From a uni-dimensional to a multi-dimensional health promotion perspective. Promoting a tobacco-free generation based on a motivational structure of behaviour
Abstract: The overall aim of this thesis was to expand the knowledge of decisive factors acting on health behaviour at an intrapersonal and interpersonal level, and to obtain a deeper understanding of smoking behaviour. A university student population (n= 332) was used in order to investigate self-rated health and health habits in relation to different personality traits and motivation for a healthy lifestyle (sub-studies I-II). In order to investigate important facets of adolescents tobacco use, a sample of 437 pupils, 293 parents and 119 school staff was used (sub-studies III-IV). A cross-sectional design was used for the sub-studies I-IV with data collected by questionnaires created for the respective sub-study and analysed with the help of descriptive and inferential statistics. There was no gender difference in self-rated health or in Sense of Coherence (SOC) ratings. High stress levels affected health among both female and male students. Female students were more motivated for a healthy lifestyle and had a healthier lifestyle in relation to smoking, alcohol use and nutritional habits than their male counterparts. Female students with high motivation and more health activities had more health complaints. Male students showed a high level of overweight. SOC and optimism were associated with self-rated health among female students only. SOC was associated with positive affect/optimism and hardiness. Smoking by siblings influenced the smoking pattern among pupils in grade eight. The pupils valued parents opinions and information on tobacco matters, and wanted adults to set a non-smoking norm. The responsibility to promote a tobacco-free generation was viewed differently among pupils, parents and school staff. To obtain a deeper understanding of smoking behaviour a philosophical analysis in three stages was performed, based on the philosophy of Merleau-Ponty (sub-study V). The analysis illuminated the need to see behaviour, including smoking, as bearing a meaning. Smoking behaviour can be used to make the smoker more visible, to enhance the sense of existing; the smoking habit is incorporated in body-mind and influences body image and image of self. Smoking by adolescents can be used as a means to achieve group membership and status and also for developing own identity. The results show that health is influenced by intrapersonal factors, but also by norms and influences from the social environment. The need to develop a multi-dimensional perspective on health promotion is emphasized where the human being, and not health, is put at the centre of health promotion. If health promotion could take the stand-point that every behaviour has a positive meaning, then it could leave the victim-blaming trail and instead take the empowering path to self-development and well-being based on the individual s own, free, but well-informed choices related to the preferred goals in life.
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