Exam 2 Flashcards
Health promotion
- idea good health or wellness is personal and collective achievement
- developing program of good health habits (individuals)
- development of interventions (psychologist)
- emphasis of good health to help people maintain healthy lifestyles and ensure availability of resources (policymakers)
health behaviours
used to enhance and maintain health
health habit
behaviour firmly established and usually performed without awareness
6 healthy habits
- sleep 7-8 hours
- no smoking
- no more than 2 drinks a day
- regular exercise
- not eating between meals
- no more than 10% overweight
primary prevention
- taking measures to combat risk factors for illness before chance to develop
- behaviour change and prevent development of poor health habits
role of behavioural factors in disease and disorder
- patterns changed
- today fewer die of acute diseases
- preventable diseases increased
risk factors for leading causes of death in Canada
HEART DISEASE: hypertension, high cholesterol, diabetes, overweight, excessive alcohol, smoking, stress
CANCER: smoking, unhealthy diet, inactivity, excessive alcohol, UV light, environmental factors
STROKE: hypertension, high cholesterol, heart disease, overweight, alcoholism, smoking, stress, inactivity
ACCIDENTAL: no seatbelt, intoxicated driving, no safety gear
CHRONIC LUNG DISEASE: smoking, air pollution, inactivity
successful modification of health behaviours can…
- reduce deaths due to lifestyle-related illness
- delay time of death
- expand years of life free from chronic disease complications
- decrease health expenditures required
factors influencing practice of health behaviours
- socioeconomic
- age
- gender
- values
- personal control
- social influence
- personal goals
- perceived symptoms
- access to health care
- supportive environment
- cognitive factors
barriers to modifying poor health behaviour
- not knowing when to intervene
- instability of health habits: controlled by different factors, may change over history of behaviour, maintained by different factors
socialization
influence of parents as role models, as move into adolescence ignore early training from parents
teachable moments
educational opportunities, certain times better than others
window of vulnerability
middle school, psychosocial vulnerability for heightened risk
benefits of focusing on at risk people
- prevent or eliminate poor habits
-effective use of health promotion dollars - easy to identify other risk factors
problems with focusing on at risk people
- dont always perceive correctly
- can lead people into hyper vigilant and restrictive behaviour
- become defensive and minimize significance of risk factor
- avoid changing behaviour
ethical issues for interventions with at risk people
- when is it appropriate time
- some react defensive
- no successful
- emphasize risk can raise complicated issues of family dynamics
health promotion and the elderly
- maintain healthy diet
- develop regular exercise
- take steps to reduce accidents
- control alcohol consumption
- eliminate smoking
- reduce inappropriate use of drugs
- vaccinate against flu
theory of planned behaviour
- suggests health behaviour is direct result of behavioural intention made of 3 components
- attitude toward action
- subjective norms regarding action
- perceived behavioural control
benefits of theory of planned behaviour
- links directly to behaviour
- provides fine grained picture of peoples intentions
- theory predicts many health behaviours
educational appeals to health behaviour
- vivid communications
- strong arguments at beginning and end
- short, direct messages
- should state conclusions explicitly
- caution with extreme messages
- include favourable and non favourable points
fear appeals
- elicit too much fear often backfire and trigger avoidance
- if fearful habit is hurting health, change behaviour to reduce fear
attitude change and health behaviours
- attitudinal approach not successful for explaining long term or spontaneous change
- communications can provoke irrational, defensive reactions
- thinking about disease may produce negative mood
- attitude change may not alter behaviour and maintain change
efforts to prevent illness
BEHAVIOURAL INFLUENCE: promote brushing teeth by providing info and demonstrating techniques
ENVIRONMENTAL MEASURES: health officials might support putting fluoride to water supplies
PREVENTIVE MEDICAL EFFORTS: dental professionals can remove calculus from teeth and repair cavaties
primary prevention
- actions taken to avoid disease or injury
- habit to use seat belt, friend reminding to use them
secondary prevention
- actions taken to identify and treat illness or injury early with aim of stopping or reversing the problem
- seeking medical care, physician prescribing medication
