Health protective behaviors

Health protective behaviors are activities designed to protect, promote, and maintain health irrespective of health status either the behaviors are influential or uninfluential (Harris & Guten 1979). Some scholars described health-protective behaviors as activities that minimize predisposition to diseases causing agents and support fast recovery and restoration of health following sickness (Spring et al. 2012, Fogelholm et al. 2010, Thijssen et al. 2010). Others described health-protective behaviors as behaviors that are directed towards reducing the likelihood of experiencing health

problems by active protection against pathologic stressors. Health

protection aims at moving away from or avoiding behaviors that can lead to illness and injury (Pender et al. 2002). Optimal health will be realized through enhancing protective behaviors which deter multiple health risk behaviors that could be detrimental to the health of adolescents (CDC 2009).

Optimism in one’s outlook about the future, presence of parents at a crucial moment (Resnick et al. 1997), and active partaking in school activities and after leisure time activity are established health-protective factors because through these behaviors, adolescents are protected from becoming Achilles heel to destructive behaviors (Blum et al. 2002). Smooth and without trouble communication between adolescents and their

mothers are associated with optimal subjective health and minimum chances of involvement in health risk behaviors (Zambon et al. 2006, Resnick et al. 1997). Also, stress-free communication with fathers

contributes to higher emotional wellbeing and prosocial behavior in boys and good body image among girls (Fenton et al. 2010, Sheeber et al. 2007).

School is the most significant setting for nearly all teenagers apart-from their families. School attendance is associated with many health behaviors (WHO 2004). Teenagers who have a positive relationship with teachers, and report having positive attitudes towards school are less likely to initiate sexual activity early, to use substances, to involve in fights & violence, and to experience depression (WHO 2002). Also, individual attributes and environmental characteristics that diminish the destructive, stressful life

events, enhance individuals' capability, and promote social competence and mental health are important to be productive in all areas of life throughout the lifespan (Kipke 1999). Exclusion from peers during an adolescent period can lead to feelings of loneliness and psychological problems whereas interaction with friends tends to improve and develop social skills and boost the ability to cope and juggle with several activities, with stressful events and challenges of every day (WHO Regional Office for Europe 2004).

Also, health-protective behaviors such as being physically active (Spring et al. 2012, Fogelholm et al. 2010), eating fruits and vegetables (Spring et al.

2012, Riboli & Norat 2003), and being adherent to prescribed medication (Spring et al. 2012, Dragomir et al. 2010), and using digital self-tracking applications for observing everyday number of steps and calorie intake for the purpose of adopting more healthy behaviors (de Boer 2020,

Moerenhout et al. 2018) are strongly associated with better health and recovery from sickness (Spring et al. 2012). Additionally, a study done on Czech adolescents found that basic factors of health-enhancing behavior during the adolescent period are a healthy diet, regular physical

movement, and avoiding drugs (Burešováa 2016). The definitions of health-protective behaviors are presented in box 5.3.

Box 5.3. The definitions of health protective behaviors.

• Health protective behaviors are activities designed to protect, promote, and maintain health irrespective of health status and either the behaviors are influential or uninfluential (Harris & Guten 1979).

• Health protective behaviors are activities that minimize predisposition to diseases causing agents and support fast recovery and restoration of health following sickness (Spring et al. 2012, Fogelholm et al. 2010, Thijssen et al.

2010).

2.5.3.1 Personal hygiene in adolescents

Personal hygiene is the cleanliness of our bodies and clothes and good maintenance of personal appearance through washing hands at critical

moments, clothes, and brushing teeth which help us to protect our health against bacteria, viruses, and fungal (Singh & Gupta 2014, Rasool Hassan 2012). Personal hygiene is the first step to optimal health. Thus, personal hygiene is among the most important routines to mankind at home and at the workplace which support people to protect their health and wellbeing and preserve optimum health (Rasool Hassan 2012). Also, personal hygiene is consistently washing the body and the hands during the

important moments, washing clothing and hair, brushing the teeth, cutting the nails, and caring for the gums (Ratnaprabha et al. 2018, IFH 2017).

