Vocabulary

• Psychology

The scientific study of the mind and behavior, encompassing various mental processes and their impact on individual and group functioning.

• Efficacy

The capacity to produce the desired effect or result; effectiveness in achieving a specific goal.

• Precaution

A measure taken beforehand to prevent harm or ensure safety; a preventive action.

• Malnutrition

A condition resulting from an imbalance of nutrients, usually through deficiencies or imbalances, leading to health problems.

• Overweight

Having a body weight higher than what is considered healthy or normal, often due to excess body fat.

• Pandemics

Widespread outbreaks of a disease that affects people over a large geographic area, often crossing international boundaries.

• Disorder

A condition characterized by a disturbance in normal functioning or structure; a medical or psychological condition.

• Seatbelts

Safety straps in vehicles designed to protect occupants by restraining movement during sudden stops or collisions.

• Vector

An organism that transmits infectious pathogens from one host to another, often an insect or other arthropod.

• Sanitation

The promotion of hygiene and the prevention of disease through the maintenance of clean conditions, including proper waste disposal and water treatment.

• Wellness

The state of overall health and well-being, encompassing physical, mental, and social aspects.

• Predisposition

A tendency or inclination to a particular condition or behavior, often due to genetic or environmental factors.

• Subgroup

A smaller, distinct group within a larger group, often sharing certain characteristics or traits.

• Tailoring

The process of adapting or modifying something to meet specific needs or preferences; customizing or applying adjustments for a particular purpose.

• Vaccine

A substance used to stimulate the immune system to defend against a particular infectious disease or pathogen, typically prepared from an inactivated or weakened form of the disease.

• Diarrhea

A condition characterized by frequent, loose, or watery bowel movements, often caused by infections, dietary issues, or other factors.

Definitions and applications

1. Definition of the theories
2. Definition of interventions
3. How theories and interventions apply to health promotion

Why Is Theory Important to Health Promotion and Health Behavior Practice?

(US Department of Health & Human Services et al., 2005)

If we are effective in public health, our programs can help people improve health and the well-being of communities. This requires behavior change at individual and community levels, and not all health programs are successful. Those most likely to succeed have a clear understanding of targeted health behaviors and their environmental context. Health behavior theory can play a critical role throughout the program planning process.

What Is Theory?

A theory is a set of concepts and definitions that explain situations by illustrating the relationships between variables. Theories must be applicable to a broad variety of situations. They are abstract, without a specified topic area. Like empty cups, theories have shapes and boundaries, but nothing inside. They become useful when filled with practical topics, goals, and problems.

• Concepts are the primary elements of a theory.
• Constructs are concepts developed for use in a particular theory. The key concepts of a given theory are its constructs.
• Variables define the way a construct is to be measured in a specific situation. When identifying what needs to be assessed during evaluation of a theory-driven program, you need to match variables to constructs.
• Models may draw on a number of theories to help understand a particular problem in a certain setting. They are not always as specified as theory.

Health behavior theories draw upon psychology, sociology, anthropology, consumer behavior, and marketing.

How Can Theory Help Plan Effective Programs?

Theory gives planners tools for designing health interventions based on understanding behavior. It helps them to step back and consider the larger picture. Like an artist, a program planner who grounds health interventions in theory does not depend on a “paint-by-numbers” approach and instead uses a palette of behavior theories, skillfully applying them to develop unique, tailored solutions to problems.

Using theory as a foundation for program planning is consistent with the current emphasis on using evidence-based interventions in public health.

• Theory provides a road map for studying problems, developing appropriate interventions, and evaluating their successes.
• Theory can also help to explain health behaviors, including processes for changing them, and the influences that affect health behaviors, including social and physical environments.
• Theory also helps identify the right target audiences and methods for fostering change.
• Researchers use theory to investigate “why,” “what,” and “how” health problems should be addressed and clarify the nature of targeted health behaviors.
• Theory guides the search for reasons why people engage in certain health behaviors; it suggests how to devise program strategies that reach target audiences and have an impact.
• Theory also helps to identify which indicators should be monitored and measured during program evaluation. For these reasons, programs based in theory are more likely to succeed.

