Outline of Major Topics and Guide for Review for Final Exam This is only a guide for review. It is not a guarantee about the material that will and will not be on the exam. But it should help you to focus your review. Sakai: Contains this study guide and sample final exam questions. Final Exam: About 80 multiple-choice questions. Primarily on material covered since the Mid-Term (about 60 questions) but also some coverage (about 20 questions) of very important and specific topics from before the midterm. Day/Time/Location of Final Exam: See syllabus Photo ID: A photo ID must be presented at the door prior to seating for the Final Exam. Pencils: Bring several #2 pencils with sharp points and good erasers Note on Videos: Videos that were shown in class have been/will be placed on reserve in the Media Center, Basement of the Kilmer Library Determination of Final Grades: Mid-Term: 30% Assignments: 25% Final Exam: 45% Total: 100% I. Key Topics from Before the Midterm (about 20 questions) Introduction to Health Psychology Changes in patterns of health and medicine Decline of infectious diseases due to better public health measures and medical advances. Ascendance of Chronic diseae often degenerative; they develop and persist over time. Greater Life expectancy Leading causes of death shift from: Pneumonia Tuberculosis Diarrhea ?to: Heart disease Cancer Stroke Decline in Infant mortality Biomedical and Biopsychosocial Models Biomedical Model - Disease is organic, there is one single cause, and health is defined as the absence of disease. Biopsychosocial Model - Disease involves the whole person, there are multiple causes, and health is defined as more than just the absence of disease. The outcomes of the following 3 things leads to health, disease, or somewhere in between. Psychology ? Personality, self-efficacy, personal control, optimistic bias, social support, stress, coping skills, diet risky behaviors, adherence to medical advice. Biology ? genetics, physiology, gender, age, vulnerability to stress, immune system, nutrition, medication. Sociology ? poverty, ethnic background, cultural beliefs, racism, living with chronic illness. Health Behavior/Seeking Health Care Health Behavior models: Health Belief Model Theory of Reasoned Action Theory of Planned Behavior Stages of Change/Transtheoretical Model Precaution Adoption Model Leventhal Commonsense Model of Self-Regulation Stress I: Physiologic Approaches Cannon ? Fight of Flight Response and Homeostasis A threatening event causes our sympathetic branch of the autonomic nervous system to react, specifically the adrenal medulla endocrine gland). This causes the release of epinephrine and norepinephrine (the stress hormones). These hormones cause an increase in heart rate, blood flow, respiration rate and muscle strength. In this way energy is mobilized and prepares for vigorous muscle activity. Selye ? General Adaptation Syndrome (GAS) Stress is a biological response caused by all noxious stimuli, nonspecifically. Alarm Resistance Exhaustion A stressor is threatening or exhilarating. The initial response to the stressor (Alarm) is bodily changes that lower resistance. Then as the stressor continues the body mobilizes to withstand the stress and return to normal (Resistance). After ongoing, extreme stressors the body is depleted of resources so we function less than normal (exhaustion). Then the body returns to homeostasis. This is similar to: Adrenal Cortex Cortisol Changes in Thymus, Ulcers, Adrenal Cortex Cortisol increases (and sometimes decreases) as an indicator of stress. It varies throughout the dayand is high in the morning, low in afternoon, lowest during sleep. Damages brain areas and may affect memory and mental health. Mason - Critiqued Selye. He challenged the non-specificity. Says homeostasis predicts specificity and that different stressors have different responses. Psychological Causation ? threat perception, uncertainty, emotional response explains why the GAS is elicited nonspecifically by very different stressors. Allostasis ? maintaining stability or homeostasis through change. Your allostatic load is the wear and tear of the body due to repeated allostasis cycles and inefficient termination. Stress II: Psychological Stress Theory Lazarus?s Psychological Stress Theory Basic Assumptions: What is important in stress? Transaction ? Relationship between the person and situation. Phemenology ? Subjective experience. Cognition ? Perception, memory, thinking. Supports adaptation in many ways, but allows psychological factors to produce stress. The process is unfolding over time. Appraisal: A cognitive-evaluative process. Primary ? Is well being endangered? Threat ? possible harm or loss. Harm/Loss ? damage already done. Challenge ? threat plus possible benefit. Secondary ? What can I do? Reappraisal: How does it look now? Appraisal