Health Psych Based on the Biopsychosocial model Topics- bio psychosocial model, Placebo effect, stress, psychosocial factors in disease, pain, health communication, belief that aid adjustments, health behavior change, sustainability, Goals- gain factual knowledge, learn fundamental principles, analyze and critically evaluate ideas, apply course material to life HeWe also discuss several other topics like engl1800
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alth persuasion: Drinking campaign- goal was to inform students that the perceptions they had were inaccurate. Reduce harmful drinking by showing that people actually drink much less than perceived. Eating Self control and self dieting Health Psychology definition- the scientific contribution of psychology to 1. The promotion and maintenance of health 2. The prevention and treatment of illness 3. The identification of the causes of health, illness and dysfunction 4. The analysis and improvement of the health care system Doctors and empathic opportunities to something like “I’m not sure what there is to look forward to” Oncologists responded with “continuers” 22% of the time. To continue to express their emotion in a similar way. 78% of the time, no continuation/ terminators. Terminated emotional expression of the patients Bidirectional relationship Health psych looks at the interplay between psych and physical health -the effects of physical health on psychological functioning -effects of psychological events on physical health Can beliefs affect your health? Levy et al. Beliefs on aging. Longitudinal study Negative views on aging: lied 1t years more Positive views on aging Lecture 2- The biopsychosocial model and methodology Illness through history Stone age- evil spirits have possessed you and entered through your head. Trephination. Healing occurred Middle age-Plague Health function of yellow bile, black bile blood and phlegm and astrology Renaissance- Greater stride with the discovery of microscopes and autopsies Medicine began focusing more and more on the body Mid 1700’s- Specific physiology All sicknesses caused by- capillary tension. Method of release of said tension was with leaches Leaches are natural anti coagulants which are still used for patients who have fingers or toes reattached 1800’s- comfort. Started noticing that untreated patients were typically doing better than those who were treated. The general response to illness was trying to comfort the person. 1900’s penicillin discovery 1928. Lead to biomedical model of health and illness. ∙ Illness is based on organ malfunctioning or biochemical imbalance ∙ Surgical or medicine related treatment ∙ Assumption- all illness has a biomedical cause ∙ Body is separate from mind ∙ Most common cause of death was influenza, tuberculosis, pneumonia, gastroenteritis ∙ Evolution of biochemical model o Successes: Acute illnesses o Infection diseases Tuberculosis Pneumonia Tetanus Typhus Smallpox Malaria Polio o Failures-chronic those that involve a slow accumulation of damage Illnesses that you live with for long period of time Revolution of what people are dying from Behaviors associated with the most common cause of death ∙ Strong behavioral component such as diet, lack of exercise, smoking, drugs etc to a much greater degree than before ∙ Evolution to our current model of biopsychosocial model Biopsychosocial model ∙ Biological factors such as organs cells tissues, ∙ Psychological factors such as individual’s motivations beliefs emotions attitudes and BEHAVIORS ∙ Social factors; society culture community family social class Why do we need a biopsychosocial model? Engel 1977 Real need to get people into this profession and field Journal of science 1. Having a biomedical defect indicates disease potential but not the disease existence – biomedical defect alone is not sufficient to lead to the disease, some people have the disease and do not even know it 2. Ignores beliefs- beliefs about illness matter 3. Two people with the same biochemical problems may have different disease outcomes 4. Successfully treating the biomedical problem doesn’t necessarily make the patient healthy 5. Behaviors matter (both of the patient and doctor) Evaluating health research 1. We need tools to decide between opposing claims 2. Study methods a. What are good methods? b. What are not so good methods? 3. Where does conflicting information come from 4. How do we make sense of it all Example- high fiber diet and colorectal cancer Surgeon observed that intestinal cancer is rare among poor rural Africans Studies with correlational design showed _____________ Correlational research design Strength- allows you to identify factors that might be contributing to a health condition Weakness- CANT distinguish between different causal stories Causations can be reversible- example with coffee and pregnancy enzyme making coffee taste bad Third variables Types of correlational design ~ Relatively weak ∙ Cross sectional- measure variables at the same time. Ex. Ask participant “do you have colorectal cancer right now” and “what is your diet right now” ∙ Retrospective or case control design – looks back in time, measure by asking “do you have cancer right now” and “what kind of things did you eat in YOUR PAST.” Can eliminate reverse causality. Problems- still correlational, and people don’t remember very accurately ∙ Case control studies- studies show that those with colorectal cancer consumed less fiber in the past than those without colorectal cancer ∙ Prospective- strongest type of correlational design. Measure predictors (baseline), look forward in time and follow them to see who develops illness. Strengths- reduces reverse causations, allows to control for confounds. Yet still correlational Experimental design- the only design that allows you to conclude that one thing causes another. Randomly assign people to conditions of your independent variable. Measure dependent variable later on Research shows through randomized trials that high fiber diets do not decrease chances of developing colon polyps (which lead to the cancer). Maybe it was red meat all along (from prospective longitudinal) Media trying to get our attention Lecture 3- Placebo effect Famous placebos 1. Theriac- made from viper’s flesh 2. Unicorn’s horn: sold for 10 times its weight in gold 3. Mandrake; used in Shakespeare and Harry Potter People would see efficacy What may actually be occurring 1. The ailment runs its course “natural history effects” 2. Specific active component of treatment help the person 3. Non specific effects of a treatment help the person. These are called the placebo effect Placebo- Latin for “I will please” Placebo- inactive substance or condition that has the appearance of an active treatment and that may cause participants to improve or change because of their belief in the efficacy of the treatment How to test 1. Run a study with three groups of subjects 2. Objectively measure your outcomes Studies that do NOT test for the placebo effect Placebo controlled double blind studies ∙ Placebo controlled double blind studies ∙ Patient given 1. Active drug 2. Placebo ∙ patients do not know what they received ∙ experiment does not know what patient received ∙ these test for TREATMENT EFFECTS/ Efficacy of the drug ∙ cannot see if theres a benefit of the placebo vs the treatment running its course Studies that DO test for placebo Three groups 1. active drug 2. placebo~active placebo (has side effects not not medicinal effects) vs inactive (sugar pill) 3. nothing (often wait list control) 4. again, patient and experimenter both do not know what the patient receives graphs with treatment being greater than placebo and placebo being greater than non treatment treatment effect stronger than placebo! Want your measurements to be objective 1. not self reported 2. ideally measured or observed by someone else Hypertension example ∙ 58% of patients received anti hypertensive reduced their blood pressure ∙ 31% in placebo group reduced their BP ∙ over half treatment