Exam 3

Arteriosclerosis

"Hardening of the arteries," chronic disease in which blood vessels lose their elasticity

Modification of Type A Behavior:Recurrent Coronary Prevention Project

(Friedman et al., 1986). Can Type A Behavior be changed and do such changes reduce the risk of a second heart attack? > 1,000 heart attack patients. Life-style (Type A) Modification vs Regular Cardiac Care Results:Type A Modification (compared to controls). Lower Type A behavior. Lower risk of second heart attack.

Blood Glucose Awareness Training

(Gonder- Frederick & Cox). Improving treatment decisions via detecting and treating BG changes. BG symptom awareness. Self-treatment decisions. Long-lasting benefits: Improved psychosocial adjustment. Reduced extreme high or low BG levels. Fewer motor vehicle accidents.

Psychotherapy with breast cancer patients

(Spiegel et al., 1989). Patients randomly assigned to either: Group Psychotherapy Normal Care Group Psychotherapy: 90 minutes weekly for 1 year. Learned hypnosis to manage pain. Discussed how to cope with cancer. Emotional expression and support.

Emotional Consequences of Cancer

/Anxiety and depression very common. About half show "significant" emotional difficulties. Improves with time; stabilizes after about 2 years. But high variability. Emotional reactions may affect survival and quality of life. Some studies show shorter survival in those with higher depression and hopelessness. May be related to effects of stress and negative emotions on immune functions (Antoni et al., 2006). Factors associated with better adaptation? Age (older age better than middle-aged). Disability (less disability/pain). Don't blame themselves or others. Involvement in tx decisions and active coping. Perceived control. Finding benefits and meaning in cancer experience.

Depression

15-20% patients with diabetes are clinically depressed. Strong association with hyperglycemia (high blood sugar). Causal direction is unclear. Treatment of depression improves depression depression and blood glucose.

Cancer

2nd leading cause of mortality in US. A set of > 100 diseases in which abnormal body cells multiply and spread forming a tumor. Benign (noncancerous). Malignant (cancerous). Involve mutations in DNA. Metastasis.

Cancer Survivorship

66 % of people diagnosed with cancer survive > 5 years. Many issues of long-term adjustment. Most stressful aspects? (Dunkel-Schetter et al., 1992). Fear of recurrence; uncertain future (41%). Physical disability, appearance, lifestyle (24%)

Stroke

A cerebrovascular accident that results in damage to the brain due to lack of oxygen

Coronary Heart Disease (CHD)

A chronic disease in which insufficient blood supply causes damage to the heart muscle.

Coronary Artery Disease (CAD)

A chronic disease in which the arteries that supply the heart become narrowed or clogged.

Angina Pectoris

A condition of extreme chest pain caused by a restriction of the blood supply to the heart.

Myocardial Infarction (MI)

A heart attack; the permanent death of heart tissue in response to an interruption of blood supply

Predictors of Adherence

Adherence is higher: Acute vs chronic diseases. Medicine vs behavior (e.g., pill vs exercise). Simple vs complex regimens. Patients' accurate understanding of their disease and treatment. Patient disease conceptualizations. High patient satisfactions with medical care. Good Dr - Patient communication•Dr. listens to Pt, is respectful, understands the patient's life.

Psychosocial aspects of diabetes management

Adherence to diabetes regimen is difficult.. Insulin injections, BG monitoring > diet, exercise. Poorer with increasing illness duration. Poorer during adolescence and young. Poorer during adolescence and young adulthood. Medical technology can help.

Uncontrollable Risk Factors

Age-Half of all CVD victims > 65 yrs. Gender -Higher risks for men-However, CVD is still the leading cause of mortality in women. Family history. Race / Ethnicity-White Americans < African-Americans-White Americans > Asian- and Latin-Americans. Due to biological or psychosocial issues?. African Americans = higher blood pressure-Lower SES = more CVD risk factors, including high-fat diets, lack of exercise, smoking, lack of access to health care, and stressful life experiences-African Americans experience discrimination.

