Eva Lindbladh

Habit versus choice: the process of decision-making in health-related behaviour

Social differences in the role of habits in health-related behaviour are explored within both sociology and economics, where we define habits as non-reflective, repetitive behaviour. The corresponding theoretical perspectives are the habitus theory, the theory of individualization, and habits as rational decision rules. Sixteen thematically structured interviews are analysed using qualitative methodology. Three aspects of habits emerged from the narrative: the association between habits and preferences, habits as a source of utility, and the relationship between habits and norms. We find that people in lower social positions are more inclined to rely on their habits and are accordingly less likely to change their behaviour. These differences are reinforced as not only the disposition to maintain habits but also the tendency to conceive of the habitual as something good seems to be strengthened in lower social positions. We also note that the intensified individualization that characterizes current society erodes the basis for habit-governed behaviour, which may also contribute to social differences in well-being. Finally, we find that the scientific dialogue has enriched both scientific paradigms, and suggest as a tentative hypothesis that the traditional economic rational-actor model may be relatively less applicable to those with limited resources.

Equity is out of fashion? An essay on autonomy and health policy in the individualized society

It is widely recognized that there is a discrepancy between principle and practice with respect to the health equity aim of public policy. This discrepancy is analyzed from two theoretical perspectives: the individualization of society and the fact that individual beliefs and values are connected to ones position in the social structure. These mechanisms influence both the choice of health policy measures and the normative judgements of preventive efforts, both of which tend to be consonant with the views of dominant social groups. In particular, we focus on the treatment of the ethical principle of autonomy and how this is reflected in health policy aimed at influencing health-related behaviour. We examine the current trend towards targeting health information campaigns on certain socio-economic groups and argue that it entails an ethical dilemma. The dominant discourse of the welfare state is contemplated as a means to understand why there tend to be a lack of emphasis on measures that are targeted at socio-economic inequalities. It is argued that there is no substantive basis in the individualized society for perceiving health equity as an independent moral principle and that the driving force behind the professed health equity goal may be in essence utilitarian.

Exhaustion measured by the SF-36 vitality scale is associated with a flattened diurnal cortisol profile

The possible association between stress-related exhaustion and reduced activity in the hypothalamo-pituitary-adrenal (HPA) axis is increasingly in focus. The aim of the present study was to examine whether exhaustion measured in a non-patient population is associated with alterations in diurnal cortisol profile. The study population included 78 working individuals. The study group was dichotomised into exhausted and non-exhausted groups by means of the SF-36 vitality scale. Salivary cortisol was measured at three times during 1 workday: at awakening, 30min after awakening, and in the evening. The results showed that diurnal cortisol variation was significantly reduced in exhausted individuals. The difference in cortisol variation was mainly due to lowered morning cortisol in the exhausted group. Differences in cortisol levels at each sampling time or in mean diurnal output of cortisol were not statistically significant. The results would support the notion that exhaustion is associated with HPA axis hypoactivity as assessed by salivary cortisol. Furthermore, the SF-36 vitality provides a measure of exhaustion that may be useful in epidemiological studies in order to explore long-term health effects of stress-related exhaustion.

An economic and sociological interpretation of social differences in health-related behaviour: An encounter as a guide to social epidemiology

We argue that the group-centred analyses of social epidemiology should follow from theoretical considerations that take the situation of the individual as their natural starting point. In a tentative dialogue between economics and sociology, we develop a framework for the analysis of health-related behaviour. Such behaviour is modelled as a process of decision-making at the individual level. Within economics, we draw specifically on the demand-for-health literature and the new institutional economics. Within sociology, Bourdieus habitus theory is presented in combination with a macro-structural approach where the focus is on the process of individualization. The relationship between these different approaches to health-related behaviour and their implications is discussed. We find that the encounter between different sciences provides valuable insights for future work in the socio-epidemiological tradition.

Exhaustion is differentiable from depression and anxiety: evidence provided by the SF-36 vitality scale.

Stress-related exhaustion is an increasingly focused phenomenon, although scientifically not yet fully conceptualised. This is perhaps partly due to the fact that the distinction between exhaustion and other already established concepts, such as depression, is not clear. This study explores whether exhaustion can be differentiated from depression and anxiety, by means of introducing the SF-36 vitality scale as a strategy for the measurement of exhaustion. The Malmö Shoulder and Neck Study cohort, in this study including 12,607 middle-aged men and women, was utilized. Depression and anxiety were assessed by the general health questionnaire (GHQ). Factor analysis was performed in order to potentially discriminate between the included measures. Factor analysis showed that all four exhaustion items of the (inverted) SF-36 vitality scale loaded on a single factor, separate from the GHQ depression and anxiety factors. These results support the notion that exhaustion can be distinguished from depression and anxiety, providing an empirical foundation for defining exhaustion as a unique concept. Furthermore, since SF-36 has been widely used in clinical and epidemiological studies, the benefits of using the SF-36 vitality scale in the assessment of exhaustion could be substantial.

Polarization in the reaction to health-risk information: A question of social position?

Dissemination of risk information is ubiquitous in contemporary society. We explore how individuals react in everyday life to health-risk information, based on what they report in personal interviews. Health-risk information was without exception recognized as unstable and inconsistent. This conformity, however, did not extend to the narratives regarding how health-risk information should be handled. Two opposite positions (ideal-typical strategies) are presented. Either you tend to process and evaluate new information or you tend to ignore it as a whole. Our attempt to reveal the underlying rationality in these two very different approaches involved the exploration of three different avenues of interpretation and brings together two scientific paradigms--economics and sociology--that provide the framework for our analysis. First, we suggest that a greater long-term experience of explicit choice implies that this kind of action becomes more natural and less resource consuming, whereas a reliance on habits in daily life--a natural adjustment to a lack of resources--makes it is more costly to bother about new information. Second, with fewer resources in the short run, fewer opportunities to mitigate bad outcomes, and greater exposure to social and material risks, one is less likely to devote resources to deal with health-risk information. Third, there are several possible links between a low propensity to take account of risk information and a high relative importance of genuine uncertainty in ones life. These theoretical perspectives provide a viable set of hypotheses regarding mechanisms that may contribute to social differences in the response to health-risk information.