Explanatory Theory and Change Theory

Explanatory theory describes the reasons why a problem exists. Factors that contribute to a problem could be a lack of knowledge, self-efficacy, social support, or resources, and these can be changed. Here are some examples of explanatory theories:

• The Health Belief Model looks at perceptions of a health problem and benefits of the treatment.
• The Theory of Planned Behavior examines the relationship between beliefs and control over behavior.
• The Precaution Adoption Process Model shows seven stages from awareness to action.

Change theory helps develop interventions. Here are some examples of change theories:

• Community Organization: This emphasizes community-driven solutions to health and social problems.
• Diffusion of Innovations: This looks at how new ideas spread within a community.

Fitting Theory to the Field of Practice

We will cover some theories that are central to health behavior and health promotion practice today. No single theory dominates health education and promotion. Some theories focus on individuals as the unit of change. Others examine change within families, institutions, communities, or cultures. Some constructs, such as self-efficacy, are central to multiple theories. One challenge for those concerned with behavior change is finding how well a theory or model fits a particular issue. Selecting an appropriate theory takes into account the many factors that influence health behaviors. Choosing a theory that will bring a useful perspective to the problem starts with an assessment of the situation and the behavior to be addressed.

A useful theory makes assumptions about a behavior or target population that are as follows:

• Logical

• Consistent with everyday observations

• Similar to those used in previous successful programs

• Supported by past research in the same area or related ideas

Using Theory to Address Health Issues in Diverse Populations

The world population is growing more culturally and ethnically diverse. Many health disparities exist among various ethnic and socio-economic groups. This highlights the importance of understanding the cultural backgrounds and life experiences of community members. Most health behavior theories can be applied to diverse cultural and ethnic groups, but health practitioners must understand the characteristics of target populations (e.g., ethnicity, socioeconomic status, gender, age, and geographical location) to use these theories correctly. There are several reasons why culture and ethnicity are critical to consider when applying theory to a health problem.

• Morbidity and mortality rates for different diseases vary by race and ethnicity.

• Rates of risk behaviors vary among these groups.

• The determinants of health behaviors vary across racial and ethnic groups.

Contributing factors to health conditions (determinants of health)

1. Psychosocial

• • a. Definition: nonmedical factors that can influence health, including the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Many different systems affect a person’s health, as this diagram illustrates: 

(Centers for Disease Control and Prevention, 2022b)

• • b. Examples:

1. 1. 1. In urban centers without stores to supply healthy foods, there can be widespread malnutrition and/or overweight due to having only fast food and processed snack foods available.
      2. Unsafe worksites can contribute to high rates of injuries
      3. In areas without enough healthcare providers, the people may suffer more with untreated and preventable illnesses.

2. Behavioral

• • a. Definition: effects on health due to an individual’s behavior
  • b. Examples:

1. 1. 1. Tobacco use causes death and illness to smokers as well as people within range of the secondhand smoke (World Health Organization, 2022a)
      2. Physical activity can lower risk for heart disease, cancer and diabetes (World Health Organization, n.d.)
      3. The harmful use of alcohol contributes to the risk of noncommunicable diseases (NCDs) (World Health Organization, 2022b)

3. Biological

(Ferranti et al., 2017)

• • a. Definition: health effects from internal factors such as genes, or external organisms such as bacteria and viruses
  • b. Examples

1. 1. 1. Pandemics can be caused by viruses such as COVID-19.
      2. Infectious diseases such as malaria can be spread by mosquitoes.
      3. Genetic abnormalities cause cystic fibrosis and other disorders.

• • c. How different models can help us figure out which of these factors is the most prevalent?

An ecological perspective looks at the many different factors that influence health. Theories and models can be grouped in three different levels of influence:

1. Individual level includes behavior and personal elements. Models at this level examine motivation for behavior.
2. Interpersonal level includes social interaction. Models at this level examine the social environment.
3. Community level may include the environment and political systems. Models at this level consider external factors, structures and policies.

4. PRECEDE-PROCEED

PRECEDE-PROCEED is a planning model that offers a framework for identifying intervention strategies and designing health promotion programs. The process starts with desired outcomes and works backwards to identify strategies for achieving objectives.