Symptom Detection

Attentional Focus Individual Differences in Neuroticism Emotional Factors Cognitive Expectations

Attentional Focus

Attentional Focus-External vs. Internal Focus of Attention (e.g., Fillingim & Fine, 1986). Experimentally manipulated focus of attention. Runners engage in a cognitive task vs attend to body. Internal = more cramps, shortness of breath, fatigue. Situational Factors affect Attention & Symptoms. Stimulating environment = external attention. Boring environment = internal attention.

Is There a Cancer-Prone Personality?

Cancer-prone (type C) personality. Suppress negative emotions. Seek harmony & avoid conflict. Unassertive-Difficulty coping with stress•Denial & Repressive Coping. Helplessness, hopelessness, & depression. Cause-and-Effect problems. Meta-analysis (McKenna et al., 1999). Modest support. Denial & repression during stress. Conflict avoidance. Type C personality claims have been over-stated.

Types of Cancer

Carcinoma — cancer of the epithelial cells that link the outer and inner surfaces of the body (breast, prostate, lung, and skin cancer). most common (85% of all cancers) Sarcoma — cancer that strikes muscles, bones, and cartilage Lymphoma — Cancer of the body's lymph system; includes Hodgkin's disease and non-Hodgkin's lymphoma Leukemia — Cancer of the blood and blood-producing system.

Medical Treatments

Cardiac Medications. Beta-blockers, calcium-channel blockers, vasodilators, anticoagulants, thrombolytic agents. Coronary Artery Bypass Graft. Form of surgery in which a small piece of healthy vein is grafted around a blocked coronary artery. Coronary Angioplasty. Surgery in which an inflatable catheter is used to open a blocked coronary artery.

Cardiovascular Diseases

Cardiovascular Disease (CVD) -Disorders of the heart and blood vessel system, including stroke and coronary diseases. Leading cause of death in both men and women in the United States. 1 of every 5 deaths is due to heart disease. >4000 heart attacks occur each day & half are fatal.

Social Consequences of Cancer

Changed social relationships. Patient may avoid support seeking. Physical condition and tx make it difficult. Psychological meaning of needing support. People may avoid the patient. Social support is important for adaptation. Social constraints (feeling constrained in disclosing thoughts and feelings) associated with poorer adjustment. Marital status and survival in late-stage cancer patients. Married > non-married; Single consistently poorest prognosis. Spousal Support (Coyne; DeRidder; Hagedoorn). Active Engagement. Discuss, collaborate, actively problem-solve. Better relationship quality and self efficacy. Overprotection (miscarried helping). Overhelping, restricting activities. Create feelings of helplessness. Protective Buffering.Hide concerns from partner, deny worrying. Poor outcomes for wives; good outcomes for husbands.

Atherosclerosis

Chronic disease in which cholesterol and other fats are deposited to inner walls of the coronary arteries, reducing circulation to the heart. Plaques form in the lining of artery

Type 1 Diabetes

Common chronic illness of childhood. Childhood/adolescence onset...usually. Most common in Caucasians. Loss of ability to produce insulin. Autoimmune destruction of cells that produce insulin. Both genetic and environmental factors. Fatal without external source of insulin. Buildup of glucose in blood stream while tissues starve. Metabolize fat for energy. Ketones are a toxic by-product ketoacidosis.

Symptom Interpretation: Am I sick? Do I need a Dr.?

Commonsense Model - Leventhal. Conceptualization of Disease. Identity Do I have a cold? Causes My classmate sneezed on me. Timeline Meh...it will pass in a week. Consequences I might miss a test. Controllability I'll rest and take care of it. Conceptualizations are "psychologically correct" even if they are medically incorrect.

Adherence

Degree to which a patient carries out the behaviors and treatments recommended by health care practitioners. Measures of adherence. Patient reports. Health care practitioner report. Monitor medication use. Pharmacy records; MEMS pill boxes-Biochemical evidence. Rates of non-adherence. @25% non-adherence to medication regimen. Osterberg & Blaschke (2005). 1/3 of prescriptions written in US are not filled. Only ½ are continued over time as needed to yield health benefits. Consequences of non-adherence. Delayed recovery. Illness worsens over time

Emotional Factors

Depression and anxiety. About 75% of patients with depression present physical symptoms as the reason for seeking care-Croyle & Uretsky (1987). Induced positive vs negative mood via film clips. Neg mood = more symptoms in past month

Early Detection (Cancer)

Detecting breast and testicular cancer. Breast/Testicular Self Examination. Source of detection of majority of tumors. Clinical breast exams (every 3 years for women between 20 and 40; annually thereafter). Genetic testing for cancer.Who should get it? Pros and cons of genetic testing.

