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PSY333H1 Lecture 5

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Lisa Lipschitz

PSY333H1F L5 Oct 10, 2013 Smoking Prevention  Most common approach is preventing children from Ch. 5 continued beginning to smoke  rmbr sensitive windows of time Why is Smoking Bhvr So Hard to Change?  Social influence intervention  Smoking is a deeply entrenched bhvr pattern o Social learning principles of modeling & bhvr’al  Initially smokers are resistant to interventions because of inoculation their lack of knowledge & their health-compromising o Youngsters are exposed to older peer models who attitudes deliver anti-smoking msgs after exposure to stimulated  Smoking is often associated w pleasurable activities (break- peer pressure to smoke time, talking w friends)  Bhvr’al Inoculation  Nicotine is addictive (avoid withdrawal) o Programs designed to inoculate people against adverse health habits  Arousal levels o Exposing them to mild version of persuasive communications that try to engage them in a poor  Appears to control anxiety & reactions to stress  Keeps body weight down health practice  Unaware of the benefits of quitting o Giving them techniques that they can use to respond  Optimistic bias: personally have a lower risk than do other smokers Life-Skills-Training Approach  Smoking prevention programs include: o Training in self-esteem & coping skills  Gender: o Men o Boost self-image to the point that smoking becomes  More likely to quit unnecessary or inconsistent w lifestyle o Emphasizing short-term conseqs  Addicted to nicotine  Nicotine replacement like the patch are  Most successful programs are interactive, build students’ more helpful refusal skills, and elicit a commitment not to smoke  These programs are somewhat promising o Women  Influenced by psychological & situational factors o Show reduction in smoking onset over time as well  Nicotine replacements do not work as well, more o 6 graders in Canada who received a social- influence program were less likely to try by the end influenced by the media, weight issues, coping of 8 grade (47% vs 60%)  Those who use smoking as a coping strategy are less likely to quit o Helped students quit (63% vs 28%)  Less likely to have social support Social Engineering & Smoking  CBT more helpful  CBT can help (Perkins, 2001, 1996)  Smoke-free workplaces reduce the # of cigarettes that  21% who received therapy stopped vs. workers smoke & decreases the prevalence of smoking 9% at one-year follow-up  Social or lifestyle change thru legislation Ppl Who Stop on Their Own  Health warnings on cigarette packages  Heavy taxation on cigarettes  Despite difficulties, half a million Canadians stop smoking each yr  Smoke-free legislation in Canada  Typically, ppl quit on their own because of health reasons  Health warning labels on cigarette packages  Have good self-control skills, self-confidence in their ability to stop, and a perception that the health benefits of stopping are o Since December 2000 Canadians have been substantial exposed to the world’s largest & most graphic warning labels o More highly educated smokers o Easier to do w supportive social networks o Must cover top 50% of the front & back of the principal  Self-quitters have very high relapse rates display surface  Ex. This is what your lungs will look like o 2/3 who quit on their own relapse after only 2 dys & 97% return within 6 mths  Fear appeals o Relates to Stage of Change Models – go up & down o Do they work? Yes! o Results: 90% of 600 Canadian smokers reported stages (repeated relapses) until reach maintenance stage that they read the labels o Follow-up 3 mths later: 23% quit or attempted & Helping Those Who Quit 25% reduced the amt they smoked per day o Greater (-)ve emotion  more likely to quit or  How can you help someone who is attempting to quit?  (+)ve support attempt to quit o Former smokers reported the labels helped them  Congratulating them refrained from starting  Celebrating  Expressing confidence in their ability Major Health Benefits of Quitting  Helping relieve stress  1 yr after someone quits, the risk of coronary heart disease  Pressuring someone & expressing doubt is unhelpful falls by ½  Former light smokers (fewer than 20 a day) who were able to to stigma, might blame mental health rather than the body  abstain for 16 yrs had the same rate of mortality as ppl who miss the illness), lower rates of surgical treatments never smoked  40% of cigarettes are smoked by ppl w mental illness  Quitting at age 35 would add 7-8 yrs to life expectancy o Less likely to receive support to quit  About 10 yrs after someone quits, the risk of dying from lung Less than 30% of those w severe mental illness receive a basic cancer falls by ½ annual physical health check  Those w mental illness face higher rates of poverty, You don’t smoke but… unemployment, lack of stable housing, social isolation  When you spend time around smokers who are actively  Report increased food cravings, decreased energy levels smoking you are at risk for illness thru passive smoking, (which increases food consumption), weight gain, second-hand smoking, or envt’al tobacco smoke decreased levels