is automatic, effortless and not necessarily conscious. Coping: Managing/Dealing with Stress Problem-focused: change the situation responsible for stress (plan, take action, try to understand). Emotion-focused: Manage negative emotions (deny, give up, take drugs/alcohol). Coping is deliberate, effortful and conscious. Definitional Problems: Stress as a stimulus But there are individual differences. Stress as a response Multiple responses, often disagree Stress as a process Vague and difficult to study (appraisal blurs with stress response). Stress is a general label for a research area. Stress III: Stress and Disease Physiological Reactivity Neuroendocrine: Energy mobilization. Fight or Flight Sympathetic-Adrenomedullary Activity (SAM) Can damage cardiovascular health. General Adaptation Syndrome Pituitary-Adrenocortical Activity (PAC) Increased susceptibility to various diseases. Cardiovascular and immune systems interact with SAM and PAC directly and via CNS. There are individual differences in physiologic responses to stressors (especially cardiovascular). They are stable over time, consistent across different lab stressors and predict risk of heart disease. Immune System Functions are to detect/protect against antigens (foreign organisms/materials, mutant cells) and remove damaged cells. Its structure is the Lymphatic system. Adrenals, Thymus, lymph nodes, adrenoids. Non-specific (Non-selective) Phagocytosis: immune cells attack antigens. Granulocytes ? biological attack Macrophages ? biochemical and engulfing. Inflammation: biochemical. Enzymes destroy invaders, phagocystosis begins, and damaged tissue is restored. Specific (Selective) Cell Mediated Macrophages mark the invader for the T-Cell to recognize and kill. Natural Killer cells seek and destroy mutant cells. Humoral Helper T-Cells help B-Cells to produce antibodies. Antibodies are proteins made for specific antigens. Primary Immunity is the first response at exposure. Secondary Immunity is ?memory based?. Coping Resources and Stress Moderators Stress-Buffering Social Networks mainly show a direct effect: Promote health whether stress is high or low. Not acting as a coping resource or true moderator. Social Support often shows a buffering effect: Promotes health more when stress is high than low. More likely acting as a coping resource/moderator. Social support is most likely to buffer stress when the type of support matches the stressor. II. Topics Covered Since the Midterm (about 60 questions) Cardiovascular Disease Nature of coronary heart disease Coronary Arteries ? Supply the heart with oxygen-rich blood. Coronary Artery Disease ? the heart is a muscle and therefore needs oxygen to work. Narrowing of the coronary arteries due to accumulation of fatty substances and other materials is CAD. CAD can progress undetected for decades ? plaque builds slowly (progressive atherosclerosis). Coronary Heart Disease Angina ? chest pain, but no damage. Myocardial Infarction ? aka ?heart attack?; some heart muscles die. Silent Ischemia ? inadequate blood flow to the heart, but no pain. Sudden Death ? cardiac death in seconds or minutes. Heart Failure ? the heart cannot provide adequate circulation to the body. Coronary Bypass Two kinds of strokes ? Common strokes are caused by a blockage of an artery, hemorrhagic strokes are caused by bursting of an artery in the brain. High Blood Pressure Consequences: Stroke ? high BP can damage vessels that supply blood to the brain, eventually causing them to rupture of clog. The interruption of blood to the brain is a stroke. Heart Attack ? high BP makes the heart work harder to pump sufficient blood through narrowed arteries ? the extra effort can enlarge and weaken the heart. Damage to Arterial Wall ? high BP can wear rough spots in artery walls; fatty deposits can collect in the rough spots and clog the arteries, raising the risk of heart attack. Recent trends and current scope of the problem Death rates for cardiovascular disease increased immensely from 1920 to about 1960. From 1960 on the deaths decreased greatly. Cardiovascular Disease Mortality by Age/Gender: Men of all ages are at a higher risk. Low risk from age 25-54. Risk increases small amount for 55-64. Risk Increases hugely and steadily as you age. Risk factors Traditional Risk Factors Only account for about 50% of cases. Main Risk Factors: Cholesterol levels (in blood) Blood Pressure Cigarette Smoking Diabetes/Blood Sugar Additional Risk Factors Diet, obesity/lack of exercise Older age Being Male Family History Being African American Psychosocial Risk Factors Psychological stress SAM/Fight-or-Flight response damages cardiovascular system. Blood Pressure/Heart Rate changes cause the coronary arteries to stretch and tear. This forces the heart to work harder and need more oxygen. This can produce arrhythmia. Other effects of SAM: stored