HES psych 1 Flashcards
What are moderators
factors that influence a relationship or treatment affect
specifies for whom the treatment works
under what conditions the treatment works
what are moderators used for
inclusion/exclusion criteria
most responsive
subpopulations
match patients to treatments
What are mediators
why two variables are related
regression to the mean
statistical phenomenon
extreme scores will eventually move towards the mean or vice versa
What are parts of the ecological model? (top to bottom)
policy
community
institutional
interpersonal
individual
What does the social gradient show?
high income=high health
non medical factors that influence health outcomes
conditions in which people are born, live, grow
wider set forces
economic policies and systems
upstream
more systemic and political
underlying factors
distal factors
downstream
more literal, apical
surface factors
proximal factors
social factors
income, wealth, health
race and racism
neighborhood and working conditions
education
stress
health impact pyramid (increasing population impact and vice versa is increasing individual effort)
counseling and education
clinical intervention
long-lasting protective interventions
changing the context to make individuals’ default decisions healthy
socioeconomic factors
upstream interventions
macro-level state and national public policy/environmental interventions
strengthen social norms and supports for healthy behaviors
to redirect unhealthy societal and industry counterforces
mid stream interventions
target defined populations
changing and or preventing
work through organizational channels
downstream interventions
individual level interventions
for those with risk factors or suffer from risk related diseases/conditions
What was the problem in Bleich’s paper?
Diet related diseases
59% of people in the US have them
90% of health care spending goes towards chronic conditions
80% go on to gain the weight back
Why are health care systems limited in their ability to address unhealthy diets?
Most of the other 80 to 90% of modifiable contributors are related to
social determinants of health —
the conditions in which people
are born, grow, live, work, and
age
Hunger free kids act 2010 (National school lunch program)
federal government mandated
1946
nutritional
increase in obesity
HHFK Act
more grains, fruits, veggies
age specific
standards for snacks
Chandran et al type of study
cohort study
What was the Healthy Hunger Free Kids program?
recognize the vast array of factors outside the healthcare system that directly and indirectly influence dietary choices
What was chandran studying?
the first to evaluate the association between the HHFKA and BMI in a large, diverse, geographically heterogenous group of school-aged children
What was the age range for chandran and the social backgrounds?
12-18 yr olds
lower income
Gearan & Fox
researched and studied school meals nutrition and cost
HHFK outcomes
decrease in BMI following implementation
no change in plate waste
a small increase in costs
According to Bleich what are some solutions to healthy eating and health behaviors in communities?
Partnerships between health systems and surrounding communities
Population-based approaches which make it easier for people to make healthy choices
Private sector
National restaurant association
Kids Livewell
Healthy Weight Commitment Foundation pledge
medical model vs public health model
unless we intervene on multiple levels such as outside behaviors, this will not be effective in long lasting change
Syme - major problems to confront
identifying risk factors
changing behavior
importance of underlying communities/systems
syme - social determinant
social class
How to explain the social gradient?
“control of destiny”
How did syme intervene to change behaviors?
He got 5th graders and set up a mentor program with the aim of giving them hope for the future
Challenges of community partnerships
Inappropriate funding mechanisms
different disciplines
intervening at many levels
What is control of destiny
the degree to which individuals feel they have the power to influence the events and circumstances in their lives
people with a higher sense of control over their lives tend to have better health outcomes, including lower stress levels and reduced risk of chronic diseases.
2 reasons for sex differences in statistics
Physiological changes
social/cultural differences
Shift in focus of biomedicine and health care system
away from acute illness and focuses on chronic disease and physical disablement
