Health behaviour in a social and temporal context
Smoking, alcohol consumption, diet and exercise are sources of risk for many chronic diseases and the need to change unhealthy behaviours is now a key aspect of health promotion policies. Interventions to change adult behaviours have been unsuccessful despite, or perhaps because of, rather dramatic secular changes. Health behaviour is usually understood in terms of three different motivating forces for action, which can be categorised as individual utility, social structure and agency (i.e. engagement in a specific social and temporal context). The first two of these have been relatively well studied. The role of individual utility has been explored using a variety of expectancy-value models that relate individual psychological attributes (attitudes, beliefs and suchlike) to health behaviour. The role of social structure has been explored by studying how behaviour varies with economic circumstances (such as income or tenure) and social relationships (such as family and neighbourhood). Less well studied has been the role of agency. This thesis develops Giddens's concept of self-identity and Simmel's ideas on fashion, to provide an operationalisation of agency. The concept of image is used to link the individual's presentation of self and the appearance of an activity, in terms of underlying attributes such as conformity, gender-identity, sociability and asceticism. Considerations of image provide a potential explanation as to why some people might be more attracted to one activity than another. The concept of status seeking is used to explore why some people are motivated to follow new trends more quickly than others. This operationalisation of the role of agency in health behaviour is tested by exploring the relationship between all these potential motivating forces (individual utility, social structure and agency) and the initiation of and change in 4 specific health behaviours (smoking, drinking, diet and exercise), using data from the 1946 national birth cohort. The 1946 cohort provides a unique opportunity to explore these relationships because it provides the historical specificity necessary to delineate the changing public image of these health behaviours. It covers a period (1946-1989) during which advice about and the public image of the 4 health behaviours changed considerably, and it has data on the cohort's health habits and self images. Results indicate that people's views of themselves in relation to public images do indeed relate to these 4 health behaviours along with the other motivating forces. Understanding how all these motivating forces operate offers the possibility of predicting future behaviour and designing strategies to promote healthy choices.