fat is released and can be deposited in arteries. Blood clots more easily (during F-O-F response) and may cause heart attack. PAC-Cortisol and other adrenal cortical hormones can have negative metabolic effects. Type A Behavior Created by Friedman and Rosenman Hostility and Anger Social networks and Social Support Gender Race/Ethnicity Depression Religiousness/Spirituality Tax Accountant Study An early study about stress and heart disease done by Friedman and Rosenman. Tax accountants were followed for several months. It was expected that their stress would peak at April 15th (tax season). Serum cholesterol, ease of blood clotting, and diet were all measures taken. Results: No significant change in diet noted. Job stress caused blood cholesterol to increase. Job Stress caused blood to clot more easily. These two effects would not have been detected by traditional risk factor assessment. Note: Type A behavior NOT measured. Type A Behaviors Original Concept: Patterns of Behaviors: Achievement striving Impatience Competitiveness Hostility Vigorous speech/Motor Behavior Response to challenges/stressors: Best measured by challenging interview. Hostile Competition Study How Hostility leads to Coronary Disease Health Behaviors: hostility is associated with additional risk factors. Psychosocial Vulnerability: hostile individuals experience more stress and have less social support. Reactivity: hostile individuals show strong physiologic response to stressors. Reactivity Hypothesis Emphasizes SAM activity. increases in blood pressure and heart rate, increases in epinephrine and norepinephrine. SAM activation can contribute to coronary heart disease in a number of ways. Reactivity is studied in humans in a laboratory setting. Measure hostility, measure baseline SAM, then introduce stressor (SAM reactivity increase) and measure stress response. Hostile Competition Experiment Hypothesis: Type A?s are especially reactive to hostile competition. Type A and B subjects randomly assigned to one of two conditions. No-Harass ? Video game with neutral competitor. Harass - Video game with hostile competitor. Conclusions: Type A?s are expecially reactive to hostile competition. Hostility and anger are more important than simple competitiveness. SAM reactivity to interpersonal conflict may explain the link of hostility to coronary disease. Animal Model of Reactivity (Macaque Monkeys) Macaques develop CHD like humans if their diet contains enough fat. They form dominance hierarchies. (Dominant has best access to food and mates; submissive have less access). There is a struggle for dominance and it is stressful ? very reminiscent of human stressors. Social re-organization is especially stressful for the dominant monkey. Dominant Monkeys under Stress have most disease, aggression associated with reactivity, and reactivity predicts disease. Cancer Nature of cancer Cancer is unrestrained growth of new cells. It has many forms and causes. There are 4 general types: Carcinomas: skin, lining of organs Most common! Sarcomas: bone, muscle, cartilage. Leukemias: blood, blood-forming cells. Lymphomas: lymphatic system. 95% are carcinomas, sarcomas, or leukemia. Tumors: Abnormal Tissue Growth Benign Tumors: remained localized, can damage nearby tissue mechanically and are generally not killers. Malignant tumors: Can invade and destroy nearby tissue, can spread (metastasize) and are more likely to be killers. Carcinogenesis Alteration in DNA ? Genetic control of cell function. Weakened immune system ? Fails to detect and repair or destroy cancerous cells. Tumor Promotion factors ? E.g. Some tumors have receptors for hormones such as estrogen. Recent trends and current scope of the problem Death rates from cancer have steadily increased since 1900; but began to decrease around the 1990s. Overall Rise since 1900: Improved diagnosis. Aging of the population Control of other diseases Increase in environmental carcinogens Recent rise in AIDS-related cancer Increased smoking and lung cancer (Men since 1950s and Women since 1960s) Recent drop in Cancer death rates: Not due to improved treatment both incidence and death rates have declined. Due to lifestyle changes less smoking-related cancer (esp. men) High incidence does not always mean big killer. Women: Breast cancer (On the rise but has high survival). Men: Prostate cancer (high incidence and high survival). Risk factors Behavioral Risk Factors Smoking Risk of lung cancer 9 times higher in smokers. Strongest link between any behavior and major cause of death. Smoking or living with a smoker can lead to Breast cancer. Smoking may multiply other risks. Risk of smoking is underestimated by smokers. No such thing as safe tobacco. Dietary Carcinogens Spoiled food Fat/Cholesterol Chemical additives Frying/barbecue Possible Dietary Protectors: Vitamins (like E, C, A, and