tertiary prevention
- actions taken to contain disease related damage
- arthritis patents doing exercises
social engineering
- modify enviornment in ways that affect peoples ability to practice particular health behaviour
- banning drug, use safety containers, vaccination requirements, low speed limits, raise drinking age
transtheoretical model of behaviour change
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
prospect theory
- different presentations of risk information will change peoples perspectives and actions
- loss-framed should work better
importance of the stages of change model
- captures processes people actually go through
- illustrates that successful change may not occur first try
- explains why people are not successful in changing behaviour
- use of model shown mixed success
social cognition model
- belief people hold about health behaviour motivate decision to change that behaviour
- expectancy value theory: people choose to engage in behaviours they expect succeed and have outcomes they value
health belief model
- whether person practices health behaviour is understood by knowing 2 factors
- whether person percieves personal threat
- whether person believes health practice will be effective in reducing that threat
CBT
- change the focus to the target behaviour itself
- looks at conditions that elicit and maintain it
- focus heavily on beliefs people have about their health habits
- importance of involving patient as co-therapist
self observations vs self monitoring in CBT process
Observations: discriminate target behaviour, record it
Monitoring: asses frequency of target behaviour
classical conditioning
- earliest principles of behaviour change, 3 phases
- UCS produce reflexive response UCS-> UCR
- UCS paired with new stimulus UCS->UCR CS->UCR
- CS evokes response CS->CR
operant conditioning
- pair voluntary behaviour with systematic consequences
- Positive reinforcement: ass something positive, makes behaviour more likely
- Negative reinforcement: removal of something negative, makes behaviour more likely
- Punishment: remove positive or provide negative and makes behaviour less likely
Modelling
- long term behaviour change
- component in self help programs
- most effective when shows realistic difficulties from behaviour change
discriminative stimuli
- elicit target behaviour, signals positive reinforcement will occur
Stimulus control interventions
- rid the enviornment of stimuli that evoke problem
- create new discriminative stimuli signalling behaviour change will be reinforced
self reinforcement
- rewarding self for desired behaviour
- positive reward : presence of somethings admirable
- negative reward: remove something aversive
- positive punishment: presence of something undesirable
- negative punishment: take something away
contingency contracting
- make contract with person regarding what rewards and punishments will occur for particular behaviours
covert self control
- teach individuals to recognize and modify internal monologues to support behaviour change
cognitive restructuring
targets thoughts for modification often involving self talk
social skills/assertiveness training
- reduce anxiety in social situations
- introduce new skills for dealing with situations
- provide alternative behaviour for poor health habit
abstinence violation effect
loss of control when person violates self-imposed rules
motivational interviewing
- psychotherapy and behaviour change techniques used to work through any ambivalence about behaviour change
relaxation training
- progressive muscle relaxation, breathing techniques paired with tension and relaxation exercises of muscle groups
preventable injuries
- unintentional injuries are major cause of death and primary cause for children under 5
- social engineering techniques are used to decrease accidents and injuries
breast cancer screening
- prevalence is high in canada
- majority detected in women over 40
- early detection through mammograms improves survival rates
prostate cancer
- most common cancer in men
- 3rd leading cause of cancer deaths
- risk increases with age
- screening important, especially after 50
colorectal cancer
- 2nd highest cancer death
- screening is distinctive
- participation predicted by self efficacy, perceived benefits, physicians recommendation, lack of barriers
skin cancer
- most preventable cancer
- several varieties
- increase in incidence of skin cancer
problem with sunscreen use
- tans percieved as attractive
- young adults concerned with appearance
- communication most successful when stressing gains rather than risks
aerobic exercise
- sustained exercise stimulated heart and lungs
- improves utilization of oxygen
- long duration and intensity cause high endurance
- jogging, running, swimming etc.