Because health behavior is influenced by both individual and environmental forces, the model has two parts: an “educational diagnosis” (PRECEDE) and an “ecological diagnosis” (PROCEED).

The PRECEDE acronym stands for Predisposing, Reinforcing, Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. This component suggests that an educational diagnosis is needed before designing a health promotion intervention, just as a medical diagnosis is needed before designing a treatment plan.

PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. This element was added later to take into account the impact of environmental factors on health. Together, these two components of the model help practitioners plan programs that exemplify an ecological perspective.

PRECEDE-PROCEED has nine steps. The first five steps are diagnostic, addressing both educational and environmental issues:

1. Social assessment
2. Epidemiological assessment
3. Behavioral and environmental assessment
4. Educational and ecological assessment
5. Administrative and policy assessment

The last four comprise implementation and evaluation of health promotion intervention. These include the following:

6. Implementation,
7. Process evaluation
8. Impact evaluation
9. Outcome evaluation (See Figure 9.)

Source: (U.S. Department of Health & Human Services et al., 2005)

During the diagnostic steps of the model, planners learn about the community’s needs.

• To conduct social assessment, they can use key informant interviews, focus groups, participant observation, or surveys to understand the community’s perceived needs.
• Epidemiological assessment may include secondary data or original data collection to prioritize health needs and establish program goals and objectives.
• Behavioral and Environmental Assessment identifies internal and external factors that affect health.

In Educational and Ecological Assessment, the planner identifies factors needed to initiate and sustain change. Behavior—such as reducing intake of dietary fat, engaging in routine physical activity, and obtaining annual mammograms—is shaped by predisposing, reinforcing, and enabling factors. The theories can help classify factors into one of three categories and rank their importance. Because each type of factor requires different intervention strategies, classifying them helps planners consider how to address community needs.

The three types of influencing factors are as follows:

• Predisposing factors that motivate or provide a reason for behavior, including the following:

• • knowledge
  • attitudes
  • cultural beliefs
  • readiness to change

• Enabling factors that enable persons to act on their predispositions; including the following:

• • available resources
  • supportive policies
  • assistance
  • services

• Reinforcing factors that are used after a behavior has been initiated and encourage repetition of behaviors by providing incentives, including the following:

• • Social support
  • Praise
  • Reassurance
  • Symptom relief

In the final diagnostic step, Administrative and Policy Assessment, intervention strategies reflect information gathered; the availability of needed resources; and organizational policies that could affect program implementation. (See Table 10.) 

The four remaining steps of PRECEDE-PROCEED are for program implementation and evaluation. Before Implementation (Step 6) begins, planners should prepare plans for evaluating:

• Process (Step 7) to measure if the program is being carried out according to plan
• Impact (Step 8), to look at changes in predisposing, enabling, and reinforcing factors that influence change
• Outcome (Step 9) to see whether the intervention has affected health and quality-of-life indicators.

The individual, interpersonal, and community-level theories discussed are most useful when applied to PRECEDE-PROCEED’s diagnostic steps.

• Community organization relates to Step 1, which may entail working with communities to identify their own needs, strengths, resources, and capacities.
• Descriptive epidemiology is most pertinent to Step 2, but community-level theories may be relevant if the community helps choose or prioritize health problems.
• Theory is most directly useful when applied to Steps 3, 4, and 5, since these steps require strategic decisions.

By using theory, the practitioner can make sound choices that are based upon more than just intuition and personal judgment.

Theory should guide practitioners’ examination of predisposing, enabling, and reinforcing factors. For example, the Health Belief Model suggests that certain beliefs might influence women’s decisions about whether or not to get a mammogram, such as these:

• Predisposing factors

• • Perceived chances of developing cancer. (perceived susceptibility)
  • How serious they believe cancer would be (perceived severity)

• Reinforcing factor

• • Receiving reassurance that they do not have cancer (perceived benefit)

• Enabling factor

• • Not having insurance coverage for screening mammography (perceived barrier)

By exploring how each of these factors affects behaviors, planners can decide how to focus strategies for an intervention, such as providing low-cost screening or changing insurance coverage. The best way to rank explanations offered by theory is to gather information directly from the target population. 