participants would have met their goals if they received placebo Surgical Placebo ∙ 650,000 people a year have arthroscopic surgery for arthritis in their knees ∙ 40% of subjects in each condition showed improvement What affects the placebo effect? ∙ How the health care provider behaves? ∙ Characteristics ∙ …. ∙ .. Provider behavior matters All patients given tranquilizer by doctor who -expressed confidence in it -expressed doubt results- confident doc 77% effective doubtful 10% effective Example 2- IBS therapeutic rituals Patient expectations ∙ double blind sham surgery controlled trial designed to determine the effectiveness of transplantation of human embryonic dopamine neruons in the braisn fo persons with advanced Parkinson’s disease ∙ no/little difference between real vs sham surgery ∙ patients whoo believed they received surgery improved, regardless of whether they received surgery or not characteristics such as the way the placebo looks also matters, and even prices What affects the placebo effects? How the health care providers behave -confidence and warmth=stronger placebo effect characteristics of patients- patients must thinks it will work situation factors/characteristics of the placebo- the more medical it seems, the better it works social norms- faithful in modern medicine placebo effects have both biological and ________ decrease anxiety endorphin release classical conditioning expectations Global vs Local effects ∙ procedure o placebo painkiller on one index finger o apply pain to both index fingers at once o patients report less pain in finger with placebo painkiller ∙ because of the specificity of the results: conclusion: placebo does not work by reducing stress, increasing mood or through endorphins conditioned pain relief- ∙ before condition o US Morphine UR pain reduction o CS- kneedle ∙ during conditioning o needle+ morphine pain reduction ∙ after conditioning ∙ CS needle CR?? Problems 1. Placebo effects get stronger over time, but conditioned effects show an extinction 2. Placebos can do the opposite of what they are supposed to do 3. Placebos can work even if no prior experience with real medicine- Rogaine Expectations- necessary cause ∙ Prior experience with the drug is not necessary ∙ The more believable the placebo, the more likely it is to work ∙ A placebo can do the opposite of the active drug ∙ There are no cases of placebo effects in the absence of an expectation Impact of placebos ∙ peptide therapeutics share price dropped 33% after new allergy vaccines only effective as placebos ∙ Merck stopped production of antidepressants when dummy pill worked just as well ∙ placebo effects getting stronger, problematic o ironically because of pharmaceutical industry Nocebo effects ∙ just like placebo effects, but inactive substance causes unpleasant effects o hair loss o nausea o medical student syndrome ∙ problem of nocebo: people drop out from medical trials because of side effects even when they get placebo Should placebos be prescribed? ∙ Cheaper, safer than drugs ∙ Patients seem to want the attention and confidence as much as the drug ∙ Might work particularly well for some ailments such as depression Lecture 4- Stress: Conceptual and Historical Issues What is stress? A negative emotional experience accompanied by predictable biochemical, physiological, cognitive and behavioral changes that are directed towards either altering the stressful event or accommodating to its effects. Types of stressors Physical- all animals might feel such as heat cold pain fatigue injury hunger, predators Psychological- are generally only considered to be stressful by humans, such as job, grades, security, money relationships traffic etc Acute- demand immediate attention and don’t last long. Appear suddenly Chronic- do not require immediate attention, last long time and are constant source of worry 2x2 matrix History of Stress research Six key moments 1. Walter Cannon fight or flight behavior a. Stress causes physiological changes i. Increase in blood sugar level ii. Large amount of adrenaline (epinephrine) iii. Increase in pulse rate and blood pressure iv. Increase in amount of blood pimped to skeletal muscles b. Changes are for fight or flight, helpful in short term, but disrupts normal functioning 2. Hans Selye: general adaptation syndrome a. Father of stress b. Published “the stress of life” c. Injected rats with ovarian extracts i. Observed enlarged adrenal glands ii. Shrunken lymph nodes iii. Bleeding ulcers d. After injecting with saline solution- found same exact results e. Response to the stress of being a lab rat since he was very clumsy and etc f. Subjected the rats to other stressful conditions of unpleasantness g. General adaptation syndrome- non specific response of the body to any demand placed upon it h. Three stages to this syndrome i. The alarm stage-mobilize resources ii. Resistance-cope with stressors iii. Exhaustion – reserves depleted 3. Holmes and Rahe a. Scaled life events that cause stress- top score was death of spouse, divorce, marital separation, detention in jail, etc… but theres also Christmas. what is most stressful is CHANGES from typical events b. c. Attached numbers to the stressful events d. e. Charles Bukowski “its not the large things that send the man to the madhouse, it’s the continuous series of small tragedies that sends the man to the madhouse” f. g. Daily hassles h. -quarreling with neighbors i. -traffic congestion j. -misplacing or losing things k. -arguments with romantic partners l. -concerns about money m. -parking ticket n. 4. Lazarus a. What matters is how we perceiving and interpret the event b. This process is known as an appraisal i. Primary appraisal ie is the event positive, negative ii. If negative- is it harmful, threatening, challenging ? 5. BlascovichAllostasis- the body’s maintenance of an appropriate level of activation during changing circumstances Allostatic load- the physiological costs of chronic allostasis ie. The ‘wear and tear” that the body experiences as a result of prolonged activation of physiological stress response The arousal to exhaustion stage (selye) may lead to cumulative damage to the organism Scaled life events that cause stress- top score was death of spouse, divorce, marital separation, detention in jail, etc… but theres also Christmas. what is most stressful is CHANGES from typical events Attached numbers to the stressful events Charles Bukowski “its not the large things that send the man to the madhouse, it’s the continuous series of small tragedies that sends the man to the madhouse” Daily hassles -quarreling with neighbors -traffic congestion -misplacing or losing things -arguments with romantic partners -concerns about money -parking ticket stress impacted by something like narrative, such as in the example with the unnamed society and penis cutting with sharp object signs to note in a clinical interview ∙ Attire/grooming ∙ Posture ∙ Physical characteristics o Skin tone, weight, symmetry, body anomalies ∙ Mannerisms ∙ Speech (articulation, prosody) ∙ Consciousness (level of alertness, fogginess, hyper vigilance) ∙ Emotional state ∙ General attitude (defiant, compliant, guarded, defensive, sincere) ∙ Thought content ∙ Thought processes o Thought broadcasting-believing that everyone can read your mind ∙ General knowledge ∙ Abstract thinking-random questions you would not think of typically ∙ Social judgment∙ Insight-“why are you here today” ∙ Cognitive functioning Verbal fluency task- FAS animals ∙ Say the names of as many words beginning with the letter F,A,S as you can in the next 60 seconds ∙ Prefrontal functioning Mini mental status exam ∙ Samples orientation ∙ Registration ∙ Attention and calculation ∙ Language Stress on Help SOUTH HALL 1431 Cognitive appraisals matter Who was most stressed? Trauma narrative=most stressed No sound= next more Least stressed: denial, detached, scientific narrative same events, but not same stress not the objective experience, but the subjectivity Blascovich- biopsychosocial model ~ distinct