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Promoting Prevention and Health Through Positive Image Awareness

The Modern Epidemic of Multiple Health Risks

Epidemiological research indicates that youth are experiencing an epidemic of multiple, co-existing health risks. No longer is it the norm for a young person to be at risk of just a single health problem, like underage alcohol use.

Rather, research indicates the majority of today’s youth are faced with two, three or even more risk habits at a time. Particularly prevalent risks include alcohol, tobacco and drug use, physical inactivity, unhealthy eating, inadequate sleep, and unmanaged stress.

Exponential Effects of Multiple Risks

Exposure to each additional risk behavior increases the likelihood of harm to a young person. Even more concerning, however, is that because co-occurring risks are often interrelated, they can exponentially increase damage to the health and positive develop of youth.

Take, for example, marijuana use and lack of regular exercise. While marijuana consumption and physical inactivity individually have significant and sometimes severe negative effects on the development and well-being of a young person, together their interaction further exacerbates harmful outcomes.

Marijuana use can reduce motivation to regularly exercise and participate in sports and other physical activities, while lack of regular physical activity can promote and support the experimentation with and regular use of marijuana. Furthermore, regular and heavy marijuana consumption and a sedentary lifestyle can affect the onset and continuation of additional risk habits like unhealthy eating, uncontrolled stress, and other substance abuse behaviors.

The Solution to Multiple Risk Behaviors among Youth

The solution to alleviating multiple health risks that youth commonly experience is to provide integrated prevention programs. Especially needed are integrated programs that connect the prevention of health risks like substance abuse with the promotion of health enhancing habits like getting regular physical activity and eating healthy. Current national, state and local trends favor increasing our efforts at integrating prevention and wellness, and behavioral with physical healthcare.

Integrated programs which bundle a number of health behavior risks can be more cost-effective than single risk behavior interventions. They are more likely to achieve broader and even larger effect sizes due to the interrelated nature and clustering of health behaviors. In addition, integrated prevention and health programs are generally viewed as more positive and enjoyable, thereby increasing funding, adoption, and participation for integrated interventions.

One proven approach to simultaneously promoting substance abuse prevention and wellness promotion leading to improvements in both physical and mental health among youth works through enhancing positive image awareness. This evidence-based strategy promotes awareness of positive image benefits associated with health enhancing habits like participating in regular physical activity, sports and exercise, along with showing how risk behaviors like marijuana use are counterproductive to achieving positive images and behaviors.

Why Target Positive Images?

Images, particularly favorable and attractive images of others and of ourselves in the future, have a powerful, naturally motivating influence on our behaviors and lifestyles. The idea that images play a major role in shaping who we are and how we act is supported by theory, research, and practice.

In theory, the influence of positive images on human behavior is confirmed in conceptual models such as Social Cognitive Theory, Prototype/Willingness Model, Behavior-Image Model, and Developmental Psychology of Self-Concept. These theoretical frameworks have identified modeling, social images, behavior-image associations, and self-image domains across the lifespan as key factors influencing human behavior development and change.

In research, both social images and future self-images have been shown to be significantly associated with youth and young adult health risk and health enhancing behaviors. In addition, interventions targeting positive images have resulted in improving various healthy behaviors and preventing substance abuse habits among youth groups.

In practice, marketing and advertising campaigns have historically used appealing images to successfully sell everything from clothing to cigarettes to automobiles. The use of positive images has been a mainstay since the creation of modern advertising and can be seen today in the promotion of nearly every product and service sold in the US. Unfortunately, the use of positive images has not been widely applied to promote healthy behaviors and lifestyles and prevent substance abuse.

A New Integrated Evidence-based Practices Model

A new integrated evidence-based practices model has emerged to combine prevention and wellness goals with positive image awareness. This model entails four simple steps, including screening, feedback, goal setting, and follow-up.

The first step in the integrated positive image awareness model involves screening of current health habits of participating youth. The purpose of screening is two-fold. First, to trigger desired behaviors and related positive images and second, provide data for tailoring feedback regarding both health enhancing and health risk habits.

