Health Psych Week 2: Ch.3-5

Venues for Health-Habit Modification

-The Private Therapist's Office: two advantages of the one-to-one therapeutic experience for the modification of health habits: 1. precisely bc it is one-to-one, the extensive individual treatment a person receives may make success more likely 2. Bc of the individual nature of the experience, the therapist can tailor the behavior-change package to the needs of the individual -Major disadvantage: only one individual's behavior can be changed at a time -Health Practitioner's Office: Advantages is that physicians are highly credible sources for instituting health habit change, and their recommendations have the force of their expertise behind them. Latinos in particular appear to be better served by health habit interventions that include face-to-face contact as compared with printed information -Disadvantage: one-to-one approach is expensive and reduces only one person's risk status at a time -The Family: Married men have far better health habits than single men, in part bc wives often run the home life that builds in these healthy habits. Children learn health habits from their parents, so making sure the entire fam is committed to a healthy lifestlyes gives children the best chance at a health start in life. Fams typically have more organized, routinized lifestyles than single ppl do, so fam life can be suited to building in healthy behaviors, such as getting 3 meals a day, sleeping 8 hours, ect. Another reason for intervening with families is that multiple family members are affected by any one member's health habits (ex. secondhand smoke). Finally (most importantly) if behavior change is introduced at the family level, all family members are on board, ansuring greater commitment to the behavior-change program and providing social support for the person whose behavior is the target. Especially helpfful in Latino, Black, Asian, or southern european cultures -Managed Care Facilities: these groups provide opportunities for general preventive health education that reach many people at the same time. Ex. clinics to help smokers stop smoking -Self-Help Groups: An estimated 8-10 million ppl in the US alone attempt to modify their health habits through self-help groups. These groups bring ppl together with the same health habit problem, and often with the help of a counselor, they attempt to solve their problem collectively. Ex. AA -Schools: We can intervene before children have developed poor health habits. Schools have a natural intervention vehicle- class of approximately an hour's duration. Morover, certain sanctions can be used in the school environment to promote healthy behaviors, such as requiring inoculations in order to attend school. Finally, a school's social climate influences how likely students are to abuse drugs or alcohol and so changing the norms about health habits may influence a large number of student ssimultaneously -Workplace Interventions: approximately 70% of the adult pop is employed, and consequently, the workplace can reach much of this population. INclude on-the-job health promotion programs that help employees stop smoking, reduce stressm change their diet, ect. Can also structure the enviornment to help ppl engage in healthy activities (many companies ban smoking in the workplace, ect.) Programs have appeared to achieve modest success, but enrollment rates can be low at 20% or less, interventions often reach those with jobs of high rather than lower occupational prestige -Community-Based Interventions: Could be a door-to-door campaign informing people of the availability of a breast cancer screening program, ect. Advantages: such interventions reach more people than individually based interventions or interventions in limited environments, such as a single workplace or classroom. Second, this intervention can build on social support for reinforcing adherence to recommended health change. Ex. if all your neighbors have agreed to switch to a low-cholesterol diet, you are more likely to do so as well. Third, these intervention can potentially address the problem of behavior-change maintenance. Finally, evidence shows that neighborhoods can have profound effects on health practices, especially those of adolescents. Have also been controversial: policymakers believe that these interventions are too expensive for the modest changes they bring about. Also, behavior change may not be maintained over time. One approach that may solve some of these problems is to partner interventions with existing community organization, such as health maintenance organizations, design and implement interventions with their help and cooperation, and build in follow-through steps with the partnering organizations to help sustain behavior change

Brief Interventions

-Brief interventions by physicians and other health care practitioners can help in bringing about smoking cessationa dn controlling relapse, but at present, advise about stopping smoking is only rarely given by health care practitioners

Life-Skills-Training Approach

-Deals with cigarette smoking per se in only a small way. The rationale for the intervention is that, if adolescents are trained in self-esteem and coping enhancement as well as social skills, they will not feel as much need to smoke to bolster their self-image. The skills will enhance their sense of being an efficacious person. Results of these programs appear to be encouraging as the smoking prevention programs based on social influence processes

Consequences of Sleep Loss

-Poor academic performance --Sleep deprived perform worse but rate performance better on exam --An interesting study of college students showed that those who got 25-30 minutes more per night tended to have more A's and B's than those who did not. If you remember anything from this section of the class, please note that no one adapts to getting less sleep. Lab studies consistently show worse performance on a range of tasks due to deprivation. The irony of those studies is that sleep deprived people who say they are just fine tend to perform the worst. -Atuomobile accidents --Fatigue is the leading cause --More than 70,000 of the nations annual automobile crashes are accounted for by sleepy drivers, and 1550 of these are fatal each year -Minor medical Illness --Cold and flu rates higher in poor sleepers -Circadian dysregulation --Like jet lag in home environment --I want to highlight a common problem among working college students with circadian rhythm dysregulation. I have quite a few students who occasionally work a third shift for a job and then wonder why they are having such a hard time in school. Periodic shift work wreaks havoc on your system (as do the completely worthless all-nighter for studying) and should be avoided whenever possible. -Psychiatric illness --Depression and anxiety --Incidence (occurance/frequency) 2x greater than general population (20% of students) --Lastly, it is no surprise that poor sleep correlates highly with depression and anxiety. Depression is the most common of the mental health diagnoses in this country. Our poor record on sleep as a culture is beginning to be seen as at least one of the contributors to the problem -Chronic insomnia can compromise the ability to secrete and respond to insulin (suggesting a link between sleep and diabetes), it can increase the risk of developing coronary heart disease, it can affect weight gain, it can reduce the efficacy of flue shots, and it is tied to chronic inflammation

Treatment for Alcohol Dependence

12-step programs -Alcoholism is a disease -AA invovlvement- maintains that alcoholism is a disease that can be managed but never cured. Recovery depends completely on staying sober. 2/3 ppl who wish to stop drinking have been able to do so, and one study reported a 75% success rate for a new york aa chapter. Successful for many reasons: AA is like a religious concersion experience in which an individual adopts a totally new way of life, develops commitment to other members, help ppl accept responsiblity for his/her life bc of emotional maturity, provide a sense of meaning and purpose in the individuals life. Significant for several reasons: one of the earliest self-help programs for individals suffering from a health proble,, and in having successfully treated alcoholics for decades, AA has demonstrated that the problem of alcoholism is not as intractable as had been widely assumed Cognitive-behavior Therapy -Learning skills to cope with situations that precipitate drinking -Drinking in moderation (more effective for some than abstinence) Motivational-enhancement Therapy: Motivational interviewing outlined in guidebooks Success Rates: -At 1 year: abstinent 85% of days (vs. 20%-30% of days at start of study) -At 3 years: 85% still abstinent CBT: Plenty of problem drinkers don't want to give up alcohol completely like in AA. CBT methods have demonstrated success in teaching people how to avoid situations that lead to excessive drinking, cope with stressors that might lead to drinking, etc. -Goal of approach: decrease the reinforcing properties of alcohol, to teach ppl new behaviors inconsistent with alcohol abuse, and to modify the environment to invlude reinforcemtns for activities that do not involve alcohol -Many programs start with self-monitoring phase, in which the alcoholic or problem drinker charts situations that give rise to drinking. COntingency contracting may be employed, motivational enhancement procedures are often included bc the responsiblity and the capacsity to change rely entirely on the client -Medicans for blocking the alcohol-brain interactions that may contribute to alcoholism. One drug is naltrexone, which is used to help prevent relapse among alcoholics. Another drug, acamprostate (Campral), has shwon effectiveness in treating alcoholism and may help alcoholics maintain abstinence by preventing relapse. Seems to achieve its effects by modifying the action of GABA, a neurotransmitter -Many programs include stress management techniques like relaxation training, assertiveness training, and training in social skills help the alcoholic or problem drinker deal with problem situations without resorting to alcohol Most of you probably have not heard of motivational-enhancement therapy. It is based on a technique called motivational interviewing that was developed in 2000. It is the technique that UW-L uses when working with a student mandated by administration for an alcohol assessment (it is called AUDIT). It is based on the Stages of Change Model from a previous lecture. Rather than tell someone to stop drinking (that approach doesn't work well with college students), you ask them a series of question about what they get (and lose) from their drinking. The idea is to help clients/patients develop the motivation to make changes themselves. I find that it works really well with college students-much more than trying to shame someone or punish them for problem drinking. -Detoxification: the process of withdrawing from alcohol, usually conducted in a supervised, medically monitored setting. First phase of treatment of hard-core alcoholics. This can produce severes ymptoms and health problems, so it is typically conducted in a carefully supervised and monitored medical setting. After this, therapy is initiated. Typically begins with a short-term intensive inpatient streatment followed by a period of continuing treatment on an outpatient basis -Approx. 720,000 ppl in the US receive treatment for alcoholism on any given day. AA is a self-help group that is the most commonly sought source of help for alcoholic related problems Relapse Prevention: more than 50% of treated patients relapse within th efirst 3 months after treatment -Practicing coping skills, or social skills in high-risk-for-relapse situations is a mainstay of relapse prevention interventions -Understanding that an occasional relapse is normal helps the problem drinker realize that any given lapse does not signifiy failure

Sleep Apnea

-An air pipe blockage that disrupts sleep, can compromise health -Each time that apnea occurs, the sleeper stops breathing, sometimes for as long as 3 minutes, until he or she suddently wakes up, gasping for air. -Difficult to diagnose becasue the symptoms, such as grouchiness, are so diffuse, but fitful, harsh snoring is one signal that a person may be experiencing apnea

Changing Health Habits

-Attitude Change and Health Behavior Educational Appeals -Fear Appeals -Message Framing

Social Engineering and Smoking

-Smoking may be more successfully modified by social engineering than by rechniques of behavioral change -Liabilty litigation is generally considered to be one of the most potentially effective means for the long-term control of the sale and use of tobacco. Transferring the costs of smoking to the tobacco industry via lawsuits would raise the price of cigarettes, lowering consumption. Second, access to tobacco may come to be regulated as adrug by the FDA. Heavy taxation is a third possibility. Not permitting smoking in plublic buildings, confining smokers to aprticular places, and otherwise protecting the rights of nonsmokers have been increasingly utilized legislative options

A Brief History of the Smoking Problem

-Smoking used to be considered a sophisticated and manly habit in the 19th and 20th century -Women started smoking 1940s -In the US, the number of adults who smoke has fallen drastically to 20%

Prevalence and Risk of Obesity

-Some studies suggest obesity has surpassed smoking in level of health risk (but controversial) -2/3 of US population is overweight; 1/3 is clinically obese -80% of overweight aduts were overweight as children -Relationship to fat cells: --# of fat cells can be increased in childhood --size of fat cells increase in adolescence and adulthood -Other risk factors include SES; role of medial cultural values (thinness norm in U.S.0> low body satisfaction); family values and beliefs (e.g., mother's body image); yo-yo dieting -A lot more recent research has taken aim at the growing obesity epidemic in children as 4/5 of obese children will maintain that status as adults. Early intervention is important. What most people don't know is the relationship between fat cell growth and age. When adults lose weight, they are not losing fat cells. From birth until adolescence, excess consumption of calories results in an increase number of fat cells. However, past a certain age, we no longer generate new fat cells. That number is now fixed. Weight loss or gain during adulthood comes from shrinking or expanding of those fat cells. The only way to remove them is surgically (i.e., liposuction), but that is rarely a fix. The brain constantly monitors levels of cells in the body, and some people who get liposuction are frustrated to learn that other areas of the body compensate post surgery to maintain fat levels. I've had patients in the past develop fatty lumps in undesirable places after receiving liposuction. Mother nature is hard to fool! In addition to the biology of fat cells, there are plenty of psychosocial factors that increase one's risk for obesity. People of lower socioeconomic status are at increased risk. Why? Many don't have the resources to buy healthy food, some don't have access to fresh veggies and fruits in their neighborhood, and others can't safely be outside in some areas to get exercise. There is also a sad paradox on thinness norms and weight problems. The U.S. has some of the highest norms for thinness in the world, yet suffers some of the highest obesity rates. Overvaluing thinness causes a lot of body satisfaction, which in turn increased someone's risk of overeating to deal with the emotional stress. Not surprisingly, family values also drive behavior. Research shows that parents (esp mothers) that stress unhealthy body satisfaction have children at higher risk for eating problems. Lastly, yo-yo dieting has been show to increase someone's risk for long-term obesity because rapid weight loss and gain wreaks havoc on our bodies. -Yo-yo Dieting: successive cycles of dieting and weight gain enhace the efficiency of food use and lower the metabolic rate. When they eat again their metabolic rate may stay low, which makes it easier for them to gain weight again even though they eat less food. Around 1/3 to 2/3rds of dieters regain more weight than they lose

Can Recovered Alcoholics Ever Drink Again?

-Those who are young and employed and who have no been drinking long and who live in a supportive environment can in moderation -Drinking in moderation has some advantages: it represents a realistic social behavior for the enviornments that a recovered problem drinker amy encounter, and tradiitonal therapeutic progrmas that emphasize total abstinence often have high dropout rates

Evaluation of Interventions

-Typically these programs show high initial success rates for quittng, followed by high rates of return to smoking, sometimes as high as 90%. Those who relapse are more likely to be young, and to have a high degree of nicotine dependence, a low sense of self-efficacy, greater concerns about gaining weight after stopping smoking, more previous quit attemmpts, and more slips (when they use 1 or more cigs) -Linking stopping smoking to other health behaviors can help reinforce the concept of an overall healthy lifestyle and may ultimately aid in preventing relapse as well (thus, treating coexisting risk factors such as high-fat diet or sun exposure can help in changing multiple habits simultaneously and does not undermine smoking cessation efforts) -Factors that predict the ability to maintain abstinecne include being well-educated, contemplating quitting smoking, being ready to quit at the beginning of an intervention, and having a sense of self-efficacy

Alcohol Dependence

1. Tolerance (physical and psychological)- the process by which the body increasingly adapts to the use of a substance, requiring larger and larger doses of it to obstain the same effects, and eventually reaching a plateau 2. Withdrawal- the unpleasant symptoms, both physical and psychological, that people experience when they stop using a substance on which they have become dependent. Symptoms include anxiety, irritability, intense cravings for the substance, nausea, headaches, tremors, and hallucinations 3. Significant time spent obtaining/using alcohol, or recovering from its effects 4. Reducing or giving up important activities because of alcohol 5. Drinking more or longer than intended 6. Persistent desire or unsuccessful efforts to cut down or control use 7. Continued use despite problems caused or exacerbated by alcohol Alcohol dependence is synonymous with what most of us would call alcoholism. Above are the official symptoms from the previous version of the diagnostic manual used by clinicians. The latest version (DSM-5) has done away with the different names (abuse vs. dependence) and simply have a diagnosis of Substance Use. It is then up to the clinician to indicate the severity and the symptoms that qualify the diagnosis. Dependence: a person is ssaid to be dependent on a substanc ehwen he or she has repeatedly self-administered it resulting in tolerance, withdrawal, and compulsive behavior Physical dependence: when the body has adjusted to the substance and incorporates the use of that substance into the normal functioning of the body's tissues. Often invovles tolerance -Craving: a strong desire to engage in a behavior or consume a substance. It results from physical dependence and from a conditioning process: as the substance is paired with various environmental cues, the presence of those cues triggers an intense desire for the substance

Theories of Origins of Eating Disorders

1. Western society's obsession with unnatural thinness; media portrayals -This one doesn't require much explanation other than to reiterate that many of the images of women (and now men) in our media are abnormally thin, and that frequent exposure to unrealistic body types negatively impacts women's and men's body image. 2. Feminist theory has shown some links with sexism, power, and control -Women have historically been oppressed in various areas, and have often felt very little control over their lives. There is a strong correlation between need to control and disordered eating behaviors. Some theorists argue that controlling what goes in and out of a woman's body might be one (maladaptive) way to exert control in a world where she otherwise feels she does not have any. 3. CBT (cognitive biases, negative emotional reactions) -More research is coming out in support of some cognitive biases in people with eating disorders, especially anorexia. A recent study suggested that there might be a problem in the area of the brain that perceives our surroundings, which might explain the body dysmorphia seen in anorexia. That means that the internal representation of their bodies might register as fat to them even when the outside world can clearly see they are significantly overweight. Emotional reactions have long been a trigger for bulimia, and some people purge to reduce overwhelmingly painful emotions from arguments, guilt, etc. 4. Brain differences in men and women (e.g., female amygdala responds to unpleasant words about body image) -Brain imaging research is tricky because you are stuck with a chicken vs egg argument. This 2004 study showed that the amygdala (part of the brain that lights up during fear) is more activated with negative words about body image. Rather than be an actual sex difference with men, it might simply reflect a learned response over time and NOT an inherent difference 5. Family Factors (e.g., high value in thinness)

Difference Between Risky Use and Abuse

Risky Alcohol Use -Women: 7+ drinks/week; 3 drinks/occasion -Men: 14+ drinks/week; 4 drinks/occasion -No alcohol-related consequences...yet Alcohol Abuse: -Recurrences in the last 12 months of: --failure to fulfill major obligations --alcohol use in hazardous situations --related legal problems --related social or interpersonal problems "Failure to fulfill major obligations" would include missing work or class due to frequent hangovers. "Related legal problems" would be underage drinking tickets, violations in the residence halls, etc.. "Related social or interpersonal problems" can occur from frequent blackouts, saying things you wouldn't normally to your romantic partner, etc.

How does Exercise Help?

Several theories: 1. Infrequent activation and discharge of adrenaline has beneficial effects (vs. chronic discharge in stress) 2. Adrenaline discharged for its purpose (physical activity) is metabolized differently 3. The hypothalamic-pituitary-adrenocortical (HPA) axid is not activated the same way during exercise -Don't judge a book by its cover: *it is more beneficial to be overweight and active than slim and sedentary*

Myths about Eating Disorders

These are some of the common misperceptions held by the public, none of them are true: -Once anorexia, always anorexia. Like alcoholism, eating disorders are not curable -Perons with anorexia are easy to identify. They are noticeably skinny and don't eat -Once someone with anorexia has achieved a normal weight,, s/he is recovered -An eating disorder is about eating too little or too mich -Parents are the cause of their child's eating disorder -Eating disorders affect only adolescent girls -People lose weight using laxatives and diuretics -Physicians can be counted on to discover and diagnose an eating disorder

What about Napping?

30-50% of students nap -Nappers have delayed bedtime of >1 hour -30% naps> 1.7 hours -Mostly late afternoon naps -Sleep >1 hr less than non-nappers -Current research suggests benefits of 20-minute nap For whatever reason, the Japanese are the world leaders in sleep research, particularly napping. The kind of napping that is common in college isn't likely to be the helpful kind because it often results in delaying the onset of nighttime sleepiness. However, 20-minute power naps (for those who can do them) show some benefits in cognitive functioning.

Anorexia Nervosa: Criteria

An obessive disorder amounting to self-starvation, in which an individual diets and exercises to the point that the body weight is grossly below optimum level, threatening health and potentially leading to death Main symptoms: -Refusal to maintain >85% of normal body weight -Intense fears of becoming overweight -Dymorphia -Amenorrhea (dropped in DSM-V) Associates with: -Genes (especially genes invovling serotonin, doapmine, and estrogen systems) -Hypothalamic abnormalities (especially a hyperative HPA axis) -Autoimmune problems -Family problems (alcohol; poor communication) -Both women who have eating disorders and those who have tendencies toward eating disorders show abnormalities in heart rate and blood pressure, probably prognosis for serious illness Anorexia is considered the most lethal diagnosis in the Diagnostic & Statistical Manual for Mental Disorders. A higher percentage of people die with that diagnosis than any other. The hallmark symptom is a medical one—failure to maintain 85% of expected weight based on sex, age, and height. It is also marked by a near-phobic reaction to gaining weight. Lastly, dysmorophia is present. Amenorrhea (lack of regular menstrual cycles) is no longer a criteria because women stop menstruating for various reasons (certain birth control pills, endurance athletes, etc.). There is mounting evidence for some heritability of anorexia, but there is no single gene that "causes" it. There is also evidence of problems with the immune system and hypothalamus, but not enough to be definitive. And while families don't cause it per se, poor dynamics can make it worse due to the chronic stress it can cause.