cardiovascular ∙ Identified psychophysiological markers of challenge and threat states ∙ Challenge (when resources>demands) o Activation of sympathetic adrenal medullary acis SAM o Release of epinephrine/norepi o Quicker recovery ∙ When demand>resouces o Activation of SAM axis as well as hypothalamic pituitary adrenocortical axis Release of cortisol Slower recovery impedance cardiograph can help you map these physiological implications -indices of response in terms of challenge and threat (HR, blood flow etc) Challenge/threat CV indices- predicts sports performance with baseball/softball .. challenge and threat index vs conference runs creating. Predictive validity in these physiological models. Build on the ideas of cognitive appraisal and lazarus model and mapped it on to specific physiological states of challenge and threat that you can assess with the use pf psychophysiology. Taylor et all- Tend and befriend ∙ Fight or flight primary physiological response to stress… ties back to behavioral response of coping. ∙ Males and females have different behavioral responses to stress: each is adaptive for that sex Males: ∙ Fight or flight is the primary response ∙ Activated by testosterone Females ∙ Tend and befriend activated by oxytocin ∙ Tending- nurturing activities, protecting offspring ∙ Befriending: seeking social support Were primarily using male rats prior to this study since they were giving more consistent responses Impact of stressors on our health Humans- not turning off stress response, “wallow in a corrosive bath of hormones” the stress response is more damaging than the stress itself Why Zebras don’t get ulcers book Autonomic nervous system 1. Sympathetic- fight, fright, flight, reproduction Need body’s resources immediately 2. Parasympathetic – mediates calm, vegetative activities, growth, energy storage and repair. More long term Stress response- collection of physiological and behavior response that help re establish homeostasis. Nonspecific response many stressors elicit similar stress responses 2 interrelated systems are involved ∙ Sympathetic SAM ∙ Hypothalamic HPA. Most likely activated due to self evaluative stressors where person doesn’t feel in control (Dickerson and Kemeny) Acute vs chronic stressors Possible harm of activating acute stressors, may possible turn to chronic? Stress response is perfectly attuned to their environment. They either escape and calm down or don’t get to escape What stress does to your body ∙ Mobilizes energy o Energy needs to be in usable form, not stored in our fat cells o Insulin secretion decreases which makes for a higher glucose level in the blood. o Stored nutrients in fat cells, liver and non exercising muscles are converted to glucose and sent to exercising muscles o Health problem- fatigue and diabetes ∙ Raises heart rate/blood pressure o Delivery to muscles as fast as possible o Health problem- chronic wear and tear of your heart. Cardiovascular disease, heart attacks, strokes (blood vessel damage) o Example- world cup and cardiovascular events ∙ Slows digestion o PNS driven thus is inhibited by stress o Bladder, large intestines empty o Health problems- ulcers (hole in wall of organ) , colitis ( inflammation of colon) , irritable bower problems o Disproven by nobel prize winners in 2007 Helicobacter pylori-stomach issues caused due to bacteria as opposed to “stress” o Wont experience ulcers unless you have this bacteria, so disproves directness between ulcers and stress ∙ Slows growth o Suppression of growth hormone o Can also be malnutrition o Orphanage study – confound was Fraulein …one was nice and the other was mean thus stress was induced on one orphanage o Care and nurturing led to more growth (than extra food rations) o Problem- dwarfism ∙ Slows reproduction o in females- reproductive hormones decrease o in female0 PNS must be on for erection o testosterone levels decrease o overall loss of interest in stress ∙ Blunts pain o Endorphin release, release of endogenous opioid peptides (endorphins) o Soldiers in war o Health prob: possible worsening of injuries ∙ Suppresses immune system o First few minutes- enhanced o After approximately 1 hour- suppressed o Chronic stress-increase susceptibility to illness/infection o Slower healing. Psychoneuroimmunology o Stress and colds Check in at cold research unit Complete questionnaire on stress and other factors Random assignment to receive cold virus or placebo Measure cold symptoms See if stressed subjects are more likely to get the cold Coping with illness and social support Case study of Scott Norris –malignant brain tumor Psychosocial factors of cancer Stress, depressed mood, lack of social support are associated with greater cortisol output, disruption of cortisol secretion and higher level of urinary catecholamine’s Can impact cancer cells in terms of development of tumors with interleukin -6 production. Higher levels of growth factors Optimism Research is discovering pathways by which these psychological factors can affect cancer progression Stanton et all- expression of emotions among people who have developed cancer ∙ Emotional processing- people try to understand their feelings ∙ Emotional expression- sharing with others ∙ Studied 92 breast cancer patients o Measured emotional processing at baseline o Measured emotional expression at baseline o Prospective correlational study ∙ Results 3 months later o More processing=more distress o More expression=less distress and better healthSelf affirmation – positive reflection on a values domain ∙ Early stage breast cancer ∙ Self affirmation writing associated with less physical symptoms and less doctor visits Coping with illness 1. Social support 2. Psychological control 3. Self affirmation 4. Positive state of min 5. Positive adjustment Social support 1. Social integration- do you have social relationships? 2. Social networking properties- what are the characteristics of your social support networks? How diverse? 3. Function- what do these relationships do for you? Do they provide support or cause conflict? 4. Transactions-in what way do people actually utilize their support networks? Social support and health ∙ They are associated: people who are socially isolated get sick more often and die at younger ages than people who have large social networks ∙ Reverse causality? ∙ Possible third variables? o Stress? o Depression Prospective longitudinal study- followed 7000 adults for 9 years -baseline: measured numbers of social ties -followed up: recorded when “if” they died results- more social ties, longer longevity men 2.3 years longer, women 2.8 years longer when having more than average number of social ties. Relationship stronger than the correlation between smoking and death, controlled for many third variables quarantine people for 5 days, then look at blood antibody count for virus Reports measured levels of colors vs illness criteria Low social network diversity are more susceptible to developing colds How does social support affect health? 