Thus, hygiene education for children should comprise hand washing, disposal of waste products from the body, and protection of drinking water (Billing et al. 1999).

Furthermore, individuals with proper personal hygiene feel good about themselves which can inspire self-esteem. However, persons with

improper personal hygiene such as dirty clothes, body odor are likely to be vulnerable to discrimination by friends and peers which can lead to mental health problems (Rasool Hassan 2012). Yet, several hundred million cannot access water to wash their hands and to soap, stopping, necessary action that would encourage them to hinder the circulation of infectious diseases worldwide (WHO 2015). In developed countries inside and outside

contamination of air, unobtainable clean water, poor public health practice, and hazardous chemicals are the major environmental concerns. Personal hygiene is essential to safeguard, improve and preserve health and to make the benefit of interventions sustainable. Diseases caused by polluted water and unhygienic conditions will continue to occur unless sanitation facilities and utensils are properly used, we wash our hands at a critical time, keep drinking water safe from trash, take showers, and do laundry regularly (Howard et al. 2002). Previous research conducted in Turkey on school children showed that living at home and going to school in urban followed proper hand hygiene procedures (Yalçin et al. 2004). Similarly, a study conducted in India showed a higher rate of adolescents in urban areas than adolescents in rural areas' use of soap to wash hands after defecation (Singh & Gupta 2014).

A variety of diseases and food-borne illnesses are caused by bacteria, pathogens, and viruses spread and transmissible usually through hands (Comer et al. 2009). The vast majority of excretes (feces, urine, sweats) associated infections are obtained through, mouths and eating hardly ever through breathing in and out. Excreta-related infections pass through a range of ways from one host to the next either through contaminated hands straight or through contamination of drinking water, soil, utensils, food, and flies indirectly. Each way of spreading depends on the virus and bacteria and geographical locations; thus, some pathogens are widespread in some populations in some areas (Brown et al. 2013). Studies indicated that in developing countries more than 80% of the diseases are caused due to inadequate and unsafe water supply, and inappropriate disposal of waste (Debesay et al. 2015, Seifu & Amy 2011, Tefera 2008). Handwashing is the best prevention method and lessens diseases, disabilities, and deaths from infectious diseases that spread by means of contaminated hands, objects, food, and water through human-to-human contacts and human-to-object contact (Biran et al. 2014). Thus, hands must be washed with detergents, soap, shampoo or wood ash, and water, especially after a toilet visit, before eating, and during processing food (Pengpid & Peltzer 2011, Howard et al. 2002). Therefore, handwashing habits, especially during a critical time, are the most important hygiene behavior that adolescents should add into their daily lives (Singh & Gupta 2014, Phiri 2000). Also, a study done in India on adolescents revealed that washing of hands before eating was about 42% of adolescents in urban and 31%

adolescents in rural (Singh & Gupta 2014).

The documented evidence showed that when water is lacking and limited, families are likely to prioritize and ration the available water for drinking, cooking, washing clothes, and household cleaning. Also,

inadequate resources for hygiene (water) will push down the priority list of personal hygiene-cleaning bodies and brushing teeth (Vivas et al. 2010, Oswald et al. 2008). Thus, shortage of resources, namely insufficient hygiene facilities may be the primary explanation for the reasons adolescents do not consistently perform personal hygiene (Vivas et al.

2010, O’Loughlin 2006). Also, a study done on the Peruvian population

found that the frequency of handwashing in the slums is linked to the amount of water used by the household (Oswald et al. 2008, Gilman et al.

1993). Water is a scarce and expensive resource in slums (Oswald et al.

2008, Adrianzen & Graham 1974) and inadequate water supply is

associated with contamination of hands and making possible transmission of infectious diseases through virus and bacteria human to human (Oswald et al. 2008).