Alcohol and Body Systems

Digestive: -increases stomach acids; irritates lining; higher risk for ulcers, gastritis, secondary diabetes, pancreatitis Curculatory: -decreased production of red blood cells and white blood cells; higher risk of infections; decrease in plateletes (bruise easier) Endocrine: -decreases progesterone, testosterone, LH; males (lower sex drive, increase impotency); females (early menopause, increase mentrual flow and discomfort, infertility) Nervous: -decreases transmission speed and blood flow; brain damage (blackouts, sleep changes); psychological problems I want to draw special attention to the impact of alcohol on the endocrine system. You all know that alcohol is one of the major contributors to hooking up on college campuses. It is often seen as a way to enhance sexual functioning (or at least interest in it). Strictly speaking from a physiological perspective, the opposite occurs. There have been studies on sexual satisfaction and physical pleasure comparing groups who are sober vs. intoxicated. In general, participants report less intense orgasm and overall sensation while under the influence. And once there is enough alcohol in your system, it can completely prevent your ability to perform sexually. What most people associate with increased libido has more to do with the frontal lobes in your brain. Alcohol reduces inhibitions and decreases social anxiety. What people perceive to be better sex is more likely a function of being less anxious, embarrassed about trying or asking for things, etc.

Bulimia Nervosa: Criteria

Main symptoms: -Regularly engage in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain -Techniques include vomiting, laxative abuse, extreme dieting and drug or alcohol abuse Associated with: -Anxiety reduction -Emotional distress -Seasonal-related depression -Women in families that stress thinness and appearance -Stress and/or women w/hyperactive HPA axis While most people associate bulimia with self-induced vomiting, any form of purging calories can qualify (laxatives, diet pills, etc.). While people with bulimia fear weight gain, it is not at the level of someone with anorexia. Additionally, most people with bulimia are either within normal weight range or slightly overweight. You don't see the same dysmorphia. Some have argued that it belongs in the anxiety disorders grouping because it looks a lot more like an anxiety disorder. Consuming too many calories causes anxiety, and purging them reduces it. Bulimia is very treatable and responds well to SSRIs and therapy. It is NOT a universal disorder. There are countries in the world where it doesn't exist, and they cannot imagine how or why it does in the U.S. and other Western countries.

Schedule for Light Exposure

-Early morning light advances circadian clock (e.g., makes you sleepy earlier) -Late afternoon bright light delays body clock (e.g., makes you sleep later) -Wear dark glasses to minimize light to retina if your body clock is shifted -Avoid bright light at night (e.g., use incandescent light with lowest wattage possible) One little known fact about light exposure is that it can impact nighttime sleepiness. Let me be clear here—not everyone is equally susceptible to this phenomenon. If you are someone who has trouble falling asleep no matter what you try, you might want to consider the suggestions above. Early exposure to natural light (I'm talking 5 or 6am) will help you fall asleep at night. Sleep specialists and neuroscientists have found that exposure to blue-wave light (the same kind used in LCD screens in our laptops and phones) activates parts of the brain for wakefulness. They recommend that we avoid exposure to screens 1-2 hours before you want to go to bed.

Health Benefits of Alcohol

-Moderate intake (1-2 drinks/day) may reduce risk of coronary heart disease by: raising levels of HDL and Lowering levels of LDL -Women may benefit from lower levels than men -Alcohol has been around in human culture probably since a caveperson got a buzz off of some rotting fruit. It is one of the psychoactive substances that seems to show some health benefits in small quantities (compared to other drugs that show zero health benefits—only costs). Specifically, several longitudinal studies suggest that very moderate intake can help raise levels of "good" cholesterol and decrease "bad" cholesterol. However, the gains aren't substantial enough for someone to start drinking if they come from a culture or belief system that prohibits it.

Is Modest Alcohol Consumption a Healthy Behavior?

-Modest alcohol intake may contribute to a longer life -Moderate intake (one or two drinks a day) may reduce rsik of coronary artery disease -Moderate drinking is associated with reduced risk of heart attack, lower blood pressire, lower risk of dying after a heart attack, decreased risk of heart failture, etc. Benefits may be especially true for older adults and senior citizens -Moderate drinking in younger pops may actually enhance risk of death, probs through alcohol-related injuries -Controversial, though, bc if there are benefits, they occur at a fairly low level, and they may be offset by other risks

Addiction Models

-Research supports that smoking is harder to stop than heroin or alcoholism. E.g., recent animal models suggest nicotine permanently alters reward centers in the brain, whihc then makes it even harder to quit -Ppl smoke to maintain blood levels of nicotine and to prevent withdrawal symptoms. IN essence, smoking regulates the level of nicotine in the body, and when plas,a levels of nicotine depart from the ideal levels, smoking occurs -Nicotine alters levels of active neuroregulators, including acetycholine, norepineephrine and vasopressin (all 3 appear to enhance memory), dopamine, endogenous opioids (acetycholine adn beta endorphins can reduce anxiety and tension) -Alterations in dopamine, norepinephrine, and opioids improve mood, and ppl find that their performanc eof basic tasks can be improved when levels of acetylcholine and norepinephrine are high -Smoking among habitual smokers improves concentration, recall, alterness, arousal, psychomotor performance, and the ability to screen out irrelevant stimuli -Habitual smokers who stop smoking report taht their concentration is reduced; their attention becomes unfocused; they show memory impairmenets; and they experience increases in anxiety, tension, irritability, craving, and moodiness -Nicotine may regulate performance and affect- enhances concentration, alertness, and calmness for habitual smokers (linked to stress reduction) -Social Learning- becomes associated with reduction in anxiety or social stress enough to then triigger cravings when nicotine levels drop

Scope of Alcohol Problem

-Responsible for approx. 79,000 deaths each year, making it the third-leading cause of preventable death after tobacco and improper diet and exercise -More the 20% of americans drink at levels that exceed overnment recommendations -Officially recognized as disease in 1957 -Alc consumption has been linked to high blood pressure, smoke, cirrhosis of the liver, some forms of cancer, and fetal alcohol syndrome, a condition o fretardation and physiological abnormalities that can arise in the offspring of heavy-drinking mothers. Alcoholics can have sleep disorders, which, in turn, may contribute to immune alterations that elevate risk for infection -32% of the 36,790 traffic-related eaths have been related to alcohol, and it is estimated the one in every 2 americans will be in an alcohol related accident during his or her lifetime -Costs of alcohol abuse and alcoholism are estimated to be approc. $184.6 billion per year -An estimated 15% of the national health bill goes to the treatment of alcoholism. About 17.6 million americans adult meet criteria for alcohol abuse and dependence -Alcohol disinhibits aggression, so a substanital percentage of homicides, suicides, and assault soccur under the influence of alcohol

Fast Facts about Smoking

-Smoking is #1 cause of preventable death; 50% of persistent smokers die from tobacco-related illness -Chief cause of death in developed countries (directly and by interaction with other health factors) -1 of 5 deaths in US associated with smoking --Largest portion due to cardiovascular disease (30%) --30% of all cancer deaths (highest) -Increases risk of erectile dysfunction by 50% -1100 die each day in US --More than from alcohol, crack, heroin, murder, suicide, car accidents, and AIDS *combined* --Equivalent of a Sept. 11 attack every three days -Quitting early enough (by middle age) can SIGNIFICANTLY reduce risk -Smoking generaly 5x higher among men than women, however, gender gap declines with younger age --In developed countries, smoking rates for men have peaked and have begun to decline; for women they continue to climb -As of 2002, about 20% of teems (13-15) smoked worldwide --80,000-100,000 children begin smoking every day- roughly half of which live in Asia -The World Health Organization states that "Much of the disease burden and premature mortality attributable to tobascco use disproportionately affect the poor" --Of 1.22 billion smokers, 1 billion of them live in developing or transitional economies -Cigarette smokers are generally less health conscious, less educated, and less intelligent than nonsmokers -Secondhand smoke put close friends and family at risk for a variet of health disorders

Preventative Approaches to Alcohol Abuse

-Social influence programs in middle schools are typically designed to tteach young kids drink-refusal techniques and coping methods for dealing with high-risk situations -Some success with these programs due to several factors: such programs enhance adolescents' self-efficacy, which may enable them to resist the passive social pressure that comes from seeing peers drink, second, these programs can chang eoscial norms that typically foster adolescents' motvation to begin using alcohol, replacing them with norms stressing abstinence or controlled alcohol consumption, thrid, programs can be low-cost options for low-income areas, which have traditionally been the most difficult to reach

Implementation Intentions

-The intention to adopt or change a particular behavior at a particular time can influence helath behavior practices and can be a simple but effective way to promote health behaviors. Forming a specific implementation intention (what, where, when) with respect to a health goal can help to bring it about

Interventions with Adolescents

-What may be needed for adolescents are inexpensive, efficient, short-term interventions rather than CB ones -Programs that include a motivation enhancement component, cognitive-behavioral techniques, a focus on self-efficacy, and social influence approaches appear to be successful and can be delivered in school clinics and classrooms -Made use of self-determination theory, which targets the cognitions of autonomy and self-control, but from the opposite vantage point: that is, they target the behavior of stopping smoking instead Maintenance: relapse prevention techniques are typically incorporated into smoking cessation programs. It's important bc the ability ot remain abstinent shows a steady month-by-month decline, within 2 years after smoking cessation, even the best programs do not exceed a 50% abstinence rate -Increasing self-efficacy may help prevent a lapse from turning into a relapse Relapse Prevention: begin by preparing ppl for the management of withdrawal, including cardiovascular changes, increases in appetite, variation in the urge to smoke, and increases in coughing and discharge of phlegm. These problems may occur intermittenly during the first 7-11 days . Some relapse prevention approaches include contingency contracting. Relapse is less likely when smoking interventions are intensive, when pharmacitherapy is used, and when telephone counseling is available

Characteristics of Health-Compromising Behaviors

-Window of vulnerability on adolescence. Behaviors sucha s drinking to excess, smoking, taking illicit drugs, practicing unsafe sex, and taking risks that can lead to accidents or early death all begin in early adolescence and sometimes cluster together as part of a problem behavior syndrome -Several heatlh problems such as obestiy, begin early in childhood, and others, such as alcoholism, may be special risks for older adults -Many behaviors are heavily tied to the peer culture, as children learn from and imitate their peers, especially male peers -Several health compromising behaviors are also intimately bound up in the self-presentation process- that is, in the dolescent's efforts to appear sophisticated, cool, tough, or savvy in his/her social environment -Another similarity is many of these behaviors are pleasurable, enhancing the adolescents ability to cope with stressful situations and some represent thrill seeking. But, each of these behaviors are highly dangerous and have been tied to at least one major cause of death in this country -Another similarity is that development of al these behaviors occurs gradually, as the individual is exposed to the behavior, experiments with it, and later engages in it regularly. As such, these health-compromising behaviors are acquired through a process that may make different interventions important at the different stages of culnerability, experimentation, and regular use -Fifth, substance abuse of all kinds, whether cigarettes, alcohol, or drugs, as well as potentiall health compromising sexual behavior, can be predicted by some of the same factors. Adolescents who get invovled in such risky behavior soften have high levels of conflict with their parents and poor self-contorl, suggesting their behaviors may be coping mechanisms for stress. Kids who try to combine long hours of emplyment with school have an increased risk of alcohol, cigarette, and marijuana abuse -Problem behaviors are more common in the lower social classes, bc lower social class is linked to more stressful circumstances with which the adolescent may need to cope. Practice of these health compromising behaviors is thought to be one reason that social class is so strongly related to most causes of disease and death

Problem Drinking and Alcoholism

Alcoholic: reserved for someone who is physically addicted to alcohol. Have withdrawal symptoms when they stop drinking, have high tolerance for alcohol, and they have little ability to control their drinking -Problem drinkers may not have these symptoms, but they have substantial social, psychological, and medical problems resulting from alcohol -Specific Behaviors in these two things: daily need for use of alcohol, the inability to cut down on drinking, repeated efforts to control drinking throguh temporary abstinence or restriction of alcohol to certain times fo the day, binge drinking, occassional consumption of large quantities of alcohol, loss of memory while intoxicated, continued drinking despite known health problems, and drinking of non-beverage alcohol such as cough syrup -Physiological dependence can be manifested in stereotypical drinking patterns (particular types of alcohol in particular quantities at particular times of day), drinking that maintains blood alcohol at a particular leel, the ability to function at a level that would incapacitate less tolerant drinkrs, increased frequency and severity of withdrawal, early-in-the-day and middle-of-the-night drinking, a sense of loss fo control over drinking, and a subjective craving for alcohol Alcohol abuse symptoms: difficulty in performing one's job bc of alcohol consumption, inability to function well socially without alcohol, adn legal difficulties encountered while drinking, such as drunk driving convictions

Interactions: Smoking and...

Cholesterol: nicotine stimulates release of fatty acids and decreases HDL (and good cholesterol). Prodcues higher rates of morbidity and mortality due to heart disease than would be expected from simply adding together their individual risks Stress: increases heart reactivity in men, blood pressure (reduce heart rate) in women. Stimulating effects of nicotine on the cardiovascular system may put smokers at risk for a sudden cardiac crisis, and the long-term effects on reactivity may aggravate coronary heart disease risk factors Weight: may interact to increase mortality. Thin cig smokers may be at increased risk of mortality, compared with average-weight smokers. Thinness is not associated with increased morality in those ppl who has never smoked or among former smokers Exercise: smoker less likely to exercise, but often increase when they quit Cancer: increased risk of breast cancer (and all cancers, really). Women who smoke and who carry genes that interfere with their ability to break down certain chemicals in cig smoke carry more of those chemicals in their bloodstream, which may trigger the growth of tumors Mental Health: increased levels of depression and anxiety in smokers vs. nonsmokers. --Depressed ppl who smoke are at substantially greater risk for cancer. Immune alterations associated with major depression interact with smoking to elevate white blood cell countr and to produce a decline in naturla killer cell activity (natural killer cells are thought to serve a surveillance function in detecting and responding to early cancers) --Smoking considered potential cause of depression and increased anxiety

Quitting: Avoiding Lung Cancer

It is not uncommon for people who have smoked for a long time to justify that they can't/won't quit because "the damage has been done." This longitudinal study from 2000 put an end to that debate, suggesting that quitting anywhere along the continuum is associated with reduced risk of lung cancer. And that is just lung cancer. More people die from cardiovascular problems associated with smoking, so the benefits of quitting are even higher. -Continued smoking: 16% dead from lung cancer -Stopped at age 50: 6% dead from lung cancer -Stopped age 30: 2% -Never smoked: <1% -This graph shows how small the risk of dying of lung cancer is for people who never smoke - it's less than 1%. -It also shows how big the risk of lung cancer is for people who continue to smoke. 16% will die from lung cancer by age 75, if they don't die from something else first (and, smoking causes even more deaths from other diseases than from lung cancer; overall, half of all persistent smokers are killed by tobacco). -For people who stop at age 50, the risk of dying of lung cancer is about 6%, which is a lot bigger than the non-smoker's risk, but the key point is that it's a lot smaller than the smoker's risk. -If you are a 50-year-old smoker who doesn't yet have lung cancer, you don't any longer have the option of being a never-smoker; your choice is between stopping at age 50, or continuing, and this graph shows that stopping still makes a big difference to your lung cancer risk. -Finally, stopping at age 30 is much better than stopping at age 50, and it's very much better than continuing.

Sleep Hygiene Instructions

Sleep hygiene is the term given to steps we can take to help make good sleep more likely. Above are well-researched and supported findings from sleep science if you are someone who struggles with falling (and staying) asleep at night. -Wake up within hour of normal wake time everyday --Consistent schedules are key. One of the difficulties with college is that people sometimes have very different class schedules on MWF and Ttu, let alone what they do on the weekends. Even if you don't have class until noon twice a week, you are probably better off waking up the same time as other days of the week. REMEMBER: This advice is for people with sleep trouble. Most of you might be better off with the extra 1 or 2 hours. -Avoid naps (if having trouble falling asleep at night) -Avoid following prior to bedtime: --alcohol within 2 hours --caffeine within 6 hours --nicotine within 2 hours --vigorous exercise within 2 hours -Warm glass of milk --Why the folk remedy of a warm glass of milk? There is an enzyme in milk that breaks down during heating that mimic the effect of melatonin (a chemical produced by your brain to induce sleep). It doesn't work with cold milk. -Very hot bath (~15 min), 1 and 1/2 hour before bedtime --A very hot bath or shower about 1-2 hours before bedtime works well too, but it has to be long enough to raise your core temperature (approx 15 min). One of the circadian rhythms that signals our bodies that it is time to sleep is a slow cooling of our core temperature. Artificially raising it with a hot bath mimics the gradual cooling process. That is also why we sleep better at slightly cooler temperatures -Turn down thermostat, no electric blankets

Social Influence Interventions

Two theoretical principles: 1. Modeling. When ppl observe models who are apparently enjoying a risky behavior, fears of negative consequences are reduced. Thus, successful intervention program with adolescents must include the potential for medling high-status nonsmokers 2. The concept of behavioral innoculation developed by W.J. McGuire. Behavioral inoculation is similar in rationale to inoculation against disease. If one can expose individuals to a weak version of a persuasive message, they may develop counterarguements against that message, so that they can successfully resist it if they encounter it in stronger form Central components of the social influence intervention program: -information about the negative effects of smoking is carefully constructed so as to appeal to adolescents -Material are developed to convey a positive image of the nonsmoker (rather than the smoker) as an independent, self-reliant individual -The peer group is used to facilitate not smoking rather than smoking Evaluation: can reduce smoking rates for as long as 4 years. Experimental smoking may be affected more than regular smoking

Disordered Eating

-*Eating disturbances* and *disordered eating* refer to a range of unhealthy diet-related behaviors: --obsession with body weight and shape --excessive restrictive eating, skipping meals, laxative and diet pill use --cycles of binge eating and dieting --self-induced vomiting and excessive exercise with the sole purpose of "purging" calories obtained from dietary intake -Many researchers view eating problems on a continuum, beginning with body dissatisfaction and weight concerns and ending with clinical eating disorders -*Eating disorders* refers to anorexia nervosa and bulimia nervosa

Smoking Prevention Programs

-Aims to catch potential smokers early and attack the underlying motivations that lead people to smoke Advantages: they represent a potentially effective and cost-effective assault on the smoking problem that avoids tha many factors that mkae it so difficult for habitual smokers to stop. Can be easily implemented through the school system

The Drinking College Student

-As many as 40% of college students are heavy alcohol drinkers -Some more successful efforts to modify college students' drinking have encouraged students to gain self-control over drinnking rather than explicitly trying to get them to reduce or eliminate alcohol consumption altogether -Program developed by Lang and Marlatt incorporates techniques dervied from cognitive-behaviroal therapy in a total program to help college studnets gain such control -Controlled Drinking Skills: training in discriminating blood alcohol level so as to control the extent of drinking; may also include coping skills for dealing with situations that are high risk for high alcohol consumption. For example, one technique for controlling alcohol consumption in high-risk situations, such as a party, is placebo drinking. This involves either the consumption of nonalcoholic beverages while others are drinking or the alternation of an alcoholic with a nonalcoholic beverage to reduce the total volume of alcohol consumed -Interest has shifted from treatment programs to prevention programs bc so many students get into a heavy-drinking lifestyle

Treatment of Alcohol Abuse

-As many of half of all alcoholics stop or reduce their drinking on their own. This "maturing out" of alcoholism is especially likely in the later years of life. Can also be successfully treated in cognitive-behavioral modification programs. Nonetheless, as many as 60% of the people treated through such programs may return to alcohol abuse -Alcoholics of low SES with low social stability often have success rates of 18% or less

How much sleep do you need?

