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Health Psychology 2580. Mondays 6:30 – 9:20 Instructors: Mark Vosvick, Ph.D. Amy O’Neill, B.S. Today’s Agenda Introduction - Distribute & Review Syllabus - Introduce Instructors - Randomize Students into Groups - PowerPoint PPT Presentation
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Health Psychology 2580
Mondays 6:30 – 9:20
Instructors: Mark Vosvick, Ph.D.
Amy O’Neill, B.S.
Today’s Agenda• Introduction
- Distribute & Review Syllabus- Introduce Instructors- Randomize Students into Groups
• Chapter 1- Foundations of Health Ψ- Lecture, discussion & questions- Breakout groups
• Chapter 17 – Future Challenges- Lecture, discussion & questions
Introducing Health PsychologyChapter 1
How have views of health changed?
What do you think psychology’s involvement is in health?
How Have Views of Health Changed?
• Leading causes of death have changed from infectious diseases to those that relate to unhealthy behavior & lifestyle
• Escalating cost of medical care is stimulus to educate about health-related practices that lower risk of illness
• New definition of health: The presence of positive well-being, not simply the absence of disease
• Questions about traditional biomedical model & advocacy for a broader perspective of health & disease
What Do You Think Psychology’s Involvement Is in Health?
Discuss
Chronic Disease
Major health problems in the U.S today are due to chronic diseases.
What’s a basic definition of chronic disease?
A disease that develops, persists or recurs over a long period of time
What’s the opposite of a chronic disease?
Acute
Chronic Disorders
• Heart Disease
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Stroke
20th & 21st Century Chronicities
Diseases associated with individual behavior & lifestyle:
Cardiovascular Disease (stroke)
Cancer
COPD (emphysema & chronic bronchitis)
Unintentional Injuries
Diabetes Suicide
Cirrhosis of the Liver HIV
All of the above have been linked to cigarette smoking, alcohol abuse, unwise eating, stress & a sedentary lifestyle
Deaths with Preventable CausesIn 1990, more than 1 million deaths (about half the deaths in the U.S.) had preventable causes*
Tobacco 400,000 Deaths 19%
Diet & Physical Inactivity
300,000 14%
Alcohol, firearms, sexual behaviors, motor vehicles & illicit drugs
200,000 9%
* McGinnis & Foege, 1993
Ranking Complexity
Looking at an entire population allows you to obtain an overview of causes of death.
What’s the problem with stopping there (i.e. only looking at the general population)?
Age & Race statistics may be skewed
Leading Causes of Death by Age
• Chronic disease are reported as the leading causes of death in middle-aged & older people.
• Young people (15-24) more frequently die from accidents or unintended injuries:
Unintentional injuries 40%Homicide 21%Suicide 14%
• For adults 25-44, HIV is the primary cause of death
Leading Causes of Death among Adults – U.S. 199515 – 24 y.o. vs 24 – 44 y.o.
Heart Disease
Cancer
Suicide
Homicide
HIV
Accidents &UnintentionalInjuries
0 5025
10.6%3.0%
13.7%4.7%
7.9%13.9%
6.4%21.2%
19.2%1%
17.2%40.4%
Leading Causes of Death by Race
Ethnic background is also a factor in life expectancy & cause of death.
Why do you think?
Social Class Differences
Research has shown that social class differences, sometimes referred to as SES (socio-economic status) are more important in predicting health risks than ethnic differences. However, this construct is complex and includes income level, education & occupation.
HealthBehaviors
Interactions
Income
Education
Occupation
Social Class
Race
Research Associations
• Poverty is a factor in disease rates & decreased life expectancy
• Disproportionate numbers of African-Americans, Latinos & Native Americans are poor
• Access to medical care is a factor that makes poverty a health risk
• Poverty is associated with poorer health habits
Conclusion: Poverty puts poorer classes at increasedrisk for disease
Poverty & Health
• Prenatal health risks
• Cutbacks in federal immunization programs
• Neighborhood violence
• Regular health care is difficult
Income Level
Within any income level, those at higher levels have better health & lower mortality
One Hypothesis: Income is related to educational level & educational level is related to behaviors that increase health risks such as smoking, eating high-fat diets & maintaining a sedentary lifestyle.