Why does all this matter?

Detection and interpretation of symptoms influence coping. Seeking medical care. Diagnosis and treatment recommendations. Adherence.

Psychosocial interventions for type 2 diabetes prevention

Diabetes Prevention Program (NIH) >3000 adults "at risk" for type 2 diabetes. Randomly assigned to: Behavioral lifestyle change (weight loss; exercise; diet). Medication (Metformin). Compared to placebo at 4 years followup: Lifestyle - 58% reduction in type 2 diabetes. Medication - 31% reduction in type 2 diabetes 10 yr followup. Lifestyle - 34% reduction in type 2 diabetes. Medication - 18% reduction. Cost-effectiveness demonstrated.

Surgery

Diagnostic. Staging (to determine the extent of disease). Curative (to remove a tumor). Restorative (to reconstruct a person's appearance or the function of an organ or body part)

Some "Fun" Facts!?

ER visits increase when news about a health scare is reported. 25 to 60% of symptom complaints have no identifiable medical explanation. 30% of patients undergoing expensive and risky diagnostic tests have no signs of disease. Women have more severe heart disease at diagnosis than do men. About 75% of patients with depression present physical symptoms as the reason for seeking medical care.

Cancer Treatment

Early detection can dramatically improve a person's chances of survival

A Cautionary Tale

Effects on survival not consistently replicated. Spiegel et al. (2007). Randomized to support group vs standard care. Across all subjects, no difference in survival. In those with ER-negative tumors, was clear benefit (30 month vs 9 month survival time).

Alcohol

Excessive drinking is a major risk factor for cancer of the upper respiratory and digestive tracts. May contribute to breast, colorectal, and liver cancer. Consuming two+ alcoholic drinks per day creates a greater risk of breast cancer. Animal research shows that drinking > 2 drinks per day may increase growth of an existing tumor.

Type A vs Type B personality

Friedman & Rosenman- competitive, hurried, hostile, aggressive people who may be at increased risk for developing CVD. Measures -Structured Interview (examples). Are you married? Has your wife/husband ever asked you to slow down in your work? Never?. Most people who work have to get up fairly early-uh, what-time-uh-do-you-uh, ordinarily-uh-have-uh-to-uh-uh-get up?

Gender differences in developing and treating CHD

Gender-Higher risks for men. Men receive more aggressive treatment than women. Women are older when first diagnosed. Women 2x more likely to die following a heart attack

Alternative Treatments

Generally unproven; many can relieve symptoms

Interpersonal Responses to Genetic Test Results

Hamann et al., 2008•49 sibling dyads with different combinations of test results (++, +-, --). Measured emotions and perceptions of support during discussion of genetic testing. Mixed vs positive or negative dyads. Reported more anger. Perceived less support. Positive dyads reported more friendly support than negative dyads.

Dr-Pt Communication Training in Primary Care

Haskard et al. (2008). 156 Dr & > 2000 pts (ob gyn, family med, int med). Randomly assigned. Physician training. 3 monthly 6 hr workshops + coaching sessions-Patient training. 20 min waiting room intervention. Both. Neither Physician Training. Increased patient satisfaction, patient report of behavioral health counseling, more "sensitive" communication (independent raters), dr satisfaction with exam. Decreased Dr satisfaction with interpersonal aspects. Patient Training. Increased satisfaction with Dr.

Psychosocial Interventions

Health Behaviors-Exercise (McCauley et al., 2010). Improved Quality of Life, Self Efficacy, Emotional Well-being. Cognitive Behavioral Stress Management

Managing type 2 diabetes

Healthy eating. Regular exercise. Possibly medication. Oral medications.Insulin therapy. Test blood sugar.

Psychosocial Vulnerability Hypothesis

Hostile & angry adults lead more stressful lives and may create more stressful lives for themselves. Also have low levels of social support, which, over time, have a toxic effect on cardiovascular health.

