PSYCHOSOCIAL CORRELATES OF HEALTH PRACTICES IN BLACK SOUTH AFRICAN UNIVERSITY STUDENTS OPSOMMING

The purpose of this study was to assess the prevalence and psychosocial correlates of health practices among young male and female adults. The sample included 793 Black University students from non-health courses chosen at random from the University of the North, South Africa. The students were 370 (46.7%) males and 423 (53.3%) females in the age range of 18 to 25 years (M age=21.0 years, SD=3.48). The assessment measures included a Health Practices Index, the Health Locus of Control Scale, Health as a Value Scale, subjective health status, subjective well-being, health benefits, and health status. Results indicated that participants practiced on average above 7 healthy behaviours from a total of 14. There was a significant sex difference in the health practices index, since on average the women’s behaviour was more healthy than that of men in terms of tobacco use, alcohol consumption, seat belt use, and cancer selfexamination, but men exercised more regularly than women. Above 70% of the participants practiced the following health behaviours: brushing teeth once or more per day, non-tobacco use, very occasional or no alcohol, limited red meat, and never sunbathed or used suncreen in that order. Formal education of the mother, internal locus of control and worse health status were positively associated with the health practices index. Other sociodemographic (age, SES, religion) and psychological (health value, health benefits) factors were not significantly related to healthy practices. RESEARCH Prof. Karl Peltzer Department of Psychology University of the North


ABSTRACT
The purpose of this study was to assess the prevalence and psychosocial correlates of health practices among young male and female adults.

INTRODUCTION
Death postponing medical technology is resulting in increased rates of chronic non-communicable disorders as well as diseases of modern life in African populations (Peltzer, 1995:20) (Walker, 1995:73f.);0.5 million South Africans suffer from diabetes (Levitt, Zwarenstein, Doepfmer, Bawa, Katzenellenbogen & Bradshaw, 1996:1014).Yach (1996:29) reports that tobacco use among Blacks is rising in South Africa.For the country as a whole, lung cancer already accounts for 24% of all death from cancer in men, and 10.6% of all such death in women.In addition, there are high rates of road traffic accidents causing premature death and disability in South Africa (Forjuoh, Zwi & Mock, 1998).
While the full aetiology of any of these diseases has yet to be understood, behavioural factors such as tobacco use, exercise, diet, alcohol consumption and preventive health checks are strongly implicated as risk factors (Steptoe & Wardle, 1992:485f.).Steptoe, Wardle, Vinck, Tuomisto, Holte & Wichstrøm (1994:331) note that health behaviours are activities undertaken by people in order to protect, promote or maintain health, and to prevent disease.The question of whether or not a "healthy lifestyle" can be identified is of major concern for health researchers and practitioners.A healthy lifestyle implies consistent health-conscious behaviour across a range of activities including dietary choice, substance use, exercise and preventive practices.Fourteen health behaviours were assessed and collated into a health practices index.
The classification of responses as healthy or unhealthy was based on the literature relating behaviour to health risk.For example, any cigarette smoking was designated a negative health practice.In addition, no attempt was made to classify people as consistently healthy, consistently unhealthy or intermediate in their lifestyles.The number of health practices was analysed as a continuous variable with possible scores ranging from 0 (extremely unhealthy behaviour) to 14 (extreme health conscious-behaviour) (Steptoe et al. 1994:333f.).
The purpose of this study was to assess the prevalence of health practices among black South African university students.The first aim of this analysis was to identify the shape of the distribution of the health practices index.The second aim of this analysis was to investigate the socio-demographic and the psychosocial correlates (locus of control, health as a value, health benefits, health status, subjective well-being and subjective health) of healthconscious and unhealthy practices.

Sample and procedure
The Data were collected by a self-administered questionnaire in a class room situation after informed consent had been obtained.Participants were assured of complete anonymity.

Measures
The Health Practices Index included 14 positive health practices.It was constructed by giving a score of 1 for each of 14 positive health practices and a score of 0 when the practice was not carried out (Steptoe et al. 1994:334f.)(See Table 1).
Data were also collected by using additional instruments that assess factors established as important to health behaviour in research in health psychology.These included the Multidimensional Health Locus of Control Scale (MHLOC) (Wallston, Wallston & De Villis, 1978), and the Health as a Value Scale (Lau & Ware, 1981).
Attitudes toward health benefits were recorded by asking participants to rate the importance of a series of behaviours for health maintenance on 10point scales, where 1=low importance and 10=very great importance to health.Four items were included in this analysis: beliefs in not eating too much fat, taking regular exercise, not smoking, and not drinking too much alcohol.
Health status was assessed by asking participants whether they suffered from any health problems that had led to treatment from a doctor or health clinic over the past month, and whether they had used prescribed or unprescribed (over the counter) medications over the past month.The three measures of health status were included in a binary Yes/ No format (scored from 0 to 3) (Steptoe & Wardle, 1992:487).
Additional measures included one item on subjective health status (rated from 1=excellent to 5=poor), one question on subjective well-being (rated from 1=very satisfied to 5=very dissatisfied, and 6 items on sociobiographic data: age, sex, religion, income, car ownership in family, education of mother and father).