Dental hygiene is another most important hygiene practice. Brushing teeth should be done at least twice a day in the morning and at night regularly (Singh & Gupta 2014, Phiri 2000) to prevent gum disease and maintain good oral health (Hassija & Sridhar 2014). Gum health is

associated with physical and psychological health and the overall health of the people (Kasmaei et al. 2014, Jurgensen & Petersen 2009, WHO, 2003).

Maintaining a high level of dental health is essential to promote quality of life, self-esteem, social confidence, enjoy food, and prevent diseases (Kasmaei et al. 2014, Guarnizo-Herreno & Wehby 2012, Jurgensen &

Petersen 2009). Brushing teeth twice every day is advised by most dentists in order to curb dental plaque or small lesions and eliminate food

impaction and then shorten the duration of common sugar impact through brushing teeth with toothpaste after meals (Attin & Hornecker 2005).

Additionally, the previous literature showed frequent dental visits, brushing teeth frequently, flossing between teeth, and consumption of food low in sugars are vital measures for prevention of dental diseases and maintaining optimal dental condition (American Dental Centre 2018).

Children should learn to brush their teeth from the early years of life, and this can guarantee an adaptation of proper dental hygiene behaviors throughout their lifespan (Pullishery et al. 2013). Additionally, a previous study showed that parents should model and supervise their children’s cleaning teeth approximately for the first 12 years until motor and mental abilities allow the children to habitually perform a proper cleaning teeth technique independently (Colgate-Palmolive Company 2015). Also, a study done in India showed that older children who had a few siblings clean their teeth twice every day than younger children who had many siblings (Kumar et al. 2011). Furthermore, when parents develop appropriate dental

hygiene habits by themselves, through copycat strategy children can develop the same behaviors with their parents (Vanagas et al. 2009, Al Ansari et al. 2003, Freeman et al. 1997).

Also, certain parental socio-ecoomic status are positively associated with more frequent tooth brushing (Rosado et al 2014, Casanova-Rosado et al. 2013, Herrera et al. 2009, Vallejos-Sánchez et al. 2008).

Studies done in low and middle-income economies revealed that

adolescents from prosperous families reported higher brushing frequency compared with those adolescents from impoverished families (Kumar et al.

2011, Al-Hussaini et al. 2003). Also, a previous study indicated that the more educated individuals are more likely to make changes when they get sick, even when the health shock is not that serious (Margolis 2013). A study done in Saudi Arabia showed that below-average dental hygiene practices, poor parental guidance and modeling on tooth brushing, poor knowledge of dental health, and exposure to cariogenic diets are

dangerous to dental wellbeing in the students (Amin & Al-Abad 2008).

Additionally, studies done on school children in nine African countries showed that two times tooth brushing practice rate was 77.3% (Peltzer &

Pengpid 2014, Pengpid & Peltzer 2011). Also, a study done on adolescents in China showed that about 44.4 brushed their teeth at least two times every day, and only 17% used fluoridated toothpaste. The risk of dental caries was low for adolescents who used fluoridated toothpaste (Zhu et al.

2003). Also, research done in Burkina Faso revealed that tooth cleaning was frequently performed using chewsticks. The use of toothpaste was rare, particularly fluoridated toothpaste was seldom (Varenne et al. 2006).

Standard dental health is about consistently doing self-care, namely, tooth brushing, minimizing the intake of cariogenic agents or sweet foods, using fluoride-containing outputs, water, and regular dental checkups, and dental health education (Al-Hussainia et al. 2003, Honkala 1993).

Furthermore, researchers indicated three reasons that are likely to motivate an adolescent to brush his or her teeth include worries about personal hygiene, ensuring clean teeth, desire for good dental hygiene, and good overall health (Ayo-Yusuf & Booyens 2011, Hattne, Folke & Twetman 2007). A study done on adolescents in Sweden found that oral health which

includes the action (the physical things we do to influence the condition of our periodontium) and condition (the physical situations of periodontium) awareness or consciousness was generally low among the adolescents (Ostberg et al. 2002). Additionally, other studies found that dental health knowledge can contribute to good dental health, especially, when attitudes and habits are developed and put into practice (Reddy et al. 2014, McGrath et al. 2007). Additionally, tooth brushing is the most typical way of

controlling periodontal diseases (Al-Hussainia et al. 2003, Sheiham 1970).