1. Direct effects model- social support leads to beneficial health at all levels 2. Buffering model- at low levels of stress, social support doesn’t really matter. At high levels of stress, support buffers and leads to better health 3. Health behavior model – social support leads to a more positive health behaviors which leads to better health. Social support and coping with cancer ∙ Survey- cancer patients want emotional support, find it most helpful, but don’t get it ∙ Longitudinal- cancer patients who receive most emotional support adjust best ∙ Intervention studies- cancer patients put in support groups with other cancer patients Women with metastatic break cancer randomly assigned to support group or wait list control group Support group women lived 18 months longer than control group women Reported less pain and distress (quality of life) even though there was a non significant difference in longevity of life among both groups not replicable Lecture 8~After midterm Next exam on may 18 Who gets sick? 3 parts of the etiology- One disease is related to personality, one does not have a personality component, one personality is related to illness in general associations says nothing about in the extreme case the person bringing on the disease due to their personality. These personality tests are malleable personality refers to individual differences in characteristic patterns of thinking, feeling and behaving. The big 5 personality predicts important life outcomes and behaviors Is set before attitudes, values or beliefs -health -social status -close relationship behaviors I. One disease that is related to personality- CARDIOVASCULAR disease.. type A personality. Exaggerated sense of time urgency. Competitive and ambitious Hostile and aggressive. Risk factor for cardiovascular disease. Discovered through a chair Robert sapolsky *** Western collaborative group study ∙ Interviewed 3000 men ages 39-59 ∙ Assessed type A personality ∙ Followed them for 8 years ∙ Twice as likely to get heart disease ∙ Twice as likely to die of heart disease ∙ Followed up for 22 more years, relationship did not hold up: noise to system. Toxic hostility was the key Type A in general : unreliable Hostility Vicious cycle: causes provocation of conflicts, undermines social support, makes environment more stressful “Angry at heart” cardiovascular reactivity – certain peoples HR goes up much higher when describing an event that made them angry death rates for cardiovascular disease – generally rising up to 1960 followed by a decline. Includes coronary heart disease, coronary artery disease and strokes 34% are due to CVD decline is due to improved emergency coronary treatment and increased awareness in risk factors of CVDHostility and Anger is more dangerous to health: to express it or express it? -expressing hostile emotion is worse for your heart than feeling angry -yet suppressing (and rumination, depression, stewing) can act as a trigger for those with CVD and precipitate heart attack or stroke Freud’s catharsis- people will be relieved or cleansed by expressing negative motion. NOT supported Expressing anger calmly and rationally in a way that resolves rather than escalates conflict is associated with better cardiovascular health Not just the anger that increases risk but the additional stress caused by alienating others due to those hostile expression, seek treatment due to undermining relationships with others How to reduce 1. progressive muscle relaxation, reduces physiological arousal and increases relaxation 2. Self talk: repeating calming statements to yourself to prevent yourself from erupting in anger 3. Cognitive reappraisal training a. Breathe b. Label c. Reappraise- make the sting out of the emotional punch- reappraise your perception of the situation in a more positive term. What matters is the subjective experience II. OPTIMISM- belief that one will generally experience good or positive outcomes a. Optimists more likely to be healthier b. More likely to use health promoting behavior c. Less likely to engage in risky behaviors d. Less likely to distressed by physical symptoms e. More likely to use effective coping techniques Optimism scales used All of these are association Turning pessimists into optimist ∙ Participants: women with HIV (24 pills per day) ∙ Had pessimists write about a positive future for a month ∙ Compared to pessimists in a non writing control group o Pessimists who wrote became more optimistic o Their behaviors changed to healthier ones III. One disease that does not have a personality component. CANCER Galen (2nd century) sad women more likely to get cancer than happy women Walshe (19th century) happy women more likely to get cancer than sad ones Believed to have nervous, overly focused on relationships, ego centered, focused on self, with negative views, lack of anxiety, unable to have relationships, etc as cancer associated yet each one has both sides of the spectrum Bad research ∙ Sample people with cancer ∙ Administer personality tests for them and the control∙ See differences Main problems: “atheoretical” studies, one without hypothesis, can find anything. Causation very unclear No random assignment Results: validity and replicability are low Good study design: larger samples, administer personality tests, wait until they all die (prospective design) and record what diseases they got along the way See which personality tests predicts who ended up getting cancer Replicate with another large sample Meta analysis ∙ Associations are weak to non significant ∙ Studies with associations between personalities ad cancer have methodological flaws ∙ Conclusion- results speak against the influence of personality in the development of cancer AFTER MIDTERM 1- PAIN 1. What is pain? 2. Types 3. Theories 4. Myths 5. Treatment Ashelyn blocker- when she was two she had a severe diaper rash… very severe, hurt to even look at it. But she never cried or complained. Notice she also had a corneal abrasion which should cause tremendous pain for anyone experiencing it, but she had no type of response. She is known as the girl who cannot feel pain- congenital insensitivity to pain with anhidrosis CIPA Hidrosis- inability to produce tears Continuous risk by not feeling pain Pain should be distinguished from suffering and nociception Pain- a conscious experience. Does not equal to pain stimulus -Pain stimulus does not equal pain: Pain stimulus is the instigator of the pain- pain doesn’t require a physical pain stimulus (such as phantom limb). A pain stimulus doesn’t always cause -pain (Alicia follmar). Pain stimulus is what is going on in the nociceptors in the peripheral NS -Pain does not equal behavior- a person can be in pain without pain behaviors (groaning) -pain behaviors do not require being in pain (acting) typically measured via self report of a 10 point scale suffering- a negative emotional feeling that may accompany pain -suffering can happen in the absence of physical pain (emotional suffering -can happen without suffering Nociception- nervous system activity, in response to a noxious stimulus, which relays information from the periphery to the brain -you can have nociception without pain~Alicia Follmarrunner person example -you can have pain without nociceptors ~ pain perplex. History of pain and patients who experience a lot of pain in week’s readings -capsaicin in hot peppers is an example- used in treating pain Nociception- text definition is confusing so ignore. pain- higher order brain processing Theories Cartesian View of the pain- Cartesian dualism: Mind and body are separate -pain has only physical causes -injury stimulates nerves, impulses are transmitted to brain, mind perceives pain 20th century research: a delta fibers and c delta fibers *Gate control theory)- nociception goes through a gate in the spinal chord (dorsal horn) that is open or closed depending on 1. activity in PNS neural activity in the brain, such as thoughts, expectations and emotions (perhaps from performing, adrenalin etc) rubbin thumb- stimulates large fibers to close the gate – emphasis on CNS mechanisms was an important contribution of the gate theory. This was unseen of prior to this time because before pain was only thought of in terms of PNS activities. Emphasizes as an active system that filters and interacts. Neuromatrix theory of pain – pain is a neuromodule. A coordinated program with sensation, motor, emotion and cognitive components. Evolution of gate theory. Pnce pain signal passes dorsal horn, it enters the brain where it competes with other emotional and cognition and may or may not trigger a neuromodule. Neuromodule can be set off without the sensory trigger. Synaptic areas from dorsal horn to brain may be pattern generating mechanisms—aka phantom limb Phantom limb Myths and beliefs about pain 1. Infants do not feel pain 2. Pains without a physical cause is a sign of a psychological problem. But in reality that pain is no less real than pain that does have a physical cause 3. The longer the duration of pain, the more painful the