Beta-carotene). Lycopene, polyphenols, flavinoids, anti-oxidants, selenium. Fiber Volume of fluid intake. Alcohol Not as strong a risk as smoking or poor diet. Related to several cancers (Pancreas, liver, breast, tongue, tonsils, esophagus). Multiplies risk of smoking. Sedentary life style UV Radiation (Esp. for fair-skinned) Sex HIV/AIDS and HPV (cervical cancer). Other Risk Factors Environmental Carcinogens Radon gas, radiation, asbestos, industrial chemicals. Genetics Suggested by effects of family history. Not confirmed by effects of ethnicity (Access, adherence, knowledge, attitudes). BRCA 1 and BRCA 2: 10% of Breast Cancer Raises many issues (Deciding to be tested, impact of test results). Impact of Genetic Testing Stress Family members Reproductive Decisions Life Planning Insurance Cancer Screening Psychosocial Risk Factors Psychological Stress PAC/SAM Activity suppressed immunity Impaired ability to detect/destroy cancerous cells? Greater susceptibility to cancer-producing viruses? Human evidence is weak and inconsistent ? few human cancers are known to be caused by viruses. Exceptions are: HPV Cervical Cancer HIV/AIDS Opportunistic Cancers Type C Personality Suppressed emotion, no fighting spirit, avoidance, depression? Evidence is weak and inconsistent perhaps influences the course but not the development of cancer. Genetic testing Psychosocial adaptation to cancer Self Identity and Cancer Wanting to have/project a desirable social image: Initiation of cigarette smoking Initiation of alcohol consumption Exposing oneself to UV radiation Engaging in risky Sexual behavior identity as key psychosocial issue in adolescence. Identity and Adaptation to Cancer Disfigurement/Loss of function and identity Meaning, mastery, self-esteem, personal growth. Adaptive/Maladaptive coping. Pain Theories of pain Early Theories of Pain Specificity Theory: Separate pain system. Pattern Theory: Pain reflects high levels of stimulation through other senses. Both of these theories are physiologically incorrect. They fail to account for psychosocial factors that influence pain experience like: Stress Culture Personality Gate Control Theory A neural ?gate? modulates pain signals before they reach the brain. The ?gate? is located in the spinal cord. Control of the ?gate?: Opened by activity in A-delta and C fibers. Closed by activity in A-beta fibers and other afferent fibers (E.g. Rubbing or pressing). Opened or closed by brain signals, a pathway for psychosocial influences. Open Gate = Pain Activity of the A-delta and C fibers produces stimulation, opening the gate in the spinal cord (specifically the substantia gelatinosa). Central control trigger is inactive, allowing the gate to remain open. Closed Gate = Decreased Pain Activity of the A-delta and C fibers produces stimulation, opening the gate. Central control trigger is active, sending messages from the brain to close the gate in the spinal cord. Activity in A-beta fibers produces inhibition, closing the gate in the spinal cord. Activity of the A-delta and C fibers produces stimulation, opening the gate. What opens the Gate? Physical Conditions ? extent of injury, physical activity. Emotional State ? Anxiety, tension, depression. Cognitive Processes ? Focusing on the pain, boredom. What closes the Gate? Physical conditions ? Medication, counter-stimulation (rubbing, pressure). Emotional State ? positive emotions, rest and relaxation. Cognitive Processes ? Distraction Cultural, ethnic, and psychological factors in pain Cross Cultural Factors in Pain/Expression Culture influences our expectations and those expectations influence our pain experience. Childbirth for Mexican Women: ?Dolor? means labor, sorrow, or pain. Childbirth is feared and severe pain is expected. Labor is painful, complications are common. Childbirth in South Pacific Culture Childbirth is routine with fewer complications. Women return to work immediately. Ethnic Differences in Pain/Expression Research involving experimental Pain: Protestants of British descent: ?matter of fact? reaction; pain is routine. Irish: Inhibition of pain, suffering. Italians: Emotional exaggeration. Jews: Emotional exaggeration ad concern about future implications. Parental Influence Children with anxious mothers show more distress at dentist. Pain and Self-Concept Kleinman?s account of the Vulnerable Police Lieutenant: Severe back pain led to self-image of someone who is spineless and unable to be assertive. The Cardiac ?Invalid?: So afraid that physical activity will cause heart pain and endanger life they become ?couch potatoes?. The cardiac ?Athlete?: So motivated to be pain and disease free, they engage in too much physical activity to prove invulnerability. Expanding the ?Non-physical Self?: Turning to art, spirituality and religion to escape pain. Finding ?Meaning in Suffering?: Viewing pain as a challenge, blessing, or