Health Behavior Hypothesis

Hostility & anger have an indirect effect through its relationship to other CVD risk factors, including obesity, hypertension, alcohol and tobacco use

•Psychophysiological Reactivity Model -

Hostility and anger act to damage the arteries and heart through heightened "cardiovascular reactivity." Unhealthy increases in blood pressure, blood levels of free fatty acids, and outpourings of epinephrine, cortisol, and other stress hormones. Hostility and anger are associated with more frequent reactivity, greater levels of reactivity, and prolonged reactivity.

Sick Role Behavior

How people behave once they have recognized a symptom and interpreted it as a potential illness (or have received a diagnosis)

What is Diabetes?

Huge health care problem. 33rd most common chronic illness and prevalence is increasing world wide. A leading cause of morbidity, mortality, & health costs. Behavioral self-management demands. Set of disorders of carbohydrate metabolism. Insulin. Blood glucose

Sexual Behavior

Human papillomavirus (HPV). HPV infection higher among sexually active youth. Increases risk of cervical cancer and other cancers. HPV vaccine can prevent. AIDS-related cancer. Kaposi's Sarcoma.

Controllable Risk Factors

Hypertension (high blood pressure). Sustained elevation of systolic and diastolic blood pressure. Normal (< 120/80). Elevated (>140/90). Smoking Doubles the chances of a heart attack or stroke-Quitting anytime helps. Obesity -Abdominal obesity promotes the greatest risk of CVD-This may contribute to men's greater risk of CVD. Cholesterol. Total > 240 doubles the risk; < 200 is associated with lower risk-HDL (high density lipoprotein) = Good. LDL (low density lipoprotein) = Bad. HDL below 40 mg/dL is considered a risk factor. Metabolic syndrome (> 3 of the following). Large waist circumference. Elevated serum triglyceride. Low HDL cholesterol. Elevated blood pressure. Glucose intolerance. Those with metabolic syndrome = 2X risk of CVD. Inflammation-Chronic inflammation can contribute to development of plaques. Stress and Heightened Cardiovascular Reactivity -Characteristic reaction to stress, including changes in heart rate, blood pressure, and hormones. Light et al. (1999). 103 college age men completed laboratory stress tasks-measured HR and BP reactions (identified top 25% most reactive). Identified who was hypertensive 10 years later. High reactivity + family history. High reactivity + high current life stress

Health beliefs

Illness conceptualizations People "believe" they can tell when their blood glucose is high or low by attending to their symptoms. Often wrong. If they use these symptom beliefs to guide their treatment decisions (e.g., when to take insulin), may lead to poorer diabetes management.

Immune System and Cancer

Immune system defends against cancer. Natural Killer (NK) cells. Aspect of Natural Immunity. Recognizes "non-self" cells. Destroys malignant cells. Psychological factors may affect NK cell activity. Stress and negative emotions

Changing Health Care Systems

Increasing responsibility placed on patients and families. Changing medical technologies. Decreased inpatient care. Patient centered care. Patient empowerment and informed decision making

Genetic Risks

Is there a genetic risk for Cancer? Nurses' Health Study (1993). Mother with cancer dx before age of 40 had 2x risk of breast cancer than without. Specific genes for breast cancer. BRCA1 and BRCA2 genes. Sharply increased risk for breast cancer in women with BRCA1 mutation. Implicated in development of breast cancer in men, and pancreatic cancer in both women and men.

Physical Activity

Lack of physical activity may be a risk factor for colon and breast cancer. Nurses Health Study. Women who exercised > 7 hrs/wk had lower risk of breast cancer than those who exercised < 1 hr/wk. Women's Health Initiative. Cohort Study. Physically active women have lower rates of breast cancer than do sedentary women. Just 1.5 hrs brisk walking/wk was enough to reduce risk.

Cognitive Expectations

Lorber et al. (2007). Testing substance with 4 known symptoms (itchy, drowsy, headache, nausea); wanted to know if caused other symptoms. Randomly assigned to receive inert nasal spray, then recorded behavior. Those who received spray displayed more visible symptoms. Petrie (2005)-Residents in neighborhoods to be sprayed with insecticides. Health worries about modern life. High health worries reported 3X the symptoms of those with low health worries.