-At least 40 million Americans most over the age of 40 have chronice sleep disorders, most commonly is insomnia. -39% of adults sleep less than 7 hours a nght on weeknights, 1/3 of adults experience sleep problems, and 54% of ppl over age 55 report insomnia at least once a week -Not everyone needs same amount (natural short and long sleepers) -BUT, sleeping less than 6.5 or more than 9 hours associated with 1.7x greater mortality and risk of disease -People who habitually sleep more than 7 hours every night, other than children or adolescents, also incur health risks. -Among college students 71% had sleep complaints in 2000 compared to 24% in 1978. Why? --going to bed later is the culprit, mostly due to screens --bedtime 1-2 hours later than 25 years ago Ask most college students how much sleep they NEED, and many will say they can get by on 4-6 hours per night. Most of them are delusional. While there is a TINY fraction of people who can get by on 4 (or require up to 14), almost 90% of us require 7-9 hours per night for optimal functioning. I find it fascinating that today's college student gets 1-2 hours less per night than a college student in the 1970s. It's not because you party harder than they did (it was the 70s). Back then, when network television programming was over at 10pm, there was white fuzz on the TV screen. There were no computers, smart phones, cable television, 24-hour restaurants, etc. Screens are one of the major culprits for our country's lack of sleep. We consistently rank among the countries with people who do not get enough sleep.

Factors Influencing BAC

-Concentrations that is ingested: the more you drink, the higher your BAC -Proof of the beverage: higher proof drinks per volume raise BAC levels -Speef of consumption: the faster you drink, the higher your BAC -CO2: scotch and soda gets you drunker than scotch and water -Sex differences due to muscle mass: women metabolize alcohol slower because they have less muscle mass (which holds more water than fat tissue). Men have more muscle to fat; women ahve more body fat -Tolerance: BAC the same, but greater tolerance= greater control of functioning -Altitude: your BAC level is higher with the same number of drinks if you are suddenly in high altitude (e.g., Denver) -Circadian variation: our metabolism changes pace subtly throughout the day -Fructose: increases metabolism in liver which can lower BAC slightly -Consumption of a meal: eating before you drink can slow down the absoption of alcohol into your blood, resulting in a lower BAC than if on an empty stomach Once you ingest alcohol, there is no way to quickly reduce your BAC. All the myths about how to sober up are garbage (cold or hot showers, drinking coffee). The caffeine myth is perhaps one of the more dangerous ones. Caffeine is a central nervous system stimulant, and alcohol is a CNS depressant. Drinking caffeine doesn't change your BAC levels—it just artificially keeps your brain awake and prevents your body from shutting down (i.e., passing out) to prevent the intake of more alcohol.

Lung Cancer Prognosis

-Generally considered poor prognosis --Untreated advanced non-small cell lung cancer survive 6 months (85-87% of lung cancers in this category) --Even with treatment, extensive small cell lung cancer or advanced non-small cell lung cancer do especially poorly, with a 50-year survival rate of less than 1% --Small cell cancer (13 to 15% of all lung cancers) usually metastasize prior to diagnosis -Early diagnosis improves survival --Early non-small cell lung cancer have a 5-year survival of 60 to 70%

Origins of Alcoholism and Problem Drinking

-Genetic factors appear to be implicated -Modeling a parent's drinking is also implicated -Men greater risk for alcoholism than women, although younger women and women employed outside the home are beginning to catch up -Sociodemographic factors such as low income also predict alcoholism -Overall, these factors account for relatively little alcoholism, instead, a gradual process invovling physiologicla, behavioral, and sociocultural variables appears to be implicated

Why is it so hard to quit smoking?

-Highly addictive -Deeply entrenched behavior pattern (gets associated with broad array of pleasurable activities) -Relationship to regulating mood -Weight Control: --implicated in teen girls who start smoking to help control weight --quitting increase cravings for simple carbohydrates --people may substitute eating instead of smoking to handle stress -Surveys of teen girls show that many start smoking as a way to help control weight since nicotine is an appetite suppressant. This is very different for why teen boys start smoking. One of the reasons people often gain weight after quitting is that they have increased cravings for the very foods that are high in calories (and low in nutrients). This just highlights how psychology (desire for thinness; fear of gaining weight; low body esteem) can increase the risk for other negative health behaviors. Health psychologists have taught public health that interventions aimed at reducing those psychological risks can then impact the health risks indirectly.

Smoking on College Campuses

-In the 1990s, prevalence of current smoking rose by 27.8% -28.5% of college students are current smokers (Ibid)-- in 2009 study, 42% of 18-25 year old smoked in the previous month -Tobacco companies have recently shifted their marketing strategies to target college students -Cigarettes are the tobacco produce of choice for college students -Students' perception of peer smoking is higher than the actual rate-- U of Wash survey showed that students thought that 94.4% of the student body smoked. In reality, only 34.4% of th student body smoked

Drinking and Driving

-MADD (mothers against drunk driving) is a program funfed and staffed by the families and friends of those killed by drunk drivers -As of yet, it seems there is no good rehabilitation program for the heavy-drinking driver, other than getting him or her off the road through stiffer penalites

Passive Smoking/ Secondhand Smoke

-Involves inhaling smoke and smoky air produced by smokers, has been tied to higher levels of carbon monoxide in the blood, reduced pulonary functioning, higher rates of lung cancer, and an increase in depression -Third-leading cause of preventable death in the US, killing up to 65,000 nonsmokers every year. Estimated to cause 3,000 cases of lung cancer anually, -Babies with prenatal exposure to secondhand smoke have a 7% reduction in birth weight -Particular risk groups: children and spouses of smokers -Nearly 40% of US children are exposed to smoke in the home, and children exposed to secondhand smoke score lower on standardized tests than those not exposed to smoke

Commercial Programs and Self-Help

-Make use of CB techniques -Self-help aids: developed for smokers to quit on their own. Include nicotine patches. Studies suggest that initial quit rates are lower but that longterm maintenance rates are just as high as with more intensive behaviroal interventions -Quitlines provide phone counseling to help ppl stop smoking and are quite successful. Ppl can call in when they want to get help for wuitting or if they are worried about relapse. Most programs are based on principles derived from CBT. Works best is smokers receive several calls arounf the time they are attempting to quit

Social Origins of Drinking

-Many ppl who eventually become problem drinkers or alcoholics learn early in life to associate drinking with pleasant social occassions -Even watching drinking on tv and in movies can act as a social influence on drinking -Ppl who marry and become parents reduce their risk of developing alcohol-related disorders -Two windows of culnerability for alcohol use and abuse: 1. when chemical dependence generally starts, is between the ages of 12 and 21 2. Late midle age, in which problem drinking may act as a coping method for managing stress. Late on-set problem drinkers are more liekyl to control their drinking on their own or be successfully treated compared with people who have more long=term drinking problems -Depression and alcoholism is linked. Alcoholism may represent untreated symptoms fo depression, or depression may act as an impetus for drinking in an effort to improve mood

Anorexia Nervosa: Treatment

-Medical stabilization is *MAIN* goal -Psychological treatment: family therapy, coping skills for prevention, meds generally INEFFECTIVE The first part of treatment for anorexia is medical stabilization, most often in the form of in-patient (or partial outpatient) treatment. A team of healthcare professionals work together to get the patient's body weight back to normal and treat any of the physical complications (cardiac problems, tissue damage, etc.). After stabilization, therapists help patients learn a new relationship to food, correct cognitive thinking problems, and try to address family conflict problems. It is important to note that there are no medications available to treat anorexia. Patients might be prescribed SSRIs to treat depression or anxiety, but those medications don't work on the symptoms of anorexia.

Drinking and Stress

-Ppl who face a lot of negative life events, experience chronic stressorts, and have little social support are more likely to become problem drinkres than ppl without these -Mayn people begin drinking to enhance positive emotions and reduce negative ones, and alcohol does reliably lower anxiety and depression and improve self-esteem, at least temporarily

Shift from Treatment to Prevention

-Prevention is more coft effective and easily implemented in school systems -Models: --Social Influence Interventions: modeling of high-status nonsmokers -Behavioral Inoculation: exposure people to weak message in support of smoking and challenge with strong counterarguments -Life skills training: give people other tools to deal with pressure; work on underlying self-concept issues -Social engineering: make it harder to start/continue smoking

Intervening with Children and Adolescents: Early Health Habits

-Socialization: health habits are strongly affected by early socialization, especially the influence of parents as both teachers and role models. Socialization is the process by which people learn the norms, rules, and beliefs associated with their family and society; parents and social institutions are usually the major agents of socialization. Even though parents may try to teach good health habits, there still may be gaps, especially if the parents are separated or there is familial distress. Also, as children move into adolescence, they sometimes backslide or ignore the early training they receive from their parents. In addition, adolescents are vulnerable to an array of problematic health behaviors, including excessive alcohol consumption, smoking, drug use, and sexual risk taking. Kids may have an incomplete appreciation of the future risks they encounter through faulty habits such as smoking and drinking (e.g., Molly's new commitment) -Using the Teachable Moment: *Teachable moment* refers to the fact that certain times are better than others for teaching particular health practices. Many teachable moments arise in early childhoos like when parents teach children safety behaviors like wearing a seatbelt and looking both ways, or basic health habits like drinking milk with dinner and not soda. Teachable moments are also built into the healthcare delivery sistem: pediatricians teach parents basics of accident prevention and safety in homes, dentists use a child's first visit to teach both the parents and the child the importance of correct brushing, etc. Teachable moments are not confined to childhood however; pregnancy represents a teachable moment for stopping smoking and improving diet. Teachable moment is the crucial point at which a person is ready to modify a health behavior -Closing the Window of Vulnerability: Middle school is an important time for the development of several health-related habits. Ex. *food choices, snacking*, and dieting all begin and *crystallize* around this time. *Window of vulnerability* (the fact that, at certain times people are more vulnerable to particular health problems) for *smoking and drug use* occurs in middle school, when students are first exposed to these habits among their peers and older siblings -Adolescent Health Behaviors and Adult Health: research shows that precautions taken in adolescence may affect disease risk after age 45 more than do adult health behaviors. Means that *health habits people practice as teenages or college students may well determine which chronic diseases they develop and what they ultimately die of in adulthood* *Choices made at this time are more influential and predictive than adult behaviors*. For adults who decide to make changes in their lifestyles, it may already be too late. Research to date suggest that this is true for sun exposure and skin cancer and for calcium consumption

Minimal Interventions

-Telephone inplemented intervention produced beneficial changes, suggesting a viable, low-cost approach to this problem (study with veterans with depression, usual care vs. telephone alcoholism and depression management program)

Social/Environmental Factors of Smokers

1. Failed attempts at a "healthier cigarette" (people made up for low nicotine by smoking more) But...recent addition of "electronic cigarette" --Before many of you were born, big tobacco came out with low tar and low nicotine cigarettes to address the critics. Research showed that people unconsciously smoked more of the low nicotine cigarettes anyway to make up for the reduction. The jury is still out on e-cigs. You will hear/read a lot in the news about them. They do appear less dangerous than traditional cigarettes with respect to exposure to smoke. But please don't be fooled into thinking they are "healthy" in any way. There are no known health benefits to nicotine. Health experts fear that people will start e-cigs only to eventually end up smoking cigarettes down the line. 2. Individual efforts to cut back undermined by tobacco industry's efforts to distort facts and manipulate nicotine levels. Ex. Second-cousin Jimmy's lab experience --Big tobacco has had great success in making cigarettes more addictive. One of my cousins (bio major) got a lab job one summer in a "third party lab" outside of Chicago. These are labs that do research for tobacco companies so the actual research isn't on their official books. Each person there had no real idea what they were working on because the tasks were so specialized. My cousin told me that during a smoke break (how ironic), they got to talking about the chemistry they were doing and came to the realization that they were developing additives to make cigarettes more addictive. 3. Rates of smoking for American adults has decreased 25% since 1979, but now minorities and adolescents are targeted --Big tobacco paid heavy fines years ago due to lawsuits. Rather than give up, they've packed their bags and moved to new markets where there is less opposition. 4. Tobacco companies moving efforts abroad --Could eventually kill a third of all young Chinese men --In survey of 1.25 million Chinese, 2/3 think smoking does little or no harm, 60% think it does not cause lung cancer and 96% do not know that it causes heart disease --Developing and transitional economies are most at risk because of a lack of sophisticated public health efforts. The Chinese study is remarkable (and sad) to reveal how little many people know about the health risks associated with smoking.

Why Do People Smoke?

1. Some genetic influences- some are stimulated by nicotine; others are calmed or depressed by it. -Few people know that nicotine doesn't affect everyone in the same way. Research shows that people who are most likely to get addicted to nicotine experience a calming effect when smoking. The rest just get jittery and nauseous when they try it for the first (or first few) times and just don't enjoy the buzz enough to continue. -Genes that regular dopamine functioning are likely candidates for heritable influences on cig smoking 2. Peer influence (and Family influence) strongest predictor -Peer influence is the strongest predictor in adolescence. Once again, it isn't the kid in the corner shoving a cigarette in your face and saying, "Try it. All the cool kids do it." A kid sees others trying it and doesn't want to be the only one left out, or doesn't want to upset the person offering the cigarette -More than 70% of all cigarettes smoked by adolescents are smoked in the presence of a peer -Smoking behavior spreads through social ties; the likelihood that someone will stop smoing increaes by 2/3rd if their spouse stopped smoking, by 25% is a sibling has, by 36% if a friend has, etc. 3. Teens more likely to smoke if parents smoke, if lower SES, and feel social pressure to smoke, and if there has been a major stressor in the family such as parental separation or job loss 4. Self-image: teens suffering from low self-image (low self-esteem, dependency, feelings of pwerlessness, and social isolation) use it to convey themselves as rebellious, tough, and mature 5. Personality Traits: associated with low self-esteem, external locus of control, and low sense of self-efficacy -22% of high school students smoke cigs regularly and consider themselves to be smokers -Chippers: a term used to describe light smokers who consume only a few (less than five) cigarettes a day and seem to do so without moving on to heavy smoking. Distinguished from heavy smokers bc even tho they have tolerance for deciance and sttitudes and health belieffs that match those of heavy smokers, they instead have more protective factors such as high value placed on academic success, supportive relationships at home, less drug use, etc. Number of chippers has increased in recent decades

Bulima Nervosa: Treatment

Focus on health complications to generate motivation -Tooth decay -Gastric, rectal, and esophageal irritation/swelling -Arrhythmia and cardia arrest Psychological Interventions -Combo of meds and CBT -Other behavioral treatments (e.g., exposure and response prevention) -Relapse prevention techniques While medical treatment may be necessary with bulimia, it isn't usually at the same level of risk as anorexia. Many of the symptoms are related to the methods of purging (vomiting causes damage to the GI tract). Interestingly, the same treatment used to treat obsessive-compulsive disorder works really well for bulimia. It is called exposure and response prevention (E+RP). Oversimplified, it involves exposing the client to the stressor (perhaps eating a "bad" food item), and not allowing them to perform whatever purging activity they would normally do to relieve the distress. Instead, they practice relaxation skills until they can use those in place of the compensatory behaviors. Bulimia is HIGHLY treatable with very good outcomes over the long term when therapy is part of the treatment.

Evaluation of Alcohol Treatment Programs

Several factors are consistently associated with success: identifying factors in the environment that control drinking and modifying those factors or instilling coping skills to manage them, ensuring a moderate length of participation (about 6-8 weeks), providing outpatietns aftercare, and actively inovling relatives and employers in the treatment process. Interventions that include these components produce up to a 40% treatment success rate

Total Per Capita Consumption in Gallons of Ethanol by State, US, 2010

Studies have consistently shown that Wisconsin ranks among the top states for alcohol consumption per person. When I show this in class, it is usually accompanied by cheers, pride, or laughter. I probably would have reacted similarly when I was in college. Having done clinical work now for ten years, I no longer find this the least bit humorous or something that Wisconsin should hold with pride. Although binge drinking is highest among college students, the good news is that about 89% of drinkers will go on to learn to drink socially, even if they have too much every once in a while. (I should also mention that about 25% of you will decide NOT to drink alcohol in college.) The sad reality is that about 11% will go on to develop alcoholism or experience severe problems from drinking. I've seen too many UW-L students come from families and communities where alcohol has destroyed friends and loved ones. Even if the total number of people suffering from alcohol dependence is low, its effects are far reaching when you consider how many others are affected down the line.

Treatments for Nicotine Addiction

Therapeutic Approaches -Nicotine replacement therapy: made use of transdermal nicotine patchesm whihc release nicotine in steady doses into the bloodstream. Significantly improes smoking cessation -Operant conditioning (ex. buzzer to disassociate environmental cures; external rewards for not smoking) -Multimodal (CBT; stages of change): Stages of change; interventions to move ppl from the precontemplation to the contemplation stage center on attitudes, ephasizing the adverse health consequences of smoking and the negative social attitudes that most people hold about smoking. Motivating a readiness to quit may, in turn, increase a sense of self-efficacy that one will be able to do so, contributing further to readiness to quit. Moving from contemplation to action requires that the smoker develop implementation intentions to quit, including a timetable for quitting, a program for how to quit, and an awareness of the difficulties associated with quitting. Moving ppl to action phase employs many of the CB techiques that have been used to modify other health habits -Social Support: more likely to be successful over the short term if they have a supportive partner (more helpful for men than women) and nonsmoking friends. -Stress management: teach ppl alternative methods for coping with stress or anxiety. Successful in helping for quitting -Relapse Managemnt (contingency contracting) -High success rates for quitting, but up to 90% return to smoking Other Approaches: -Doctor's advice: small % of success, but translates to many people given 70% of people visit an MD each year -Worksite interventions: Bans show some promise, but only 2% quit upon follow-up. Do not seem to be substantially more effective than other intervention programs, not does quitting smoking seem to be sustained in workplaces over time -Community-based programs: intensive education results in 8-15% reduction. Public education campaigns: internet intervention program advantages: people can seek them out when they are readu to, and without regard to location. They can deal with urges to smoke by getting instant feedback from an internet service. Long-term efficacy for smoking cessation -Government interventions: smoking and tobacco advertising bans (cigarette advertising banned in UK in 2003). Increasing cost through taxes (WHO research shows increasing tobacco taxes from 52$ of market price to 72% increase government revenue from tobacco by roughly 50%, while at the same time decreasing demand by nearly 40%)

Marketing Impact on Teens to Buy Cigarettes

Tobacco industry REPEATEDLY denied (and continues to deny) that it targets underage smokers. Here are some studies that suggest otherwise: -Teens are more likely to be influenced to smoke by cigarette advertising than they are by peer pressure -Teenagers are 3x as sensitive as adults to cigarette advertising -Between 1989 and 1993, when advertising for the new Joe Camel campaign jumped from $27 million to $43 million, Camel's share among youth increased by more than 50%, while its adult market share did not change at all -Six years after introduction of Virginia Slims and other brans aimed at female market in the late 1960s, smoking initiation rate of 12 year old girls had increased by 110% -Examples of how tobacco advertising is targeting growing markets. One shows a couple who looks like they might be retired (growing baby boomer market segment). The one with the man of Asian descent in front of a turntable is an example of how most recently, tobacco companies are targeting adolescents from minority groups (also a growing demographic).

