314 - MT2 Flashcards
cost effectiveness of healthy lifestyles
- occurs through…
less costly than treatment of disease
- occurs through indiv efforts, interaction (env shapes behav) w medical syst, mass media and legislation
Health enhancing vs health compromising behaviours
Health enhancing: exercise, eating healthy, sleep»_space; promote health
Health compromising; excessive drinking, smoking, drug use, unsafe sex, risk-taking behaviours»_space; undermine or harm current/future health
health and behaviour factors
- disease pattern change?
- deaths
- most preventable cause of death
- patterns of disease in North America have changed from acute infectious disorders to “preventable” disorders
- half of deaths are caused by preventable behaviours
- obesity/lack of exercise»_space; about to overtake tobacco as most preventable cause of death
obesity
- BMI + risk
- 1994 to 2013 change
- biological links?
- countries involved?
- age/gender
- eating disorders
- overweight if BMI is 25+, obese if body mass index (BMI) is 30 or higher»_space; measure of adult’s weight in relation to height»_space; disease risk increases as BMI increases beyond normal level
- age adjusted prevalence of obesity and diagnosed diabetes among US adults»_space; went from 14% in 1994 to more than 26% in 2013 (very high!)
- correlation is not causation! but there are biological links
- obesity not limited to the US»_space; rates are high in US/Mexico, medium in Canada (nearly 1/3 of CAD are obese!) /European countries, and low in Asian countries
- age also plays a role»_space; mostly 55-64yo are obese compared to other age groups
- more men obese than women
- eating disorders are also prevalent (BMI < 18.5)
health advocates (3)
- want calorie counts on menus (became part of legislation in Ontario, 2017)
- advocate for tax on sugary drinks (did not pass, but normal sales tax was added)
- want to take vending machines away
Health habits (3)
- change?
- how do they happen?
- when are they developed?
- predictors
- attitude/beliefs
- health-related behaviour»_space; firmly established, stable, but can change over time
- often automatic»_space; occurs outside awareness
- often developed in childhood»_space; typically stabilize around age 11-12
- health behaviours are not strongly tied to each other»_space; doing one does not predict doing others
- health behaviours are not governed by single set of attitudes or beliefs
eg. social encouragement: dieting, seat belts
eg. people changing: experience, peer pressure
socialization influences early health habits (3)
- window of vulnerability
- parents: model»_space; brushing teeth, wearing seatbelt
- social institutions: increase physical activity required, encourages healthy snacks at school
- peers
Window of Vulnerability: adolescents may ignore early training
- adolescents are particularly vulnerable (body changes = feeling awk = less exercise)
- poor diet, smoking, alcohol/drug use, risky sexual behaviour, low phys activity
Targeting at risk ppl
- prognosis
- tailoring
- problems (3)
- early identification may benefit prognosis
- knowledge helps monitoring»_space; tailor to high risk ppl
problems:
- most ppl don’t always perceive risk correctly
- most ppl are unrealistically optimistic ( difficult to target those who are at risk because they think it won’t happen to them)
- stress»_space; don’t stress out the ppl ur trying to help by scaring them!
teachable moment
2 examples
certain moments are better than others for teaching particular health practices
eg. emphasize teeth brushing at dentist visit
eg. stopping smoking during pregnancy
percentage of death
- 1960s vs now
- why?