health benefits of regular exercise
INCREASE: cognitive, oxygen, immune system
DECREASE: resting heart rate, blood pressure, cancer, negative mood
why is diet important
- contribute to diseases
- implicated in development of several cancers
- improves health
resistance to modifying diet
- problem maintaining change
- some recommendations are restrictive, expensive, hard to prepare
- stress has direct effect on eating
- some may alter mood and personality
importance of weight control
- leptin and insulin hormones control eating
- ghrelin explain why dieters gain weight back
- leptin signals hypothalamus whether body has sufficient energy stores
- malfunctioning ventromedual hypothalamus interferes with normal eating habits
stress and eating
- stress affects people differently
- stress influences what food is consumed
- anxiety and depression figure into stress eating
obesity as health risk
- WHO states rates has doubled
- 1/5 Canadians is obese (more men)
- portion sizes increased and we eat more processed food
- fat and sugar consumption contribute greatly
where the fat is
- abdominally localized fat is potent
- excessive central weight, stress weight
factors associated with obesity
- number and size of fat cells
- style of eating
- fat cells increase fat storage later
- family history
- obesity and dieting as risk factors
- set point theory of weight
obesity in childhood
- genes contribute to risk
- sedentary lifestyles
- early eating habits
- negative impact on self-esteem
obesity
WOMEN: fat should constitute 20-27% if body tissue
MEN: 15-22%
accelerometer
measure physical activity
things to consider when want to lose weight
- pace
- methods
- intervention
- activity
- efficiency
- danger
- costs
- advertising
stages of sleep
- theta waves, lightest stage
- spindles, K waves, body temp drops, breathing and heart rate even out
3&4. deep sleep, delta, blood pressure falls, strengthen immune system
REM: beta, vivid dreams, consolidating memories
sleep and health
- less than 7h of sleep affect cognition, mood, performance and quality of life
- chronic insomnia linked to diabetes, heart disease, less efficacy to flu shots
- sleep deprivation affect immune system
- too much sleep ties to psychopathology and chronic worrying
Keys to good nights sleep
- regular execise
- bedroom cooled
- comfortable bed
- regular schedule
- nightly rituals
- noise generator
- dont eat too much or little
- dont smoke or drink alcohol
- no strong smells
- no naps after 3pm
- cut back on caffeine
- if awake, read quietly in another place, associate bed with sleep
implementation intensions
- specific intention highlights “how when and where” of behaviour also includes “if then” plans to deal with anticipated barriers
biopsychosocial factors and health compromising behaviours
- childhood, environment, adverse childhood experiences
- risk seeking, personality, genetic risk
- social inequality, society
- normalization of alcohol use disorder and SUD
DSM-5 criteria for SUD
- 11 basic criteria
- risky, social impairment, sacrificed other activities, neglected important roles, increased use, spending too much time using, pharmacological effects
pharmacological effects of SUD
TOLERANCE: process body increasingly adapts to use of a substance
WITHDRAWAL: unpleasant symptoms people experience when stop using substance
ADDICTION: state person becomes physically dependent on substance following use over time
Unease Modulation Model
- addiction comprises 2 types of unease, general and absence unease
- treatment: assist person to tolerate both types by choosing healthy behaviours
Harm reduction
- reduce negative effects of health behaviours without extinguishing problematic health behaviours completely or permanently
opioid use before and during pandemic
EMS responses to suspected OD: before-> 11,996, after-> 12,130
Opioid related poisoning: before-> 4,514, after-> 5,240
Opioid toxicity: before-> 3,658, after -> 6,265
standard drinks
WOMEN: no more than 10/week, 2/day
MEN: no more than 15/week, 3/day
FASD
- congenital damage to CNS from prenatal alcohol exposure
- developmental disabilities, facial deformities, mental health issues
synergistic effects of alcohol use
societal normalization -> alc use
corporate influence -> alc use
mental health <-> alc use
genetics <-> alc use
alc use -> physical health effects
AUD DSM-5
- risky driving
- impaired control
- social impairment
- pharmacological effects
- meet 2/3 criteria during 12mo period
detoxification
- first phase of treatment
- carefully supervised and medically monitored setting
% of students binge drinking at campus event
- happy hours: 78.4%
- low-priced bar promo: 83.2%
- special beer promo: 86.1%
- cover charge for unlimited drinks: 84.5%
alcohol related problems of university students in 1 year period
- most have had a hangover and memory loss
- few have got hurt or injured and engaged in unsafe sexual activity
smoking status by age group and sex
- 12-17yo: males more
- 18-23: males more (peak)
- 35-49: makes more
- 50-64: males more, women peak
- 65+ males more
- overall men and women’s use increases then decreases
self help aids
- specific instruction for quitting, nicotine gum and patch
steps to help prepare for quit day (smoking)
- select date
- complete pledge
- delay 1st cig of day
- develop strict schedule
- avoid activities that trigger smoking
day before you quit (smoking)
- throw cigs
- tell trusted friend for support
- feel good about having courage to try
on quit day (smoking)
- dont smoke
- self talk
- call trusted friend
- relax
- reward self
- avoid triggers
smoking prevention programs
catch potential smokers early and attack underlying motivations leading people to smoke