Family Teamwork Intervention

Low intensity, integrated into routine care. 3-4 brief sessions at their clinic visits. Intervention targets sharing responsibility for diabetes tasks and ways to avoid conflict tasks. Randomized clinical trials support the effectiveness of the intervention. Sustained parental involvement over 1-year without increased conflict. Better metabolic control over 1-2 year followups.

Treatment Goal for Type 1 Diabetes: Maintain "normal" Blood Glucose

Maintain "normal" Blood Glucose. Coordination of multiple behaviors: Inject insulin, Test blood sugar, Diet, Exercise. Complex cognitive skills. Life-long motivation

Cancer Susceptibility

Many uncontrollable factors, such as gender, age, and ethnicity affect susceptibility. The older people become, the greater their chances of developing and dying of cancer. The prevalence of different cancers varies by age group. Leukemia is more common among children and most common childhood cancer. Cancer is 2nd leading cause of death in children (behind accidents) Cancer Susceptibility. Latino and Asian individuals have lower rates for some cancers than White Americans. African-Americans have the highest rates for cancer mortality in the United States. May be related to some health behaviors. Race/Ethnic differences in diet, tobacco use, and other risk factors play a role (African-Americans tend to smoke more and consume fattier diets). African-Americans tend to have less access to health insurance and health care facilities.

Positive Adaptation to Cancer

Most cancer patients adapt remarkably well. 90% of cancer patients report benefits. Improved relationships. Greater appreciation of life. Reprioritized life goals. Greater empathy. Positive beliefs and finding meaning can facilitate adaptation, and may be associated with improved immune function.

Type 2 diabetes

Most common form (90% of cases). Insulin-resistance. Hyperinsulinemia. Many people with type 2 diabetes are undiagnosed. Risk Factors: Age, Adult-onset...usually. Genetics / Family history. Obesity. Minority & Low SES.

Warning Signs of Heart Attack

Most fatalities = delay. Chest discomfort-pressure or tightness. Pain spreading to shoulders, neck, or arms. Shortness of breath. Lightheadedness, nausea, fainting, sweating. Anxiety, impending doom.

Treatment Side-Effects

Nausea and vomiting. Serious concern. Expectations increase nausea. Anticipatory nausea. 25-50% of patients. Chronic Pain. Fatigue-Increases with depression and sleep problems. Exercise interventions are helpful.

Individual Differences in Neuroticism

Neurotic individuals report more symptoms. Are they just "whiners and complainers"?. Cameron et al. (1994). Breast Cancer pts tamoxifen vs. placebo. Tamoxifen has identifiable side-effects. High Neuroticism = earlier detection of real symptoms.

Modifiable Psychological Factors:Hostility and Anger

Nonsupportive findings on Type A Behavior-e.g.., WCGS 22 year follow-up = no link to CHD mortality. Hostility is the "toxic" component of Type A Behavior-Cynicism, Distrust, Anger. Example items from the hostility scale: "When someone does me wrong, I feel I should pay him back just for the principle of the thing" (true)"I think most people would lie to get ahead" (true)"Most people make friends because friends are useful to them" (true)"I am not easily angered" (false). Associations with CHD. Hostility = 1.5 times as likely to have a heart attack. Anger = 2.5 times as likely to have a heart attack-Independent of other risk factors

Seeking Medical Care

Normal users-Age (higher use in very young and very old). Gender: Females > Males. Women are more likely than men to report symptoms and to use health services. Women may be exposed to more illnesses. Women may be more sensitive to symptoms. Gender roles make it more acceptable. Men may not go to doctor even with serious problems (NCHS, 2006): Over 1/3 wouldn't go to a doctor immediately, even experiencing chest pain or shortness of breath. Only 32 percent had been checked for cancer (mostly prostate) in the past year. Overusers: 25 to 60% of symptom complaints have no identifiable medical explanation. Over-use estimated to be 16% of all medical costs. Health anxiety. Excessive concern about being ill based on misinterpretation of symptoms. Hypochondriasis-Believe symptoms result from serious disease despite medical reassurance; > 6 months; interferes with social functioning. Delayers-Delaying tx for breast cancer affects mortality:< 3 months = 50% 8 yr survival > 6 months = 31% 8 yr survival.

What Causes Cancer?

Now, back into groups of four, and discuss: What causes cancer? What have you heard? What do you think? What evidence do you have? How would you find out more if you wanted to know more?Have a new group leader to report out, if called on.