punishment. Though pain is unpleasant, it is an adaptive system. It is sensory, neurobiological, emotional and cognitive. Its neurobiological basis allows social and psychological influences. Psychosocial influences include culture, parenting, perceptions and expectations. Pain can have powerful personal meanings that affect self-concept. Living with and Managing Chronic Disease Issues and goals Extend Life (Mortality) Control Disease (Morbidity) Decide among treatments, adapt to treatment, stress and eide-effects, make lifestyle changes. Maintain Quality of Life Psychosocial Development (Erickson) Age 12-17: Identity/Role Confusion ? Self Concept Age 18-40: Intimacy/Isolation ? Relationships Age 40-65: Generativity/Stagnation ? Productivity Age 65+: Integrity/Despair ? Accept Mortality, Life Meaning, Life Purpose. Age and Mental Health in Chronic Illness In General Mental health increases with age. Those with anxiety and depression have lowest mental health. Life Stress Monitoring Program for Heart Attack Patients Goal: Prevent second heart attack and/or death. Design: Treatment and Control Groups (Randomized). Monitoring: Monthly telephone call asking: Did patient have high stress level? Had patient been hospitalized? Treatment: Home-based stress reduction tailored to patient, with education, support, referral. Results: Appeared to reduce the incidence of recurrent MI and Cardiac Death in an all-male sample. Important outcomes and an inexpensive study. Randomized design was weakened by selective loss of subjects. Complex Treatment: Results may not reflect emotional support at the time of stress (Medication compliance?) Follow-up Studies: No benefits in men. May have increased negative outcomes in women. ?Repressive copers? (avoidants): Negative impact Nurse visits did not permit ?repression?? ENRICHD Depression and low social support as risk factors. The post-MI patient Cognitive-Behavioral Therapy Preliminary evidence: Not effective Spiegel?s Intervention Study of Women with Advanced Breast Cancer Purpose: Evaluate effects of psychosocial treatment on pain, quality of life (not death). Subjects: 86 metastatic breast cancer patients. Design: Treatment and Control Groups (Randomized) Treatment: 1 year of weekly supportive group therapy with self-hypnosis for pain. Results: Months Survived: Treatment Group ? 36.6 Control Group ? 18.9 Difference Began 8 months after treatment ended. Problems/Issues: Small Sample, some subjects were lost. Treatment group less sick when study began. ?Effective? ingredient is unclear: ?Living life fully? Improved communication with doctor and family. Facing/Mastering fear of death Controlling pain and symptoms. Follow-up studies have failed to replicate these results. O?Leary?s Cognitive-Behavioral Intervention Study of Women with Arthritis Purpose: Evaluate effects of increased self-efficacy. Subjects: 30 female arthritis patients. Design: Treatment and control groups (Matched). Measures: Self efficacy for managing arthritis Pain Physical functioning Inflammation (MD rating) Cognitive-Behavioral Treatment Group Small groups that met for 2 hours every week for 5 weeks. Received information, pain-management skills and a phone ?buddy system?. Control Group Only received information booklet. Results: Evidence that treatment was efficacious. Evidence that increased self-efficacy mediated the treatment (explained how/why it worked): Treatment Increased Self-Efficacy Improved Functioning HIV/AIDS Nature of HIV/AIDS HIV ? Human Immunodeficiency Virus HIV1 ? Causes most cases in the U.S. HIV2 ? Causes most cases in Africa. HIV seropositivity ? Infected by the HIV virus May be symptom free May infect Others AIDS ? Acquired Immunodeficiency Syndrome From few weeks to 10 year post HIV infection. Usually involves an opportunistic infection. No recovery. Symptoms of HIV/AIDS Stage 1: 1-8 weeks post infection. Fever, sore throat, skin rash, headache. Stage 2: Lasts up to 10 years post-infection. Symptoms are minimal or absent. Stage 3: Swollen lymph nodes, fever, fatigue, night sweats, appetite/weight loss, diarrhea, white spots in mouth, rash. Stage 4: CD4+ T-Cell count less than 200/mm3. Highly susceptible to infection. AIDS and Opportunistic Infection Immune system can fight common infections but cannot fight viruses. Antibodies already manufactured are not killed. Immune system cannot develop a response to new, rare, infectious agents. Such as: Pneumocytis carinii pneumonia Kaposi?s Sarcoma Invasive Cervical Cancer Pulmonary Tuberculosis Recurrent pneumonia CNS infections. Etiology Initially, HIV infection may be suppressed. It then binds to CD4 molecules of T-Cells. HIV invades those cells and incorporate its genetic material into the cell?s DNA. The T-cell can no longer perform immune functions, but reproduces and passes on infection to daughter cells. Recent