However, existing evidence has shown that tooth brushing alone is not enough to prevent dental caries (Al-Hussainia et al. 2003, Reisine & Psoter 2001) because brushing alone is inadequate to clean between and the surface of teeth. Thus, the utilization of dental floss together with teeth brushing is recommended in preventing dental caries and periodontal disease (Al-Hussainia et al. 2003, American Dental Association 1988, WHO 1987).

The third most important hygiene practice is putting on hygienic clothes.

Children should put on clean clothes, including underwear, each day and change play clothes if they become too dirty (Singh & Gupta 2014, Phiri 2000). Hygiene promotion is known as a cost-effective intervention against spreadable infections (Biran et al. 2014, Laxminarayan 2006). Adolescents do not necessarily get the significance of personal hygiene and how to perform and maintain it. Teaching children about personal hygiene begins at home through family members. Thus, children are taught what to do and how to follow hygiene guidelines without help (Singh & Gupta 2014, Dongre et al. 2007).

Children should give personal hygienic practices maximum attention because they can be mocked in the school by friends for having a dirty body, outfit, and greasy hair which indirectly can lead to lower

self-confidence and feeling of dislike among adolescents. Thus, children should be taught to bathe every day and to wash their hands frequently with detergents especially during a critical time and brush teeth at least in the morning and evening, and floss between teeth regularly (Singh & Gupta 2014, Dongre et al. 2007). Additionally, stepping up the supply of water in quality and quantity is important for personal hygiene promotion,

especially, improving the quality of water to prevent the ingestion of a virus, bacterium, germs, and another microorganism. (Babu et al. 2014, Billing et al. 1999). Also, a study done on school adolescents in Bogota, Colombia revealed that the unavailability of facilities for personal hygiene prevents adolescents from adopting proper hygienic behavior which in turn, hampers health promotion practices (Lopez-Quintero et al. 2009).

A study done in Senegal showed that the factors that prevent students from washing their hands were forgetfulness, lack of time, hurry to go to playtime, and filthy bathrooms (Lopez-Quintero et al. 2009). On the other hand, factors that inspire handwashing among adolescents are

determinations to avoid unpleasant odors, to nurture their health and stay healthy, to boost social status and popularity since clean people are more accepted, to enhance their affiliation-connection with others, and promote their social networks, for the attraction since people who keep their

personal hygiene are more attractive, wish to avoid disease and looking for comfort that comes from clean and fresh hands after washing (Vivas et al.

2010, Scott et al. 2007). The previous study indicated that placement of permanent and visible soap distributors, and access to hand-washing facilities in and near school cafeterias, and reminders such as signals and motivators in bathrooms and school cafeterias, promote performing the handwashing practices in adolescents (Lopez-Quintero et al. 2009).

However, many students live in households and going to schools with limited access to running water and challenging areas to access water (Vivas et al. 2010, Oswald et al. 2008). Thus, when obtaining water is hard, apparently, families are forced to supply water with quotas and re-use their water resources (Vivas et al. 2010, Oswald et al. 2008).

Good personal hygiene habits for teenagers and kids must be chosen according to their developmental phase. The hygiene promotion education should include raising awareness on good personal hygiene behavior such as washing the body often, cleaning the teeth at least two times every day, washing hands during crucial times washing the hair with soap once or twice a week, changing dirty clothes into clean clothes and proper menstruation control for mature girls. It is a time when adolescents

embrace changes in their bodies (Singh & Gupta 2014, Dongre et al. 2007).

Studies showed that students who have had adequate information regarding knowledge, attitudes, and practices (KAP) of basic hygiene behaviors, were more likely to have clean clothes and to have a lower risk of infectious diseases (Vivas et al. 2010, Kumie & Ali 2005).