Life-Style Intervention to Reverse Heart Disease

Ornish Program: Comprehensive Lifestyle Change. Diet. <10% fat; no oils; minimal animal products; limit salt, caffeine-Exercise•Moderate exercise of 3 times/wk for 30 min-Stress-Management and Social Support-Delivery of Program is intensive. Results: (Ornish et al., 1990 and 1998)-Quality of life and angina improved-Atherosclerosis reversed•1 Year Followup:4.5% improvement in artery occlusion vs. 5.4% worsening. 5 Year Followup: 7.9% improvement vs. 27.7% worsening. Benefits strongly associated with maintaining lifestyle changes. American Heart Association's concerns. Medical skepticism about wide-spread application. Too demanding and relapse is high. Mostly highly motivated have been studied.

Dr-Patient Communication

Physician Contributions. Not listening. Not explaining. Use of jargon. Stereotypes of patients. Cooper et al (2012) "unconscious" racial bias and Dr-patient communication. Implicit Association Test. Audio-recordings of 40 drs with > 250 patients. Dr with bias favoring whites-more dominant with all patients; less positive emotional tone and slower speech with black pts. Patients were less confident in Dr, less involved with care, less satisfied with care. Patient Contributions. Don't ask. Don't tell.Anxiety. Improving Dr-Pt. Communication. Patient. Centered Communication. Provide care that is consistent with patient values, needs, and preferences (whole person), and that allows patients to actively participate in treatment decisions. Focus on Physician. Focus on Patient.

Individual Differences in Preferences for Control

Preferences for Healthcare. Health Opinion Survey (Krantz). I usually don't ask the doctor or nurse many questions about what they're doing. I'd rather have doctors and nurses make the decisions about what's best than for them to give me a whole lot of choices. I usually ask the doctor or nurse lots of questions about procedures during an exam. It is better to trust the doctor or nurse in charge of a medical procedure than to question what they are doing. I'd rather be given many choices about what's best for my health than to have the doctor make the decisions for me. Preferences for Healthcare-Match between individual preferences and treatment recommendations may produce better adjustment. Adherence in renal dialysis pts (Christensen et al.) in clinic vs. in home dialysis. Better adherence for clinic dialysis among those with low preference for involvement. Better adherence for home dialysis among those with high preferences for involvement.

Enhancing Control and Coping with Stressful Medical Procedures

Preparation for Stressful Medical Procedures. Information. Coping strategies. Childhood Immunizations (Manimela et al.,2000). Randomly assigned to reassurance vs distraction.Reassurance: Parents were very confident in ability to reassure child there was nothing to fear. Reassurance was worse: More physical restraint required. More verbal fear displays by child.

Symptom Interpretation

Previous experience. Social factors. Lay referral network. Interferes with your daily roles and obligations. Internet. Symptom characteristics.Painful. Visible. Persistent

Cancer Incidence

Prostate (in men) and Breast (in women) are most common sites but not the most deadly. Lung cancer 2nd most common in both men and women, but contributes to the most mortality. One good place to learn more is SEER (seer.cancer.gov) Surveillance, Epidemiology, and End Results program.

Why Do Hostility and Anger Promote CVD?

Psychophysiological Reactivity Model Psychosocial Vulnerability Hypothesis Health Behavior Hypothesis

Spiegel et al., 1989 - Results

Psychosocial Well-Being-Psychotherapy group (vs normal care). Lower anxiety and depression. Less pain. More active coping Survival Time from Entry into Study: Normal Care= 18.9 months Psychotherapy = 36.6 months

Modifiable Psychological Factors:Type A Behavior

Relation to CHD. Western Collaborative Group Study. Prospective study of >3000 healthy men. Measured Type A Behavior. Followed over time. In the 1st phase (8.5 years), Type A > Type B. Doubled the chance of developing CHD.

Short and long-term consequences

Severe hypoglycemia (low blood sugar). Most common with type 1 diabetes. Frightening! Automobile accidents. Cognitive deficits. Prolonged hyperglycemia (high blood sugar) blindness (retinopathy). Renal failure renal failure (nephropathy). Limb amputations limb amputations (neuropathy). heart disease.