of physical activity o Also can be physical side effects  No Qs on midterm about sleep! Reflection Paper  500 words  Due: Hardcopy on Oct 17 in class  Topic: Write a reflection on the film “Unnatural Causes: Is Inequality Making Us Sick?” (1hr) o Won’t be tested on it  Potential topics: o Initial reactions o What did you learn? o Surprised by an aspect of the info? o Any lingering questions? o How does it relate to your life? o Are you going to make any changes after viewing the film? In Sickness & In Wealth:  Biology  innately us, who we were born to be o Misses that we grow up & develop, interact w world o Carry our history in our bodies Second-Hand Smoke Prevention  USA: Highest gross national product in the world:  Legislation to restrict smoking envt (ex. public places &  2.3 trillion $ per yr on medical care (nearly 1.2 of world) workplaces) th  But live short, sicker lives (ranked 30 in life expectancy)  Legislation to prevent smoking in cars w children under  Many babies die in 1 yr of life the age of 17  47mil have no health care o Since 2008 all provinces (except Qubec) banned o Not the cause of illness, disease smoking in cars  Economic status  indiv bhvrs o  Reduced exposure by 33% o Social Determinance of Health  In some provinces, worker’s compensation will compensate o Lifetime of experience shaped by social experience for second-hand smoke illnesses  Twins in dif households  dif SES  dif health states  Louisville, Kentucky Mental Health & Health o Push personal responsibility, health – in social context  People with serious mental illness die an avg of 20 yrs o Data maps: correlations of illness, death – highest in earlier than rest of population west end  More likely to die from preventable illness (i.e., cancer, heart o Death 5, 10 yrs earlier in these areas disease)  Excess death: should be able predict how many ppl in a  3 times more likely to develop diabetes population should die at any one time  Twice as likely to die from heart disease o If excess: have a problem  26 districts w own economic envt & distinct health profile  Canadians w symptoms of depression also report  More east  more affluent experiencing 3 times as many chronic physical conditions o Higher SES, 6 figure income o Those w chronic physical conditions have twice as o Healthier likelihood of experiencing a mood or anxiety disorder o Top 1% of Americans (top 1% have more $$ than the o 2 way relationship btwn physical & mental health other 99% combined) o Feel safe enough in neighbourhood to go exercising  Why? o Life expectancy 81: 2yrs more than national avg  Side effects of medication, smoking, lack of basic health  Fine gradation along ladder in both health & wealth checks, professional not taking their concerns seriously (due 1970s: Pioneering Whitehall studies o How social influences affect disease o 29 000 British civil servants  Biological reasons: o Lower grade of employment  high rate of every major o Stress response: brain perceives threat  adrenal cause of death glands release cortisol  increase blood glucose, BP o Even though Britain has pubic healthcare, even w o Stress helps to motivate us controlling for unhealthy bhvrs o Cortisol helps immune fn’ing  Ex. Poor smoker has higher rate of disease than o Normal stress response spikes then goes away wealthy smoker o When stress response stays on for mth, yrs  produce o Social gradients of disease also in USA too much cortisol  Over 70% of affluent Americans: good health – twice than  Chronic cortisol can impair memory, shrink poor Americans brain areas, impair ability to use glucose o Middle level: Good health decreases significantly   heart disease, diabetes, accelerated aging  Almost twice the rate of chronic disease  Lots of stress in hospital o Lower level: twice rate of disease o Pagers o  excess death o Floor technician, clinical lab supervisor, CEO all o Reverse slope for chronic disease stressed  Social gradients in health found everywhere  But chronic stress & effects are not equally  Middle class Louisville: distributed on a hierarchy o Feel fine  Macac Monkeys: o College grads live on avg 2.5 yrs longer than highschool o Harassment by dominant animal grads  Has control to make optimum envt for self  Connects to type of job, optimism about future o Subordinate animals must be aware all the time – in  But depends on if you can afford it state of chronic stress  75 yr life expectancy  High levels of cortisol circulating in blood o 25k debt + mortgage  (-)ve on cellular fn & tissues  Cost of college increased by 35%   much larger athroschlerotic plaque than a  More college degrees in east, north dominant monkey that ate the same  Low class Louisville:  Solely due to stress o Mother working full-time   compromised artery  myocardial  Mother lost job  ill – high bp  saw doctor infarction (heart attack)  r more often  mental & physical toll on herself, Chew on cotton swabs to release cortisol: compare w SES him, his brother o More education. Higher income  less cortisol released o Owning a house is normally financial security during day o Couple had combined salary of 48k (USA median)  Exposed healthy ppl to cold virus: o Age 37: corey has hypertension o Those w less