A study done on students in India revealed that poor hygienic behavior was a risk factor for diarrhea, fever, cough, flu, worms in the intestine, head lice, scabies, dental caries, and multiple boils and sores (Sarkar 2013).

Studies showed that among powerful reasons for handwashing practice in Sub-Saharan Africa include afraid of miss school due to illness, worries that illness prevents them from spending time with their friends, peers and adolescents believed that having clean hands are associated with having clean books that in turn resulting in better grades (Vivas et al. 2010).

Infectious diseases will continue as the leading cause of diseases and deaths worldwide (Chami et al. 2014). Fortunately, by means of consistent access to pure and adequate water, proper hygiene habits, good nutrition, and primary healthcare several infectious diseases are preventable (Chami et al. 2014, Pruss-Ustun & Corvalan 2006). Thus, infectious diseases that are avoidable by improved hand hygiene include gastrointestinal infections (Biran et al. 2014, Aiello et al. 2008, Ejemot et al. 2008), respiratory

infections (Biran et al. 2014, Cowling 2009, Aiello et al. 2008), trachoma (Biran et al. 2014, Emerson et al 2000), fatal neonatal infections (Biran et al.

2014, Manandhar & Rhee 2008) and possibly intestinal illnesses (Biran et al.

2014, Bieri 2013). Study shows respiratory and intestine infections are the two major contributors to child mortality worldwide (Liu et al. 2012).

According to WHO death of teenagers from diarrhoeal which are strongly linked to poor water, poor hygiene practices, have gradually declined to just 600, 000 in 2012 from around 1.5 million in 1990 (WHO 2015). Growing evidence estimated that access to running water, appropriate hygiene habits can prevent about 9% overloads of disease and 6.3% of deaths globally (Ratnaprabha et al. 2018, Prüss-Üstün et al. 2008).

Also, evidence showed that over one billion people, the majority in rural areas, are affected by one or more infectious diseases in developing countries (Chami et al. 2014, Lozano 2012). Hygiene promotion through improved water supply and personal hygiene practice is required to

control and monitor infectious diseases. Good hygiene practices improve health and optimum health promotes happiness (Pengpid & Peltzer 2011).

A handful of studies were done on the hygiene behavior of adolescents in Ethiopia. One study found that the majority of children in Ethiopia did not know the possibility of the spread of diseases through body waste and excretion (Kumie & Ali 2005). Another study done on school adolescents in north Ethiopia indicated that about 70% of adolescents did not wash their hands after the utilization of restrooms and after meals. Also, 97% of adolescents reported that they did not use soap to wash hands during the critical moments and about 78% of students did not apply the correct handwashing procedures (Assefa & Kumie 2014).

Appropriate hygiene behavior and access to running water will

significantly improve the nutritional status of children by reducing a variety of intestine diseases and diarrhea. Hygiene improves health and healthy people are economically active which could boost up their income (Babu et al. 2014). Handwashing intervention at school could reduce absenteeism by improving health (Bowen et al. 2007, Biran et al. 2014). Thus, it is critical to promote adolescents’ hygiene behaviors through modeling and hygiene education at home, school, and in the community where adolescents spend most of their time. Establishing proper hygiene behaviors during the adolescent period and childhood is essential because adolescents can continue with health-supportive hygiene behaviors in adulthood. There is a

significantly improve the nutritional status of children by reducing a variety of intestine diseases and diarrhea. Hygiene improves health and healthy people are economically active which could boost up their income (Babu et al. 2014). Handwashing intervention at school could reduce absenteeism by improving health (Bowen et al. 2007, Biran et al. 2014). Thus, it is critical to promote adolescents’ hygiene behaviors through modeling and hygiene education at home, school, and in the community where adolescents spend most of their time. Establishing proper hygiene behaviors during the adolescent period and childhood is essential because adolescents can continue with health-supportive hygiene behaviors in adulthood. There is a

In document Health behaviors among adolescents in Ethiopia (sivua 131-171)