Life ExpectancyThe 20th century witnessed a dramatic increase in life expectancy in the U.S. (from 47.3 to 76 years)
What factors do you think contributed to this?• Better control of infectious diseases• Reduction of infant mortality rates• Safer drinking water & milk supplies• More efficient sewage disposal• Improved nutrition• Antibiotics• Improved medical care
Escalating Medical Costs
• As people live to middle & old age, they tend to develop chronic diseases which often require extended (and frequently expense) medical treatment.
• The cost of medical treatment is increasing much faster than inflation (a 600% increase from 1975 to 1995)
• Curbing medical costs requires a greater emphasis on the early detection of disease & on changes to a healthier lifestyle & to behaviors that are preventative in nature
Strategy• Early detection of high blood pressure, high
serum cholesterol & other precursors of heart disease allows conditions to be controlled, decreasing risk of serious disease or death
• Screening for risk is preferable to remedial treatments since chronic diseases are difficult to cure & living with these diseases decreases quality of life
• Maintaining health through a healthy lifestyle is even more preferable than screening
So which is the best strategy?A healthy lifestyle along with early detection & reduction of health risks
What is Health?
Discussion
Two Categories:
Health is an ideal state
Health is a movement in a positive direction
Markers of Health
Psychological Manifestation- A subjective feeling of well-being
Social Manifestations- High levels of social productivity
- Low demands on the health care system
Cultural Implications
What does it mean to be healthy?Ancient Hebrews: a gift from God, but disease is a punishmentAncient Rome: an absence of pathogens, such as bad air or body fluids, that cause diseaseEarly Christians: not as important as disease, which is a sign that one is chosen by GodWorld Health Organization: A state of complete physical, mental & social well-being
Changing Health ModelsBiomedical Model
- defines health as an absence of disease- diseases are caused by specific pathogens
Biopsychosocial Model- defines health as a positive condition- a medical model that takes into account the patient, the social context in which he/she lives & the complementary system devised by society to deal with disruptive effects of illness
Major Trends in Health Care Chronic diseases have replaced infectious diseases as the leading cause of death & disability
Increase in chronic disease has resulted in an increase in medical costs
Definition of health is changing from ‘the absence of disease’ to a ‘state of positive well-being’
Emergence of the biopsychosocial model of health
Psychology & HealthSince most chronic diseases stem at least partly from individual behavior, psychology (otherwise known as the science of behavior) has become involved in health care
Major contributions: techniques for changing behaviors implicated in chronic diseases, relieving pain, reducing stress, improving adherence & help in living with chronic illness
Psychology in Medical Settings
In the 1940’s medical training limited psychological factors to how they related to disease
In the 1960’s behavioral science became a part of the curriculum in most medical schools
By the 1990’s, MD’s no longer thought of health psychologists as stats consultants, test administrators or therapists with skills limited to psychosomatic illness.
Psychosomatic Medicine
Psychosomatic medicine is concerned with the emotional & psychological components of physical diseases & the psychological & somatic factors that interact to produce disease
Early Research
1932 – Cannon observed that physiological
changes accompany emotion*
This research demonstrated that emotion could cause physiological changes which might be related to the development of physical disease
* Kimball, 1981
1943 – Dunbar developed the notion that habitual responses, which people exhibit as part of their personalities, are related to specific diseases – i.e. a relationship between personality & disease
1950 – Alexander saw psychosomatic disorders as resting on a link between personal conflicts & specific disease. He believed some people were more vulnerable to effects of stress on organ systems and would develop a disease to which they were most vulnerable
Terminology
By the 1970’s the emphasis shifted away from specific diseases & the term psychosomatic was no longer applied to diseases but to an approach to the the study & treatment of disease.