RESULTS
Table 1 summarises the frequency in percent for the health practices index for men and women (see Table 1).University students practiced on average above 7 healthy behaviours from a total of 14.There was a significant sex difference in the health practices index, since on average the women's behaviour was more healthy than that of men (t=-4.388;p<.001).
Women practiced more non-tobacco use, non or very occasional drinking, avoided fat and used seat belts more often than men did.While 25% of the women examined breats for lumps at least ten times a year, none of the men checked their testicles for lumps at least ten times a year.Some men did test but less frequently and thus not qualifying for a healthy practice.Men did more often physical exercise and had less between-meal snacks than women did.Above 70% of the participants practiced the following health behaviours: brushing teeth once or more per day, non-tobacco use, very occasional or no alcohol, limited red meat, and never sunbathed or used sunscreen in that order.
Almost one quarter (23.1%) indicated that they used sun protection, sunscreen cream or lotion.The least (less than 40%) health behaviours practiced by the students were: breast or testicle self-examination, no between-meal snacks, fruits at least once a day and always wearing a seat belt in that order.
The distribution of the health practices index is shown in Figure 1.
Among the sociodemographic variables none of the factors was associated with the health practices index except for the formal education of the mother.
Regarding psychological factors the internal locus of control and also the total Health related locus of control measure was positively associated with the health practices index.Moreover, worse health status (more frequent doctor visits, more often medicines prescribed by a doctor and more often bought medicines from a shop in the past 4 weeks) was also associated with the health practices index.
The item-correlations between non-smoking, nondrinking and eating pattern are shown in Table 3.
A bell-shaped distribution was seen, with few individuals at the extremes and no indication of a bimodal or trimodal distribution.
Analysis of variance was calculated between the health practices index and psychosocial factors.4).
aged 20-35, and chemotherapy is effective if the cancer is diagnosed early (Steptoe & Wardle, 1996:63).In comparision with European samples, students in this sample had a much higher rate of non-smokers (80%) (as compared to Britain 69.2%), and limited alcohol consumption (78%) (as compared to Britain 67.1%).However, this sample had much lower recommended fruit consumption (29%) as compared to British students (53.1%) (Norman, Bennett, Smith & Murphy, 1998:174).Steptoe and Wardle (1992:490) found among European university students that the proportion of non-smokers ranged across countries, from 54.8 to 84.6 percent for men and 59.3 to 87.6 percent for women.Various practices included in the index should not be considered as having equal importance to health.For instance, not smoking can be seen as much more important than having breakfast everyday (Steptoe et al. 1994:339).

Sociodemographic variables
This study found that on average the women's behaviour was more healthy than that of the men.
In accordance with a study among European university students (Steptoe et al. 1994:339) the total mean health practices index score was higher for women than for men, reflecting the general finding that women show healthier behaviours than men across a wide range of activities.Despite this difference, the distribution of the health practices index was similar in the two sexes.The assumption that with rising socioeconomic status healthy lifestyle may deteriorate was not confirmed.Interesting is, however, that formal education of the mother of the participant was positively related with the health behaviour score.This is an important finding for health promotion programmes.

Psychosocial correlates
Results of analysis of the health-related locus of control scales presented a mixed pattern.The only robust effect was that participants with a more

Prevalence of healthy practices
The use of absolute criteria for classifying health practices resulted in a wide variation in the prevalence of each positive practice (cf.also Steptoe et al. 1994:338).For example, more than 70% of the participants scored positively for the items concern-  healthy lifestyle had stronger internal locus of control than others did.This finding is in line with findings with a health behaviour measure, which had been used with a representative population sample in Britain (Norman et al. 1998:171).Moreover, worse health status (more frequent doctor visits, more often medicines prescribed by a doctor and more often bought medicines from a shop in the past 4 weeks) was also associated with the health practices index.This seems to indicate that healthy practices lead to an improved health status.

Limitations
Limitations of the study are that such health behaviours like safer sex and blood pressure or

Figure
Figure 1: Distribution of the Health Practices Index (from 0 to 14) dental check-ups have not been included.It should also be mentioned that this study only looked at psychosocial factors as determinants of health-conscious and unhealthy practices and disregarded macroeconomic conditions, the sociocultural context, family habits, and personality factors (seeSteptoe et al. 1994).The health practices index used here assessed more health hazard/health risk appraisal or health-protecting (preventive) behaviours based on a risk-reduction model rather than on a health-enhancement model such as in the Health-Promoting Lifestyle Profile(Walker et al. 1981).