memory. Graphs with curves and area under curve a. Peak pain- intensity of pain at its worst b. End pain- the intensity of pain at the initial and final moments of the episode c. Total pain is the area under the curve d. For observers, the important aspect is total pain. For the person actually going through the pain, whats important is the peak pain and the end pain. Peak and end evaluation and duration neglect. Having memory of gradual declining contributes to a reduced pain memory as opposed to something that was much shorter lasting yet intense e. Strong correlation with peak pain and end pain for patients. Peak and end pain predicts the experience of pain for patients, duration was irrelevant f. Colonoscopy and follow up example g. People recalled experience being less painful when they had diminishing amounts of pain added in small amounts Coping in pages 166-169. Giving people more sensation information, relaxation techniques, procedural information, emotion management techniques- helping people label the emotions they experience, distraction/attention redirection-patients randomly assigned in cardiac ward with a window had greater distraction and a shorter recovery period (distraction can help people), social support/modeling-assigning two people together Guest lecturer Entertainment Education EE Fear appeals and focus on persuasive attempts. Tend to focus on arguments. Around 2000 introduction to narrative in attempts to persuade Resistance goes up when you notice that it is a persuasive attempt Entertainment education tries to overcome this resistance PSA entertainment education- embedding persuasive messages in entertainment programming GOAL; increases audience knowledge, attitude and behaviors about health issues Research on narrative in trying to persuade Character in soap operas, radio shows etc.. place stories of health threats etc See less of this effect in the US of shaping through entertainment due to divided attention Designated driver campaign-in light of prevalence of drunk drive deaths, professor in Harvard became interested and wanted to incorporate the idea of a designated driver into television. Very subtle introduction Do these kinds of messages work and what psychological aspects make it work? META analysis- 2 reasons why these messages can be successful 1. Narrative engagement- absorption/transportation into compelling drama with uncertainty/suspense. Engaging in the story as if you are in it yourself. The more dramatic or suspenseful, the more you will be engaged, the more your cognitive energy is inside of that story. Cognitive energy is not focused on critiquing, but more on following the story . persuasive attempt to fall into the background. Not as resistant, not counter arguing, not looking for flaws 2. Character engagement- identification, similarity parasocial relationships (they feel like a friend). Again, minimizes resistance. This is done by tapping on behavioral relevance, and efficacy Social genitive theory- idea of behavioral modeling based on outcomes being negative or positive… influences what you believe you can do or should do. Observational learning in the real world is the key. As a result of media exposure rarely tested in the media domain, which is strange because it is such an important and crucial theory 3 functions of observational learning ∙ Informational function- should be learning appropriate responses ∙ Motivational function- where you establish value for engaging in the behavior ∙ Reinforcement function- tighten and strengthen the connection between the behavior and outcome Observational learning is NOT equal to mimicry/imitation. Actually changing your social structure and changing your behavior. Behavior is influenced, even if not in that moment, it is influenced in the future in case this situation happens to you Usc sherik _____ Key questions ∙ Do narratives offer persuasive advantages ? ∙ Challenge: what is the control group? ∙ A lot of unknowns whether it has to do with narratives themselves or perhaps other aspectsz? Tamale Narrative more emotional, transportation, identification among Mexican American subgroup. But no difference in behavioral intentions AND emotions negatively associated with attitudes. Only initial BI predicted post test BI. Less likely to have a positive attitude on the message being told if they felt the story was funnier, emotionally attuned etc… ie thye thought it was funny reduces the seriousness of the topic being discussed Highest negative emotion was among Mexican American women This tamale EE message was not very successful in promoting the message, but participants gained some knowledge Does narrative offer persuasive advantages? – evidence narrative persuades as we know Less clear if there are any advantages May be more likely to attract/hold attention Advantage is that you are interested in it…selective exposure Attract and keep your attention Social sharing of messages on social media is more driven by emotionality, the more emotional the more likely to share. More memorable and up for discussion Limits to social cog theory within media context Audiences have a schema of what is going to happen to the characters Contrary to SCT, people who watched either the negative or positive condition of the TV show with her being promiscuous sex, the number of participants who said their future expectation of a future one night stand went up. In both conditions. Dilemmas of EE 1. Prosocial content. Not all agree on what is prosocial. with the example of practicing safe sex vs abstinence 2. Audience segmentation. Some are left out of “treatment” 3. Oblique persuasions- most realize the entertaining message is designed to persuade, hoping for enough humor or subplots to make the message more interesting , because typically it is pretty obvious to figure out 4. Unintended effects- messages can backfire. Sometimes audiences identify with the negative model. More subtle message=more likely to miss Nursing hom experiment 2 grpups- one was given freedom in terms of ddeviding who gets to visit them, how their arrange their furniture and they get one plant to take care of. The other group had an emphasis on the staff and everyone taking care of them, told that research was conducted to see the best possiblr way to arrange things and, had a plant but nurse took care of it. Measured how uch activity they had, alertness of residents Enhanced control group was happier, more active and alert. 93% showed some form of mental or physical improvement. In the comparison, 71% became more debilitated. 18 month follow up, lower mortality rate and maintained their advantages compared to the comparison group Criticisms of this study- key finding of the morality was marginally significant- it was at best viewed as a trend Awareness- the experimenters were aware of the conditions, could have been acting differently towards the people in the different conditions Very small sample size- also randomized based on floor Ethical issues. they were not unaware of the conditions so the control vould have known that the other group was receiving a treatment and they were not. Another experiment- control of visiting hours. Student program where college students were paired with retirees. Experimental control was much greater 1. One group was visited by students at prearranged times. Regular predictable visits 2. Second got to schedule when their students would come and visit 3. Third, students just came to visit randomly within normal business hours Health hopefulness and lonliness measured right away Health and morality more long term Those who had control of when the students visited were more beneficial in the short term Strong negative facts when control was removed at the end of the study The first two (who had a say in time and the ones who had controlled time visits) had better results at first. Health declined dramatically for residents who had control over the visiting times over time. Giving control and taking it away was worse than not having it at all. Importance