in the 1960s it was mostly (50.6%) CVD»_space; heart disease, stroke»_space; now its mostly cancer (28%)
- result of behaviour risk factor modifications/medial treatment
health behaviour
- well behaviour
- symptom-based behaviour
- sick-role behaviour
- breast cancer health behaviour
- any activity trying to maintain/improve health, regardless of if it works
well behaviour: maintain/improve health or avoid illness
- depends on motivational factors»_space; perception of threat of disease (if you’re not sick you won’t try to be especially healthy»_space; good diet, exercise, etc)
symptom behaviour: ill person tries to determine and fix problem»_space; complaining, seeking help
sick role behaviour: treat illness»_space; adjust lifestyle
- sick ppl have a special “role”»_space; exempt from obligations/tasks»_space; stay home from school/work to recover
breast cancer health behaviour: women ages of 50-69 should get mammogram every 2 years (self/physician check not effective)
Illness prevention
- clean teeth example
- primary, secondary, tertiary prevention
Example: having clean teeth
- behavioural influence (brush teeth)
- environmental measures (put fluoride in the water supply)
- preventative medical efforts (repair cavities)
- primary prevention: actions to avoid disease/injury
- secondary prevention: actions to identify/treat illness or injury»_space; stop/reverse problem
- symptom-based behaviour
eg. physical examinations yearly - tertiary prevention: actions to contain damage done by serious injury/progressed disease»_space; prevent disability/reoccurrence + rehab
problems in promoting wellness
- individual (3)
- interpersonal
- community (+ problems)
Individual: health behaviours are less appealing and less convenient than unhealthy behav
- little incentive to change immediately, especially if healthy
- hard to change habits, need knowledge, planning skills and self-efficacy
- being sick/on drugs affects mood/energy/cog resources/motivation
Interpersonal: social factors»_space; marriage partners adopt each other’s behaviours»_space; family dynamics may get interrupted (eg. they go eat out when you’re on diet)
Community: more likely to do if gov’t/healthcare systems encourage
problems: insufficient funds for research, hard to adjust to diff age/sociocultural backgrounds, lacking safe spaces for exercise, fast food restaurant, health insurance
Reinforcement
+/-
Extinction
results in desirable state of affairs
- positive reinforcement: reward added
- negative reinforcement: bad thing removed
extinction: if consequence of behaviour is eliminated, response tendency is weakened gradually
modeling and antecedents
modeling: learning vicariously (observational learning)
antecedents: internal/external stimuli that precede and set occasion
for behaviour»_space; habits
eg. coffee with cigarette after breakfast
conscientiousness association
dutiful, organized»_space; associated with practicing health behaviours (fitness, healthy diet, taking prescribed meds, etc)
optimistic beliefs
- ppl who partake in health behaviours
- health professionals
- ppl have feelings of invulnerability at all ages
- ppl with health behaviours feel less at risk for health problems»_space; unrealistically optimistic»_space; unlikely to take preventative action
- health professionals implement programs to make ppl see risks realistically
A. Health belief model
- definition
- barrier examples (3)
- perceived threat factors (3)
- sum
- shortcomings (3)
taking preventive action depends on assessment of threat to person and weight pros(benefits to health)/cons (barriers»_space; perceived costs) of taking action
eg. financial, psychological (embarrassing), or physical (distance to doctor’s office too far)
perceived threat factors:
- perceived seriousness (if left untreated)
- perceived susceptibility (likelihood of development)
- cues to action (reminders)
sum = benefits - barriers: extent to which taking action is more beneficial than not
Shortcomings:
- does not take into account habitual health behaviours (eg. brushing teeth)
- no standard way of measuring components
- perceived susceptibility/seriousness
- diff surveys used to measure - assumes that ppl think about risks in a detailed manner
B. Theory of Planned Behaviour
- intention (barriers, env, health goals)
- attitude
- subjective norm
- perceived behavioural control
- support for theory
- shortcomings (4)
ppl decide their intention in advance»_space; intentions are the best predictors of what ppl will do (goals make it much more likely)»_space; linking attitudes and intentions directly to behaviour
intention: do I intend to change my behaviour?»_space; just intention alone may not be enough
- barriers (like time, other business) get in the way
- environmental factors (eg. weather/seasonal effects)
- health goals are especially hard since you have to change complex habitual behaviour
- attitude regarding the behaviour (is it a good thing to do?)
- based on the outcome, and whether it would be rewarding (what will happen if I change my behaviour?) - subjective norm (impact of social pressure/behaviour’s appropriateness»_space; based on other’s opinions (env) and motivation to comply
- perceived behavioural control (self-efficacy)»_space; expectation of success
- judgements combine to form intention»_space; leads to performance
- If you have all 3 it will likely result in the intended behaviour!