Eight Types of Interventions

(Smith et al., 2015)

Throughout this course, you will be coming up with interventions that work with the different models that you will be exploring. The types of interventions are listed below with examples, but you are encouraged to come up with more interventions on your own. Get creative! At the end of the course, you will be using organizing these intervention types into a framework based on the models and theories you will have studied.  

• Health Communication Strategies

• • Description: presenting health messages, ranging from advertising for public awareness to complex social marketing. A key element in communicating health messages includes Health Literacy (see below). (Centers for Disease Control and Prevention, 2022)
  • Examples:

• • • Public service announcements about where to obtain COVID-19 vaccine.
    • Billboards reminding people to wear seatbelts.
    • Campaigns to prevent drug overdose deaths with Naloxone.

• Health Education Strategies

• • Description: nearly all health interventions include education, but education may not be enough to create behavior change. For a person who already has motivation to change, simply providing information can help improve health.
  • Examples:

• • • Telling mothers the benefits of breastfeeding.
    • Explaining the causes of diarrhea and how to avoid it.
    • Showing how to apply first-aid after an injury.

• Health Policy/Enforcement Strategies

• • Description: passing and enforcing laws that require behavior change by residents.
  • Examples:

• • • Indoor clean air laws that prohibit smoking.
    • Taxes on soft drinks that decrease rates of purchasing.
    • Seat belt and helmet laws that lower rates of vehicle injury and death.

• Environmental Change Strategies

• • Description: reducing the transmission of infections by cleaning sources of infection or illness
  • Examples:

• • • Vector control, clearing mosquito breeding areas.
    • Improving air quality to decrease incidence of asthma.
    • Providing sanitation and sewage systems.

• Health-Related Community Service and Mobilization Strategies

• • Description: various community groups including nonprofit agencies and businesses form coalitions to collaborate on health improvement projects.
  • Examples:

• • • Community campaign to improve trails and bike paths.
    • City-wide project to decrease drug overdose deaths.
    • Intramural and after-school sports programs for youth recreation.

• Behavior Modification Activities

• • Description: techniques to replace unhealthy behaviors with desirable habits, such as positive or negative reinforcement.
  • Examples:

• • • Reminders and encouraging messages to help someone stop smoking.
    • Buying new clothes to reward yourself for losing weight.
    • Providing recognition awards for days of sobriety in Alcoholics Anonymous.

• Organizational Cultural Activities

• • Description: structured plans for health promoting events within a population’s traditional culture.
  • Examples:

• • • The CDC provides funds for Tribal Practices for Wellness among Native Americans and Alaska Natives. (Centers for Disease Control and Prevention, 2023a).
    • The Colombian government arranged for special burial ceremonies to accommodate cultural practices for Indigenous groups.
    • Many faith-based groups worked together with government agencies to respond to COVID-19 in ways that were culturally appropriate to each group.

• Social Activities

• • Description: health promotion in a socially supportive environment to reinforce healthy behaviors while providing companionship and decreasing social isolation.
  • Examples:

• • • Line dancing and square dancing parties to encourage fun physical activity.
    • Youth-Against-Tobacco clubs in high schools.
    • Hiking and walking groups where members encourage each other.

CASE STUDY EXAMPLE OF A HEALTH PROGRAM DEVELOPED WITH PRECEDE-PROCEED

PRECEDE:

Phase 1 Social assesment
Surveys and town meetings reveal that people in this community want to reverse the recent trend of increasing rates of obesity and overweight.

Phase 2 Epidemiological assessment
Data from surveys and area agencies show the residents eat few fruits and vegetables and are mostly sedentary.

Phase 3 Behavioral and Environmental Assessment
Observations discover that the neighborhoods have few food stores and residents have few places to exercise

Phase 4 Educational and Organizational Assessment
Coalition brings together leaders, agencies and key community members who set goals of developing community gardens, walking trails and bike paths.

Phase 5 Administration and Policy Diagnosis
Coalition leaders meet with government representatives who designate plots of land available for gardens and routes for trails and bike paths.