of control Issues- with the student inevitably having to leave. Can lessen these effects by getting ready and preparing for the end of the relationship. Issue of debriefing since the participants are told that there are positive and beneficial effects which no longer holds to be true. Greater appreciation for control and predictability for senior residents. Now things are more in line with the enhanced control condition Impact with stress- giant meta analayisis. Laboratory stressors and which one greatest cortisol release? Threatening of self esteem or social status and uncontrollable stressors I. Finding ways to assert control over ways Gaining control? Inteveiwing women with breast cancer- talk about issues on losing control POSITIVE ILLUSIONS- not really linked to the progression of the disease 1. Illusions of having the knowledge- more beneficial coping Reassert control by gaining information about your situation= so that you can understand it. The women became experts of their condition Having knowledge=you can control it Practical reasons for knowing the information but also give an illusion of control 1. Many of the women strove to create attributions/ reasons behind their conditions. If you can explain it, you can prevent it. one woman thought she developed breast cancer because a frisby hit her in the chest. Helped her feel like she could control it. 2. Changing behavior – prevent from happening again II. Writing about events 4. Penebaker and the expressive writing assignment for 15 minutes a. Goal is to understand why you are thinking so much about the issue that you are writing about. You kind of figure it out as you are writing. Degree of effect on physical health was astonishing and unexpected Lecture I missed – Persuasion Motivation to change health behaviors? We often have the information we need in order to change our behavior Arousal by fear.. Changing our behavior- critical to health 7 items of healthy behaviors steeper slope of line of % of people dying with respect to how many of those 7 behaviors you perform. Also divided by age, so first when you are younger than 45, and chances increase with age Want to persuade people to act in a healthier way Persuasive communications Fear? What should you emphasize in your messages? Assumptions underlying health persuasive communications such as peer pressure and our social networks? Fuels to reason or emotion ? Model of persuasion- biggest factors to consider is whether or not your audience is involved and attuned to the message Central-People are careful information processors. Perhaps they would benefit more from data and informative stuff Peripheral- need to grab their attention ELABORATON LIKELYHOOD MODEL!!! Most utilized emotions in persuasion- FEAR Model of fear and attitude change. Inverted U shaped curve of fear and persuasion (attitude change), People need to have a moderate level of fear in order for change to occur Hammond META analysis-Question: Is fear effective in leading to a health behavior change? Self reports of large text and frightening pictorial ____ have increased motivation to quite, and changes in smoking levels Conclusion: effective. Also noticed among other cultures Drawbacks- Self report, People typically have a hard time describing the reasons behind their behavior (social psychology) Second META analysis- field studies Evidence suggests that positive effect on attitudes, intensions and behavior. Overall effect size was 0.29. significant overall, yet had moderating factors in augmenting the fear message Curvilinear effect? Fear works best when combined with a message and efficacy of reducing your action.. efficacy statements+fear=works best Severity and susceptibility One time behavior- easier to maintain Need behavioral skills along with the fear to create the actual behavior (long term) Backfiring? Sexual transmitted disease videos and saying that this can happen to you- defensive response- people thinking they are less susceptible to the risk Why the risk? Self affirmation theory- People are inclined to see each other in a good light- when seeing a risk being possible to happen to them, they are very bias. Unrealistic optimism. Motivate inferences- health information critique Skeptical and critical of information that is offensive to you Affirmation of self image in other domains- reducing of acting defensively. Less resistant. Don’t need to respond to every threat. People should be more open to health threatening info and more likely to change their behaviors Value affirmation vs control condition. Then showed the aids “people like us” informative video Series of questionnaires on the perception of the video and perception of the likelihood of them getting aids Oh you get 3$ and you can purchase condoms for 10 cents each (dependent variable) Affirmation condition- saw themselves as higher risk of HIV. 50% purchased condoms Self affirmation and alcohol consumption and breast cancer. Greater message acceptance. Found it earier to imagine the negative consequences. Greater intensions to reduce alcohol condumption Suggests that fear messages can induce self defensiveness, and self affirmation is one way to help avoid this State of reactance?? People do not like to be told what to do Study- people presented with information on the negative effects of alcohol use on college students. 18% said they experience memory difficulties. 1 in 10 had a memory blackout, greater risk of bad grades, sexual assault, accidents and injuries. Followed up by the type of recommendation people would make. Interested in seeing what causes more reactance??? Half participants got a dogmatic message- too strong “it has to be like this”- people don’t like having their freedom to make a decision taken away Other half got a more neutral “you may wish to carefully consider” Clever methodology Dependent variable- number of ounces of alcohol consumed after receiving the message Dogmatic- led heavy drinking males to drink more High fear messages less effective on men then women Not much of effect on light dirnkers. Larget effect on heavy drinkers. How message is framed- -message framing if you don’t do it, bad things can happen or positive things can happen if you do behave. Example brushing teeth Which message is better? Individual differences! Avoidance and approach Experiment with flossing sashes and testing for avoidance / approach prior. Susceptibility to illness High risk avoidance Cultural variables Amweican culture is very approach oriented culture peer pressure passive- people seem to know what the cool kids are doing active peer pressure- more of the typical definition of peer pressure “hey do this drug” DARE experience- roleplaying. Police officer would role playing being the drug dealer effectiverandomly assigned to DARE programs- 1000 students compelte DARE vs standard health education. No effect of dare on cigarette, alcohol, peer pressure reistance, self esteem, DARE not effective dominant model of 1980’s “just say no” actively resist.. not said to be effective evolved to hipper edgier 5/16/17 Health behavior change: Models 6pm Buchanan 1910 the assumption of most health campaigns informationattitudebehavior change models of health behavior change 1. Health belief model a. 1960s. psychologists with US public health.. mobile tuberculosis screenings b. people not signing up with this free health measure c. interviewed and questioned people as surveys. People who got the screenings and who did not. This gives insight on the health belief model d. 2 big questions i. do you perceive a health threat? 1. perceived vulnerability- am I vulnerable to the threat 2. would the threat be severe? ii. can the behavior being advocated reduce that threat? 1. Will the behavior work? 2. Do the benefits outweigh the risks? e. Increasing mammography i. Info based on health belief model .. tried to increase each of the below 1. Vulnerability- tried to increase the perceived vulnerability 2. Severity- talked about how much deadlier it would be if detected later rather thane earlier 3. Effectiveness of mammography-improved dramatically, showed pictures of how the process works 4. Advantages of early detection- less severe surgery if caught early. Had interviews with women who had gone through it and had an early detection- better treatment options and benefits 5. 