with more intensive programs.

There may also be activities at the level of general health that can encourage people to stop smoking. For example, there have been campaigns aimed at risk groups, for example people with a higher risk of cardiovascular disease. Such interventions are usually expensive and the long-term effects are limited.

Why is smoking behavior difficult to change?

Previous documents have shown that people can stop smoking for a short period, but that the percentage of ex-smokers who fall back into smoking behavior is very high. Smoking is a behavioral pattern that is difficult to change. This is because smokers resist resistance to interventions. This resistance is caused by a lack of knowledge and their health-damaging attitudes. Smokers are less well informed and less concerned about the health consequences of smoking than non-smokers. Because many smokers have their first experiences with smoking during adolescence, they link smoking to pleasant events. During adolescence, smoking mainly takes place among friends and at parties. This also makes it more difficult to change the smoking behavior. Smoking behavior is very individual. Therefore, a group intervention can not handle all factors that apply to all individuals.

Another important factor that makes smoking cessation difficult is addiction. The withdrawal symptoms that occur after stopping smoking are usually an incentive to start smoking again. The long-term effects of quitting smoking also increase the chance of a relapse. These consequences include nausea, weight gain, fatigue, headache, sleep problems, anxiety and hostility.

Another factor that makes it difficult to stop smoking is that smoking has a positive effect on a person's mood. Smoking monitors reactions to stress and anxiety. This could be a reason for former smokers to pick up smoking again. This increases the chance of a relapse.

Smoking provides control of the weight. Because the weight remains low by smoking, many girls start smoking in adolescence and many adults have difficulty stopping smoking. Weight gain often follows after stopping smoking. This is partly due to changed eating habits after stopping smoking. Ex-smokers need sweet carbohydrates; One reason for this could be that carbohydrates increase the mood. These carbohydrates can also regulate the nicotine-reduced insulin levels and the nicotine-elevated catecholamines. Another reason people arrive after stopping smoking is that nicotine ensures high energy consumption. After smoking cessation, this higher energy consumption disappears.

Ex-smokers have to find a different way of dealing with stress than smoking. This can be stress-induced food. This also ensures weight gain. The best way to let people cope with the risk of weight gain after stopping smoking is to make them aware of the high risk. People also need to be encouraged to start exercising and to develop habits.

Stopping yourself

People usually quit smoking because they are worried about the health risks. People who want to stop themselves have good self-control skills, a lot of self-confidence that they can stop and the idea that the health benefits outweigh the disadvantages of quitting smoking. Stop smoking yourself is best if someone does not smoke too much and has a social network that supports him / her. Most smokers who quit by themselves, fall back into their old habit at a certain moment. After a few attempts, most independent smoking cessation quarters are successful.

Prevention of smoking

Because the reasons someone starts smoking nowadays are better understood, they want to try to prevent people from smoking. This can be done through smoking prevention programs. These programs aim to identify and eliminate the underlying reasons for starting smoking in potential smokers. The advantages of these prevention programs are that they are cost-effective and that a lot of results are achieved, because they do not have to take into account the factors that make it so difficult for smokers to quit. These prevention programs can easily be given during school hours and therefore do not require much time from normal education.

Intervention through social influence

Evans has developed a program that prevents young people from smoking. He starts from the fact that young people smoke more quickly when their parents or friends do that. Starting smoking is therefore influenced by the modeling of others. His program through social influence must therefore include the possibility of modeling. He wants young people to model themselves on a non-smoker with a high status.

Another component of the intervention via social influence is behavioral vaccination. This is equivalent to a regular vaccination. Someone is exposed to a seductive message, after which there are counter-arguments against this message. This allows this person to better withstand this message.

The program of intervention through social influence consists of the following three elements:

• The information about the negative effects is given in such a way that it appeals to young people. Although many young people know that smoking is bad for their health, they continue to do so. Therefore, suitable anti-smoking materials must be developed for this specific group. The campaigns should not, for example, emphasize the health problems in 20-30 years, but rather the problems that could currently occur. Attention can also be paid to the financial costs and the negative social consequences of smoking.

• Materials are being developed that create a positive image of a non-smoker, as if this were an independent and independent person. Films and posters can be developed that make the choice among young people themselves through slogans such as "Make your own choice", or "Here are the facts, so make your own choice". There are also techniques that tobacco manufacturers use to persuade people to smoke.

• The group of friends is used to reach non-smoking instead of smoking. The people used for the posters and films are often older adolescents who convey the message of non-smoking. By playing a role, they can make it clear what friend pressure is and how it can be resisted to come up with the choice of non-smoking. A few students can also come together with such an older adolescent after watching a film, for example.

Whether these prevention programs are successful is difficult to estimate. They often only postpone the smoking behavior. Research has shown that intervention through social influence can reduce the number of smokers for about four years. Experimental smoking is probably more influenced by these programs than regular smoking. The experimental smokers will stop by themselves more quickly through these programs.

Vocational training

A program other than intervention via social influence is the lifelong training program. This approach also wants to try to prevent smoking in adolescents. The theory behind this training assumes that if young people are trained in their self-confidence and coping and social skills, they will feel less need to boost their image by smoking. The results of this training correspond with other anti-smoking programs. In addition, this program is successful in the reduction of smoking over a certain period. Because creating and giving these programs is very expensive, a CD-ROM has been developed that allows students to learn the skills interactively. Research has shown that young people can better say 'no' to such marijuana through such a CD-ROM. It is therefore interesting to make even more of these interactive programs, because the costs are very low.

Social engineering

Smoking may well be addressed from the social environment. It may be helpful to increase the cost of cigarettes by increasing the tax on cigarettes or by increasing the costs of tobacco manufacturers. This could reduce smoking and prevent people from smoking.

Another measure is to allow smoking only in certain places. In this way, non-smokers also do not experience the harmful effects of smoking. Some employers have stop-smoking programs for their employees. The measures via social engineering to reduce the number of smokers will increase in the coming years.