The psychosomatic approach describes illness as complex & that the single-factor pathogen model is no longer viable
Psychosomatic medicine started as a reform movement in medicine but was not entirely successful in emphasizing the psychological & social components of somatic disease.
Behavioral medicine has subsumed the original objectives of the psychosomatic movement.
Behavioral Medicine
1977 – a conference at Yale University led to the definition of a new field, behavioral medicine, defined as ‘ the interdisciplinary field concerned with the development & integration of behavioral & biomedical science knowledge & techniques relevant to health & illness & the application of this knowledge & these techniques to prevention, diagnosis, treatment & rehabilitation
Goals of Behavioral MedicineDesigned to integrate medicine & the various behavioral sciences, the goals include:
Improved prevention
Diagnosis
Treatment
RehabilitationB-Med attempts to use psychology & the behavioral sciences along with medicine to promote health & treat disease
Behavioral HealthBehavioral health emerged about the same time as B-Med and emphasized the enhancement of health & prevention of disease in healthy people rather than the Dx
& treatment of disorders in sick people. Behavioral health is an interdisciplinary subspecialty in B-Med specifically concerned with the maintenance of health & the prevention of illness & dysfunction in currently healthy people.
Behavioral Health TopicsTopics included within behavioral health:
Injury Prevention Cigarette Smoking Alcohol Use Dieting Exercise
Focus is on individual responsibility for health & wellness rather than physician dx, treatment or rehabilitation
Health Psychology
Related to both B-Med and behavioral health is a discipline within the field of psychology called Health Psychology, the branch of psychology that concerns individual behaviors & lifestyles affecting a person’s physical health.
Health Ψ Contributions
Health psychology contributes to:
The enhancement of health
The prevention & treatment of disease
The identification of health risk factors
The improvement of the health care system
The shaping of public opinion with regard to health
Specifically, Health Psychology involves the application of psychological priniciples to such physical health areas as:lowering high blood pressurecontrolling cholesterolmanaging stressalleviating painstopping smokingmoderating risky behaviorsencouraging regular exerciseencouraging regular medical/dental examsencouraging safer behaviors
Additionally, health psychology helps to identify conditions that that affect health, diagnose & treat certain chronic diseases & modify the behavioral factors involved in physiological & psychological rehabilitation.
History of Health Ψ
1973 – the Board of Scientific Affairs of the APA appointed a task force to study the potential for psychology’s role in health research.
1978 – APA established Division 38, Health Psychology
1982 – the journal Health Psychology began publication
Group Exercise
Future Challenges
Chapter 17
Looking Toward the Future
Healthy People 2000
Three broad goals, 22 priority areas & 300 main objectives
Broad Goals:– Increasing the span of healthy life– Reducing health disparities– Increasing access to preventive services
Increasing the Span of Healthy Life
Well-year
- the equivalent of a year of completely well life, free of dysfunction, symptoms & health related problems
Health expectancy
- the period of life a person spends free from disability
Reducing Health DisparitiesHealthy People 2000
- a plan to reduce ethnic & socioeconomic disparities by targeting minority groups separate from general population
Healthy People 2010- emphasis shifted away from targeting special groups toward high standards of improved health for everyone
Factors Contributing to Disparity
• Education
• Income
• Occupational Status
• Ethnic Background
Complex interactions between these, which complicates interpretation of reasons for disparities
Example of Disparity
African Americans, compared to European Americans:
- have shorter life expectancy- higher infant mortality rate- more homicide deaths- increased cardiovascular disease rates- higher cancer mortality- more tuberculosis- more diabetes
Native Americans
Low economic status & lack of access to medical care affect Native Americans at least as strongly as African Americans.
- shorter life expectancy
- higher mortality rate
- higher infant mortality
- higher rates of infectious illness
Latino/Hispanic AmericansMany Latino’s/Hispanic Americans also experience low socioeconomic status & poor education but not all groups are equally affected & their health & longevity tend to vary accordingly.