PROCEED:

Phase 6 Implementation
Coalition subcommittees plan with local agricultural agencies to set up 2 new community gardens, meet with city park & recreation officials to develop walking trails and bike paths. Coalition sets a budget and timeline, recruits volunteers and publicizes the projects.

Phase 7 Process Evaluation
Leaders evaluate: How are the committees working together? How are the gardens, trails and paths progressing?

Phase 8 Impact Evaluation
Leaders evaluate: Are people using the garden produce? Are walkers and bikers using the trails and paths?

Phase 9 Outcome Evaluation
Final evaluation: have residents’ fruit and vegetable consumption increased? Has physical activity increased? After years of the project, have rates of obesity and overweight leveled or decreased?

Disciple Learners and Disciple Practitioners

This is a course about health behaviors and how to be an instrument of effective, positive change. Before you can be that instrument, it is imperative to examine your own paradigms and beliefs.

A paradigm is a basic schema that organizes our broadly based view of something. Consider for a moment your paradigm about people. If you were sitting on a bench in a public place watching people walk by, what would you notice about them? What judgments would you make?

This week, you will meet your classmates and instructor and examine your own paradigms and biases regarding human behavior. Once you understand where you are coming from, you can then begin to develop the ability to consider a different paradigm—to understand a target population before you try to help them.

The following two excerpts are from conference and devotional talks where the speakers give great counsel on how we can better relate to others in our Public Health work. We can learn from Christ’s example how to better serve others by seeing them as Children of God, our brothers and sisters.

1. Great Measure of Discipleship

(Brother Kenneth L. Southwick, 2007)

“The great measure of our discipleship is how we treat others.” I would agree with that; that also is a correct answer. What I would invite you to think about today is how we treat others is determined by how we view others. We need to pay particular attention to how we view others.

Let me say it this precisely, our judgments about, our conclusions concerning, and our actions toward others all grow out of how we view them. If this is the case, then the question becomes, “do we see others as a spirit son or daughter of God, as a person, as a human being, as a soul of infinite worth?” Or do we see them as something less? Or do we fail to see them at all?

Some bad things come from our failure to see others for who they really are. Some of the world’s greatest evils can be traced to this failure. Genocide, ethnic cleansing, racism, misogyny, and a whole list of other ills all flow from it. But of course none of us are guilty of those kinds of things, and we are not here today to talk about them.

What I will propose is that (1) the failure to see others properly is widespread. You and I do it all the time. (2) Most of us are not even aware that we do it. And (3) finally, and most importantly, failing to see others for what they truly are makes us less like the Savior.

How does that work? When we see others in the proper way, we cannot help but love and lift them, just as the Savior would. When we fail to see them in the proper way, we almost always devalue and dismiss them, like Christ never would.

Now what do I mean when I say, “We see others as something less than what they are?” I will give you five examples and try to explain myself. This is not an exhaustive list, of course. I have to warn you some of these may be a little bit painful because they might hit just a little bit too close to home. You are going to think that I sound like an expert. Sadly, that is because I am an expert.

Now for each of these I am going to hold up an object. I do that on purpose because when we see others as less than who they really are we see them as objects.

The first object is a checklist—one that you can put on your refrigerator with magnets or that sits on the corner of your desk. Sometimes, instead of seeing another as a person to be served, we see them as a task to be accomplished. That is very easy to do in the workplace, and unfortunately I think that it happens often in our church callings. Have you ever approached home teaching, or visiting teaching, or member missionary work, or some other aspect of your church calling in that way?

You may remember this story from Elder Dallin H. Oaks. He shared this in the October 2001 General Conference:

“I was assigned to visit a less-active member. A successful professional many years older than I. Looking back on my actions, I realize that I had very little loving concern for the man I visited. I acted out of duty with the desire to report 100 percent on my home teaching. One evening, close to the end of the month, I phoned to ask if my companion and I could come right over and visit him. His chastening reply taught me an unforgettable lesson, ‘No I don’t believe I want you to come over this evening,’ he said, ‘I’m tired, I’ve already dressed for bed, I am reading, and I am just not willing to be interrupted so that you can report 100 percent on your home teaching this month.’ That reply still stings because I know he had sensed my selfish motivation.”