30% in the next 3 months, 50% in the next 6 months ii. Control group: were given no information 1. 10% had mammograms in the next 3 months, 20% had in the next 6 months. f. Strengths- includes many useful constructs, Focuses on peoples beliefs- it is a subjective model g. Weakness- assumes behaviors are rational. Assumes people have the skills to alter behavior (like quitting smoking). Ignores social context of many health behaviors (like quitting drinking because it typically occurs in a social environment) 2. Information motivation behavioral skills model IMB- Gold standard a. Model developed by social psychologistsb. In the context of the AIDs crisis c. William and jeff fisher d. Graph with steep slope from 1985 to 1992ish e. Problem- relatively few interventions had significant impact on AIDS risk behavior f. Information and motivation have direct effects for simple behaviors (Carrying a condom properly) and indirect effects for tougher behavior (introducing condoms) g. Aids risk reduction information and aids risk reduction motivation combined to form aids risk reduction behavior skills which ultimately leads to aids risk reduction behavior h. Fisher et all 1996 i. Participants: 744 UCONN undergrads assigned by dorm floors to interventions vs control ii. Information: AIDS 101 slide show iii. Motivation is composed of the following components 1. Attitudes towards performance of AIDS preventive acts 2. Social norms regarding performance of such acts 3. Perception of personal risks for AIDS. Small group discussions and “people like us”., incorporating some of the health behavior model iv. Behavioral skills 1. Objective skills for performing acts 2. Self efficacy for changing behavior v. Information, motivation behavioral intentions and perceived effectiveness of using condoms all increased relative to control vi. One and four months later, condom availability condom use and discussion about AIDS both were higher than control vii. Very effective intervention form. Replicable 3. Diffusion of innovations theory a. Sociological model of behavioral change i. Knowledge ii. Persuasion iii. Behavior change iv. Confirmation b. Opinion leaders c. –behavior change: OL influence other peoples decisions d. sought out for info and advice e. informal exertion of influence, just through information f. effective role models g. bridge between innovators and everyone else h. Kelly et all 1991 i. Step 1- seek out opinion leader OL-Bars, identified OL through consensus ii. Stage 2-Trained OL- information on safe sex strategies. How to effectively share this information iii. Stage 3- opinion leaders spread the word- initiate one on one discussions iv. Personally endorse the values of safe sex v. In intervention city-more people had protected sex. More condom use. vi. No change in comparison city 4. Stages of change theory a. 10 successful techniques b. ____for the trans theoretical model, applicable to the theories above c. people have different stages of change and stages of readiness d. precontemplation, contemplation, preparation/action, maintenance, leave treatment, relapse e. helps explain low success of smoking campaigns f. practical0 doesn’t force techniques into one theory g. realistic- acknowledges heterogeneity- people in different stages h. weakness- doesn’t give new techniques. People in same stage for different reasons. Doesn’t explain how people can move from one stage to the next 5. Social norms approach a. Misperception of norms b. Princeton students: thought that the average students were much more comfortable with drinking norms than they themselves were c. Misjudged the norms of drinking, over time men came to act in accordance with the perceived (though inaccurate) norm=PLURALISTIC IGNORANCE d. Pluralistic ignorance- belief that ones private attitudes are different from others e. New insight on norms i. A norm does not require the majority to believe the content ii. Individuals who don’t do the behavior can still contribute to bad health outcomes through talking “I don’t drink that much, but UCSB is a big party school” iii. Intervention: can new information change a perceived norm and then health behavior UCSB perceived drink survery Misperceiving the UCSB norms ?? 2 explanations Psych 101 students are not representative sample: the UCSB norms could be accurate Psych 101 students are a representative, but misperceived the UCSB norm Actual norms are high Review session for Exam 2 A disease related to personality: CVD Risk factors 1. Age 2. Family history 3. Gender 4. Ethnic background 5. Smoking 6. Weight/diet 7. Exercise 8. Education level and income 9. Social support and marriage 10. Type A pattern a. Exaggerate time urgency b. Competitive and ambitious c. Hostile competition with others/aggressive d. Anger (emotion) and hostility (attitude) e. Not type A itself, but more so the hostility and anger that comes with it 11. Anger “dammed if we do damned if we don’t” a. Exercise vs suppression b. How to express- catharsis need to tell everyone. Freud c. Expression does not actually reduce the effects of itd. But suppression also leads to other problems Most related to personality- anger and hostility! Relationship but not directly causal A personality that is related to illness ∙ Optimistic: believe that they will generally experience good outcomes ∙ Health benefits of optimism o More likely to engage in health promoting behaviors o Less likely to engage in risky behaviors o Less bothered by physical symptoms (such as side effects of medications). Stick to their medicine ∙ Better coping techniques o Writing about positive future can increase optimism and health in HIV+ women. Improved their experience with HIV not the HIV itself Psychosocial factor and cancer- the disease that has nothing to do with personality ∙ At different points in time, cancer was thought to be attached to different personalities o 2nd century sad people o 19th century happy 2 main problems with the research and cancer? -going to find any kind of relationship if you have a set of data - no hypothesis -1. not theory based -2. all correlational studies. All participants already had cancer. Bidirectionality is implied in there results PAIN- an overview ∙ Ashlyn ∙ Important role of pain ∙ Critical for survival – feedback ∙ Protective and adaptive ∙ Influences by external factors such as context, culture and gender Physiology 1. Nociceptios in PNS first sense injury a. A delta fibers- mylenated fibers transmit sharp pain b. C fibers- unmylenated fibers transmit dull aching pain c. Disregard A beta fibers 2. Release chemicals to spine/brain 3. Brain regions identify site of injury and send messages back down spine Theories of pain 1. Specific theory a. Amount of pain equals severity of the wound. b. But soldiers, athletes ?? expectations of self reported pain experience? 