Attitudes and Changing Health Behaviors: Some Caveats

-Attitudinal approaches do not explain spontaneous behavior change very well, nor do they predict long-term behavior change very well. An additional complication is that communications degined to change peple's attitudes about their health behaviors sometimes evoke defensive or irrational processes: people may perceive a health threat to be less releant than it really is, they may falsely see themselves as less vulnerable than others, or they may see themselves as dissimilar to those who have succumed to a particular health risk -Attitude-change procedures may not go far enough by providing the informational base for altering health habits. Attitude change procedures may instill the motivation to change a health habit but not provide the preliminary steps or skills necessary to actually alter behavior and maintain behavior change

Characteristics of Interventions

-CBT strategies shown to promote adherence --Contingency contracting --Self-monitoring (e.g., workout logs) --Goal-setting ("lose 2 lbs per week" instead of "lose 30 pounds") -Individualized programs work best (but personal trainers often screw this up) Cognitive-behavior therapy has shown to be an effective intervention because it uses a combination of approaches that we covered earlier. Self-monitoring is a great example, and one of the ways that help people reach that 6-month point where exercise becomes a habit. Here's how it works: Let's say you are new to strength training, and your initial goal is "to have really toned muscles." You should know that "really toned muscles" will take more than 6 months, and likely require more than just lifting weights. If you just start lifting weights without tracking anything, you will most likely give up before reaching the goal. However, if I have you write down the number of repetitions and the weights that you do each workout, over time you will see very steady progress. Many people find they can almost double in strength with some lifts in 4-6 weeks, but will still see no change in body composition. Most of the initial gains are due to neuro-muscular facilitation, i.e., your brain just getting more efficient at communicating to your muscles to fire the right number of fibers to lift the weights. Muscle growth will only become noticeable once you get past those initial adaptations, and only if you switch up your routine. The workout logs come in handy at this point when your gains are more subtle because you can still see little progress day by day. The small, frequent reinforcement helps bridge the gap until your body starts to show visible change. There is also considerable research in effective goal setting. Experiments have shown that groups of dieters encouraged to "lose 1-2 pounds per week" are more likely to reach their goal than a group told to "lose 30 pounds" even when doing the same exercise regimen. Another key to exercise interventions is that they are tailored to individuals' needs. One of the hardest things to watch as a personal trainer was seeing some other trainers try a "one size fits all" model for their clients. Trainers often have very good intentions, and in doing so just have clients do what worked for themselves instead of taking the time and thought that goes in to adapting programs. Failing to individualize programs result in clients failing to reach goals (and wasting money) at best, and injury at worst -The usefulnes of the transtheoretical model of behavioral changes (stages of change) produces higher level of physical activity -Interventions that incorporate princples of self-control (enhancing beliefs in personal efficacy) and that muster moticational efforts (enhancing a sense of perceoved behavioral control and inducing people to form behavioral intentions) can be successfil in changing exercise habits. Coupling self-monitoring with an enhanced sense of control appear to be especially effectivee -Perceived importance and concern about physical activity predicts initiation of an exercise program, whereas control over deterrents, both environmental and personal, such as low self-efficacy or poor availability of places to get exercise, preicts maintenance. -Family interventions have shown some success, as well as worksite interventions -Invervention with stage-targeted mailers encouraging physical exercise among older adults, those who reported receiving and reading the interventon materials were significantly more likely to be exercising 6 months later. Advantage is low cost and ease of implementation. Text messages has had success in promoting exercise such as brisk walking -Relapse prevention techniques have been used to increase long-term adherence to exercise progrmas. Such techniques include increasing awareness of the obstacles to obtaining regular exercise and helping people develop ways to cope with temptations not to exercise -Incorportating exercise into a more general program of healthy lifestyle change can be beneficial as well. Motivation to engage in one healthy behavior can spill over into another. Linking health habits to to each other in a concerted effort to address risk can work. -Exercise interventions may promote more general lifestyle changes. Study: 60 Hispanic and Anglo families half of whome had participated in a 1-year intervention program of dietary modification adn exercise, went to zoo, results: families that had participated in the intervention consumed dewer calories, ate less sodium, and walked more than the families in the control condition -If ppl participate in activitites that they likfe, that are convenient, that they are motivated to pursure, and for which they can develop goals, exercise adherence will be greater. Ensuring ppl have realistic but postitive expectations for their exercise programs amy also improve long-term adherence -Negative effects of intervention programs: study found that an intervention program directed to college men adn women inadvertently promoted an increase in the desire to be thin, despire warnings about dieting -Little evidence that physical activity websites provide the kind of individally tailored program that is needed to get ppl to participate on a regular basis -Exercise levels in the US pop has increased substantially in recent decades. The number of ppl who participate in regular exercise has incrased by more than 50% in the past few decades

Stress and Eating

-Complex relationship: --1/3 (1/2 in book?) of people eat more while under stress, and 1/2 eat less --1/2 eat less due to lower appetite --some gender differences (e.g., men eat less; women eat more under stress) -Dieters under stress prone to relapse when coping skills and defenses are down -Stress eaters experience greater fluctuations in anxiety and depression than do nonstress eaters. Thos ewho eat in response to negative emotions show a preference for sweet and high-fat foods -Ppl who eat in response to stress usually consume more low-calorie and salty foods

Support for the Health Belief Model

-Explains people's practice of health habits quite well. -Ex. it predicts preventive dental care, breast self-examination, dieting for obesity, AIDS risk-related behaviors, participation in a broad array of health screening programs, and drinking and smoking intentions among adolescents

Treatments to Obesity

1. Dieting -1/3 to 2/3 of dieters regain more weight than they lose on their diets -little support for the notion that diets lead to lasting weight loss or health benefits -Scratch dieting off the list. It simply doesn't work for most people UNLESS physical activity is part of the plan, and that it is designed to be sustainable over the long term. -Weight loss produced through dietary methods is small and rarely maintained for long 2. Fasting -very dangerous except for very extreme cases of obesity -people fast for different reasons, and there is nothing wrong with fasting for religious practices. Medical fasting is used very rarely, and only under supervision. Most people should not use this technique for weight control. 3. Surgery -for those 100% overweight; some contraindictions like depression, high life stressors, no social support, failed repeatedly to lose weight through other methods, and who have complicating health problems that make weight loss urgent -Bariatric surgery occurs in two modes. One is attaching a (like a temporary "staple") to reduce the size of the stomach to help control intake. The more aggressive versions include things like permanent surgery that reduces the size of the stomach, or re-routes the small intestines to a small stomach pouch (gastric bypass). Ten years ago there were restrictions on who could get this surgery. For one, you had to have twice the BMI for your sex and age. Secondly, you had to have tried several other weight control techniques with no positive response. Lastly, good bariatric surgeons would rely on psychologists to help with evaluations to determine if people were good candidates. Research has shown that people suffering from depression, many life stressors, or little to no social support have very poor outcomes of the surgery because it requires significant lifestyle changes. Some of those restrictions have been lifted over the years. I do fear that some people will look to this as a quick fix rather than make the more gradual changes that have shown promise. 4. Medications -appetite suppressants; ephendrine (dangerous) -Some people use medications to control food intake. Stimulants like caffeine and more powerful amphetamines have the side effect of suppressing appetite. Ephedrine and chemical copies have been used by people to help with weight loss. DO NOT USE THEM. They have been implicated in deaths which many of you have seen in the news. Leave it to medical professionals to prescribe medication for appetite control 5. Multimodal -only approach that shows long-term success -Lastly, multimodal approaches are the only ones that show long-term success. That means we have to use several different techniques such as stimulus control (avoid places where you overconsume), dietary changes ("eat this, not that" approaches), physical activity, social support, therapy, etc. -Cognitive Behavior Therapy (CBT) -Screening: screen applicants for their readiness to lose weight and their motivation to do so. Unsuccessful prior dieting attempts, weight loss and regained, high body dissatisfaction, and low self-esteem are all associated with less weight loss ofor behavioral weight-reduction programs, and these cirteria can be used to screen individuals or to provide a better match between a particular treatment program and a client -Self-Monitoring: self-monitoring simultaneously defines the behavior and makes clients more aware of their eating pattern. Behavioral control techniques are used to modify stimuli in their enviornment (getting rid of unhealthy food and buying healthy stuff), and to train patients to change the circumstances of eating -Controlling Eating: Clients may be urged to count each mouthful of food, each chew, or each shallow. Longer and longer delays are introduced between mouthfuls so as to encourage slow eating (delays are first introduced at the biginning and end of the meal). They can use positive reinforcement to gain control over their eating by rewarding themselves when they do something right -Controlling Self-Talk: positive expectationss, the formation of explicit implementation intensions, and satisfaction with one's treatment outcome are both tied to weight loss. A strong sense of self-efficacy also predicts weight loss. Goal of these elements of interventions is to increse a sense of self-determination, which can enhacne intrinsic motivation to continue weight loss and dietary efforts Relapse Prevention: begins with effective screening of applications to weight-loss programs. Other relapse prevention techniques include matching treatments to the eating problems of particular clients, restructing the environment to remove temptation, rehearsing high-risk situations for relapse, and developing coping stategies to deal with high-risk situation

Health Behaviors

-Behaviors undertaken by people to enhance or maintain their health. Poor health behaviors are important because they are implicated in illness and also because they may easily become poor health habits

Perceived Threat Reduction

-Has two subcomponents: 1. whether the individual thinks the health practice will be effective 2. whether the cost of under-taking that measure exceeds its benefits -Ex. a man who feels vulnerable to a heart attack and is considering his diet may believe that dietary change alone would not reduce the risk of a heart attack and that changing his diet would interfere with his enjoyment of life too much to justify taking the action. Thus, although his belief in his personal vulnerability to heart disease may be great, if he lacks faith that a change of died will reduce his risk, he would probably not make any changes

Why don't people exercise?

-Lack of time, resources, know-how -Other life stressors undermine efforts -Dr. Mckelley's theory: facts don't convince us-> exercise needs to be tied to long-term personal or emotional values -Recommended 5-6 times per week of moderate to vigorous exercise -Facts don't convince most of us...they just fail to engage the emotional side of our lives that is responsible for many of the decisions we make in the moment. Research continues to mount that they best way to get people to change behavior is to link it to their values. Telling an older adult to exercise because it will improve their blood pressure profile is not very motivating. Talking with them about how excited they are about seeing their grandchild graduate college in 4 years, and then pointing out how exercise will likely improve the likelihood of living to that day...that is motivating. We need to learn what people value, and then help them see how their behaviors align (or not) with that value

How Much Exercise?

30+ min of moderate-intesnity activity on most, if not all, days of the week or 20 minutes or more of vigorous activity at least 3 days a week -Lifestyle intervention aimed at increasing physical activity may represent a good start for aging sedentary adults and for th obese

Obesity

-Definition: excessive accumulation of body fat -Fat should constitute about 20-27% in women and 15-22% in men -400 million ppl worldwide are obese and 1.6 billion are overweight, including 20 million children under age 5 -Obesit has replaced malnutiriton has the most prevalent dietary contributor to poor health worldwide -Global epidemic stems from genetic susceptibility, the increasing availability of high-fat and high0energy foods, and low levels of physical activity -67% of adult US pop is overweight, and 34% is obese -Avg American's food intake rose from 1,826 cals/day in the 70s to more than 2000 by mid 90s. -Obesity and overweight may account for 14% of all deaths from cancer in men and 20% of all deaths from cancer in women -Obesity has been assocaited with atherosclerosis, hypertension, diabetes, gallbladder disease, arthritis, and heart faitlure. Also increases risks in surgery, anesthesia administration, and childbrearing. One study found that women who were 30% were moe than 3x as likely to develop heart disease as women who were of normal or slightly under normal weight -Obesity is one of the chief causes if diability, and rates have soared in the last 15 years, jumping to 50% of ppl age 30-49 who cannot care for themselves or perform routine houehold tasks -People who are overwieght at age 40 are likely to die 3 years earlier than those who are thin -Body Mass Index (BMI)- (weight/height2)x 703 *Healthy weight: 18.5 to 24.9 *Overweight: 25 to 29.9 *Obesity (class 1): 30 to 34.9 *Obesity (class 2): 35 to 39.9 -Severe obesity (class 3): 40 or more -Problems with this approach: where fat is distributed is very important (central or upper body distribution most related to health risk, i.e., apples vs pears). Doesn't condier gender, bone density, or lean muscle mass -Other ways to measure include water displacement, MRI, or DEXA (computer-assisted tomography scanning) -Defining obesity is not an easy task. For the purposes of this class, we will use the standard medical definition based on the calculation of body mass index (BMI). These are what medical professionals use, as do researchers from the CDC when they report statistics like "over 2/3 of U.S. adults are overweight, and 1/3 are clinically obese" -However, there are some problems with BMI. First, where body fat is distributed matters. People who carry their excess fat around the midsection (called "apples", abdominal fat increases in response to stress, and apples are more psychologically reactive t stress and also show greater cardiovascular reactivity and neuroendocrine reactivity to stress) are at higher risk for a range of health problems compared to those who carry it in their buttocks and thighs (called "pears"). One of the reasons is that abdominal fat is stored in the connective tissue around major organs and impacts their functioning. Second, BMI doesn't take into account wide variation in other components of body mass. Men's bones are denser, on average, than women, which increases the numerator in the equation. Muscle tissue is also three times more dense than fat tissue, so the same volume of muscle weighs more than fat. Arnold Schwarzenegger one his first Mr. Universe competition at the age of 19 with less than 5% body fat. He would have scored in the severe obesity range given the standard BMI calculation. Although it is way to expensive to do on a large scale, better ways to measure body composition (body fat percentage) include water displacement, MRI scans, and DEXA scanning. -Psychological distress casued by obesity: more likely to develop personality disorders and psychiatric conditions, especially depression and problems of self-regulation. Depression may be maintained by the recognition that the world is not deigned for overweight people (someone might have to pay for 2 seats on an airplane, have trouble finding clothes, etc.)

Self-Control Behavior

-IN this appraoch, the individual who is the target of the intervention acts as his or her own therapist and, together with outside guidance, learns to control the antecedents and consequences of the target behavior to be modified -Self-control is not an unlimited resource, however. Successfully exerting self-control at one time or over one set of behaviors may deplete the ability to exhibit subsequent self-control

At-Risk People (another vulnerable group)

-Intervening with At-Risk People: Ex. daughters of women who have had breast cancer are a vulnerable population who need to monitor themselves for any changes in the breast tissue and obtain regular mammograms. -Benefits of Focusing on At-Risk People: Early identification and intervention may prevent or eliminate the poor health habits that can exacerbate vulnerability (ex. getting men at risk for heart disease to avoid smoking or stop at a young age may forestall a debilitating chronic illness). Working with at-risk populations represents an efficient and effective use of health promotion dollar. Also, focusing on at-risk populations makes it easier to identify other risk factors that may interact with the targeted factor to produce an undesirable outcome (ex. not everone who has a family history of hypertension will get it, but focusing on the people who are at risk may reveal other factors that contribute to its development) -Problems of Focusing on At-Risk People: *People do not always perceive their risk correctly* (e.g., example of handguns and swimming pools: a child is 100 times more likely to drown than die by a firearm. ). *Most people are unrealistically optimisitic about their vulnerability to health risks*. Optimism is good for recovering from surgery ("I'll be fine") but not great for smoking ("I'll be fine") Health behaviors are not widely shared, they're more distinctive. Ex. smokers overestimate the number of other people who smoke. When people perceive that others are engaging in the same unhealthy practice, they may perceive a lower risk to their health. 2. Sometimes testing positive for a risk factor leads people into needless worry or hypervigilant and restrictive behavior. Ex. women at genetic risk for breast cancer appear to be more physiologically reactive to stressful events, raising the possiblity that the chronic stress associated with this familial cancer risk may change psychobiological reactivity. Ppl can become defensive, minimize the significance of their risk factor, and avoid using appropriate services or monitoring their condition -Ethical Issues: at what point is it appropriate to alarm at-risk people if their personal risk may be low? Should you tell an adolescent girl her risk at a time when she is attempting to come to terms with her emerging sexuality? Some people, such as those predisposed to depression, may react especially poorly to the prospect or results of genetic testing for health disorders. In many cases, there is no successful intervention for genetically based risk factors. (ex. boys at-risk for heart disease getting taught stress management probs wont help). For other disorder, we may not know what an effective intervention will be. Also, emphasizing that risks are inherited can raise complicated issues of family dynamics, potentially pitting parents and children against each other and raising the issue of who is to blame for the risk. This whole thing remains a controversial issue.

Primary Prevention

-Measures designed to combat risk factors for illness before an illness has a change to develop -Instilling good health habits and changing poor ones is the task -Two general strategies: 1. (most common) employ behavior-change methods to get people to alter their problematic health behaviors. Ex. programs designed to help people lose weight 2. (more recent) keep people from developing poor health habits in the first place. Ex. smoking prevention programs with young adolescents (obviously this one is more perferrable)

Relapse

-One of the biggest problems faced in health habit modification -Occurs both with people who make health habit changes on their own and with those who join formal programs to alter their behavior -Particular problem with the addictive disorders of alcoholism, smoking, drug addicition, and obesity, which have relapse rates between 50 and 90% -Paradoxical, most smokers quit after 3-4 previous attempts -One thing that people (and therapists) fail to plan for during behavior change is relapse even though it is quite common. Many of you have heard the term, and it is often seen as a negative thing. However, relapse itself is a paradox. Research shows that most smokers require 3-4 failed attempts until treatment sticks. So in some ways, relapse is a necessary condition for long-term change. The problem is that we put so much time, energy, and creativity into treatment and forget that maintaining behavior change often requires a different approach. I tend to tell clients early on that relapse is part of the process, and we plan for it to happen. Rather than react with shame and frustration (which only makes it more likely they will engage in old behaviors), they are prepared to intervene and get back on track.

Family History and Obesity

-Twins reared apart show a tendency toward obesity when both naturla parents were obese, even when the twins' enviornments are very different= proof of genetics in obesity -Children who were later to become obese wer distinguished by a vigourous feeding style, consisting of sucking more rapidly, more intensely, and longer, with shorter bursts between sucking -Many factors in home such as the type of diet consumed, the size of protions, adn exercise patterns, contribute to obesity that runs in families

Obesity in Older Age

1 in 4 ppl older than 50 is obese (w/ body mass index equal to or higher than 30), and more than 9 million adults in the us are at least 100 pounds overweight -Weight gain in older years is associated with reduced gray matter volume in the brain, a signficant predictor of cognitive decline

Interesting Research

1. "The wisdom of the body" with infants. -It was once believed that our bodies are naturally "wise" and will consume the right nutrients if left to our own devices. A creative study placed equal amounts of each of the food groups in front of babies and measured consumption of each food group. The researchers were excited to see that their hypothesis held, and that most babies consumed the recommended proportions of the food groups on their own. Unfortunately, no one was able to replicate this study. Why? Because the initial one didn't include desserts like ice cream, chocolate, etc. When babies were given that choice, I think you know what happened. Humans crave sweets because they are high in energy and would have been in limited supply to our ancestors. We are not wired to make healthy choices when the food industry spends billions on research in ways to make food taste better. 2. Portion control (never-ending soup bowl) -Many people think that they are capable of controlling intake via portion size. An awesome study had two groups of people eat soup, and asked them to stop when they have enough. The control group had a normal soup bowl. The experimental group didn't know it, but their bowls were being refilled at such a slow rate from a tube below that they were unaware that it was happening. The results? The experimental group consumed significantly more calories. Our eyes are not good predictors on what we will consume. 3. Telling people that food is high in fast -One of the best things about fat is that it helps make food taste good. Researchers developed a granola bar but labeled them in two different ways. One group was told they were low fat, and the other were told they were higher in fat. What group consumed more? The high fat condition because our brains associate fat with food tasting good. 4. Differences between 8-in and 12-in plates -It is well known that at least one difference in why Americans struggle with obesity over Europeans is portion sizes. Our culture is obsessed with "value" when we eat out. The bigger the plate and servings, the better. Many American tourists complain about European restaurants because their portions are so much smaller (or put another way, reasonable). One research team hypothesized that most people will eat whatever is on their plate. One group was given a meal that took up most of the space on an 8-in plate, and the other group most of the space on a 12-in plate. They were then asked to rate how satisfied they were with the meal, including their level of satiety. Guess what? There was no difference in satisfaction, but the 12-in group obviously consumed more calories. As a society we could drastically change our nation's health status by reducing portion Several sizes, but very few people are willing to do that because of the perception that they would be spending more for less! 5. Low-fat substitues can cause weight gain -rats given low or high-fat Pringles, or combo -combo group gained most b/c eating low-ft foods trains body to burn less fat in response -stick to low calorie instead -decades ago fat was demonized in medicine and health research, and it launched a decades-long failed public experiment on low-fat foods. We only saw the obesity problem worsen. Not all fats are evil, and certain ones are essential for healthy brain functioning. A recent study showed that reduced fat foods can impact rats' metabolism of fat, causing them to burn less in response. Weight loss should target overall calories—not obsess about fat.

