L18 Health risk/enhancing behaviours

Question 1

Health behavior

• Matarazzo (1984) distinguished between

Answer 1

• behavioural pathogens:
• the health damaging/health risk behaviours such as excessive alcohol consumption, smoking, fatty diet.
• behavioural immunogens:
• the health protective/health enhancing behaviours such as exercise, health screening uptake, breast self examination, and low fat diets.

Question 2

Chronic disease in Australia

Answer 2

• heart disease, stroke, cancer and other chronic diseases looming epidemics that will take the greatest toll in deaths and disability” (WHO, 2005)
• Chronic diseases impact heavily on:
• Burden upon patients/carers
• Rates of death/disability
• Use of health services
• Healthcare expenditure

Question 3

prevalence chronic disease in aus inc or dec?

Answer 3

increasing. • Chronic diseases are the leading causes of death and disability in Australia and the burden of these conditions can be high for people who have them, their families and carers

Question 4

what do health risk behaviuors NOT CAUSE?

Answer 4

Tobacco
Causes EVERYTHING except colorectal cancer and Depression (2 things)

Physical Inactivity
Causes everything except lung cancer, chronic obstructive pulmonary disease, asthma (3 things)

Risky Alcohol
Doesn’t cause heart disease, type 2, kidney disease, lung cancer, chronic obstructive pulmonary disease, asthma (6things)
Risky alcohol is the safest!!

Poor Diet
Doesn’t cause Arthritis, lung cancer, chronic obstructive pulmonary disease, asthma, depression (5 things)

Question 5

Primary causes of death in Australia

Answer 5

Coronary heart disease
- Smoking, diet, exercise, alcohol
Stroke (and other cerebrovascular diseases)
- Smoking, diet, alcohol, exercise
Cancer (primarily lung, breast, prostate, colorectal, majority age over 65)
- Smoking, alcohol, Diet, Health screening, Self-examination
Dementia
- Smoking? Alcohol? Exercise? Diet?
Dementia the links are less clear, but it’s likely these things will have an impact

Question 6

Smoking

Risks Increased risk of:

Answer 6

• Coronary heart disease (amputation risk)
• Stroke
• Peripheral vascular disease
• Cancer
• Responsible for more drug-related hospitalizations and deaths than both alcohol and illicit drugs combined

Question 7

Prevalence (% of 14+ years)

• Daily smoking:

Answer 7

2001: 19%
2013: 13%

Question 8

Prevalence (% of 14+ years) Never smoking

Answer 8

• Never smoked* more than 100 cigarettes in their lifetime:
2001: 51%
2013: 60%
there appears to be an increase in the prevalence of never-smokers at each measurement point between 1993 and 2013

Question 9

Australia’s approach to cigarettes

Answer 9

• Gone from heavy smoking advertising in sport to banning it
• POS, out of sight (prompt is not there to buy)
• Plain packaging (starting to see other countries doing this)
• Tobacco tax

Question 10

Factors associated with smoking

Answer 10

1. People living in Remote and very remote areas were 2 times more likely to smoke daily than those in Major cities
2. People living in areas with the lowest socioeconomic status (SES) were 3 times more likely to smoke than people with the highest SES.
3. Indigenous Australians were 2.5 times as likely as non-Indigenous Australians to smoke tobacco daily
4. Compared with heterosexual people, those who identified as being homosexual or bisexual were more likely to smoke daily.

Question 11

Why start smoking?

Answer 11

1. Modelling - Children with peers, elder siblings or parents who smoke are more likely to initiate smoking
2. Social pressure/learning/reinforcement - If friends smoke, a child/young person can develop shared positive attitudes towards smoking, or reduced perceptions of risk.
3. Weight control - Identified as a motive for smoking initiation and maintenance among young girls.
4. Risk-taking or problem behaviours- Smoking is often associated with other problem behaviours such as truancy, petty theft, underage drinking.
5. Health cognitions - such as ‘unrealistic optimism’ regarding the potential of experiencing negative health outcomes. (‘won’t happen to me’ thoughts)

Question 12

Why continue smoking?

Answer 12

1. Pleasure or enjoyment of the behaviour, taste and effects
2. Smoking out of habit
3. Psychological and/or physical addiction
4. Smoking as a form of stress self-management/ anxiety control
5. Low self-efficacy

Question 13

“the second most widely used psychoactive substance in the world (after caffeine)”

Answer 13

Alcohol consumption (Julien, 1996, p101)

Question 14

Recommendations (for healthy adults not pregnant)

Answer 14

Drinking no more than two standard drinks per day maintains the risk of long-term alcohol-related illness at a low level.
On any individual occasion, drinking no more than four standard drinks maintains the risk of short-term, alcohol-related injury at a low level.