trends and current scope of the problem In 1994, AIDS had become the leading killer of individuals age 25-44 in the U.S. Since then incidence and deaths have declined. Prevalence has continued to rise (living longer). African American Women have high risk. Women?s risk is mainly caused by heterosexual sex. Gay men are at extremely high risk. HIV testing HIV antibody tests ? ELISA, Western Blot (more accurate). Measures of Viral Load ? amount of virus. Problems: In early stages of infection, ELISA and Western Blot may be negative. A few people have a virus but test negative on ELISA and Western Blot for several years. Transmission of HIV Requires Exposure to Bodily Fluid Blood, semen, vaginal secretions, Saliva, urine, tears, breast milk. Blood and Semen have highest concentrations. Transmitted by: Male-male sexual contact Injection drug use Heterosexual contact Birth to HIV+ mother Transfusion of blood/blood products. There is no ?safe sex?! Low Risk ? Mutual Masturbation, no sores/cuts. Medium Risk ? Penetration, properly-used latex condom High Risk ? penetration without a latex condom Most transmission involves unprotected vaginal sex, unprotected anal receptive sex and unprotected oral sex. Risk also depends on number and status of partners. Risk factors Male-Male Sexual Contact This is the primary cause in the U.S. Main risk factors with this group unprotected anal sex, anonymous sex, multiple partners, drug/alcohol, being young, being a risk-taker. Injection Drug Use Second most frequent cause in U.S. Main risk factors within this group intoxication, limited access to sterile needles, and women being financially dependent on an infected man. Heterosexual Contact Fastest growing cause in the U.S. Leading cause in Africa. Males to Female transmission is 8 times more likely than Female to Male transmission. For females Sex with injection drug user main risk. In general Drugs/Alcohol are a main risk. Birth to HIV+ Mother Birth Process and Breast Milk Drugs can cut rate from 15-30% to 8% or less. HIV/AIDS prevention Primary Prevention ? Interventions that help promote safer sex. Knowledge about HIV transmission and AIDS. Perceived personal vulnerability to HIV/AIDS. Social norms favoring latex condom use. Self-efficacy for controlling risky behavior. Skills training: Determining risk status of partners, resist coercive sex, resist pressure to perform high-risk sex, avoiding intoxication when sex is likely Availability and proper use of latex condoms Making safer sex more erotic. Secondary Prevention ? Reduce stress and promote adherence in HIV+ Individuals. Reduced stress of receiving HIV+ individuals. Improved quality of life in HIV+ individuals. Increased compliance with complex drug regimens. Treatment of AIDS Drug Treatment Less chance of transmission from mother to newborns. May increase survival time. Drug combinations that include protease inhibitors are especially promising: Suppress (do not eliminate) virus. May need drugs for lifetime. For many, dramatic effects are reversed after a time. Problems with compliance. Psychosocial influences on the course of HIV/AIDS Studies of Psychosocial Factors and Adaptation to HIV In HIV+ gay men, those who concealed their sexual orientation developed AIDS symptoms more rapidly more closeted = more rapid progression. In HIV+ gay men, those who concealed their sexual orientation had lower CD4 cell counts, felt more socially constrained and more depressed. For HIV+ gay men who are high in ?Rejection Sensitivity? those staying closeted were not so negatively affected. Pessimism about AIDS predicted whether or not symptoms developed in HIV+ gay men mainly in those who lost a close friend to AIDS. Cigarette Smoking Recent trends and current scope of the problem Cigarette Consumption 1900-2000 Steady increase until around 1960s Steeper increase at specific points: 1917 - U.S. Entry to WWI 1929 - Great Depression 1942 ? U.S. Entry to WWII Decreases/Leveling off when reports linking smoking to cancer occur, Surgeon General reports, Broadcast ban. Current smokers have been decreasing from 1965. Former smokers increasing since 1965. Never smokers increasing since 1965. Percentage of Americans who smoke regularly decreased as of the 1960s. The once large sex difference has been reduced considerably. Education level is now the best predictor, as is SES. Smoking is the single deadliest behavior EVER in the U.S. and is now the largest preventable cause of death and disability. Causes about 440,000 deaths per year. Costs billions in medical expenses and time lost from work. Main health risks: Cancer Cardiovascular Chronic Obstructive Pulmonary disease Fires These all have direct effects and amplify the effects of other risk factors. Natural History of Smoking Preparation Initiation Becoming Maintenance Early Stages of Smoking Modeling ? learn to expect that