Who practices good health? What are the factors that lead one person to live a healthy life and another to compromise his or her health?

-*Demographic Factors of Good Health: *younger, more affluent, better-educated people under low levels of stress with high levels of social support* typically practice better health habits than people under higher levels of stress with fewer resources (*they're the healthiest*) -*Age: Vary with age. Health habits are typically good in childhood, deteriorate in adolescence and young adulthood, but improve again among older people --Curvilinear relationship (U-shaped). Children usually have pretty positive health habits in that they eat balanced meals (if/when required by caregivers), get plenty of exercise through play, and usually get enough sleep. Health habits decline beginning in adolescence and continue to bottom out in middle age (due to stress, balancing work and family, etc.). While older people certainly experience increased health and medical problems due to aging, their health habits are often better than those in middle age. When people retire many of them commit to healthier lifestyles to try to extent functioning into old age. -*Values: STRONG predictor of health behaviors. Heavily influence practice of health habits. Ex. exercise for women may be considered desirable in one culture but undesirable in another. As a result, exercise patterns among women will differ between two cultures.T hink about the difference in the number of men vs. women that lift weights. While it is certainly increasing, in the past it would have been unheard of to see women in the weight room because that kind of exercise was not valued. That had long-term implications for women's health. Weight bearing exercise like strength training helps reduce risk for osteoporosis later in life. Women are particularly at risk due to loss of minerals during menstruation, yet society's values left them out of a very helpful preventative behavior -*Personal Control: The *health locus of control* scale measures the degree to which people perceive themselves to be in control of their health, perceive powerful others to be in control of their health, or regard chance as the major determinant of their health. People who are predisposed to see health as under *personal control* may be more likely to practice good health habits than those who regard their health as due to chance factors --Self control is a more precise term for what we call willpower. --People who have an internal locus of control are more likely to engage in positive health behavior because they attribute behaviors to themselves (internal). In contrast, many people who have external locus of control are more likely to blame poor health on external factors ("I live too far from a gym", "healthy food is too expensive", etc.). -Social Influence: Family, friends, and workplace companions can all influence health-related behaviors in both beneficial or adverse direction. Ex. peer pressure often leads to smoking in adolescence but may influence people to stop smoking in adulthood. --Social influence or an adolescent's need to conform to fit in is a better way to think about how peers influence behavior in very subtle ways. Many teens would rather not stand out by going against those around them, and that sometimes leads to making risky health decisions --However, influence shifts to peers in early adolescence and remains a strong influence until early adulthood -Personal Goals and Values: If personal fitness or athletic achievement is an important goal, the person will be more likely to exercise on a regular basis than if fitness is not a personal goal. *Self-affirmation*: a process by which people focus on their personal values which bolsters the self-concept. When they have this, they show better health habits -Perceieved Symptoms: some health habits are controlled by perceived symptoms. Ex. smokers may control their smoking on the basis of sensations in their throat. A smoker who wakes up with a smoker's cough and raspy throat may cut back in the belief that he or she is vulnerable to health problems at that time. Or, when they notice that they suddenly get winded when running up the stairs -Access to the Health Care Delivery System: Using tuberculosis screening programs, obtaining a regular Pap smear, getting mammograms, and receiving immunizations for childhood diseases such as polio are examples of behaviors that are directly tied to the health care delievery system. -- It is a very simple finding that those who live close to health-related facilities (hospital, gym, health food store, etc.) are more likely to report positive health outcomes. -Cognitive Factors: Like knowledge and intelligence. E.g., obesity in intellectually disabled population. Ex. the belief that certain health behaviors are beneficial or the sense that one may be vulnerable to an underlying illness if one does not practice a particular health behavior also predicts health behaviors --There are correlations between cognitive functioning and health outcomes, with people lower in IQ experiencing a higher number of negative outcomes. --. Someone with Down's syndrome has very little control of their own health decisions. Sadly, obesity is a major problem in that population, a double whammy since they are already at increased risk for cardiac problems. However, food (particularly junk food) can be highly reinforcing. Caregivers sometimes give in to the ease of using food as a way to motivate, with then makes it more likely that people with Down's end up suffering from weight-related problems.

The Mass Media

-Mass media campaigns bring about modest attitude change but less long-term behavior change. Nontheless, mass media can alert ppl to health risks that they would not otherwise know about. Characters can be role models. Mass media can have a cumulative effect in changing the values associated with health practices -Telephone: CBT has been implemented with success via tv to address fatigue and lack of activity in chronically ill populations, dietary change, and HIV risk-related behaviors -The Internet: One reason for their success may be that they increase people' perceptions of autonomy. May be as promising as face-to-face interventions; they have advantages of low cost, saving therapists' time, reducing waitlist and travel time, and accessibility to people who might not seek out a therapist on their own

Cancer-Related Screening

Breast-self-examination (BSE) --only roughly 1/3 of women do it, and many incorrectly --difficult to detect bumps unless taught with synthetic models Mammograms --use declines with age even though risk increases. Fear of radiation, embarassment over the procedure, anticipated pain, anxiety, fear of cancer, and, most importantly, especially among poorer women, concern over costs act as deterrents to getting regular mammograms --not well-integrated in regular check-ups as women may have to see three different providers --for women over age 50 and for at-risk women over age 40, national health guidelines recommend a mammogram every year --why is screening through mammography so important?: 1. the prevalence of breast cancer in this country remains high 2. the majority of breast cancers continue to be detected in women over age 40, so screening this age group is cost effective 3. early detection, as through mammgrams, can improve survival rates --chaning attitudes toward mammography may increase the likelihood of obtaining a mammogram. The health belief model and the theory of planned behavior (positive attitude+ perceived social norms as favoring their obtaining a mammorgrma) has been associated with a greater likelihood of obtaining mammogram. Transtheoretical model of behavior change also predicts decisions about mammography, with interventions more successful if they are geared to the stage of readiness of prospective participants Testicular self-examination (TSE) --most common cancer in men aged 15-35, but most do not check Prostate chancer screening --ex. creative implementation in Maryland at Redskins stadium . I usually borrow several synthetic breasts from a colleague in Health Ed & Promotion, and let students practice. Research has shown that it significantly improves a woman's ability to correctly conduct a self-examination. I ask the same question of male students and testicular self-examination. Even though it is the most common cancer for college-age men, very few have ever checked. One of my favorite examples of creative interventions was something that the Redskins did back in 2005 (and have since). They brought in a mobile screening unit in a semi truck parked where everyone was tailgating. They announced that any man interested in a free screening could come in and get an autograph with a famous NFL quarterback (I can't remember who it was). They ended up screening thousands of men who would not otherwise have gone in for a screening, and detected early warning signs for prostate cancer in a handful of them. This is an example of opportunistic screening—sometimes you have to go to where the at-risk group is to remove the barrier of them going there in the first place. Colorectal Cancer Screening: -Second leading cause of cancer deaths -Colorectal screening is distinctive for the fact that people often learn that they have polyps (a benign condition that can increse risk for colorectal cancer) but not malignancies -Self-efficacy, perceived benefits of the procedure, a physician's recommendation to particiapte, social norms favoring participation, and low perceived barriers to taking advantage of screening program all predict the participation in colorectal cancer screening -Beliefs that predict the intention to participate in colorectal screening, whereas issues related to life difficulties (low SES, poor health status) are better predictors of action than intentions, with better life situation associated with more use of screening programs -Community-based programs that employ such stategies as mass medica, community-based education, social networks, etc., indicate that community-based intervention can attract older population to engage in appropriate screening behaviors. Hispanics are at particular risk for colorectal cancer

Environment Challenges of Healthy Eating

-1/3 of US adults get less than recommended servings of fruits and vegetables -1/2 fail to meet reduction in fat and sodium levels and for increasing fiber, fruit, and vegetable consumption -Unehalthy easting contributes to more than 400,000 deaths per year -Food manufacturers and restaurants not interested in helping (from 1977 to 1996, salty snacks up by 93 calories, soft drinks by 49 calories, hamburgers by 97 calories, french fries by 68 calories, and mexican food by 133 calories -Many people in low-fat diets compensate by ingesting more of other calories -High cost of healthy foods -Even the diet/health food industry is to blame. Many of the foods labeled as low fat ended up higher in calories because they have so much sugar added to compensate lost flavor due to lower fat content. -Supermarkets in high-SES neighborhoods carry more health-orientated food products than do supermarkets in low-income areas. Thus, even if the motivation to change one's diet is there, the food products may not be

Benefits of Exercise

-30 min/day can decrease the risk of several chronic diseases including heart disease and some cancers including breast cancer. -Increased efficiency of the cardiorepiratory system, improved physical work capacity, optimization of body weight, improvement or maintenance of muscle tone and strength, increases of soft tissue and join flexibility, etc., and reduction in poor health habits, including cigarette smoking, alcohol consumption, and poor diet -2/3 of adults do not achieve recommended levels of physical activity, and about 40% of american adilts do not engage in any leisure-time physical activity -Exercise is more common in women than men, in african americans and hispanics than whites, among older than younger adults, and aomng those with lower versus higher incomes 77% men and 71% women do not have any regular leisure time source of physical activity, and over 2/3 of older adults are not as active as they should be -Report lack of time, stress, interference with daily activities, and fatigue as barriers to obtaining exercise -Physician recommendation is one of the factors that lead people to increase their exercise, but they don't uniformly recommend it -Effects of exercise translate directly into increased longevity and delayed mortality. Study estimated that by age 80, the amount of additional life attributable to aerobic exercise is betwee 1 and 2 years

Belloc and Breslow (1972) study of good health habits maintaining good heath

-7,000 people who lived in Alameda County, California were studied. -Scientists defined several important good health habits: sleeping 7 to 8 hours a night, not smoking, eating breakfast each day, having no more than one or two alcoholic drinks each day, getting regular exercise, not eating between meals, and being no more than 10% overweight -Asked the people to indicate which of these behaviors they practiced, how many illnesses they had had, which illnesses they had had, how much energy they had had, and how disabled they had been over the previous 6012 month period. -Researchers found that the more good health habits people practiced, the fewer illnesses they had had, they better they had felt, and the less diabled they had been -Folow-ups of these individuals 9-12 years later found that mortality rates were dramatically lower for people practicing the seven health habits. Men following these habits had a mortality rate only 28% that of the men following 0-3 health practices. Women had mortality rate 43% that of the women following zero to three of the health practices

Health Promotion

-A general philosophy that has at its core the idea that good health, or wellness, is a personal and collective achievement. -For the individual, it invovles developing a program of good health habits early in life and carrying them through adulthood and old age. -For medical practitioner, health promotion invovles teaching people how to achieve a healthy lifestyle and helping people *at risk* for particular health problems offset or monitory those risks -Health psychologist, health promotioninvovles the deveelopment of interventions to help people practive healthy behaviors and change poor ones -Community and national policy makers: health promotion invovles a general emphasis on good health, the availability of information to help people devlop healthy lifestyles, and the availability of resources to help people change poor health habits -Mass media: contribute to health promotion by educating people about health risks posed by certain behaviors such as smoking or excessive alcohol consumption -Legislation: contribute to health promotion by mandating certain activities that may reduce risks, such as the use of child-restraining seats and seat belts *In the past, prevention efforts relied on easly diagnosis of disease to achieve a healthy population, with only passing attention paid to promoting healthy lifestyles in the absence of disease. Health promotion appears to be both more successful and less costly than disease prevention, making it evident we must teach ppl the basics of a healthy lifestyle across the life span

Health Habits

-A health-related behavior that is firmly established and often performed automatically, without awareness. Usually develop in childhood and begin to stabilize around age 11 or 12 -Ex. wearing a seatbelt, brushing ones teeth, and eating a healthy diet are examples of health habits -Althought a health habit may develop initially because it is reinforced by specific positive outcomes, such as parental approval, it eventually becomes independent of the reinforcement process and is maintained by the enviornmental factors with which it is cutomarily associated. so, it can be highly resistant to change -but I just wanted to highlight that when behaviors become automatic and without too much awareness, they firmly enter the realm of habitual behavior. I suspect you can come up with negative ones (smoking cigarettes, overconsumption, etc.) and positive ones (brushing your teeth, making sleep a priority). Health behaviors are among the toughest to change, and many people blame willpower or self-control. However, as humans we tend to significantly underestimate the impact of our surroundings (people, places, time, etc.) on our behavior. For example, one study on the relationship between where your entry door is in relation to the kitchen predicted caloric intake. Simply having people walk in their front door (that doesn't connect to the kitchen) instead of the interior garage entry into the kitchen reduced their weekly caloric intact by 10-15%.

Theory of Planned Behavior

-A theory that attempts to link health attitudes directly to behavior -According to this theory, a health behavior is *the direct result of a behavioral intention*. Behaviroal intentions are themselves made up of three components: attitudes toward the *specific action, subjective norms regarding the action, and perceived behavioral control* -Attitudes towards the action are based on *beliefs about the likely outcomes of the action and evaluations of those outcomes.* -Subjective norms are what a person believes *others* think that person should do (normative beliefs) and her or his motivation to comply with those normative beliefs. -Perceived behavioral control is the perception that one is *capable of performing the ation and that the action undertaken will have the intended effect*; this component of the model is very similar to self-efficacy -Benefits: it provides a fine-grained picture of people's intentions with respect to a particular health habit. It also provides a model that links beliefs directly to behavior -Evidence: predicts a borad array of health behaviors, including condom use among students, sunbathing and sunscreen use, use of oral contraceptives, consumption of soft drinks, ect.

Ethnic and Gender Differences in Health Risks and Habits

-African American and Hispanic women get less exercise than do Anglo women and are more liekyl to be overwieght; Latinas acculturated to the mainstream culture do better than less acculurated Latinas. Anglo and AA women are more likely to smoke than Hispanic women. Alcohol consumption is a substantially greater problem among men than women, and smoking is somewhat greater problem for Anglo men than for other groups -Health promotion programs for ethnic groups also need to take account of co-occurring risk factors. The combined effects of low socioeconomic status and a biologic-predispoisition to particular illnesses puts certain groups at substantially greater risk. Ex. dia betes emong Hispanic and hypertension among AA

Message Framing

-Any health message can be phrased in positive or negative terms -Messages that emphasize potential problems seem to work better for behaviors that have uncertain outcomes or for health behaviors that need to be practiced only once, such as vaccinations; messages that stress benefits seem to be more persuasive for behaviors with certain outcomes -Which kind of message framing will not affect behavior also depends on people's own motivation. On the whole, promotion-orientated messages may be somewhat more successful in getting people to initiate behavior change, and prevention focus may be more helpful in getting them to maintain behavior change over time

Cognitive Behavioral Therapy (CBT)

-Approaches to health habit modification change the focus to the target behavior itself- the conditions that elicit and maintain it, and the factors that reinforce it -The use of principles from learning theory to modify the cognitions and behaviors associated with a behavior to be modified; cognitive-behavioral approaches are used to modify poor health habits, such as smoking, poor diet, and alcoholism -The most effective appraoch to health habit modification often comes from CBT. Therapists select several complematary methods to intervene in the modification of a target problem and its context -Advantages of CBT for health behavior change: 1. A carefully selected set of techniques can deal with all aspects of a problem: self-observation and self-monitoring define the dimensions of a problem, stimulus control enables a person to modify antecedents of behavior; self-reinforcement controls the consequences of a behavior; and social skills training may be added to replace the maladaptive behavior once it has been brought under some degree of control. A combination of techniques can be more effective in dealing with all phases of a problem than one technique alone. 2. Therapeutic plan can be tailored to each individual's problem. 3. The range of skills imparted by multimodal interventions may enable people to modify several health habits simultaneously, such as diet and exercise, rather than one at a time -Focuses especially heavily on the beliefs that people hold about their health habits. People often generate internal monologues that interfere with their ability to change their behavior, and unless these internal monolouges are modified, the person will be unlikely to change a health habit and maintain that change over time -Recognition that people's cognitions about their health habits are important in producing behavior change highlights another insight about the behavior change process: the importance of invovlving the patient as cotherapist in the behavior-change intervention

Health Promotion and Older Adults

-At one time, prejudices beliefs that health promotion efforts would be wasted in old age limited this emphasis. -Now, policy makers recognize that a health older adult pop is essential for controlling health care spending and ensuring that the nation can sustain the increasingly older adults population that will develop over the next decades -Focused on several behaviors: maintaining a health balanced diet, developing a regular exercise regimen, taking steps to reduce accidents, controlling alcohol consumption, eliminating smoking reducing the inappropriate use of prescription drugs, and obtaining vaccinations against influenza. -Exercise: one of the most important health behaviors to target because exercise helps keep people mobile and able to care for themselves. For the very old, exercise has particularly beneficial long-term benefits, substantially increasing the likelihood that older adults can maintain the basic activities of daily living -Alcohol: controlling alcohol consumption is also important to target for good health among older adults. Some older adults develop drinking problems in response to age-related issues, such as retirement or lineliness. Other may try to maintain drinking habits they have had throughout their lives, which becomes more risky with old age. Moreover, many older people are on medications that may interact dangerously with alcohol -Vaccinations Against Influenza: important for several reasons. 1. flu is a major cause of death among older adults. It also increases the risk of heart disease and stroke bc it exacerbates other underlying disorders that older adults are more likely to have -Enhancing self-efficacy generally and with respect to particular health habits, such as physical activity, can be an essential component of any intervention with older adults -By age 80, health habits are the major determinant of whether a person will have a vigorous or an infirmed old age. Evidence suggets that health habit changes are working

Exercise as Stress Management

-Brown and Seigel study on if adolescents who exercised were able to control their stress better and avoid illness than those who did not. Results: the negative impact of stressful life events on health declined as exercise levels increased. Exercise may be useful for combating the adverse health effects of stress -One possible mechanism whereby exercise amy buffer certain adverse health effects of stress invovled its beneficial impact on immune functioning. An increase in endogenous opioids (natural pain inhibitors) stimulated by exercise may effect immune acticity during period of psychological stress -Economic benefits: suggests that such programs can reduce absenteeinsm, increase job satisfaction, and reduce health care costs, especially among women employees

Where do we focus interventions, and why?

-Children -Adolescents: Time is a factor (e.g., sun damagel calcium intake and osteoporosis) -At-risk populations (e.g., genetic predisposition) -Eldery: the elderly population is the most vulnerable to health problems due to it taking longer to bounce back from injury or infection. Many of the efforts are aimed at protecting and treating them. -If you have limited resources, health prevention efforts are targeted at the groups where you get the most for your money. Many negative health behaviors take a long time to cause problems. For example, excessive exposure to UV rays through tanning in high school and college don't usually show up until midlife in the form of various skin cancers. Same thing with calcium intake. If you aren't getting enough minerals in your diet as a child and adolescent, bone density problems won't show up until late in life after it is too late to reverse. -Another way to target interventions is to find people we know to be at risk. Health screenings is one example. There are some disorders or problems that have strong genetic components (e.g., breast cancer), so learning early you are at risk can help people make more informed choices about their health.