Standard drink = 10g alcohol
One glass of red, slightly less white, 1.6 in a schooner of beer
National Health Medical Research Council (2009) – under review
People will minimize the amount they drink when ASKED.

They have DROPPED the recommendation that you should have an alcohol free day.

Question 15

Alcohol risks short and long term 3 and 5

Answer 15

Short term				
•	Pedestrian, road and other accidents
•	Domestic and public violence
•	Crime
Long term
•	Liver disease 
•	Cancer (oral, oesophagus, larynx)
•	High blood pressure
•	Pancreatitis
•	Brain damage

Question 16

Alcohol Prevalence (% of 14+ years)
•	Exceeding guidelines for reducing long-term harm:

Answer 16

2001: 21%
2013: 18%

All adults: 19.1%
Men: 28%

Significant decrease amongst adults, men and women since 2010
Australian Institute of Health and Welfare (2014b)

Question 17

Alcohol Prevalence (% of 14+ years)– Exceeding guidelines for reducing short-term harm:

Answer 17

2001: 29% 2013: 26%

There has been a decrease in the amount of adults and 18-24 y/olds binge drinking weekly to daily, since 2010

Question 18

Factors associated with risky drinking

Answer 18

1. People living in Remote and very remote areas were 2 times more likely to drink alcohol in risky quantities than those in Major cities
2. People living in areas with the highest socioeconomic status (SES) were more likely to drink alcohol in risky quantities than people with the lowest SES.
3. Compared to non-indigenous Australians, Indigenous Australians were more likely to be abstinent. But amongst those who did drink, this was at more risky levels.
4. Compared with heterosexual people, those who identified as being homosexual or bisexual were more likely to drink alcohol in risky quantities.

Question 19

Why higher alcohol amongst same-sex attracted people?

Answer 19

1. Gay and lesbian young adults who experienced a greater number of negative reactions from people important to them about their sexual orientation disclosure reported heavier drinking.
2. Social drinkers also held less negative internalised stigma about homosexuality than did binge or heavy drinkers
3. Bi-negativity: being asked: “when are you going to come out all the way?” and
4. People assuming you will sleep with anyone.
5. Experienced bi-negativity was positively related to binge drinking

Question 20

Recommendations for safer sex

Answer 20

• Regular STI checks
• Covering potentially-infectious areas
• Preventing/reducing the transfer of bodily fluids between partners
Use of:
• Internal (“female”) or external (“male”) condoms or gloves during penetrative sex
• Condoms and dental dams for oral sex
• Lubricant to reduce condom breakage during anal sex

Question 21

Prevalence of condom use
amongst adults who had casual intercourse
• Used condom every time:

Answer 21

2002: 41%

2013: 49%
de Visser et al. (2003; 2014)

Question 22

Factors associated with condom-use

Answer 22

Amongst Women:
-	Less likely after 30
-	Less likely after excessive alcohol consumption
Amongst Men:
-	More likely with more than one partner

Question 23

Why not use protection?

Answer 23

Social: unlike other behs, sex is inherently social
• Difficulty/embarrassment in raising issue
• Anticipated objection
• Worry about STI implications
Lack of self-efficacy for correct use
Attitudes:
• Reduced spontaneity
• Unrealistically positive view of their partner, risk is low

Question 24

Exercise

Recommendations (for adults)

Answer 24

• Moderate activity, at least 150-300 min/week:

* Vigorous activity, at least 75-150 min/week:

Question 25

Benefits | Reduced risk of:

Answer 25

Physical: • Cardiovascular disease • Type II diabetes • Cancer (colon, breast) Psychological: • Anxiety disorders + symptoms • Major depressive disorder + symptoms • Stress

Question 26

Prevalence (amongst adults)• Meeting exercise guidelines:

Answer 26

2005: 30% 2012: 43%

Question 27

Factors associated with exercising

Answer 27

1. Younger people more likely to meet guidelines than older people 2. Higher SES people more likely to meet guidelines than lower SES people 3. More educated people more likely to meet guidelines than less educated people 4. People in major cities more likely to meet guidelines than people in regional or remote areas

Question 28

More likely to exercise if: 3 internal 5 external

Answer 28

- High self-efficacy - Interested in and enjoy exercise - High social support External - Have fewer time constraints - Family and/or neighbors exercise - Have social support for exercising - More active neighbors (and dog owners are on average 2 kg lighter than those who don’t own dogs)