smoking will cause reinforcements received by smokers. Peer Pressure ? Overt encouragement to smoke. Identity Formation ? important psychological issue in adolescence. Adolescents usually have a positive image of the smoker as rebellious, tough, mature. Adolescents are most vulnerable to these influences. Have low self-esteem Dependent Low-achieving External locus of control Later stages of Smoking Regulation of Cognition and Affect Physical Addiction to Nicotine Health Risk Expense Nicotine Regulation (Addiction) Model Many seem to need more and more cigarettes (tolerance) Smokers smoke to maintain a certain level of nicotine in the body. Deprivation causes withdrawal (unpleasant symptoms) which stimulated smoking. But Long after quitting former smokers crave, often relapse. ?Chippers? show no tolerance (can smoke a little) and no withdrawal (possible genetic factor). Regulation of Cognition and Affect Smoking can increase alertness/concentration, relaxation, pleasure (positive reinforcement). Smoking can decrease anxiety, tension, pain (negative reinforcement). Some of these effects become conditioned to social, environmental stimuli, including stressors. Smoking becomes part of problem and emotion-focused coping. Intervention: What are the major types of intervention and what works? Alcohol and Drug Use Historical trends and current scope of the problem 63% adults current drinkers, 37% non-drinkers. 50% of alcohol is consumed by 10% of the population. College drinking ? binge drinking highest rates at 18-24. More than half of drinkers 18-25 are binge drinkers. Overall U.S. consumption has declined since 1980. Risk factors Distribution of the problem: Who drinks? Ethnicity: Euro-americans have the most drinkers. Asian americans have the fewest drinkers. Native Americans have the heaviest binge drinking. Age: 18-24 has highest heavy/binge drinking. 12-17 has reduced by change in the law. Gender: Men have more drinkers and are heavier/binge drinkers. Education: More schooling, more drinkers. More heavy/binge drinking for drop outs. Definitions and assessment ?Regular Drinker? ?Light? to ?Moderate? ?Heavy Drinker? A ?binge? is considered having 5 or more drinks on one occasion. A ?binger? is one who does this at least once per month. Alcoholism ? Disease brought about by chemical properties of alcohol. Gamma ? loss of control once drinking starts. Delta ? Inability to abstain. Disease model has been replaced by a Moral Model. Does not explain why people drink in the first place. Does not explain why people continue to drink moderately. Does not explain why many effects of alcohol reflect psychological factors. Alcohol Dependency Syndrome Narrow Drinking repertoire. Salience of drinking. Tolerance. Drink to avoid. Withdrawal. Impulsion to drink. Independence returns after abstinence. Explanation of use and abuse Both genetic and environmental causes: How much of each is controversial. One gene common in Asians unpleasant flushing. No specific gene identified that promotes drinking. Hazards Direct Hazards: Chronic Liver disease - cirrhosis. Korsakoff Syndrome ? cognitive impairment. Heavy drinking can lead to a thiamin deficiency. Light drinking may be beneficial. Cancer ? oral, pharynx, esophagus, larynx. Cardiovascular disease ? hypertension, heart muscle damage, fat matabolism. Fetal Alcohol syndrome Indirect Hazards Accidents ? a leading cause of death in U.S. Leading cause for those under 45. 32% of fatal unintentional injuries involve alcohol. Driving under the influence is more common in men 18-20 and 21-25. Unintentional Injuries have dropped in death rate since 1965 but the drop has slowed. More than twice as likely to kill men than women. Primarily motor vehicle accidents. Homicide Rape/Sexual Abuse Unsafe Sex Suicide Possible Benefits Light/Moderate Drinking reduced mortality and morbidity compared with non/heavy/binge drinking. May protect against coronary heart disease cause an increase in high density lipoprotein (LDL) and reduce tendency to form blood clots. Possible less risk for Type 2 diabetes, ulcers, cognitive impairment. Women experience benefits and hazards at lower drinking levels. Theories of alcohol use Personality Theory Not a single, coherent theory Psychoanalytic, dependency, need for power, impulsivity. No eveidence for an ?Alcoholic Personality?. Incorperated into other theories: anxiety, impulse control, sensation seeking. Tension Reduction Theory Reduces tension only in a narrow dose range. Not all drinkers experience tension-reduction. Does not explain expectancy effects. Many effects in addition to tension-reduction. Useful part of more complex theories. One is stress-response-dampening theory. Social Learning Theory Views drinking in terms of its natural history. Preparation Established drinker. Initial drinking: pleasure (reinforcement), fits with beliefs, and