Have you ever viewed someone as a task to be accomplished? Have you ever felt like someone was viewing you in that way?

The next object is a bunch of grapes. Sometimes we see others not as an individual, but only as a member of some group. We are unable to distinguish them as an individual person. This is very easy to do when someone has a different skin color than we do, and we succumb to racial stereotypes and prejudices. This also happens frequently when that other person subscribes to a different ideology or worldview than we do. We cannot separate them from the group they belong to, or the ideas they subscribe to.

The third object is a can of mosquito spray. Sometimes we see others not as a person but as a pest or a nuisance, an annoyance to be dealt with, postponed, simply endured, or avoided altogether. Now you are probably thinking to yourself, “Brother Southwick I don’t ever do that.” Have you ever looked at the caller ID and saw who was calling and thought, “Oh, I don’t want to talk to them right now.” Have you ever been walking on campus by yourself or with friends and changed your route because you saw someone up ahead that you did not want to talk to? I told you some of these were painful. That is viewing someone like a pest or a nuisance.

The next one is a TV remote. I had a hard time coming up with the label for this particular category. But I will tell you the experience that caused me to think of this. Not too long ago, I had come home from work after a rather strenuous day. I had taken my shoes off and loosened my tie and was lying on my bed watching the evening news. My ten-year-old son came into the bedroom with his basketball under his arm and said, “Hey, Dad, you want to shoot some hoops?” I am ashamed to say that sometimes—and I was guilty of it on this occasion—we view others as an interruption. So I paused the news I was watching long enough to go out and play basketball with my son.

This last one really hurts. The last object is a mirror. Sometimes we see others as a mirror. When we do this, what we are most interested in is what is reflected back about us. We treat that person a certain way not because they deserve to be treated that way, but because we want to be known as a person who treats people that way. We are more interested in the other person’s opinion of us than we are the other person. Now this one is particularly hazardous because generally we are doing well, our conduct toward them is right and proper, but our motives are all wrong. In addition, there can become a certain hollowness about our actions that oftentimes can be sensed by that other person.

Once we have identified this particular flaw, this failure to see others appropriately all the time, what do we do? How do we change? Well I wish I knew the answer to that. I am a much greater expert on the behaviors themselves than on how to correct the behaviors. But here are some ideas.

One, just simply being aware that we do it helps a lot. Any physician will tell you that the first step in treatment is a correct diagnosis of the illness.

A second thing is to pay attention to when we are most likely to see others for less than what they are. For me, I have identified three times when I do it the most: One is when I am in a real hurry and I am pushing against some deadline or another. Another is when I am frustrated or angry. And a third is when I am distracted or when I have something on my mind.

The third thing we can do to take corrective action is to adapt the counsel found in Moroni 7:45 “Pray unto the Father with all the energy of heart” that He will help us see others as we should.

The final thing I think we can do once we have seen this in ourselves and are attempting to change is to study closely the mortal ministry of the Savior. I have been very impressed this year in Sunday School to re-read and study the Savior’s life. It has been amazing to me to see how He never does this and how the people around him, even His disciples did on occasion, fail to see others as they should.

Brothers and sisters, I testify that one of the great measures of our discipleship is and will be how we view others. May we always see them as a spirit son or daughter of God, as a soul of infinite worth, as a human being, as an individual person. And may we treat them accordingly. For to do so is to be a true disciple of Christ and to do as He does. I testify of a loving Heavenly Father who sees us and knows us as individuals and of His son Jesus Christ, the Savior and Redeemer of the world. In the name of Jesus Christ, amen.

2. Instruments of the Lord’s Peace

(Elder Robert S. Wood, 2006)

President George Albert Smith observed, “There is nothing in the world more deleterious or harmful to the human family than hatred, prejudice, suspicion, and the attitude that some people have toward their fellows, of unkindness.” In matters of politics, he warned, “Whenever your politics cause you to speak unkindly of your brethren, know this, that you are upon dangerous ground.” Speaking of the great mission of the latter-day kingdom, he counseled: “This is not a militant church to which we belong. This is a church that holds out peace to the world. It is not our duty to go into the world and find fault with others, neither to criticize men because they do not understand. But it is our privilege, in kindness and love, to go among them and divide with them the truth that the Lord has revealed in this latter day.”