support: empirical evidence for ToPB across a broad spectrum of health behaviours: flossing, phys activity, fruit/veg consumption, seat-belt use, and breast self-examination»_space; all based on separate long-term longitudinal studies and clinical trials with N>100 participants
shortcomings:
- intentions and behaviour are not strongly correlated»_space; ppl don’t always do what they claim to decide »_space; intentions can change
- incomplete»_space; does not take experiences with the behaviour into account»_space; more likely to do again if done before
- assumes that ppl think about risks in a detailed manner
- does not account for habitual health behaviours
Theory of planned behaviour
- planning»_space; mental simulation
a) action plans
b) coping plans
planning: the bridge between goals (recommendations»_space; in order to maintain/see it through) and behaviour»_space; key variable in health behaviour
- beyond intention
- a mental simulation commits the indiv to perform a behaviour once the critical situation is encountered
a) action plans: plans regarding the initiation of behaviour (when, where, how structure)»_space; break it down into actionable units
b) coping plans: plans regarding the maintenance of behav in the face of barriers»_space; plan B instead of dropping behaviour
C. Stages of Change Model
- what does it do?
- 5 stages
- importance of timing
readiness to change
- help people advance: describe in detail how to carry out change, plan for problems that may arise»_space; provides a framework for a wide range of potential interactions by health promoters (if they have a negative response, you need to talk to them about their failures/obstacles)
- the model identifies a number of stages which a person can go through during the process of behav change
stages:
- precontemplation: not considering changing»_space; refuse/not thought about it
- motivational enhancement strategies - contemplation: aware that a problem exists»_space; considering changing, not ready
- assessment and treatment matching - preparation: plan to pursue behaviour goal
- action: active efforts to change behav
- maintenance: maintain successful changes
- relapse prevention/management
- important to know where they are at so that you can tailor the message to suit their needs
eg. if theyre already committed you dont want to bore them by trying to convince them
eg. if you try talking about obstacle management but they don’t even know the risks yet, you will miss the opportunity to bring them in
gender and health
- who lives longer?
why?
- hormones (stress, estrogen)
- health compromising behaviours
- work
- consulting
- women tend to live a few years longer than men, but women have higher rates of acute diseases
- physiological reactivity (blood pressure/stress hormones) affect men more
- estrogen delays CVD»_space; reduces cholesterol
- men smoke, drink, do drugs, eat unhealthily, become overweight and partake in risky sexual behaviours more than women
- work env for men is more hazardous»_space; more fatalities
- women more likely to consult a physician
Sociocultural factors and health
- relevance
- social status
- immigrants
- biological factors
- cognitive/linguistic factors
- social and emotional factors
relevant on national and international levels
- social status: lower SES (eg. minority groups) = poorer health habits
- immigrants: adopt health behaviours of new culture (acculturation)
- biological factors: differ in physiological processes/stress reactivity
- cognitive/linguistic factors: diff ideas of illness causes, diff pain perception, language difference impairs ability to communicate
- social and emotional factors: differ in stress experienced (physiological reactivity) and coping; social support differs
Methods for promoting health
- providing info (3)
- features to enhance motivation (4)
- motivational interviewing»_space; decisions
- behavioural/cognitive methods»_space; prevention
Providing info: what to do, when, how, where
- mass media»_space; negative consequences
- internet»_space; websites
- medical settings»_space; Dr office»_space; advantages (once a year, respect for professionals) and disadvantages (tight scheduling, lack of expertise, dr may be intruding on personal life)
Features to enhance motivation:
- use tailored content»_space; specific to indiv
- educational appeals»_space; non-tailored, general info
- fear appeal»_space; motivated by fear to protect health
- message framing»_space; emphasize physical/social consequences , provide instructions
Motivational interviewing: resolve ambivalence in changing behav»_space; decisional balance and personalized feedback
Behavioural and cognitive methods: enhance ppls performance of preventive act»_space; manage antecedents and consequences»_space; enhance self-efficacy
HIV infection
- leads to?
- how does it spread?
- gender?
- circumcision?
human immunodeficiency virus: leads to AIDS (acquired immune deficiency syndrome)»_space; there is no vaccine
- spreads through contact of bodily fluids (eg. sex, drug needles)
- more common in males (75% of new cases)
- circumcised = much less risk of infection
Sleep facts
- who does not get recommended amt of sleep?
- why worsening?
- younger?