Characteristics of Setting

-Convienient/easily accessible exercise settings= higher rates of adherence (e.g., La Crosse vs. Texas cities) -Exercise at 90% maximal HR= non-compliance -Sticking to program longer than 6 months (50% drop out of exercise program within 6 months) -Lack of resources for physical activity may be a particular barrier for regular exercise among those low in socioeconomic status -Improving environmental options for exercise, such as walking trials and recreational facilities, increases rates of exercise, and when neighborhoods have these facilities available, the likelihood of being overweight in the community is reduced -More likely to engage in physical activity whe they know neighborhood is safe, when they are not socailly isolated, and when they know about what exercise opportunities are available to them in their area Something as simply as pleasant outdoor surroundings influence exercise. Just living in a community surrounded by bluffs increases the likelihood of wanting to be outside. La Crosse consistently ranks in the top for small cities and health behaviors (if you leave out binge drinking). In comparison, major Texas cities like Dallas-Fort Worth, Houston, and El Paso are often in the top ten for least health cities. They have massive highways that require driving everywhere, there aren't a lot of pedestrian areas, and they are not bike friendly. They are simply not designed to encourage healthy outdoor activity. Another MAJOR barrier in some gyms are the people around you. If someone new to exercise joins a gym and sees conditioned people working at 90% their maximal heart rate, they are very likely to abandon their program. Instead, they should start at a much lower target (40%) and gradually increase to a level with benefits. Another well-supported finding in health psych research is that it takes about 6 months for something to become a habit. Most people drop out of exercise programs by 3-4 months. I worked in gyms long enough to call this these folks the "New Year's Resolutionists." The gyms gets really crowded in January, but often returns to pre-January 1 levels by March or April. Settings that focus on quick results end up creating unfortunate barriers to people developing long-term habits.

Factors Associated with Obesity

-Depends on btoh the number and the size of an individual's fat cells. Moderately fat= fat cells are typically large, but theres not an unusual number of them. Severely obese= large number of fat cells and the fat cells themselves are exceptionally large -Childhood constitutes a widow of vulnerability for obesity: 1. the number of fat cells a person has is typically determined in the first few year os life, by genetic factors and by early eating habits. Poor eating habits in adolescence and adulthood are more likely to affect the size of fat cells but not their number -Avg number of daily snacks rising nearly 60% over the past 3 decades. Time invovled in preparing food bc of microwaves and advances in food processing and packaging has led to greater concenience for presparing food

Relapse Prevention

-Enrolling people who are initially highly committed and motivated to change behavior reduces the risk of relapse and weeds out people who are therefore vulnerable to relapse. This is controversial -On one hand, denying ppl access to a treatment program may be ethically dubious. On the other, including people who are likely to relapse may demoralize other participant sin the behavior change program, demoralize the practitioner, and ultimately make it more difficult for the relapser to change his or her behavior -Building relapse prevention technqiues into the program: one strategy involves having people identify the situations that are likely to promote a relapse and develop coping skills that will enable them to manage that stressful event. This strategy draws on the fact aht successful adherence promotes feelings of self-control. The mental rehearsal of coping responses in a high-risk situation can promote feelings of self-efficacy -Ex. Self-talk: Internal monologues; people tell themselves things that may undermine or help them implement appropriate health habits, such as "I can stop smoking". Will enable them to talk themselves through tempting situations -Cue Elimination: involves restructuring the environment to avoid situations that evoke the target behavior. Ex. alcoholics who drank exclusively in bars can avoid bars. For habits, cue elimination is impossible

What are the major individual characteristics that influence a person's likelihood to exercise?

-Family History (e.g., positive attitudes towards exercising, practice of exercise predict future exercise, have strong sense of self-efficacy for exercising, who perceive themselves athletic, social support from friends to exercise, ect.) -Gender (e.g., boys socialized earilier; middle-aged women least likely, possibly due to significant barriers (lack of time if expected to do both paid work and household tasts)) -Overweight less likely than those who are not overweight to participate in exercise programs -High self-efficacy for exercise. Self-efficacy is the belief that you have the skills necessary to engage in a behavior. Many people don't do strength training because they don't have the know-how to use sometimes complicated machines in the weight room. Ppl who are high in self-efficacy are more likely to practice it and more likely to perceive that they are benefiting from it than are people low in self-efficacy -Ppl who enjoy their form of exercise, and who believe that ppl should take responsiblity for their health are more likely to be invovled in exercise programs -A sense of support and group cohesion contributes to participation, may be especially important among Hispanics. -Individuals at risk for cardiovascular disease do show greater adherence to exercise programs than those who are not, however, outside of the cardiovascular area, there is no general relationship between ehalth status and adherence to exercise programs -Interventions that enhance exercise self-efficacy can achieve good results, as well as those aimed at modifying exercise goals and self-efficacy might help increase exercise in older adults

Fear Appeals

-Fear Appeals: assumes that if people are fearful that a particular habit is hurting their health, they will change their behavior to reduce their fear -Research has found that the relationship between fear and behavior change is not always direct -Persuasive messages that elicit too much fear may actually undermine health behavior change. Research suggests that fear alone may not be sufficient to change behavior. It can affect intentions to change health habits but it may not produce long-lasting changes in health habits unless it is couples with recommendations for action or information about the efficacy of the health behavior -Providing information does not ensure that people will perceive that information accurately. Instead of making appropriate health behavior changes, the person may come to view the problem as less serious or more common than he or she had preciously believed -Fear appeals may increase awareness of risk but not necessarily change behavior

Reseaons for Relapse

-Genetic factors may be implicated in alcoholism, smoking, and obesity. Withdrawal effects occuri in response to abstinence from alcohol and cigarettes and can prompt a relapse, especially shortly after efforts to change behavior. Conditioned associations between cues and physiological responses may lead to urges or craving to engage in the habit -Relapse is more likely when the individual has low self-efficacy for performing the health behavior (e.g., abstaining from alcohol) and expects that the unwanted health behavior will be reinforcing ( "a few drinks will relax me") rather than punishing ("I will have a hangover"). Relapse occurs when motivation flags or goals for maintaining the health behavior have not been established. Relapse is more likely is a person has little social support from family and friends to maintain the behavior change. -Relapse is more likely when people are depressed, anxious, or under stress. -A particular moment that makes people vulnerable to relapse is when they have one lapse in vigilance. Ex. that one cigarette or that single pint of ice cream can produce what is called *abstinence violation effect*- that is , a feeling of loss of control that results when a person has violated self-imposed rules. The result is a more serious relapse, as the person's resolve falters. Especially true for addictive behaviors, bc the person must also cope with the reinforcing impact of the substance itself

Mini Lecture Content: His Graduate School Experience

-He paid for school by being a certified personal trainer. -Family Health Intervention, tried to help neice lose weight -Had to develop weight loss plan by scratch, made binders with all aspects of health. -12 members in the group, most of them would qualify of obese by body mass standards, from age 30-60 plus the neice -He took an academic approach but everyone's eyes were glazing over, so he changed tactics and asked everyone why they were here -Talked for about two hours, he realized that everyone knows what they're supposed to do, but that's not why people engage in health. -Formal exercise wasn't gonna work with the 15 year old, she was resistent, but she played pingpong for an hour and a half straight dripping sweat, so as long as she didn't realize she was working out she was fine -He realized he looked at it from a values perspective and not a benefit perspective -It's values that predicts exercise and health adherence and not knowing the benefits of it

Behavioral Assignments

-Home practice activities that support the goals of a therapeutic intervention -Behavioral assignments are designed to provide continuity in the treatment of a behavior problem, and typically, these assignment sfollow up points in the therapeautic session. Ex. if an obese client was involved in self-monitoring, the client would be encouraged to keep a log of his eating behavior, including the circumstances in which it occurred. This log could then be used by the therapist and the patient at the next session to plan future behavioral interventions -Includes homework assignments for both client and therpist. This is to ensure that both parties remain committed to the behavior-change process and that each is aware of the other's commitment -Client engages in some type of challenges/task in between sessions (ex. changes rate of eating) -Why would this work so well? Client involved in and responsible for treatment, learns to analyze behavior for future situations, homework increases feelings of self-control Summary of advantages: 1. client becomes invovled in the treatment process 2. client produces an analysis of the behavior that is useful in planning further interventions 3. the clinet becomes committed to thetreatment process throguh a contractual agreement to discharge certain responsibilities 4. Responsiblity for behavior change is gradually shifted to the client 5. the use of homework assignments increases the client's sense of self-control

Effects on Psychological Health

-Improves mood and well being immediately after, may be improvement in general mood and well being after long-term participation -Sedentary behavior may even be arisk factor for depression -Some positive effects of exercise on mood may stem from factors associated with exercise, such as social activitiy and a feeling of invovlement with others -Improved sense of self-efficacy can also underlie some of the mood effects of exercise. Study: results indicated that, compared with a control group, ppl in the efficacy condition had significantly higher levels of perceived self-efficacy and these perceptions were associated with improvements in mood and psychological well-being -Has been used for a treatment in depression bc of effects on mood and self-esteem. Study: depressed women + either exercise class, drug treatment, or combined. Results: exercise group improved their mood signifcantly and as much as those who received only the drug or the combined treatment. Once treatment was discontinued, those who continued to exercise were less likely to become depressed again when compared wit those who has been on the drug treatment -Effects are often small, and the expectation that exercise has positive effects on mood may be one reason taht people so widely report the experience -Impact of exercise on cognitive functioning: beneficial effects, especially on executive functioning invovled in planning and higher-order reasoning. Also appears to promote memory and healthy cognitive aging. One does not need to engage in strenuous physical activity to get the cognitive benefits of exercise

Obesity in Childhood

-In the US, approximately 37% of children are overwieght or obese, but other countries are gaining, 20% in Europe and 10% in China -60% of overweight children and adolescents are already showing risk factors for cardiovascular disease, such as elevated blood pressure, elevate lipid levels, or hyperinsulemia, and being overweight in childhoof predicts risk for coronary heart disease in adulthood -African American and Hispanic adolescents are at particular risk. Current generation of children has a shorter life expectancy due to high rates of obesity than their parents -Causes of obesity: genes, increasinly sedentary lifestlyes among children, and overeating in infancy and childhood

Motivational Interviewing

-Increasingly used in health promotion techniques -Originally developed to treat addiction, the techniques have beena dapted to target smoking, dietary improvements, exercise, cancer screening, and sexual behavior among other habits -In MI, the interviewer is non-judgeemental, nonconfrontational, encouraging, ad supportive. The goal is to help the client express whatever positive or negative thoughts he or she has regarding the behavior in an atmosphere that is free of negative evaluation. Clients talk as least as much as counselors during MI sessions -An amalgam of princples and techniques drawn from psychotherapy and behavior-change theory. It is a clinet-centered counseling style designed to get people to work through the ambivalence they may be experiencing about changing their health behaviors. It appears to be especially effective for those who are initially wary about whether to change their behaviors -There is no effort to dismantle the denial often associated with the practice of bad health behaviors or to control irrational beliefs or even to persuade a clinet to stop drinking, quit smoking, or otherwise improve health. Rather, the goal is to get the client to think through and express some of his or her own reasons for and against change and for the interviewer to listen and provide encouragement in lieu of giving advice -It is limited in the number of people it reaches bc its a one-on-one therapeutic technique

Perceived Health Threat

-Influenced by at least three factors: 1. general health values, which include interest in and concern about health 2. specific beliefs about personal vulnerability to a particular disorder 3. beliefs about the consequences of the disorder, such as whether they are serious

Individual Challenges of Eating Healthy

-Insufficient attention to long-term monitoring and relapse prevention techniques -Low self-efficacy for change -Many diets are restrictive, monotonous, expensive, and difficult to implement -Tastes are hard to alter; comfort foods may help to turn off stress hormones, such as corisol, thus contributing to eating things that are not good for us -Low sense of self-efficacy, a preference for meat, a lack of health consciousness, a limited interest in exploring new foods, and low awareness of the link between eating habits and illness are all associated with poor dietary habits -Stress, lower-status job, high workload, and lack of control at work are associated w/ unhealthy dieets -A strong sense of self-efficacy, knowledge about dietary issues, family support, and the perception that dietary change has important health benefits are also critical to making dietary change. -As I mentioned earlier with relapse, one of the main reasons diets fail is because they are unsustainable. A large meta-analysis of weight loss programs found that diets alone are doomed to failure, and many people end up weighing more in the long term. Yo-yo dieting is a terrible and unsustainable practice. One of several reasons they fail is that they are only designed for short-term results. Additionally, many people believe they don't have the skills and knowledge to make long-term change. This isn't surprising given all of the false information out there in advertising and social media posts. A major reason most diets don't last is that they are way too difficult to implement for any number of reasons. -Many of you have probably heard of the Paleo diet made famous by CrossFit enthusiasts. I am a CrossFitter, and I've tested the Paleo diet. I've also interviewed the professor behind the diet and research on a radio show. Even he claims that for it to work for most people, shooting for 80% of the target diet is reasonable. It has consistently been rated one of the worst diets because it is expensive (e.g., grass-fed beef costs 4-5 times more than conventional beef), and most Americans can't afford or don't have access to a regular supply of fresh, organic fruits and vegetables. Additionally, grains are such a part of our food system that they are difficult to avoid when eating out in public.

Social Engineering

-Involves modifying the enviornment in ways that affect people's ability to practice a particular health behavior. These measures are called passive bc they do not require an individual to take personal action. Ex. wearing seat belts= active measure that an individual must take to control possible injuries -Banning certain drugs, such as heroin and cocaine, and regulating the disposal of toxic wastes are examples of health measures that have been mandated by legislation. Both smoking and alcohol consumption are legally restricted to particular circumstances and age groups. Requiring vaccinations for school entry has led to ore than 90% of children receiving most of the vaccinations they need -Social engineering soluations to health problems are more successful than individual ones. Ex. lowering speed limit to prevent motor vehicle crash -Limits: even though smoking has been banned in many public areas, it is still not illegal to smoke; if it were, people would find that in opposition to their civil liberties -Social engineering is a much larger scale attempt at changing behavior. It assumes that there are some things we have too much difficultly controlling on our own, so the government (or other institution) steps in to enact laws or policies to increase our motivation. All of the things above have either been discussed or enacted to influence health behavior on a larger scale.

Self-Reinforcement

-Invovles systematically rewarding oneself to increase or decrease the occurence of a target behavior -Positive self reward: rewarding oneself with something desirable after successful modification of a target behavior (ex. seeing a movie after weight loss) -Negative self reward: removing an aversive factor in the enviornment after successful modification of the target behavior (ex. removing miss piggy poster from fridge) -Ex. of negative self reward study to control obesity: bag of fat in fridge, only portions can be remove when lose weight -Self-reward has proven to be a useful technique in the modification of behavior. Have intrinsic advantages in that no change agent, such as a therapist, is required to monitor and reinforce the behavior; the individual acts as her or his own therapist Self-punishment: two types: -Positive self punishment: invovles the administration of an unpleasant stimulus to punish an undesriable behavior. Ex. might self-administer a mild electric shock each time he or she experiences a desire to smoke -Negative self punishment: consists of withdrawing a positive reinforcer in teh environment each time an undesribale behavior is performed. Ex. smoker might rip up money each time he or she has a cigarette that exceeds a predetermined quota -Studies concluded: 1. Positive self-punishment works somewhat better than negative self-punishment 2. self-punishment works better if it is also coupled with self-rewarding techniques. -Ex. a smoker is less likely to stop smoking if he rips up a dollar bil each time he smokes than if he self-administers electric shock; these princples are even more likely to reduce smoking if the smoker also rewards himself for not smoking.

Transtheoretical Model of Behavior Change

-J.O Prochaska made -Sometimes called the stages of change model or Prochaska and Di Clemente's stages of change -Analyzes the stages and processes people go through in attempting to bring about a change in behavior and suggestes treatment goals and interventions for each stage -Originally developed to treat addictive disorders, such as smoking, the stage model has now been applied to a broad range of health habits such as exercising and sun protection behaviors 1. Precontemplation: no intention of changing his or her behavior. Don't even know they have a problem 2. Contemplation: people are aware a problem exists and are thinking about it but have not yet made a commitment to taken action. Weighing pros and cons of changing 3. Preparation: people intend to change their behavior but may not yet have begun to do so. Ex. buying a pair of gym shoes in preparation to start running 4. Action: individuals modify their behavior to overcome the problem. Includes stopping the behavior and modifying one's lifestyle and environment to rid one's life of cues associated with the behavior 5. Maintenance: people work to prevent relapse and to consolidate the gains they have made. If people are able to remain free of the addictive behavior for more than 6 months, he or she is assumed to be in the maintenance stage 6. Relapse. This model iis conceptualized as a spiral

Relaxing Training

-Joseph Wolpe (1958) developed a procedure knwon as *systematic desenitization (using counterconditioning)* for the treatment of anxiety. Procedure involved training the client to substitute relaxation in the presence of curcumstances that usually produced anxiety. To induce relaxation, Wolpe taught patients how to engage in deep breathing and progressive muscle relacation, that is, *relaxation training*. -In progressive muscle relaxation, an individual learns to relax all of the muscles in the body to discharge tension or stress. As noted earlier, many deleterious health habits, such as drinking or smoking, respresent ways of coping with social anxiety. Thus, in addition to social skills training or assertiveness training, people amy learn relaxation procedures to cope more effectively with their anxiety -Overzealous interventionists have sometimes assumed that more is better and have included as many components as possible, in the hope that at least a few of them would be successful. This approach can backfire. Overly complex behavior-change programs may undermine commitment because of the sheer volume of activities they require. A multimodal program must be guided by an intelligent, well-informed, judicious slection of appropriate techniques geared to an individal problem. was made famous for applying classical conditioning to change behavior. He argued that we can't be fearful/anxious and relaxed at the same time, so all we need to do is teach people how to get good at calming themselves, and then apply that to the stimulus that causes anxiety. It requires three steps: 1. Teach people relaxation skills and let them practice. This is easier said than done. Some people use progressive muscle relaxation, some do controlled breathing, some meditate, etc. 2. The therapist helps them develop a hierarchy of things that create anxiety. Let's assume your roommate binge eats under stress. They are most likely to binge during heavy exams, and least likely early in the semester. You would have them come up with about 8 increasingly anxiety-provoking thoughts/images and create a hierarchy. 3. For the final step of systematic desensitization, you have them picture or experience the lowest level on the hierarchy and pair that with their relaxation intervention. Once their anxiety drops to a low enough level, you have them move up the hierarchy. Over time they learn to associate the exam with relaxation instead of the anxiety that drives eating. 3 Steps: 1. progressive relaxation, 2. development of anxiety hieracrchy and control scene, 3. combo of progressive relaxation and anxiety hierarchy -Somewhat useful in smoking cessation

Modeling

-Learning that occurs by virtue of witnessing another person perform a behavior. -Similarity is an important principle in modeling. To the extent that people perceive themselves as similar to the type of person who engages in a risky behavior, they are likely to do so themselves; to the extent that people see themselves as simlar to the type of person who does not engage in a risky behavior, they may change their behavior. -Can be an important long-term behavior technique. Self-help programs have modeling when people go to groups and share what worked for them to stop drinking or whatever, and by listening to these accounts, the new convert can learn how to do likewise and model effective techniques in his or her own rehabilitation -Can also be used as a technique for reducing the anxiety that can give rise to some bad habits or the fears that people may have when going through some preventive health behaviors, such as receiving inoculations. A person's fears can be reduced by observing the model engaging in the feared activity and coping with the fear effectively -When modeling is used to reduce fear or anxiety, it is better to observe models who are also fearful but are able to control their distress rather than models who are demonstrating no fear in the situation. Fearful models provide a realistic portrayal of the experience, so the person trying to change his or her behavior may be better able to dentify with them than with models who are unrealistically calm in the face of the threat -Reciprocal interactions between behavior and social environment, similarity is important, can reduce anxiety and fear about an axtivity (creative study on kids receiving shots, imporant to show fear *and* coping skills). CAVEAT: always exceptions to the rules with interventions