promoted by social environment. Modeling and peer pressure. Central Concept: Alcohol-related expectancies. Drinking as Coping: Stress dampening. Drinking to avoid withdrawal. Alcohol Myopia Psychological and chemical effects produce a kind of shortsightedness (superficial thinking). Drunken Excess ? Behavior is exaggerated because it is no longer inhibited (friendliness, sexuality, aggression). Self-Inflation ? Self-evaluations are enhanced. Drunken Relief ? less worry, less self-criticism, stress reduction. Is maximized by drinking alcohol plus distracting activity. Intervention: What are the major types of intervention and what works? What are the differences in societal attitudes toward tobacco, alcohol, and other drugs? Eating and Weight Control Recent trends and current scope of the problem Americans are fat and getting fatter with adult obesity increasing by 50% from early 1980s to late 1990s. A decrease in percentage of calories from fat has been offset by increase in calories consumed. An increase in use of non-caloric sweeteners has been offset by an increase in caloric sweeteners. Risk factors Distribution of the problem: Who is overweight and obese? Definitions and assessment Weight Control ? Concerns energy. Intake What is eaten (e.g. fats, carbohydrates), how much is eaten (calories). Expenditure Basal (resting) metabolic rate and physical activity/exercise. Older System Overweight 10-20% greater than ?desirable weight? Obesity More than 20% greater than desirable weight. Newer System Overweight Body mass Index of 25 or more. Obesity BMI of 30 or more. Percentage of Body Fat ? difficult and expensive to measure. Fat Distribution ? ?pears? and ?apples? based on waist to hip ratio. Central adiposity metabolic effects; may interact with stress hormones ? health risk. Biological determinants of eating and weight problems Social and environmental determinants of eating and weight problems Psychological impact of eating, overweight/obesity, and body image Intervention: What are the major types of intervention and what works? Exercise controls and reduces weight. Directly burns fat and calories. Temporarily increases metabolic rate. Increases muscle mass. Exercise and Fitness What is exercise? Isometric: Muscle contraction against resistance (like pressing against a wall) that builds muscle strength. Isotonic: Muscle contraction and joint movement (like weight lifting) that builds muscle strength and endurance. Isokinetic: Muscle contraction with joint movement; resistance in both directions (like a nautilus machine) that builds muscle strength and endurance. Requires Equipment. Anaerobic: Short, intense energy bursts (like sprinting or softball) that builds speed and endurance. Aerobic: Sustained large-muscle activity requiring large increase in oxygen (like jogging, swimming) that increases cardiorespiratory fitness. What is fitness? Depends on the duration, frequency, and intensity of exercise. Three general forms: Muscle strength/endurance. Flexibility Cardiorespiratory fitness. Heart rate must be increased for a sustained period of time several times per week to increase oxygen supply. This causes the heart to do less work: More blood pumped with each heart beat. More oxygen extracted from blood that is pumped. Lower resting heart rate and blood pressure. What are the benefits of exercise? Physical Fitness Weight Control Cardiovascular Health Reduces risk of cardiovascular disease and death. Reduces levels of LDL (bad cholesterol). Reduced cancer risk Reduced risk of bone loss Control of diabetes Decreased anxiety Increased mood and self esteem Increased mental performance Body image; eating disorders. Future Challenges and the Rising Threat of Infectious Disease 1. What are the challenges? 2. What are the global, socio-political issues? 3. What will be the role of Health Psychology? III. Guide to what will not be on the final 1. Biology: Organize your preparation for biological terms that relate to psychological and health concepts. There will not be pure anatomy/physiology questions. You do not need to study figures depicting bodily systems. 2. Health Care system: Questions will be related to concepts that describe psychological states and processes (e.g., adherence, depersonalization); there will be no questions about the structure and function of the health care system itself. 3. Statistics/numbers: There will be very few questions requiring you to remember a specific statistic or number. Question of this sort will be confined to the major health problems (smoking, alcohol consumption) and will usually involve comparisons or trends. 4. Films: Viewing each film once and making notes of the major points will be sufficient. 5. Specific studies: Those covered in class before the midterm will not be covered in the final.
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