- 1/3 Canadians do not get the recommended 7 hours of sleep (worsening over time»_space; sleep durations have decreased over the past decade»_space; could be due to changes in technology use
- when ppl are younger (children/adolescents) they need more sleep
why is good sleep important?
- benefits of sleep (4)
- problems with lack of sleep (4)
sleep = the final frontier; not as studied as the other things such as diet/exercise
Benefits:
- reduces disease risk: CVD, cancer, hyperT, diabetes, pain, obesity, depn
- helps conserve energy
- helps consolidate memory and increase brain plasticity
- eliminate toxins and repair tissues
Problems with lack of sleep:
- attention, learning and memory (cognitive function): risk of accidents and impulsive/risky behaviour
- mood/psychological functioning (dep/anx): having psych issues puts at risk for sleep disorders like chronic insomnia
- interpersonal relationships strained»_space; less marital satisfaction
- quality of life is lower
Define good sleep S A T E D
are you SATED?
Satisfaction: self reported sleep quality
Alertness: day time functioning; how refreshing was your sleep?
Timing: bed time + wake time»_space; how consistent?
- at risk for metabolic problems if lacking consistency
Efficiency: time spent asleep divided by the time spent in bed (ideally 85-95%)
Duration: amount of time asleep (total sleep time)
- recommended adults get 7H of sleep every 24H
Two Process Model
- Process S (3 pts)
- Process C (4 pts)
- Factors (9)
- light
for normal sleep (in a typical adult)
- Homeostatic sleep drive: Process S (balance)
- need for sleep (pressure) increases the longer you are awake
- caused by accumulation of sleep-inducing substances (melatonin)
- homeostatic sleep drive is strongest around 10pm (when you normally sleep) - Circadian rhythm: Process C (pressure)
- internal biological clock that regulates periods of sleepiness/wakefulness throughout the day
- internal clock located in the suprachiasmatic nucleus (SCN), which is within the hypothalamus
- dips around 2-4am, and 1-3pm in adults
SCN synchronized by environmental cues (light exposure)»_space; makes you more awake and sets SCN pattern
- circ rhythm at its peak around 9pm»_space; keeping you awake despite process S
Factors: light (most important), food, temp, meds, substance use, meal times, naps, exercise, daily schedule»_space; direct or non-direct effects
Light: photosensitive retinal ganglion cells in the eyes sense brightness and send info to the SCN
SCN
- what is it
- full dark?
- light conditions (3)
- who does this affect most? (2)
master clock that determines continuous cycle of physiological changes within cells (hormones for waking/sleeping)
- when kept entirely in the dark circ rhythm barely changes
- too much/too little light/seeing light at wrong time of day can mess up internal clock
- problem for ppl who work at hight/ppl with sleep disorders and ppl with visual impairments (cant reach ganglion cells)
Disruptions to circadian rhythms
- jet lag (2)
- work
- timing
- light conditions (2)
- jet lag: body stuck in a diff time zone
- social jet lag: sleeping in on weekends
- working night shifts: especially irregular shifts»_space; metabolic problems
- irregular sleep/wake times
- too little light during day
- too much light at night
recommended amt of sleep for healthy adult
- consensus recommendation (age and amount)
- based on what?
- when is it appropriate to sleep 9+ hours?
consensus recommendation (experts >> Sleep Research Society and American Academy of Sleep Medicine) say that adults (18-60 yrs) should sleep 7+ hours per night on a regular basis to promote optimal health - based on studies of disease, cognition and safety
when is it appropriate to sleep 9+ hours?
- younger adults, ppl recovering from sleep debt (not sleeping enough for a long time), ppl with illnesses
- some ppl say too much sleep is bad
How did experts come up with 7+ hours for 18-60yo?
- studies (number, based on?)
- voting + statement
- which does not have a clear recommendation?