The Lord has constituted us as a people for a special mission. As He told Enoch in ancient times, the day in which we live would be one of darkness, but it would also be a time when righteousness would come down from heaven, and truth would be sent forth out of the earth to bear, once more, testimony of Christ and His atoning mission. As with a flood, that message would sweep the world, and the Lord’s elect would be gathered out from the four quarters of the earth. Wherever we live in the world, we have been molded as a people to be the instruments of the Lord’s peace. In the words of Peter, we have been claimed by God for His own, to proclaim the triumph of Him “who hath called you out of darkness into his marvelous light: Which in time past were not a people, but are now the people of God.” We cannot afford to be caught up in a world prone to give and to take offense. Rather, as the Lord revealed to both Paul and Mormon, we must neither envy nor be puffed up in pride. We are not easily provoked, nor do we behave unseemly. We rejoice not in iniquity but in the truth. Surely this is the pure love of Christ which we represent.

In a world beset by wrath, the prophet of our day, President Gordon B. Hinckley, has counseled: “Now, there is much that we can and must do in these perilous times. We can give our opinions on the merit of the situation as we see it, but never let us become a party to words or works of evil concerning our brothers and sisters in various nations on one side or the other. Political differences never justify hatred or ill will. I hope that the Lord’s people may be at peace one with another during times of trouble, regardless of what loyalties they may have to different governments or parties.”

References

Brother Kenneth L. Southwick. (2007, Spring). The Great Measure of Discipleship. BYU Idaho. https://www.byui.edu/devotionals/brother-kenneth-l-southwick

Centers for Disease Control and Prevention. (2022a, April 15). Health Communication Strategies and Resources. Centers for Disease Control and Prevention. https://npin.cdc.gov/pages/health-communication-strategies

Centers for Disease Control and Prevention. (2022b, December 8). Social Determinants of Health at CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/about/sdoh/index.html

Centers for Disease Control and Prevention. (2023a, January 27). Tribal Practices for Wellness in Indian Country (TPWIC). Centers for Disease Control and Prevention. https://www.cdc.gov/healthytribes/tribalpractices.htm

Centers for Disease Control and Prevention. (2023b, March 31). What Is Health Literacy? Centers for Disease Control and Prevention. https://www.cdc.gov/healthliteracy/learn/index.html

Elder Robert S. Wood. (2006, April). Instruments of the Lord’s Peace. The Church of Jesus Christ of Latter-Day Saints. https://www.churchofjesuschrist.org/study/general-conference/2006/04/instruments-of-the-lords-peace?lang=eng

Ferranti, E. P., Grossmann, R., Starkweather, A., & Heitkemper, M. (2017). Biological determinants of health: Genes, microbes, and metabolism exemplars of nursing science. Nursing Outlook, 65(5), 506–514. https://doi.org/10.1016/j.outlook.2017.03.013

Smith, P., Morrow, R., & Ross, D. (Eds.). (2015). Chapter 2: Types of intervention and their development. Field Trials of Health Interventions: A Toolbox. 3rd Edition. https://www.ncbi.nlm.nih.gov/books/NBK305514/#chapter-2-div1-2

U.S. Department of Health & Human Services, National Institutes of Health, & National Cancer Institute. (2005). Theory at a Glance: A guide for health promotion practice (2nd ed.). https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf

World Health Organization. (n.d.). Physical Activity. World Health Organization. https://www.who.int/health-topics/physical-activity#tab=tab_1

World Health Organization. (1986). The 1st International Conference on Health Promotion, Ottawa, 1986. World Health Organization. https://www.who.int/teams/health-promotion/enhanced-well-being/first-global-conference

World Health Organization. (2022a, May 24). Tobacco. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/tobacco#:~:text=Key%20facts,exposed%20to%20second%2Dhand%20smoke

World Health Organization. (2022b, October 12). NCD Hard Talks webinar: Unlocking behavioural insights for NCDs. World Health Organization. https://www.who.int/news-room/events/detail/2022/10/12/default-calendar/ncd-hard-talks-webinar--unlocking-behavioural-insights-for-ncds