Health and well-being practice questions.

According to the transtheoretical (stages of change) model, a person who has actively changed their behaviour and sustained it for more than six months is in which stage?

• Contemplation
• Preparation
• Action
• Maintenance

Answer: Maintenance

Maintenance is the stage in which the new behaviour has been sustained (typically beyond six months) and the person works to prevent relapse; action is the earlier phase of recent change.

A person facing a months-long crisis at work shows persistently raised cortisol. Which system is chiefly responsible?

• The HPA axis
• The sympathetic adrenal medullary pathway
• The parasympathetic vagal pathway
• The hypothalamic thirst circuit

Answer: The HPA axis

The slower hormonal route drives sustained cortisol release, whereas the sympathetic route produces the fast adrenaline surge of the first seconds.

A campaign uses frightening images of disease to change behaviour. Research on fear appeals suggests they work best when the message also:

• gives clear, achievable steps to act
• raises the fear as high as possible
• omits any statement of personal risk
• targets people already free of risk

Answer: gives clear, achievable steps to act

Fear without perceived efficacy tends to produce avoidance of the message rather than change, which is why efficacy information is the active ingredient.

Holmes and Rahe's (1967) Social Readjustment Rating Scale measures a person's stress by:

• adding up the life change units of events experienced in the past year
• recording daily hassles in a diary over a two-week period
• measuring cortisol in saliva samples taken across a working day
• rating how threatening the person judges each current demand to be

Answer: adding up the life change units of events experienced in the past year

The scale is a checklist of life events with fixed weightings, which is also its main weakness: it ignores how the individual appraises an event, so the same event scores the same for everyone.

A national programme vaccinates schoolchildren against a virus before anyone in the group is infected. This health strategy is best classified as:

• Primary prevention
• Secondary prevention
• Tertiary prevention
• Relapse prevention

Answer: Primary prevention

Primary prevention stops a condition arising at all; secondary prevention detects it early, as in screening; tertiary prevention limits the damage once the condition is established, as in rehabilitation.

Berkman and Syme's (1979) nine-year follow-up of adults in Alameda County found that people with the fewest social ties:

• were around twice as likely to have died by the end of the follow-up
• reported more stress but showed no difference in mortality
• had lower cortisol levels than people with many social ties
• were more likely to have taken up healthier eating habits

Answer: were around twice as likely to have died by the end of the follow-up

The design was a longitudinal correlational study, so it shows that social integration predicts survival but cannot show that isolation causes death: poor health may itself reduce social contact.