The Regulation of Eating

-Leptin and insulin circulate in the blood in concentrations that are proportionate to body fat mass. They decrease appetite by inhibiting neurons that produce the molescules neuropeptide Y (NPT) and agouti-related peptide (AgRP), peptides that would otherwise stimulate eating. They also stimulate melacortin-rpoducing neurons in the hypothalamus, which inhibit eating -Leptin is secreted by fat cells and is an important player in weight control. Leptin appears to signal the neurons of the hypothalamus as to whether the body has sufficient energy stores of fat or whether is needs additional energy. Leptin inhibits the neurons that stimulate appetite and activates those that suppres appetite. -Ghrelin: may play an important role in why dieters who lose weight often gain it back so quickly. Ghrelin is secreted by specialized cells in the stomach, spiking just before meals and dropping afterward. When ppl are given ghrelin injections, they feel extremely hungry. Therefore, blocking ghrelin levels or the action of ghrelin may help people lose weight and keep it off

Lifestyle Rebalancing

-Long-term maintenance of behavior change can be promoted by leading the person to make other health-orientated changes in lifestyle. Lifestyle changes such as adding an exercise program or using stress management techniques, may promote a health lifestyle more generally and help reduce the likelihood of relapse -Social support in maintaining behavior change is equivocal; some studies say it's important, others suggest not -Overall: relapse prevention seems to be most successful when people perceive their behavior change to be a long-term goal, develop coping techniques for managing high-risk situations, and integrate behavior change into a generally healthy lifestlye -Concluded that relapse prevention techniques were effeective for reducing substance use and improving psychosocial functioning, and were particularly useful for people with alcohol problem

Classical Conditioning

-Made by Ivan Pavlov in the early 20th century -One of the earliest principles of behavior change identified by researchers. -The essence of classical conditioning is the pairing of an unconditioned reflect with a new stimulus, producing a conditioned reflex. -One of the first methods used for health behavior change. Ex. Anatabuse (unconditioned stimulus) is a drug that produces extreme nausea, gagging, and vomiting (unconditioned response) when taken in conjunction with alcohol. Over time, the alcohol will become associated with the nausea and vomiting caused by the Antabuse and elicit the same nausea, gagging, and comiting response (conditioned response) without the Antabuse being present -Classical conditioning approaches to health habit modification do work, but clients know why they work. Alcoholics, for ex., know that if they do not take the drug they will not vomit when they consume alcohol. Therefore, even if classical conditioning has sucessfully produced a conditioned response, it is heavily dependent on the client's willing participation -They are no longer widely used bc they produce health risks as well -Behaviors elicited automatically by some stimulus (Pavlov's dogs). Doesn't produce new behavior, but causes existing behavior to occur (e.g., increased HR), always invovles reflexive behavior, and learn new "association"

Determinants of Regular Exercise

-Many kids get exercise through pe classes in school, but by adolescents, the practice of reguar exercise has declined substantially, especially among girls and among boys not invovled in formal athletics -Smoking, being overweight, and teen pregnancy also account for some of the decline in physical activity -Adults cite lack of time and other stressors in their lives as factors that undermine their good intentions -Erma Bombeck: "the only reason i would take up jogging is so that i could hear heavy breathing again" -Evaluations of exercise programs: 6-month participation levels range from 11% to 87%, averging about 50%. Means that on average, only half of those people who initiate a voluntary exercise program are still participating in that program after 6 months. -Paradoxically, although exercise seems to be a stress buster, stress itself is one of the most common reasons that people fail to adhere to their exerice regimens

Self-Monitoring

-May programs of CB modification use this as the first step toward behavior change. -Rationale: a person must understand the dimensions of the target behavior before change can begin. Self-monitoring accesses the frequency of a target behavior and the antecedents and consequences of that behavior. This process also sets the stage for enlisting the patient's joint participation early in the effort to modify health behaviors Step 1: Learn to discriminate the target behavior. For some behaviors, this step is easy. A smoker can obiously tell whether he/she is smoking. However, other target behaviors or cognitions, such as teh urge to smoke, may be less easily discriminated; therefore, an individual may be trained to monitor internal sensations closely so as to identify the target behavior more rapidly -Client learns to describe and identify problem behavior (antecedents: things that come before, behavior, and consequences). Step 2: Charting the behavior. Techniques range from very simple counters for recording th behavior each time it occurs to complex records documenting the circumstances under which the behavior was enacted as well as the feelings it aroused. Ex. a smoker may be trained to keep a detailed behavioral record of all smoking events. May record each time a cigarette is smoked, the time of day, the situation in which the smoking occurred, and the presence of other people (if any). May also record subjective feelings prior to lighting the cig, the emotional responses that preceded the cig (like anxiety or tension), and the feelings that were generated by the actual smoking of the cigarette. This way, she can begin to get a sense of the circumstances in which she is most likely to smoke and can then initiate a structure behavior-change program that deals with these contingencies -Research has shown that self-monitoring is an effective first step in changing behaviors. However, it is rarely enough for lasting change and needs combined with others. It simply requires that you recognize a negative behavior and start to pay attention to it. Let's look at someone's tendency to snack too frequently. In the first step, you notice the antecedents (things that come before the snacking). You learn that you do it when bored, while watching TV, and studying. The consequences might be that you are less bored, less stressed, less hungry, etc. (in the short term) and gaining an extra pound every week or two. I would have you keep a chart of all of the snacking behavior, what happened before, and what happened after. This act alone results in a reduction in snacking because people start to pay attention to the behavior and make other choices.

Interventions to Modify Diet

-Needs to begin with education and self-monitoring training, bc many people have little idea of the importance of particular nutrients, let alone how much of them their diet actually includes; estimation of fat intake appears to be poor, for example -Implemented through cognitive-behavioral interventions. Include self-monitoring, stimulus control, and contingency contracting, coupled with relapse prevention technqiues for high-risk-for-relapse situations, such as partites -Training in self-regulation can improve dietary adherence, including planning skills and formation of explicit behavioral intentions -Family: when all family members are committed to and participate in dietary change, it is easier for the target family member to do so as well. Eating together as a family in early years may have multipe health benefits in later years. Father food choices dominate what family eats. -Latino pop: face-to-face contact with a health advisor who goes through the steps for successful diet modification may be especially important, due to the emphasis on personal contact in Latino culture and communication -Schools need to ban snack food, make school lunch programs more nutritious, and make snack foods more expensive and healthy foods less so

Consequences of Relapse

-Negative emotions such as dissapointment, frustration, unhappiness, anger, ect. -Reduced sense of self-efficacy -A shift in attributions for controlling the health behavior from the self to uncontrollable external forces -Could lead ppl to think they'll never control the habit, that it's simply beyond their efforts -Could also have paradoxical effects, leading people to perceive that they can control their habits, at least to a degree. Ex. smoking often fails multiple times until they succeed later

The Myth of Diet Soda

-One can of Coke contains 135 calories vs. zero calories for Diet Coke -If i switch to diet soda, I will lose approximately one pound for every 24-pack, woohoo! -BUT... --diet coke produces a spike in insulin, whihc blocks the breakdown of fat (brain thinks sweet=sugar) --aspartame interferes with feelings of fatiety by disrupting chemical processes that use mouth to calculate how much you've consumed (you keep eating longer than you would have without it) -Only works if you don't change other eating habits Many people think that by switching from regular to diet that they will lose weight. And they absolutely will ONLY if they don't change any other consumption patterns. But that's not what most people do. When your taste buds detect sweetness, the brain releases insulin in the bloodstream to process the ingested sugar for energy. Calorie-free artificial sweeteners trick the brain into releasing insulin, but now it doesn't have anything to process. Excess insulin actually slows down the breakdown of fat in the body. To compensate, your brain signals your body to consume foods that contain sugars to help deal with the excess insulin. Research has shown that consuming diet soda sometimes results in consuming more junk food while snacking, and those people don't enjoy any of the intended consequences. Your best bet is to replace soda with water or tea.

Sun Safety Practices

-Over 50,000 new cases of skin cancer will be diagnosed this year alone -Basal cell and squamous cell carcinomas do not typically kill, but malignant melanoma takes over 8,000 lives each year -In the past two decades, melanoma incidence has risen by 155%, these cancers are among the most preventable -Excessive exposure to UV rays is the chief risk factor -Sun protective behaviors are practice consitently by less then 1/3 of american children, and more then 3 quarters of american teens get at least one sunburn each summer -Health psychologists have tried to to use education interventions designed to alert ppl to the risks of skin cancer and to the effectiveness of sunscreen use for reducing risk -Effective sunscreen use is influences by a number of factors, including knowledge about skin cancer, perceived need for sunscreen, perceived efficacy of suncreen as protection against skin cancer, and social norms regarding sunscreen use -The type of skin one has (burn only, burn then tan, or tan w/o burning) suggest ppl are beginning to develop some understanding of their risk -Communication to adolescents and young adults that stress the gains that sunscreen use will bring them, such as freedom from concern about skin cancers or improvements in appearance, appear to be more successful than those that emphasize the risks -When the risks are emphasized, it is importantt o stresss the immediate adverse effects of poor health habits rather than the ling-term risks of chronic illness, bc adolescents and young adults are especially influenced by immediate concerns -Communication drawing on the stages-of-change model, which aims to move people who tan from a precontemplative to a contemplative stage and subsequently to implementation of sun-protective behaviors, may also work

Operant Conditioning

-Pairs a voluntary behavior with systematic consequences. They key is *reinforcement* -When a person does a behavior that is followed by positive reinforcement, that behavior is more likely to occur again. In contrast, if a person preforms a behavior and reinforcement is negative or the behavior is punished, the behavior is less likely to be repeated. -Many health habits can be thought of as operant responses. Ex. drinking may be maintained bc mood is improved by alcohol, or smoking may occur bc peer companionship is associated with it -Reinforcement schedule: a continous reinforcement schedule means that a behavior is reinforced every time it occurs. However, continuous reinforcement is vulnerable to *extinction*: if the behavior is occasionally not paired with reinforcement, the individual may cease performing the behavior, having come to anticipate reinforcement each time -Psychologists learned that behavior is more often resistant to extinction if it is maintained by a variable or an intermitten reinforcement schedule than a continuous reinforcement schedule -Positive reinforcement, negative reinforcement (increases behavior). Positive punishment, negative punishment, and extinction (decreases behavior)

How do you spot a fad diet?

-Promise quick fix or too good to be true -Dramatic statements refuted by reputable scientific organizations -Lists of "good" and "bad" foods -*Recommendations made to help sell a product* -Poor research support --lack of peer review --studies ignore individual differences --signle case study design -Eliminated one or more of the major food groups One key point I want to make is that very few foods are inherently bad (with the exception of some manufactured things like trans fats). Put another way, nature has provided a wide range of nutrients for consumption in moderate quantities. The real culprit is overconsumption of some (sugars, sodium) and underconsumption of others (leafy greens, lean proteins, etc.). Any diet that requires you to purchase a product with its brand name (Atkins bars, South Beach, etc.) is a fad diet. Very few of them have been put to randomized controlled trials, the gold standard for medical research. Anything that makes outrageous claims for quick results is garbage. Of the major diets studied over large samples, it all boils down to what Michael Pollan calls his food rules: "Eat food, not too much, mostly plants. Eating healthy isn't cheap, but it isn't complicated. It doesn't have to be restrictive, either. Most well-studied diet programs allow for a few unrestricted meals each week.

Barriers to Modifying Poor Health Behaviors

-Researchers don't know as much as they would life about how and when poor health habits develop and exactly when and how one should intervene to change health habits. Ex. young children usually get enough exercise, but as they get older, a sedentary lifestyle may set in. How and when should one intervene to offset this tendency? Decline in exercise is due to change in enviornment, such as no longer having to take a pe class, than to the motivation to get exercise. Also, people often have little immediate incentive for practicing good health behaviors. Health habits develop during childhood and adolescence when most people are healthy so poor health habits like smooking and drinking have no apparent effect on health and physical functioning...until they're older. -Emotional Factors: People may not be motivated to change bad habits. Unhealthy behaviors can be pleasurable, atuomatic, addictive, and resistant to change. Affective attitude, namely emotional beliefs about a health habit, predict its practice, a factor that needs to be taken intp account in trying to change health habits. Negative affect can undermine receptivity to health messages, and stressing benefits can undercut this source of resistance. Other emotional processes influencing health behavior change include defensive responses to stress. Health behavior messages often stress risk-related information that cna be threatening to people, and so sometimes people deny their perceived risk or avoid processing risk-related messages, which undermines behavior change -Instability of Health Behaviors: health habits are only modestly related to each other. Difficult to teach people a concerted program of good health behavior because health behaviors must be tackled one at a time. Another difficulty in modifying health habits is that they are unstable over time. Ex. a person may stop smoking for a year but take it up again during a period of high stress.

Self-Efficacy and Health Behaviors

-Self-efficacy: the belief that one is able to control one's practice of a particular behavior -Important determinant of health behaviors -Ex. smokers who believe they will not be able to break their habit probably will not try to quit, however much they think that smoking is risky and that quitting is desirable -Typically, research finds a strong relationship between perceptions of self-efficacy and both initial health behavior change and long-term maintenance of change -We can say that whether a person practices a particular health behavior depends on deveral beliefs: the magnitude of a health threat, the degree to which that person believes he or she is personally vulnerable to that threat, the degree to which that person believes he or she can perform the response necessary to reduce the threat (self-efficacy), and the degree to which the particular health measure advocated is effective, desirable, and easy to implement

Theories of Obesity

-Set Point Theory of Weight (Brownell and Walden, 1992) --the idea that every individual has an ideal biological weight, which cannot be greatly modified --The set point acts like a thermostat regulating heat in a home. A person eats if his or her weight gets too low and stops eating as the weight reaches its ideal point --Some evidence that body compensates (by adjustments of energy expenditure) if efforts to lose weight go beyond certain level (e.g., decreases metabolism; lower activity levels) -Obese personality --no empirical support --more support for link between brain mechanisms and control (e.g., rat studies of severed ventromedial hypothalamus The jury is still out on "causes" of obesity, but I wanted to highlight some ideas that you might have heard of in the past. One is the set point theory that states each person's brain has an ideal set point for lifetime body weight, and that most people have great difficulty changing their weight past a certain threshold. When they severely restrict food intake in a fad diet, the brain compensates for the reduced caloric intake by slowing down the metabolism. This is one possible reason that diets alone do not result in changes in weight. Exercise would be needed to break through that barrier. Still, there is no part of the brain that has been identified where this theoretical set point exists. For a long time, society blamed obesity on individuals' personality. Obese people were believed to be lazy, lack motivation and ambition, etc. I want to be clear that there is NO empirical support for an "obese personality" style. What is more likely is that people vary in their ability to control food intake which might be mediated by a part of the brain called the ventromedial hypothalamus. The hypothalamus helps regulate the functioning of many of the body systems. There have been rat studies where that portion of the brain was severed, and rats in that group literally ate food until they died from overconsumption. I suspect advances in neuroscience that will take place over the next 50 years will show us some really interesting things when it comes to controlling weight.

Guidelines for Healthy Eating

-Taste= chemical gatekeeper of eating -Breakfast consistently shown to be most critical meal -Mathematics of weight loss/gain --to lose a pound, you need a 3500 calorie deficit --to gain a pound, you need a 3500 calorie surplus --ex. one study showed average caloric intake for adult's Thanksgiving day is 7000 calories --Body reacts to extreme caloric restriction by slowing down metabolism --Some exceptions with metabolic disorders -Healthy weight loss (1-2 lbs PER WEEK, anything else is water weight or risky) -Focus in FEELING good over LOOKING good Here are the basic guidelines for health eating: 1.) Eat breakfast. You wake up dehydrated and low on caloric needs, so kickstarting your metabolism is a good way to go. There have been controlled studies where groups of participants consume the exact same number of total calories in a day and keep identical exercise programs. One group consumes most of their calories from lunch through dinner, and the second group includes breakfast. The second group ended the study with healthier dietary profiles (blood sugar, body fat percentage, etc.). 2.) While it is true that some people have metabolic disorders that mess with normal processing of calories, the vast majority of people are subject to the mathematical laws of weight loss/gain. It is simply a matter of what goes in (through eating) vs what goes out (through exercise, normal daily living, etc.). 3.)Run away from any diet that promises weight loss that exceeds 1-2 pounds PER WEEK. 4.)Studies on motivations for dieting have shown that people with the goal of looking good good are significantly less likely to maintain a weight loss program (exercise plus diet) than those who are motivated to feel good.

Why is Dieting Important?

-The best known dietary factor that has been implicated in a broad array of diseases and risks for diseases is the relation of dietary factors to total serum cholesterol levels in general and to low-density lipid proteins in particular -Diet is only one determinant of a person's lipid profile, but it's an important one bc it's controllable -Swtiching from trans fact and saturated fast to polysaturated fats and monounsaturated fats is one of the most widely recommended courses of action. Reduce amount of red meat and fatty food consumption and increase veggies and fruit to achieve this -Diet may contribute to over 30% of all cancers. Dietary habits have been implicated in the development of several cancers, including colon, stomach, pancreas, and breast. -High diet in fiber may protect against obesity and cardiovascular disease by lowering insulin levels, and a diet high in fruits, veggies, whole grains, etc., lowers the risk of CHD -Mediterranean Diet: rich in vegetables and low in read meat and high in poultry and fish -Low Carb Diet: choosing vegetarian sources of fat and protein and reducing consumption of breads and other high-carb foods -Atkins: substantial reduction in carbs, while consuming more sources of protein and fat as alternative sources of energy -Med and Low Carb can be effective alternatives to low-fat diets, in part bc they have beneficial effects on lipids (low-carb diet) and on glycemic control (med diet) -Statins: class of drugs that substantially reduces cholesterol in conjunction with dietary modification. Together with diet modification they appear to lower cholesterol levels significantly -Caloric restriction may increase life span

Using the Health Belief Model to Change Behavior

-The health belief model also predicts some of the circumstances under which people's health behaviors will change. -Ex. Bob and his smoking and his Uncle -Bob's perceived susceptibility to the illness changed both bc a member of his own family had been struck down and bc the link between smoking and cancer had been graphically illustrated -Highlighting perceived vulnerability and simultaneously increasing the perception that a particular health behavior will reduce the threat are somewhat successful in changing behavior, whether the behavior is smoking, preventitve dental measures, or osteoporosis prevention measures. -However, it focuses heavily on beliefs about the risk, rather than on emotional responses to perceived risk, which also predict behavior. It also leaves out an important component of health behavior change: the perception that one will be able to engage in the health behavior

Role of Behavioral Factors in Disease and Disorder

-The prevalence of acute infectious disorders, such as tuberculosis, influenza, measles, and poliomyelitis, has declnes becasue of treatment innovationsand changes in public health standards, such as improvments in waste control and sewage. -But, there has been an increase in *preventable disorders*, including lung cancer, vardiovascular disease, alcohol and other drug abuse, and vehicular accidents -Role of behavioral factors in disease and disorder is clea. Estimated that nearly half of the deaths in the US are caused by preventable factors, with smoking, obesity, and drinking being the top three. True for the past 15 years, only change being obesity and lack of exercise are about to overtake tobacco as the most preventable causes of death in the US> -Cancer deaths alone could be reduced by 50% simply by getting people to reduce smoking, eat more fruits, get more exercise, and obtain early screening for breast and cervical cancer. -Successful modification for health behaviors, then, will have several beneficial effects: 1. will reduce deaths due to lifestyle-related diseases 2. may delay time of death, thereby increasing general life expectancy 3. (most important) practice of good health behaviors may expand the number of years during which a person may enjoy lfe free from the complications of chronic disease

Motorcycle and Automobile Accidents

-The single greatest cause of accidental death -Safety measure such as reducing highway driving speed to 55 miles per hour, requiring seat belts, and placing young children in safety restain seats have reduced the number of severe injuries and vehicular fatalities -Bies and motorcyle riders, making themselves visible through reflective or fluorescent clothing and using helmets has reduced the seerity of accidents by a substantial degree, especially serious head injury -Risk perception of automobile accidents appears to have little impact on ppl's driving. To promote seatbelt usage, a combo of social engineering, health education, adn psychological intervention may be most appropriate -Community wide health education programs aimed at increasing seat belt usage and infacnt restraint devides can be successful. One program increased the use from 24% to 41%, leveling off at 36% over a 6 month followup period. Legal solution may be more effective on the whole.