The second step in the positive image evidence-based practices model is to provide feedback and positive image communication to youth. First, positive feedback is provided to participants for engaging in each health enhancing behavior and avoiding each risk behavior, along with messages linking specific behaviors with key positive images.

Next, positive images are triggered by using vivid image terms (e.g., fit, active, strong, successful) illustrating peers and future selves experiencing positive image benefits from individual health enhancing behaviors. In addition, costs of engaging in specific risk behaviors are presented in terms of interfering with each healthy behavior and positive image, while producing opposing negative behavior and image effects.

The third step in the integrated positive image model is providing participants an opportunity to develop self-regulation skills to set and monitor concrete goals for each of the targeted health enhancing and risk behaviors to achieve desired future images. This process involves having participants make a public commitment, strengthening their resolve to work toward achieving multiple behavior goals and modify goals as needed over time.

The fourth and final step in the positive image integrated practices model involves following up with participants to reinforce image awareness and image-behavior connections, and strengthen motivation to continue setting multiple health behavior improvement goals. Follow-up strategies can take various forms, including providing participants with booster materials like booklets and parent flyers, repeating consultations over time, providing new consultations targeting other prevalent youth risk and health behaviors, and offering subsequent goal setting activities.

Based on our research evaluating integrated prevention and health interventions, we recommend every young person from childhood through young adulthood should receive at least one annual positive image program integrating prevention with wellness to “vaccinate” them against common youth health risks. However, administering integrated programs with youth every 3-12 months is thought to be optimal for protecting youth from multiple risks and enhancing positive youth development.

Effectiveness of Integrated Programs Targeting Positive Images

The development of the evidence-based practices model for integrating prevention and health using positive image awareness has evolved via an iterative process. This process has included theory development, program application, intervention evaluation, theory and program revision, more evaluation, and so on.

To date, the theoretical Behavior-Image Model and the integrated positive image practices model of screening, feedback, goal setting, and follow-up have been applied to developing and evaluating over a dozen successfully integrated prevention and health programs for youth. These include SPORT for children and adolescents, InShape for college-aged young adults, and most recently, theMotivational Coaching Program (MCP) and In God’s Image (IGI) for youth.

Both SPORT and InShape have also undergone multiple rigorous evaluations. These studies have been published in premiere scientific journals and show that these brief integrated programs are effective at preventing and reducing risk behaviors like alcohol, tobacco, and marijuana use, while also increasing health promoting habits like moderate and vigorous physical activity and goal setting. Certain positive behavioral effects resulting from the single brief positive image consultation found in the SPORT and InShape programs have been found to last up to year.

SPORT and InShape are also listed in a number of prominent evidence-based directories. These include SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP), and Blueprints for Healthy Youth Development, among others. SPORT and InShape were developed and evaluated over many years using hundreds of young people participating from varied settings with funding from the National Institutes of Health (NIH).

Conclusions and Recommendations

Today’s youth are exposed to many serious co-existing health risks. These risks interact to exponentially increase the likelihood of youth experiencing damage to their physical and mental health, well-being, academic success, and future positive development.

The solution to this major health epidemic on our youth is to provide evidence-based programs and practices that integrate the prevention of risk behaviors like substance abuse with the promotion of health enhancing habits such as physical activity and healthy eating. A new evidence-based practices model which targets positive image awareness has been shown to be easily implemented using screening, feedback, goal setting, and follow-up.

The use of positive image communication has a firm foundation in theory, research, and practice for influencing health and other behavior change among youth and adults. The integrated positive image evidence-based practices model has been used to successfully develop over a dozen prevention with health programs. Several of these programs have undergone multiple rigorous evaluation trials supporting their effectiveness to prevent risk behaviors while at the same time promote healthy habits.

Increasing the application of the integrated positive image practices model to provide youth from childhood through young adulthood with integrated prevention and health interventions would greatly reduce youth vulnerability to multiple common health risks, while increasing positive behavior and image resiliency and self-regulation skills of young people to set and achieve multiple behavior improvements throughout their lives.


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