Question 29

Healthy diet recommendations

Answer 29

``` Best way is to categorise ‘sometimes’ foods and others. Recommendations (for women) Two fruit, 5 veg Recommendations (for men) 2 fruit, 6 veg ``` * Vegetable serve is 75g * About half a cup of cooked vegetables or a cup of raw vegetables like lettuce. * Fruit serve is 150g * 2 small pieces of fruit or one medium size piece of fruit.

Question 30

Benefits healthy diet

Answer 30

Reduced risk of: • Coronary heart disease • Stroke • Lung cancer

Question 31

Prevalence (amongst adults) | • Meeting fruit guidelines:

Answer 31

2005: 54% 2012: 49% Australian Bureau of Statistics (2012), Australian Institute of Health and Welfare (2011) GETTING WORSE!

Question 32

Prevalence (amongst adults)– Meeting vegetable guidelines

Answer 32

2005: 14% | 2012: 6%

Question 33

Factors associated with F&V consumption

Answer 33

SES: • Higher (more likely to meet guidelines) Age: • 5-7 years: 55% 12-34 years: 4% 55+ years: 8% highest meeting guidelines: 2-4 year olds; lowest meeting guidelines: 12-34 year olds

Question 34

Why not eat F&V?

Answer 34

* Parental socialisation * Permissiveness; feeding practices (cooking regularly, eating with kids etc) * More child-centred = more F&V * More permissive = less F&V * Perceived and/or actual barriers: * Lack of knowledge and skills for preparing and cooking such items * Length of preparation time (Lea, Worsley & Crawford, 2005) * Cost and availability (e.g. rural areas) (Lee et al., 2002) Less access + more expensive in some rural areas, but not major cities. * Misinformation: * Consumers reluctant to eat vegetarian diet because of concerns about lack of nutrients and iron (Lea & Worsley, 2001), requires more planning

Question 35

Why eat F&V? (Young Australians) | Pearson, Ball and Crawford (2011)

Answer 35

* 12-15 year olds in Victoria * Vegetables: * Peer support (How supportive best friend is of the individual’s healthy eating) * Self-efficacy (for increasing their vegetable consumption) * Perceived availability of F&V in the home (How available they see vegetables in the home) * Fruit: * Healthy eating value (How important healthy eating is to the person) * Modeling by mother (How healthy the mother’s diet is) * Self-efficacy (for increasing their fruit consumption) * Perceived availability of energy-dense food in the home (How available they see cookies, cakes, chips etc in the home)

Question 36

HPV vaccination | Recommendations

Answer 36

• Ideally, before sexually active • Free nationally for 12-13 year olds The National HPV Vaccination Program began in 2007 for females, and was extended to include males in 2013. Since 2007, the National HPV Vaccination Program has been credited with dramatically reducing the incidence of the HPV virus in Australia. In year 7, immune system goes into over drive, more effective than when you are a small child.

Question 37

Predicted drop HPV

Answer 37

Predicted drop from 7 in 100,000 to 4 in 100,000 cervical cancer by 2035 as long as Women 25+ get screening and yr 7s get vaccines

Question 38

Benefits of HPV vaccination

Answer 38

Protects against HPV types 16 and 18. Amongst cancers attributable to HPV, types 16 and 18 cause approximately: • 75% of cervical cancers • 85% of vulvar and vaginal cancers • 90% of cancers of the mouth/throat • 75% of penile cancer • 95% of anal cancers • 45-90% of tonsil & base of tongue cancers • Also protects against HPV types 6 and 11, which cause: • 90% of genital warts 100% of cervical cancers are attributable to HPV. The huge majority (90-93%) of anal cancers are also attributable to HPV. Amongst the other types of cancer, the percentages attributable to HPV vary between 12-64%.

Question 39

HNSCC

Answer 39

25% of all Head and neck squamous cell carcinoma (HNSCC) (Kreimer et al., 2005), and the majority of these HPV-associated HNSCC are oropharyngeal (tonsillar and base of tongue) squamous cell cancers. In fact, HPV is now the major cause of oropharyngeal cancer in developed countries, detected in 45–90% of cases HPV has also been detected in a smaller subset of laryngeal (24%) and oral cavity (23%) cancers (Kreimer et al., 2005)

Question 40

* Prevalence | * Had all three hpv vaccinations:

Answer 40

2007 National HPV vaccination program initiated Girls 12-17: 71% 2011 Women 18-26: 33%

Question 41

Factors associated with uptake

Answer 41

• Health insurance status (may not be issue in Australia) • Program location (higher for school-based population) • Parental concern about: safety and side-effects initiation of early sexual behaviour (? Although unlikely to be a founded concern) Only one study showed relationship between concerns about sex in children and acceptability/uptake (3 showed no relationship) • Lower SES people also have higher rates of cervical cancer and HPV • Rates appear (not tested) higher within school-based programs • Higher when recommended by health care professional •