Stimulus Control

-The successful modification of health behavior invovles understanding the antecedents as well as the consequences of a target behavior. Individuals who practice poor health habits, such as smoking, drinking, and overeating, develop ties between those behaviors and stimuli in their environment. Each of these stimuli can come to act as a discriminative stimulus that is capable of eliciting the target behavior -Things (people, environment) come to act as discriminative stimuli (sd) for certain behaviors (you are more likely to do in presence of Y). Goal: rid environment of sd for negative behaviors, create new sd for positive health behaviors -Discriminative Stimulus: An enviornmental stimulus that is capable of eliciting a particular behavior; for example, the sight of food may act as a discriminative stimulus for eating. Discriminative stimulus is important because it signals that a positive reinforcement will subsequently occur -Stimulus-control Interventions: with patients who are attempting to alter their health habits take two approaches: ridding the enviornment of discriminative stimuli that evoke the problem behavior, and creating new discriminative stimuli, signaling that a new response will be reinforced -How to apply this: eating is typically under control of discriminative stimulo, including the presnece of desirable foods and activities with which eating is frequently paired (such as watching tv). An early step in the treatment of obesity, individuals might be encouraged to reduce and eliminate these discriminative stimuli for eating. They would be urged to rid their home of rewarding and enjoyable fattening foods, to restrict their eating to a single place in the home, and to not eat while engaged in other activities, such as watching tv. Other stimuli might be introduced in the enviornment to indicate that controlled eating will now be followed by reinforcement (ex. putting signs in strategic locations around the home) -Stimulus control requires us to pay close attention to things in our surroundings that encourage certain behaviors. Think about binge drinking. College students are the highest risk group (above same-aged peers who are working full-time instead of attending college). However, binge drinking only happens in certain contexts. I'm willing to bet most of you are not beer bonging at your cousin's first communion, funerals, or a business lunch with your boss. What are some of the discriminative stimuli for binge drinking? Maybe certain friends, wristband nights downtown, keg parties, cheap drinks, the presence of a ping pong table, drinking games, etc. Stimulus control requires eliminating the stimuli that encourages a negative behavior (perhaps avoiding bars that have wristband nights) and/or creating stimuli for positive behaviors (hanging around people who drink socially).

Meditation and Health Behavior Change

-This focus is based on the idea that stress can trigger many poor health behaviors, such as overeating, drinking, and smoking -Mindfulness meditation teaches people to strive for a state of mind in which one is highly aware and focused on the present moment, accepting and ackowledging it without becoming distracted or distressed by stress. The goal of mindfulness meditation is to help people apprach stressful situations mindfully rather than reacting to them automatically -Acceptance and Commitment Therapy (ACT): a CBT technique that makes use of acceptance, mindfulness, and commitment to behavior change. Sometimes people need to be able to move away from difficult thoughts and feelings and simply accept them while still persisting in desired actions, such as controlling diet. The goal is to try and change the private experience and thereby maintain commitment. ACT does not challange thoughts directly, but instead teaches people to notice their thoughts in a mindful manner and from a distance so as to be able to respons more flexibly to them

Cognitive Restructuring

-Trains people to recognize and modify these internal monologues (like self-critisicsm or self-praise) to promote health behavior change. Sometimes the modified cognitions are antecedents to a target behavior. Ex. if a smoker's urge to smoke is preceded by an internal monologue that he is weak and unable to control his smoking urges, these beliefs are targeted for change. Trained to develop antecedent cognitions that would help him stop smoking (ex. "I can do this" or "ill be so much healthier"). -Cognitions can also be the consequences of a target behavior. Ex. an obese individual trying to lose weight might undermine her weight-loss program by reacting with hopelessness to every small dieting setback, instead taught to think "I can do this" -In a typical intervention, clients are first trained to monitor their monologues in stress-producing situations. In this way, they come to recognize what they say to themselves during times of stress. THey are then taught to modify their self-instructions to include more constructive cognitions (ex. "smoking causes cancer") -Modeling can be used to train a client in cognitive restructuring. The therapist may first demonstrate adaptive cognitive restructuring. She may identify a target stress-producing situation and then self-administer positive instructions (such as "relax, you're doing great"). The client then attempts to cope with the stress-producing situation, instructing himself out loud -Recognize and modify internal monologues about to promote behavior change -Help client to generate a competing thought/saying -Repetition is CRITICAL -The basis of cognitive therapy is the assumption that what or how we think influences our behavior. If I tell myself I am hungry, I am more likely to reach for that snack. Cognitive restructuring aims to change a client's internal monologue about health behaviors. Imagine that I asked you to do the things above. Many of you would instantly say, "I don't have time. I don't like getting sweaty. I don't like the taste of vegetables. I'm too busy to sleep." Cognitive restructuring requires you to generate a competing thought. When asked to exercise, instead of "I don't have time", you would say, "I can make time in my schedule for exercise by cutting out or reducing ______" (that blank could be Pinterest, Reddit, etc.). Cognitive restructuring is simple but not easy. It requires repetition for the competing thought until that one becomes the default! Easier said than done.

Using the Stage Model of Change

-helpful because it suggests that particular interventions may be more valuable during one stage than another. Ex. a smoker in the action phase is not going to be helped by information about the importanc eof not smoking, but info about the importance of controlling alcohol consumption may be valuable to a person who is just beginning to contemplate that he or she has a drinking problem -Parallels real processes people go through (it's iterative). Explains why it is so difficult to change. Help highlight why some campaigns don't work. Ex. 50-60% smokers in precontemplation, 30-40% in contemplation, and 10-15% prepared for action. -Suggests that particular interventions may be more valuable at one stage than another -Precontemplation stage (give info about problem)-> contemplation (appropriate intervention may induce them to assess how they feel an think about the problem and how stopping it will change them)->Preparation (intervention designed to get ppl to make explicit commitments as to when and how they will change)-> action (interventions that emphasize providing self-reinforcement, social support, ect)-> maintenance -Mixed results with this model -Earlier models failed to reflect the true complexity of human behavior, and this one does a better job with it. The best thing to come out of it is that it highlights why some interventions and public health campaigns fail. They usually only target people in one stage, and sometimes very few people are actually in that stage. Smoking cessation is a great example. Littering public spaces with flyers on free cessation programs isn't helpful because less than 15% are even at the stage where they are ready to make change. Efforts need to focus on the majority who haven't even considered quitting!

Why are health habits relatively independent of each other and unstable?

1. Different health habits are controlled by different factors. Ex. smoking may be related to stressm whereas exercise may depend on each of access to atheletic facilities 2. Different factors may control the same health behavior for different people. One person's overeating may be "social" and she may eat primarly in the presence of other people vs. another individual's overeating may depend on levels of tension, and he may overeat only when under stress 3. Factors controlling a health bejavior may change over the history of the behavior. THe intial instigating factors may no longer be significant, and new maintaining factors may develop to replace them. Ex. peer group pressure (social factor) is important in initiating the smoking habit, over tie, smoking may be maintained because it reduces cravings and feelings of stress 4. Factors controlling a health behavior may change across a person's lifetime. Ex. regular exercise occurs in childhood because it is built into the school curriculum, but in adulthood, this automatic habit must be practiced consciously 5. Health behavior patterns, their developmental course, and the factors that change them across a lifetime will vary substantially between individuals. One individual may have started smoking to control stress; the reverse pattern may characterize the smoking of another individual *health behaviors are elicited and maintained by different factors for different people, and these factors change over the lifetime as well as during the course of the health habit. Health habits are difficult to change. As a result, health habit interventions have focused heavily on those who may be helped the most- the young.

Functions/Theories of Sleep

1. Rest, recovery, and homeostasis -Body and blood cell work -Immune system repair -Keep circadian rhythms entrained 2. REM (rapid eye movement) -Memory consolidation and development of neural connections -Eyes dart back and forth, breathing and heart rates flutter, and we often dream vividly. Marked by beta waves, and is believed to be important for consolidating memories , solving problems from the previous say, and turning knowledge into long-term memories NREM (non-rapid eye movement). Consists of 4 stages: 1. lighted and earliest stage of sleep, marked by theta waves, when we begin to tunr out the sound around us, although we are easily awakened by any loud sound 2. Breathing and heart rates even out, body temp drops, and brain waves alternate between short bursts called sleep spindles and large K-complex waves 3 and 4. deep sleep, marked by delta waves. These are the stages most important for resotring energy, strengthening the immune system, and prompting the body to release growth hormone Despite what we know about the importance of sleep, there is still no universal agreement as to why we do it. It clearly serves a very important process(es) because we have evolved to have it as a requirement. Sleeping for our primitive ancestors would have been very costly because you are utterly helpless to predators while sleeping. The fact that it exists suggests that it is crucial to our survival

Attitude Change and Health Behavior Educational Appeals

Educational appeals make the assumption that people will change their health habits if they have correct info. Research has provided the following suggestions of the best ways to persuade people through educational appeals: -Communications should be *colorful and vivid rather than steeped in stats and jargon*. If possible, they should also *use case histories* -The *communicator should be expert, prestigious, trustworthy, likable, and similar to the audience* -Strong arguments should be presented at the *beginning and end of a message, not buried in the middle* -Messages should be *short, clear, and direct* -Messages should *state conclusions explicitly* -Extreme messages produce more attitude change, but only up to a point. Very *extreme messages are discounted*. Ex. you should exercise for at least half an hour 3x a week vs. one that recommends several hours a day -For illness detection behaviors (such as HIV testing or obtaining a mammogram), emphasizing the problems that may occur if the behaviors are not undertaken will be most effective. For health promotion behaviors (such as sunscreen use), emphasizing the benefits to be gained may be more effective -If the audience is receptive to changing a health habit, then the communication should include only favorable points, but if the audience is not inclinded to accept the message, the communication should discuss both sides of the issue -Interventions should be sensitive to the cultural norms of the community to which they are directed.

Behavioral Factors and Illness

-25% of cancer deaths (and large number of cv disease could be avoided by eliminating soking) -Males aged 35 to 55 could reduce risk of CV disease by 20% with a 10% reduction in body weight -Modifying health behaviors could help reduce the $1 trillion spend yearly on health and illness -Estimated that as much as 95% of back pain is triggered by the psyche

Home and Workplace Accidents

-Accidents like accidental poisonings and falls, are the most common causes of death and disabillity among children under age 5 -Parents are more likely to undertak einjury prevention activities if they believe that the recommended steps really will avoid injuries, if they feel knowledgeable and competent to teach safety skills to their children, and if they have a realistic sense of how much time will actually be invovled in doing so -Pediatricians are incorportating such taining into their interactions with new parents, and such interactions can be successful -Accidents in the workplace have declines since the 1930s. May be due in part to better safety precautions by employers. Accidents at home have actually increased. -Falls remain a significant problem for the elderly that is likely to increase as the demographics of the pop change. More than $20 billion are spent each year as a result of fall-related injuries, with the largest cost the repair of hip fracture. More than 12800 die each year of fall-related injuries, and many more are diabled. At least 25% of older adults may remain hopsitalized for at least a year due to injuries from a fall -How to reduce fall risk: 1. dietary and medication intervention to reduce bone loss 2. physical acitivity involving balance, mobility, and gait training reduces the risk of faills 3. taching older adults to make small changes in their homes that may reduce trip hazards can help like nonslip bathmats or grab bars and hand rails on both sides of stairs

Facts about Accidents

-Accidents represent one fo the major causes of preventable death in this country -Nearly 1.3 million ppl die as a result of read traffic injuries, and the estimated conomic cost of accidnets is $518/year -Traffic accidents represents one of the largest causes of death among children, adolescents, and young adults. -Bike accidents cause more than 700 deaths per year, prompt more than 500,000 emergency room visits, and constitute the major cause of head injury, thereby making helmet use an important issue -Several million ppl are poisoned each year in the US, half of whom are children under 6 years old -Occupational accidents and their resulting disability are a particular health risk for working men. Home accidents are estimated to cost $217 billion in most productivity and quality of life

Research of Eating Disorders (?)

-Belief that one should control one's *weight* significantly related to disturbed eating, body dissatisfaction and poor self-esteem...whereas belief that one should control one's *lifestyle* and accept resulting weight showed a strong protective relationship -Eating disorder diagnoses increasingly given to children as young as 5 years old -I find these research findings very useful for healthcare professionals because it can help us learn to change the language we use around our bodies. Too much of the media, marketing, and advertising messages out there target body dissatisfaction and weight, and fail to address the larger lifestyle concerns.

Reducing Relapse

-Center on three techniques: 1. Booster sessions following the termination of the initial treatment phase are one method. Ex. several weeks/months after intervention, smokers may have an additional smoking-prevention session 2. Add more components to the behavioral intervention, such as relaxation therapy or assertiveness training 3. Consider abstinence a lifelong treatment process, as in AA. Drawback to this is that it can leave ppl feeling constantly vulnerable to relapse, potentially creating the expectation of relapse when vigilance wanes. Also, it implies that people are not in control of their habit, and research says that self-efficacy is an important component in initiating and maintaining behavior control

Contingency Contracting

-Contingeny Contracting: an individual forms a contract with another person, such as a therapist, detailing what rewards or punishments are contingent on the performance or nonperformance of a behavior -A form of self-punishment that has been used in behavior modification -Ex. a person who wants to stop drinking might deposit a sum of money with a therapist and arrange to be fined each time he or she has a drink and to be rewarded each day that he or she abstained -Ex. his deals with former clients -Delivering reinforcement or punishment is CRITICAL

Self-Determination Theory

-Self-Determination Theory (SDT): autonomous motivation and perceived competence are fundamental to behavior change. -People are said to be autonomously motivated if they experience free will and choice when acting. From a health standpoint, then, behavior change is more likely when the change is personally important and ties to important values. The cimpetence component is similar to self-efficacy -If a woman changes her diet because her physician tells her to, she may not experience a sense of autonomy and instead may experience her actions under another's control. The behavior change effort, according to the theory, would not have her wholehearted commitment under these circumstances. If experiences as autonomously chosen, however, she should be intrinsicially motivated to persist. -SDT has been used as a basis for interventions to reduce smoking and alcohol and drug use in adolescents, among other health behaviors

Social Skills Training

-Some por health habits develop in response to or are maintained by the anxiety people experience in social situations. Social anxiety acts as a cue for the maladaptive habit, necessitating an alternative way for coping with the enxiety -Social Skills Training or Assertiveness Training: individuals are trained in methods that will help them deal more effectively with social anxiety. The goals of social skills programs as an ancillary technique in a program of health behavior change are to reduce anxiety that occurs in social situations, to introduce new skills for dealing with situations that previously aroused anxiety, and to provide an alternative behavior for the poor health habit that arose in response to social anxiety

Aerobic exercise

-Sustained exercise that stimulate sand strengthens the heart and lungs, improving the body's utilization of oxygen. -Marked by its high intensity, long guration, and requisite high endurance -Jogging, bicycling, rope jumping, and swimming -Other forms of exercise such as isokinetic exercises like weight lifting or high intensity, short-duration, low-endurance exercises like spirinting may be satidying and may build ip specific parts of the body but have less effect on overall fitness bc they draw on short-term stores of gltcogen rather than on the long-term energy conversion system associated with aerobics

The Health Belief Model

-The most influential attitude theory of why people practice health behaviors -According to this model, whether a person practices a particular health behavior depends on two factors: whether the person *perceives a personal health threat*, and whether the person believes that a *particular health practice will be effective in reducing that threat* -People change based on two factors: 1. Belief in *health threat* -General health beliefs (e.g., interest and concern about health) -Beliefs about vulnerability (ex. lifeguard and tanning) -Beliefs about whether or not consequences are serious 2. Belief that *specific behavior can reduce threat* -Belief that specific measure can be effective against threat -Belief that benefits of health behavior outweight the costs

SES, Culture, and Obesity

-low socioeconomic status women, and African American women are heavier than their counterparts. One factor why SES is not associated with obesity in men and children is bc the simple fact that diets high infats and sweets costs less than those high in vegetables, fish, and fruit -Values are implicated in obesity. Thinness valued in women from high SES levels and from developed ountries, which in turn leads to a cultural emphasis on dieting and on physical activity

Operant Conditioning to Change Health Behaviors

-People typically will be positively reinforced for any action that moves them closer to their goal. As progress is made toward reducing or modifying the health habit, greater behavior change may be required for the same reinforcement. -Ex. Mary might set reinforcers that can be administered when particular smoking-reduction targets are met (like going out to see a movie)

Risk/Issues

1. People don't walways perceive their risks correctly. A child is 100 times more likely to drown than die by a firearm. 2. People unrealistically optimistic about vulnerability. Optimism is generally a good thing for health, but too much of it actually increases a person's risk for mortality. Why? Optimism is good for recovering from surgery ("I'll be fine") but not great for smoking ("I'll be fine"). 3. Psychological disturbance with the "diagnosis" of risk. Sometimes telling people they are at risk for something backfires because it can elicit chronic worry or stress, which then increases their risk. Genetic counseling is tough because it is hard to predict how someone will react to news. Some people rally and decide to make healthy change, others throw their hands up and say, "Why bother? I'm just going to get cancer and die young anyway." 4. Few successful interventions for genetically-based risk factor. One of the major challenges with genetic risk is that we have very few interventions for those risk factors. If you test positive for the risky variants for prostate cancer, there aren't any specific things you can do to change that risk. 5. Pointing out inheritability can cause family strife. Pointing out that things run in families can sometimes leave family members blaming each other for their health problems.

Troubling Statistics about Obesity/Disorders

In a recent study, young girls were quoted as saying that they would prefer to *what* than to be fat? -have cancer -lose both their parents -love through a nuclear holocaust -81% of 10-year-old girls are afraid of being fat -Average age of eating disorders onset has dropped from ages 13-17 to ages 9-12 -25% of first graders admit to having been on a diet -# of males with EDs have doubled during the past decade (male body dysmorphic disorder) -What percentage of American college women are disordered eaters?- 40 to 50 percent

Where are Weight-Loss Programs Implemented?

Workplace Weight-loss Interventions: -effective technique is competition between work groups to see which group can lose the most weight and keep it off Commercial Weight-Loss Programs: -more than 500,000 ppl each week are exposed to behavioral methods of controlling obesity through commercia clinics such as TOPS, weight watchers, and jenny craig Evaluation of Cognitive-Behavioral Weight-Loss Techniques: -cb programs typically produce better modest success, with weight loss of nearly 2 lbs a week for up to 20 weeks and long-term maintenance over 2 years. Programs that are longer lasting and that emphasize self-direction and exercise and include relapse prevention techniques are particularly successful. Responses to weight loss programs are variable Taking a Public Health Approach: -the increasing prevalence of obesity makes it evident that a public health model that emphasizes prevention will be essential for combating this problem. Leads to enormous costs to the economy. The Institue of Medicine and the National Academy of Sciences have critized the food industry for marketing high-calorie, low-nutrient junk foods to children, which is likely to prompt additional intervention by the gov to control health rsks for children. WHO has argud for several changes, including food labels that contain more nutiriton and serving size info, a special tax on foods that are high in sugar and fat, and restiction of advertising to children or required health warnings