2. Gate control a. Existing activity in spinal cord determine fate of incoming sensory information b. The brain can close this gate (emotions, expectations) c. Stimulations can close gate (i.e. rubbing hurt finger) 3. Neuromatrix a. Pain is the neuromodule of many components including emotions, sensations and cognitions b. Physical stimulus competes with other brain activity to be felt as pain c. Pain can also be triggered without physical stimulation (phantom limb) Neuromatirx and phantom limbs Venn diagram of pain suffering and nociception which can exist independently, with 2 overlapping, or all overlapping. Pain and nociception- massage. Feel something as pain but not neceserily suffering Individual differences of pain experience ∙ Individual difference o Question of direction between chronic pain negative outcomes such as depression or alcohol abuse ∙ Cultural gender variations o Men and women ∙ What is the difference between pain and suffering Suffering could accompany pain but suffering is the emotion Acute pain vs chronic pain- chronic pain often appears in absence of any identidiable tissue damage Examples of chronic pain are headaches, lower back, arthritis, osteo__ Managing pain 1. Tolerance- need more to get some effect. Higher dose 2. Dependence- drugs removal produced withdrawal. Example- the shakes after withdrawal of pain meds 3. Craving- conditioned reminders triggering desire 4. Addiction – physical/psychological dependence Tolerance can happen on its own Addition is characterized by behaviors impaired control over drug use, compulsive use, continued use despite harm and craving. Some under prescribing going on due to worries about addictions Who experiences more pain? (Kahneman)- colonoscopy surgery ∙ Total pain ∙ Peak pain ∙ End pain ∙ Observers of patients in pain ∙ Patient’s perception of pain ∙ 2 Curve with area under curve ∙ easing into and easing out to is much more preferred even though they are in a longer lasting state of pain ∙ recency and primacy entertainment education ∙ definition: embedding persuasive messages in entertainment programming ∙ goal: to increase audience knowledge and improve attitudes and behaviors about a health issue 2 mechs 1. narrative engagement 2. character engagement 3. social cognitive theory- observational learning 4. narrative vs non narrative persuasion- advantages and disadvantages to both! 5. Dilemas of EE a. Prosocial contents not universal- abstinence vs contreseptives b. Audience segmentation- message needs to be designed specifically for the audience of interest c. Oblique persuasion- how subtle is too subtle d. Unintended effects- womens health issue video. Cultural experience can make you interpret a message completely differently e. If you know that something is going to get taught to you, youll have a pre disposed idea of what is being taught Goal of narrative- to get rid of pre existing biases. But with narrative you could have a message that is too subtle or not subtle enough Beliefs that aid adjustments 1. Sense of control over your life a. Nursing home study with the plant. Enhanced control vs just control i. 93% more improvement and lower mortality rate ii. but these mortality rates were just marginally significant b. visiting study in od people home i. ending study and taking control from home residents effected their health in a more long term ii. control=given control of the conditions which was the experimental group 2. Writing about your problems 3. Finding meaning in traumatic events- constitute in a broader meaning of out life. Perhaps the wisdom we gained or what we learned. Some sort of positive outcome How to regain lost control ∙ Get information about situation ∙ Find explanation ∙ Change behavior Inhibition of information vs disclosure Keeping identity hidden is cognitively taxing because of monitoring of ones speech Not disclosure itself that matter Finding meaning ∙ Meaning help us structure out world ∙ We find meaning by incorporation the negative events into our story ∙ Objective health benefit Persuasive messages ∙ Does the message appeal to reason or emotion?- involved or uninovolved audience? ∙ Does the message appeal to fear? – more effective for one time behavior ∙ Can the message cause reactance? - heavy drinkers and dogmatic messages Emotion- gets your attention.. so if audience is not engaged Persuasive messages ∙ Is the message framed in terms of graining or loses? Approach oriented vs avoidance ∙ Match the message to the motivational style ∙ What assumption does the message make about our peer pressure o DARE program- authority to adolescence- not actually that effective o Different type of messaging Models of health behavior change1. Most interventions assume a straight line between leanring about a better behavior and acting on it 2. Its not quite that simple 3. Health belief model 4. Information motivation behavioral skills model 5. Diffusion of innovations theory 6. Social norms approach a. Drinking studies and perception 7. Transtheoretical model of behavioral a. Most current b. AKA stages of change theory c. Precontemplation d. Contemplation e. Preparation f. Action g. Maintenance – prevent relapse h. Doesn’t really tell us much about the psychological aspects i. Also no new information is given in the theory Gate control cant explain phantom limb Cartsian- pain is purely physical Malzack’s n Guest lecturer after MT 2 Health psychology and the environment Cameron Brick Health and environmental change I. Proposal Human health requires stabilizing ecosystems and using natural resources at their replaceable rate Health -highly developed nations. Many US deaths are associated with individual lifestyle habits -developed nations where lifestyle is less important. Malnutrition, unsafe water, poor sanitation, air pollution vulnerable populations 1. Infants 2. Elderly 3. Children 4. Sick people who have weak immune systems 5. Pregnant women Environment- all of that is external to the individual host. Physical, biological, psychosocial Physical- air water soil, housing, climate geography heat light noise debris radiation How much of this substance can we be exposed to? How can we balance exposing people to the substances while also keeping people safe? Heat wave example II. Dramatic progress in public health 1810- most peoples life expectancies were much lower and people were clustered in the low life expectancy and poverty sector of the graph.1949 widest difference in countries, US and Japan were crawling much further up than the rest, most other countries were still in the bottom left portion. Countries start catching up. “converging world” industrial revolution- global living standards. Sustainability- are we creating a kind of world where we can expect populations to flourish in the future? Forests- 4% left III. public health intervention models human needs, human wants, and choice of technology, human and biological consequences, exposure to materials or energy, release of materials or energy Flint Public health intervention model more effective and universally accessible Environmental stewardship model- between humans and environment Clinical intervention model- practitioner and patient Infectious diseases 1. conditions involving geographical range, seasons, intensity of exposure, etc IV. perception of threats V. divergence of perceptions of risk and what are actually harmful video with 4 components of threats first no evidence second yes there’s evidence third the evidence is not man made fourth- oh its actually concerning? Detection and deflection of threats.. brain doesn’t treat all threats the same 1. Intentional 2. Immoral 3. Imminent 4. Instantaneous 5. Intense Influenza vs bomber. Smallest intentional action captures our attention much more intensely than something like influenza which is unintentional yet more influential in terms of killing Threat to our tomorrow but not to our today/near future Much more concerned with the now- evolutionarily- as opposed to the future Rate of change- if slow enough, rates go undetected… “not happening fast enough” Terrorism encapsulates exactly the type of threat which pushes all those 4 I’ 1. Public concerns are increased by high profile accidents and rare catastrophes 2. Most concern is about involuntary risk 3. Most people over estimate salient risks 4. There is high anxiety about long term exposure to low concentrations of compounds: not a big risk Combined CO2 and solar forcing through geologic time X axis- how long ago temperature is plottedEconomy vs environment argument- but need environment tin order ot even have an economy Its real, its bad. its us, experts agree, there’s hope Public has a poor perception of how many of the experts agree Lead exposure- IQ Vaccines Global warming Paris climate summit Air pollution Cities in China and India are the top contributors of cities with highest pollution Infant mortality-pneumonia Longevity Quality of life