- reviewed >5k studies»_space; scientific evidence»_space; based on how good the studies were rated
- went through several rounds of voting»_space; for each hour range of sleep, each expert rated their agreement to the statement “based on the available evidence, [X] hours of sleep is associated with optimal health with the [X] subcategory in the [X] category (eg heart disease)
*only breast cancer doesn’t have a clear sleep rec
Sleep architecture
stage 1, 2, 3/4 and REM
tend to cycle through stages (if healthy sleep)»_space; 4-5 cycles
stage 1: 7 mins, light sleep
stage 2: light sleep, sleep spindles (bursts of brain activity/waves)»_space; HR and metabolism slow, body prepping for deep sleep
stage 3/4: SWS, deep sleep (delta waves)
- if woken from deep sleep you are disconnected
- SWS is most restorative»_space; repairs muscle/tissue/growth and devel/boosts immune fxn/build up energy for next day
- less time spent in deep sleep as you age»_space; impaired (major health complaint)
REM: rapid eye movement»_space; brain is active/dreaming»_space; similar to when awake»_space; important for memory consolidation (short to long term)
- tends to decrease as you get older
- occurs abt 90 mins after you fall asleep (10 mins long)»_space; inc duration as night goes on
sleep latency
- min/max times
- age factor
time it takes to fall asleep»_space; 10-15 mins in healthy adults
- if it takes less time you’re probs sleep deprived, but if it takes more than 30 mins = sign of insomnia
- as you get older it takes longer to fall asleep
WASO
- definition
- sign of insomnia?
wake after sleep onset
- how much time you’re awake during the night after you have fallen asleep the first time (tossing and turning)
- more than 30 mins = sign of insomnia»_space; inc w age
Study: metabolic consequences of sleep and circadian disruption
- research question
- methods (sample size, environment, 1 week, 3 weeks, 9 days)
- results (2)
Research Question: does prolonged sleep restriction w circadian disruption impair glucose regulation and metabolism in humans?
Methods:
- 21 participants (younger/older adults)
- stayed in controlled lab env for almost 6 weeks (light, food, temp and activities all controlled)
- 1 week of sleep saturation 10-16hrs»_space; make sure nobody is sleep deprived; get used to env
- 3 weeks of sleep restriction (5.6 hours per day) and disrupted circadian rhythms (sleep period staggered each day)
- after 3 weeks of disruption, had recovery period (9 days)»_space; 10-16hrs»_space; went back to normal (not permanent)»_space; both younger and older
Results: after 3 weeks of sleep restriction (reduced time in bed) and circadian disruption (disrupt inner clock)
- resting metabolic rate decreased
- insufficient insulin response after a meal»_space; resulting in too much glucose in blood
Insulin controls blood glucose levels
- insulin
- after eating
- what does insulin do?
- no insulin (2)
insulin: hormone made by pancreas»_space; allows body to use glucose (sugar) from food
- after eating, blood sugar is high
> pancreatic cells release insulin to bloodstream
> insulin signals fat cells to absorb sugar»_space; used for energy - insulin keeps blood sugar from getting too high (hyperglycemia) or too low (hypoglycemia)
- if there’s not enough insulin or body becomes resistant to insulin»_space; leads to metabolic problems (at risk for diabetes)
Study: younger adults vs older adults
- younger and older
- what else did they measure?
- effect?