social influence intervention
- prenatal smoking and peer pressure promote smoking
1. info of neg effects carefully constructed to appeal to adolescents
2. material developed to convert positive image of non smoker and self reliant individual
3. peer group used to facilitate not smoking rather than smoking
behavioural inoculation
if one can expose to weak dose of germ, one may prevent infection because antibodies develop against germ
life skills training approach
- trained in self-esteem and coping enhancement as well as social skills, wont feel as much need to smoke to bolster self image
passive smoking
tied to higher levels of CO2 in blood, reduced pulmonary functioning, higher lung cancer rates
eating disorders
anorexia nervosa: obsessive disorder, self starvation, body weight grossly below optimum level
bulimia: alternating cycles of binge eating and purging through techniques of vomiting, laxative use, extreme diet
continuum of treatment related behaviours
SCREENING: cancer screening, blood pressure test, genetic screening
CARE-SEEKING: treatment delay, readiness, physician visits, medical appointments
MAINTENANCE + ADHERENCE: treatment discontinuation, non-adherence, adherence treatment dropout
medical students disease
- situational factors makes illness or symptoms salient promotes their recognition
- study illness, believe you have it
illness representations
- acquired through media, personal experience from family and friends`
- illness schemas
- self regulatory model of illness cognitions: identity, consequences, causes, duration, cure of illness
3 models of illness
ACUTE: caused by specific viral or bacterial agents, short duration, no long term consequence (flu)
CHRONIC: caused by several factors, long duration, severe consequences (heart disease)
CYCLIC: alternating periods during which there’s either no or many symptoms (herpes)
Lay referral network
- informal network of family and friends who offer own interpretations of symptoms well before any medical treatment is sought
complementary and alternative medicine (CAM)
- on rise
- gaining popularity and acceptance in canada
- complementary therapies increasingly used (massage, chiropractic, acupuncture)
natural and non-prescription health products
- vitamins, minerals, herbal remedies, teas, plant products
cyberchondria
use of internet to fuel anxiety
outcomes of search for health information on internet
- search health info, increase in distress/anxiety, cyberchondria + avoidance of internet searches
OR - search health info, decreases in distress/anxiety, classical reassurance performed on internet
somaticizers
- individuals who express distress and conflict through bodily symptoms
age predictors of health service use
- very young and elderly use health services most
- young children develop number of infectious childhood diseases
- late adulthood people develop chronic conditions and diseases
gender predictors of health service use
- women use more medical services frequently
- pregnancy and childbirth
- women not subjected to same social norms
- perception that getting treatment disrupts women’s lives less than men
socioeconomic status and culture predictors of health service use
- lower SES use medical services less than higher SES at first but then more visits
- lower SES make more emergency room visits
- discrimination by health care providers may lead to perception that low SES seek more care
- minorities more likely to visit doctor but not specialist
- language barriers
secondary gains
illness benefits: ability to rest, fired from unpleasant tasks, cared by others, time off work
nosocomial information
- infection from exposure to disease in hospital
Types of delays
delay behaviour: seek treatment for symptom but delays doing so
appraisal delay: time takes to decide symptom is serious
illness delay: time between recognition symptom implies illness and decision to seek treatment
behaviour delay: time between deciding to seek treatment and actually doing so
medical delay: time between making appointment and receiving medical care
who delays
- those who believe symptoms are not serious
- elderly
- no regular contact with physician
- seek treatment primarily in response to pain and social pressure
- fearful of doctors, examinations, surgery and medical facilities
nurse practitioner
registered nurse, education in health assessment, diagnosis, management of injuries, illness, prescribe drugs
holistic health
positive state to be actively achieved, not absence of disease
elderspeak
overly caring, sends message elderly are incompetent
improving adherence to treatment
- listen, repeat
- clear instructions
- special reminders
- short words
- provide info
- find worries
why practitioner can be effect agent of behaviour change
- credible
- make it simple
- help make decisions
- privacy
- warmth
- family cooperation
- monitored
non adherence
non adherence: dont adopt behaviours and treatments recommended
creative non adherence: modifying and supplementing prescribed treatment regimen
double blind experiment
- participant and researcher dont know who has placebo
hospitalization impact on patients
- structure of hoospital
- functioning of hospital
-changes in hospitalization - burnout among Canadian nurses
irving janis study
- importance of worry for patients about to have surgery and preparatory information
- too much fear= cant process preparation information
- little fear= not vigilant or worried enough to process info
- moderately worried= vigilant enough, not overwhelmed by fears, realistic expectations
patient contributions to faulty communication
- patient characteristics
- patient knowledge
- patient attitudes toward symptoms