This group fares about the same or better than European Americans on health & mortality measures
- lower death rates
CuriouslyLow death rates (specifically due to heart disease, stroke & lung cancer) among Latino/Hispanic Americans is puzzling, given the high rates of smoking, obesity & hypertension in this group.Hypothesis?A lag during transition from adopting U.S. lifestyle behaviors to the development of associated chronic diseases
Asian AmericansAsian Americans who adopt U.S. lifestyle behaviors that increase their risk, however this group still has a more favorable health status & life expectancy than other ethnic groups.
- lower infant mortality- longer life expectancy- lower lung & breast cancer deaths- lower cardiovascular death rates
Increasing Access to Preventive Services
Primary Prevention- consists of immunizations & programs that encourage lifestyle changes- encouragement to quit smoking, eat properly, exercise & moderate drinking- usually a good bargain (i.e. cost effective) with few risks
Secondary Prevention- screening people at risk for developing a disease in order to find problems in their early & more treatable stages.- costly
Profession of Health PsychologyGoal of Health Psych:
Translate knowledge into actionFour Major Contributions:
- accumulate more information on behaviors & lifestyles vis a vis health & illness- promote & maintain health- contribute to the prevention & treatment of disease- help to formulate health policy & promote the health care system
Psychology’s historical involvement in changing human behavior positions it to:
- help people eliminate unhealthy practices- support their attempts to incorporate healthy behaviors into an ongoing lifestyle
Challenges include:Asthma Arthritis
Alzheimer’s AIDS Cancer Stress
Diabetes Headaches Cardiovascular disease
Employment OpportunitiesSince the early 1980’s, employment opportunities for health psychologists have increasedPositions includeFaculty appointments in universities & medical schools, postdoctoral research fellowships, predoctoral internships, employment in hospitals, clinics, private practices, HMO’s & pain clinics
TrainingHealth Psychologists now receive a solid core of graduate training in areas such as:-biological bases of behavior, health & disease-cognitive & affective bases of behavior, health & disease- social bases of health & disease- psychological bases of health & disease, focusing on individual differences- advanced research, methodology & statistics- psychological & mental health measurement
Work Settings
• Universities
• Hospitals
• Clinics
• HMO’s
• Private Practice
• Center for Disease Control (CDC)
• National Institute of Health (NIH)
A Day in the Life of…Health Psychologists:
- Teach- Conduct research- Provide service to individual patients & agencies
Much of the work is collaborative, frequently working with teams of health professionals including physicians, nurses, physical therapists & counselors
Services Include
• Alternatives to pharmacological treatment– Biofeedback instead of analgesic drugs for
headache patients
• Primary treatment for physical disorders that respond favorably to behavioral interventions (chronic pain & GI problems)
Services Continued
• Traditional psychological services for hospitalized patients (i.e. cardiac or cancer patients)
• Help to improve adherence to medical regimines (including drugs)
• Provide assessments
Future Challenges
• Changing patterns of illness
• Escalating cost of health care
Changing Profile of DiseaseTrend shifts from Cardiovascular Disease
(CVD) to Cancer• Focus has been on CVD, with the
development of behavioral interventions for reducing cholesterol, lowering blood pressure, encouraging exercise & promoting heart-healthy behavior
• An expectation that deaths from cancer will surpass CVD
• The prominence of cancer as a cause of death among young & middle-aged adults– Children & adults from 50 – 65 show a
greater tendency to die from cancer– Cancer accounts for more premature death
than CVD
• The leading cause of death in young & middle-aged women– 37% of deaths in women btwn ages 15 &
64 (only 22% for CVD)
• Reducing unintentional injuries – the leading cause of death for young people btwn ages 15 & 24. Leading killers:
- motor vehicle crashes- intentional violence- suicide
• Aging of the U.S. population. After 65, many people develop chronic illnesses & suffer from chronic pain
Controlling Health Care Costs
• Health Care Costs in the U.S. have escalated at a higher rate than inflation & other costs of livingContributors to increase:– Proliferation of hospitals– Growth of technology– Large proportion of MD’s are specialists– Growing Administrative costs