younger adults: after disruption, glucose levels (at pre-diabetic level) are much higher than normal»_space; not mounting a sufficiently high insulin response
older adults: same as younger
- also measured resting metabolic rate»_space; oxygen consumption
- hint to metabolism»_space; changes in metabolic rate
- BIG effect on obesity/diabetes in the long term! (even tho this was only 3 weeks)
chronic insomnia
- definition
- causes
- statistics
3P model
- perpetuating behaviours
- precipitating situations
- predisposing factors
Definitions: pre-morbid, acute, early development, chronic
difficulty falling asleep, staying asleep, or getting refreshing sleep at least 3 times a week for past 3 months
- caused by increased arousal»_space; closely tied to stress/emotional issues/age
- in US, 1/10 adults have chronic insomnia, and 1/3 ppl experience 1 of the symptoms
3P model
- Perpetuating: behaviours that lead insomnia to continue over long term (chronic)»_space; caused by controllable behaviours such as poor sleeping habits, working (blue light)/worrying before bed (inc tension/cog arousal), medication/caffeine (stimulants which activate SNS)
- Precipitating: situations such as a new job/job stress, fam stress (caring for newborns, disabled ppl), illness/injury (brain injury/depression/chronic pain)
- can push you over the edge and cause early/acute insomnia - Predisposing: factors such as personality (neuroticism), hyperarousal, genetics, chronotype (night owls at greater risk for insomnia)
- not enough on its own to cause insomnia itself
pre-morbid = before insomnia acute = temporary symptoms early = early devel chronic = long term (3mo)
variability in sleep patterns
- mean
- more variability =? (6)
- depression
- pain conditions
- cross sectional data
- even if you’re getting a mean 7h of sleep (some days lots, some days little) and you don’t have any insomnia symptoms, you are at greater risk of health problems
- more night to night variability in sleep measures is associated w worse mental and physical health»_space; inflammation, depression, gastrointestinal and breathing problems (asthma), pain (arthritis, migraines), neurological diseases
- ppl who have depression have difficulty in regulation of sleep»_space; leads to variability
- pain conditions can disrupt sleep»_space; more inconsistent
- this is a correlation! not causation!»_space; cross sectional research = no directionality since you measure both at the same time
Promoting good sleep behaviours
- example + 2 reasons
- limit the amt of time awake in bed»_space; designed to decondition pre-sleep arousal (if you stay there and worry/be tense, it will be harder to sleep), and to re-associate bed with rapid onset, well-consolidated sleep
Typical instructions for sleep problems include… (6)
- keep a fixed wake time 7 days a week
- use bed for sleep and intimacy only»_space; dont do work in bed»_space; stress
- sleep nowhere else except bedroom
- if still awake after 15 min, leave bedroom and do something relaxing and return when sleepy
- keep naps <30 mins and before 3pm
- bright light in the morning (>30 mins)
addiction
- definition
Physical dependence
- tolerance
- withdrawal
Psychological dependence
- dependence potential
condition produced by repeated consumption of a psychoactive substance»_space; physical and psychological dependence
Physical dependence: body adjusted to substance»_space; becomes part of normal bodily functioning
- tolerance: body adapts»_space; requires larger doses to get same effect
- withdrawal: phys/psych symptoms when you stop/reduce substance use»_space; results in anxiety, instability, cravings, nausea, headaches, hallucinations and tremors
Psychological dependence: feel compelled to use substance for the effect even if they arent physically dependent
*dependence potential is high for cocaine/heroin, moderate for marijuana, and low for LSD
substance use disorder
- DSM-5»_space; symptoms (6)
- mild, moderate and severe disorders
Dagnostic and Statistical Manual of Mental Disorders (DSM-5)»_space; published by APA
Symptoms:
- great deal of time spent trying to obtain substance/recovering from use
- showing tolerance»_space; inc doses to attain same effect
- strong cravings
- failing to fulfill important obligations (eg. absence from work)
- repeated risks taken for phys injury (eg. drunk driving)
- substance-related legal difficulties (eg. arrested for disorderly conduct)
- having 2 is mild, 4-5 is moderate, and 6+ is a severe disorder
Remission: no longer meeting diagnostic criteria for dependency
Processes leading to dependence
- Reinforcement (positive/negative)
- avoiding withdrawal
- substance-related cues
- expectancies
- personality and emotional factors
- genetics
- smoking vs drinking
- adolescence vs adulthood
- environment
- Reinforcement
- positive reinforcement: feeling a rush/buzz
- negative reinforcement: stop cravings/dull pain/cope with stress - Avoiding withdrawal
- substance-related cues: associating substance use with internal or env stimuli that are regularly present
eg. smell of cig smoke (conditioned stimulus) is paired with the buzz feeling (unconditioned stimulus) you get after smoking - expectancies: from your own experiences/from watching others
eg. drinking is fun/sociable/grown up - Personality and emotional factors: impulsive, high-risk taking, sensation-seeking, low self-regulation ppl are more susceptible
- being depressed/anxious increases risk for substance abuse - Genetics: heredity influences addiction
- MZ twins are more likely to have similar behaviour in substance abuse than DZ twins»_space; specific genes involved
- genes for smoking not the same as genes for drinking
- substance use strongly influenced by social factors in adolescence, and more by genetics in adulthood
- high parental involvement can counteract genetic risk
- epigenetics important (env)