chronic stress caught fewer colds than o Avg life expectancy 6 yrs less than wealthy those w more chronic stress neighbourhood o Paradym we can use to see how effectively the immune  Cultural demarcation: system is fn’ing o Knight street: Downtown business envt across from  Higher status  less stress  better immune fn public housing projects, loan places  CEO: high demanding job, but have the resources to manage o Every city has a “knight street” the stress  These difs are not natural  Corey has to answer to high-ups, bounced around o Arise from policies or absence of policies o 1/5 American men work in low income, highly  No regulation of fast-food outlets controlled job  1/3 of residents in district high: no highschool diploma o More likely to experience high bp at wor, less likely to o Many live below poverty line decrease during sleep o Life expectancy 9 yrs less than high class, 3 yrs less o Doesn’t venture farther than is neighbourhood, feels than low class uncomfortable o Less fluency o A lot of violence in his neighbourhood o Eat what fits budget - $200 per mth  Accumulation of stressors or the accumulation of resources to o Social secutiy, SSI manage them is determined by class o 12% unemployed – more than double the national avg  Higher SES: more time to exercise (don’t have to bus for long o Getting a job – could lose medical coverage for meds time), more ability to get to places where one can make needed to work choices to by healthy food o 28 yrs old: thyroid problems, arthritis, heart attack  SES  control over parts of life (ex. food, vacation)  Can predict for the most part what someone’s life expectency  Low SES: no family vacations will be depends on where they live o Children stressed – can’t do anything about it o But it shouldn’t be this way o Walk in grps since scared to be alone  Social class is the most influential factor on health  Most of the poor in America are white o What is social class? Confidence, wealth  21% of American children live in poverty  lifelong health  How do we carry social class in our bodies? conseqs o Control of destiny: ability to influence events that o Burden of not knowing if will have resources  toxic to impinge on your life, ability to manage stressors brain due to increase hormone levels o Have to work more, job insecurity  decrease control  Brain circuitry damages over your own life  increase risk of illness o Pile up of risk, burdens; as opposed to cumulative  Invest early, set good trajectories; or engage in damage protection control  Another cold virus study: o Asked ppl if their parents owned their own home when Ch.6 – Stress they were a kid  Great predictor What is Stress?  More yrs parents owned home  less likely to  A (-)ve emotional experience get cold virus  Overlapping terms:  Poor or not, prognosis can be worse if you aren’t white o anxiety, frustration, trauma, conflict, trauma, emotional  African American die earlier, have higher rates of chronic distress illnesses than white ppl across all social gradients  Accompanied by predictable biochemical, physiological, o Not due to genetics cognitive, bhvr’al changes o Vigilance, burden it takes to be constantly on guard  Directed either toward altering the stressful event or o Racial discrimination – linked w high bp, increased accommodating to its effects rates of infant death, coronary heart disease o 1 of the best illustrations of the mind-body relationship  National study: over 83 000 excess deaths in African American o An example of the interaction btwn perceptions, bhvrs, community alone predispositions, and social/envt’al context  These health gradients aren’t fixed  Stressors: what “cause” the stress o Can get rapidly worse, so can get rapidly better  100yrs ago, avg American lived only 48 yrs Person-Envt Fit o Improvements reached Americans thru Social Reform  The relationship btwn the indiv & the envt (taxes on income, education, more hygiene)  Stress is the conseq of a person’s appraisal processes: the  Blacks excluded from many of these laws assessment of whether personal resources are sufficient to meet  Better housing the demands of the envt  1960s: civil rights laws, medicare, Medicaid o Is the situation challenging, moderately stressful or o Black-white gap in income & health narrowed very stressful o Economic policy = Health policy  Stress is determined by person-envt fit o Narrowed economic gap  improve health o Can one’s personal resources meet the needs of the  Don’t eliminate hierarchy but constrain the way it affects envt human beings o Provide help to all  reduce disparities Theories and Models Used to Study Stress  Opposite direction since 1980s  Cannon’s FIGHT-OR-FLIGHT response (1932)  Recession: reduced taxes for wealthy, social programs o The body’s complex autonomic reaction when faced w a  Gap btwn super rich & middle class is widening perceived threat  Record low of health & equality in 1976  since then it has o When organism perceives a threat, the body is rapidly soared aroused & motivated via the sympathetic NS and  Poor are getting poorer, middle class is getting squeezed endocrine system o  more health problems in future o Mobilizes organism to attack the threat or to flee  Wealth = health o Sustained arousal lays the groundwork for health o Personal asset & resources  health problems  Weath-health gradient not as steep in other nations o Evolutionary o Many have resources like universal health coverage, at o Homeostasis: the dynamic physiological response on the part of the body to maintain a stable internal sate in least 4wks of payed vacation, higher minimum wage, free college education spite of the demands of the envt  Health is more equitably distributed Theories & Models of Stress o Yet USA is the richest country in the world  Movement in Louisville  Selye’s General Adaptation Syndrome (GAS) o New health equity centre  address health needs of  3 phases: 1. Alarm phase: body reacts to stressor (defense) each community o Don’t just need more exercise & better diet o Activation of the sympathetic NS o Need better social conditions o Epinephrine is released, heart rate & blood pressure ↑, faster breathing, sweat glands activated  Seattle: o Target asthma, filtering air inside homes 2. Resistance phase: organism makes efforts to cope/adapt w  Must empower communities  empower ppl to change their the threat o Mobilizes resources lives o Disease occurs if stress continues (if constantly in o Power controls health  Arizona: Native Americans farming again  taking control of Resistance Phase) their destinies & diabetes 3. Exhaustion phase: occurs if the organism fails to overcome the threat & depletes its physiological resources  Over $1trillion/yr lost due to chronic illnesses causing work absence o Activation of the parasympathetic NS st o Abnormal reaction causing the person to become  This might be the 1 generation where kids live shorter lives exhausted than their parents  Alarm  Resistance  Exhaustion  Can be used in slower stress situations instead of just fight orsiology of Stress flight response  ANS is divided into the: 1) sympathetic NS & 2)  But doesn’t take into account psychological factors parasympathetic NS o Cognitive appraisal case  Perception of threat mobilizes the body to act thru 2 interrelated systems: The 3 Phases of Selye’s (1974) General Adaptation Syndrome 1. Sympathetic Adrenomedullary System (SAM) – the sympathetic NS & the adrenal medulla are most important o Initiates the body’s fight-or-flight response 2. Hypothalamic-Pituitary Adrenal (HPA) axis – initiates a response in the hypothal o Hypothal: portion of the brain that initiates the stress  Assumes we’ll react the same to all stressful situations response o incorrect o A delayed response to stress that attempts to minimize the initial impact & restore the body to a Criticisms of Seyle’s GAS: balanced state  Assigns a very limited role to psychological factors o Appraisal factors (Lazarus & Folkman, 1984)  Sympathetic Adrenomedullary (SAM) system  Assumes that responses to stress are uniform o Cortex o Evidence that dif stressors are influenced by o  Hypothal activates sympathetic arousal personality, perceptions, and constitutions o  stimulates adrenal medulla to secrete hormones, epinephrine& norepinephrine Theories & Models Used to Study Stress o  (increase blood pressure, heart rate, sweating, etc.)  Tend-and-Befriend Theory (Taylor et al., 2000)  Hypothalamic-pituitary-adrenocortical (HPA) axis o In addition to the Fight or Flight response, ppl respond o Hypothal activates specific hormones (corticotrophin- to stress w social & nurturing bhvr releasing hormone) o Tending: nurturing activities o  stimulates anterior pituitary gland (secretes o Befriending: affiliating w others & seeking social adrenocorticotropic hormone), contact during stress o  causes adrenal cortex to release corticosteroids  May be particularly true for women (cortisol, beta-endorphins) o Self-preservation & protection o  mobilizes body’s energy resources, raises blood o Biological mechanism: Oxytocin (stress hormone sugar level to provide energy for cells influenced by estrogen) Psychological Appraisal and Stress  Missing from earlier models  Lazarus = psychological view of stressors (perception)  Transactional: stress refers to relationship btwn person & the envt  Primary Appraisal o The perception of a new or changing envt as beneficial, neutral, or (-)ve in its conseqs  Secondary Appraisal o The assessment of one’s coping abilities , resources and judgment as to whether they will be sufficient to meet the threat of new or changing event  Reappraisal Appraisal o Change when new info becomes available (more or less stressful)  Stress o Appraising events as harmful, threatening, or challenging, and assessing one’s capacity to respond to Physical Purpose Symptom those events: exceed one’s resources are perceived changes as stressful Increase HR, Speed up delivery of Racing or pounding stronger oxygen, remove heart The Experience of Stress heartbeat carbon dioxide Redirect Provide big muscles w Pale; cold blood flow energy, lose less blood if attacked Increase Provide more oxygen Fasting breathing; breathing for energy dizziness Increase Cool body, prevent Sweating sweating overheating Pupils dilate Widen visual field to More sensitive to light  Diathetic indivs respond pathologically to the
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