The Healthy Heart

Size of a clenched fist. 11 ounces. Consists of 3 layers of tissue Epicardium - outer surface of the heart Endocardium - inner lining of heart chambers Myocardium - heart muscle. Pumps 5 or more quarts of blood each minute through four chambers.

Depression

Strongly implicated risk factor in CHD and metabolic syndrome; rivals regular exposure to secondhand smoke. People who are depressed are 2x as likely to develop CHD. Triples chance of dying from CHD -Both biological and behavioral explanations. Not simply an aftereffect of CHD diagnosis-an independent risk factor. Remains underdiagnosed and often untreated in many people with CHD.

Risks of Tanning Beds

Sunbathing and Tanning Beds. Melanoma is increasing in general. 75% increased melanoma risk among those who used tanning beds before age 35 (IARC, 2007). 5.6% adults nationwide reported indoor tanning in past 12 months (Mean > 10 times in past yr). Most common. Young women, especially white women.

Medical Treatment Options

Surgery Radiation Therapy Chemotherapy Alternative Treatments

Risk Factors for Cardiovascular Disease

The Framingham Heart Study. Landmark prospective study of risk factors in CVD

Illness Behavior

The ways in which people respond to physical symptoms, including recognizing the symptom and interpreting the symptom.

Tobacco

Tobacco Use. The single most lethal carcinogen. Most tobacco-related deaths result from lung cancer. Also linked to cancers of the mouth, pharynx, larynx, esophagus, pancreas, uterine cervix, kidney, and bladder. Tobacco use after cancer is dx can contribute to additional tumors, and reduced effectiveness of tx.

Environmental and Occupational Hazards

Toxic Chemicals. Asbestos increases risk of lung cancer. Radiation / UV Light Exposure. 40-50 percent of Americans > 65 develop skin cancer. Thinning of ozone. Malignant melanoma. A potentially deadly form of cancer that strikes the melanin-containing cells of the skin.

The Illnesses

Type 1 diabetes. Loss of ability to produce insulin. Type 2 diabetes. Insulin resistance or defective production of insulin. Gestational diabetes.

Chemotherapy

Use of medicines to treat cancer.

Radiation Therapy

Using x-rays/gamma rays to destroy malignant tumors.

Parental Involvement in Diabetes

Who is responsible for deciding insulin dose?Who is responsible for checking blood glucose levels? Etc... (1 = child alone, 3 = mother/child share, 5 = mother alone). Parental involvement declines in involvement declines in adolescence. Declines are associated with poorer management. Goal is to maintain involvement while supporting the adolescent's autonomy. Mismatches can involve under-involvement or over-involvement.

Why Gender Differences?

Women are more likely than men to report symptoms and to use health services-Women may be exposed to more illnesses-Women may be more sensitive to symptoms. Gender roles make it more acceptable. Men may not go to doctor even with serious problems (NCHS, 2006): Over 1/3 wouldn't go to a doctor immediately, even experiencing chest pain or shortness of breath. Only 32 percent had been checked for cancer (mostly prostate) in the past year.

Gender differences in delay among cardiac patients

Women may delay seeking medical care for cardiac symptoms. Vignette study. Do gender stereotypes (women don't get heart disease) affect delay? (Martin et al., 1998). 2 conditions (male vs female; low vs high stress). Patient having cardiac related symptoms. In males, symptoms attributed to CVD in both stress conditions. In females, symptoms attributed to CVD in low stress condition. Found even when physicians were participants! Followup study with real CVD patients (Martin et al., 2004). Interviewed 157 patients about symptoms and treatment seeking Symptom attribution. Females < males on attributing symptoms to MI initially. Lay consultation - both genders consulted with others about symptoms equally, but received different advice. Females less likely to receive suggestion that symptoms are cardiac. Females less likely to receive advice to seek medical care. Delay in seeking care. Evidence that females delayed seeking care.

Diet and Obesity

a factor in 1/3 of cancer deaths. Foods that increase risk. Saturated fats (e.g., red meats). How prepared (avoid cured, smoked, charred meats). Foods with potential benefits. High fiber (e.g., fresh fruits and vegetables). Beta-carotenes (e.g., foods that are dark green, orange or red have high beta-carotene and antioxidants).