MIDTERM STUDY GUIDE
What is Health?
“Health psychology is an interdisciplinary field concerned with the application of psychological knowledge and techniques to health, illness, and health care.” (p. 11) ∙ The word is derived from Old High German and Anglo Saxon words meaning whole, hale and holy. The etymology of “heal” has been traced to early European roots indicating kailo
(whole, uninjured, good omen). Eventually the word became heil, which meant unhurt and unharmed (German).
Historical Perspectives of Health & Illness
∙ Ancient Greece: health and illness viewed in terms of bodily functioning (Rather than evil spirits) something in naturalistic terms (in the sense of viewing the body as an organism and the functioning of the body is something we can
understand through natural investigation).
∙ Hippocrates (460337): illness occurs in body and is independent of the mind, four humors: blood, black bile, yellow bile and phlegm. worked with the idea of the four humors, the body is composed of this. When they are balanced, you are healthy, if they are not, you are not healthy. They saw it largely independent from the mind, thus you look at the body.
∙ EX: black bile leads to melancholia
nWe also discuss several other topics like why were previous scholars’ estimates of the pre-Columbian Indian population erroneously low?
Personali ty Types
Yellow Bile Don't forget about the age old question of  For what nonnegative values of γ will the the solution of the initial value problem u′′ + γu′ + 4u = 0, u(0) = 4, u′(0) = 0 oscillate ?
If you want to learn more check out What is the organ tissues?
angered, bad temper
Despondent, sleepless and irritable
Winter Don't forget about the age old question of You may be asking, “So what’s D&D?
∙ Galen (second century): disease occurs in specific parts of the body, different diseases have different effects on the body. Sought the different types of diseases and the effects it had on the body. It is important because we have a sense of describing disease and looking at specific areas, not simply holistic.
∙ Collapse of Roman Empire (5th century)
∙ Return to view of illness as result of spirits, demons or punishment of God (most important one here, if you did something morally one, not due to a physical accident)
∙ Authority of physical healers replaced by priests who has the authority to diagnose and come up with theories?
∙ Treatments influenced by religious doctrines, very different from the naturalistic approach
∙ Because people and animals are seen to have souls, body is sacred and dissection forbidden (medical training, experiments) this is the strong dominant view ∙ Rise of Christianity in Europe created a shift in medicine.
∙ Rebirth of inquiry in Europe & Scientific Revolution If you want to learn more check out What are risks from smoking?
∙ Rene Descartes (15961650): new model of mind and body relationship ∙ Crucial in the rise of modern medicine
∙ They are separate substances but interact through pineal gland
∙ Notion that animals have no souls (justifies experiments done on animals), human soul leaves body at death, the body that remains is no longer sacred, thus dissection is now possible.
The MindBody Problem
∙ What is the relationship between the physical body and the nonmaterial mind? ∙ Descartes: mindbody dualism
∙ Dualism: they are in fact two different substances (body and mind) ∙ Monism: says there is only one substance (materialists, physical matter, while idealisms say there is only the mind)
∙ Illusions of the what the real one is, the mind, less extreme way of looking at the world
Need Satisfaction the attainment of physical health, agency and autonomy, the satisfaction of all physical, cultural, psychosocial, economic and spiritual needs with indication that agency and autonomy are the most basic requirements for every person.We also discuss several other topics like What are the Early Evolutionary Theories & Observations?
Self-Determination Theory competence, relatedness and autonomy
Quality of Life (QoL)
Aristotle: happiness is viewed as the meaning and purpose of life Bentham: pleasure without pain
Collins Dictionary: general well-being of a person or society, based on health and happiness rather than wealth.
Subjective Well-Being (SWB) Umbrella term for different valuations that person’s make regarding which they live. (Dr. Happiness, Ed Diener)
∙ ADDS 4-10 YEARS OF LIFE.
Theory of Well-Being
An infant’s attachment to their caregiver creates a template for how the infant will stay in proximity to a person who provides a safe space for exploring. The caregivers response is internalized as a mental model of the world and will be used in a general manner trough out the infant life known as attachment style in turn influencing overall life satisfaction.
Eudalmonic degree to which a person is fully functional and occurs when they are living with their authentic self (daimon).
Ecological Validity: Could not be generalized outside the laboratory
Ethnocentrism: considers national or large group samples as analysis units rather than individuals. A bias stemming from membership of a particular ethnic group.
Selfways: what it means to be a good or bad person and what causes us to become ill or healthy.
Approaches to Health Psychology First article from readings is great for providing extra information on these approaches!
1. Clinical Health Psychology
∙ Most ‘mainstream’ of the four approaches
∙ Partly overlapping with clinical psychology (methods, theories) ∙ Relies heavily on biopsychosocial model (explicitly)
∙ Successful in bringing to prominence psychological perspective on health, illness, health care
∙ Focus is on physical illness and dysfunction
2. Public Health Psychology
∙ Focused on health promotion and prevention on population level (rather than individual levels)
∙ Designs things for large amounts of individuals it is not focused on one person ∙ Health seen as outcome of social, economic, political aspects of people’s lives ∙ Prevention focused on collective level – Takes time – Difficult to
evaluate/measure– Difficulty in tackling major social problems (eg poverty) ∙ More interdisciplinary than Clinical HP (generally how we can use more approach than one)
3. Community Health Psychology
∙ Similarities to Public HP – Focus on collective level – Health seen as outcome of social, economic, political contexts
∙ Focus on particular communities/groups and empowerment to achieve better health outcomes (not the entire public)
∙ Strong focus on action research
∙ Blurs the boundary between participant and researcher
4. Critical Health Psychology
∙ Need to evaluate theories and practice and how they maintain unjust social relations
∙ Always looking for power differences
∙ Who benefits? We can intervene unless we know where the interests are. ∙ Focus on concept of power, how it functions to facilitate or prevent health ∙ Based on ideas from ‘crisis’ in social psychology (1970s) – Reexamination of science– Can psychologists be objective and valuefree?
REMEMBER: the individual is at the CORE of the Onion Model.
∙ Number one determinant: where you are born.
∙ Natural Events and Disasters
∙ Human induced issues
MacroSocial Context (AKA the Glass Jar in which you are making your choices) AKA large-scale social economic, political and cultural forces that influence the life course of masses of persons simultaneously. It includes government organizations, religions, corporations and other large environmental events.
∙ Individual expression and agency constrained by powerful factors ∙ Political and economic systems (democracy or dictatorship)
∙ Systems of discrimination (gender, race, ethnicity, culture, religion and social class)
∙ Culture and religious discourse people who were very religious on average were seen as more healthy but others had significant health issues. It goes both ways. ∙ Literacy and education
∙ Health is strongly correlated with ALL
Globalization process by which businesses develop international influences
Health Care is the systematic response to overall Health
∙ Global Debt
∙ Limited resources due to population growth Disease prevalence & Health care sustainability
∙ Economic wellbeing is highly correlated with health health gradient (SES predicting mortality)
Defined as a level of income below that people cannot afford a minimum, nutritional adequate diet and essential requirements that are not food.
Major impacts are the following: safe water, environmental sanitation, adequate diet, secure housing, basic education, generating opportunities, access to medical and health care.
Gross National Income (GNI): monetary value of all goods and services produced in a country in a year.
Greatest predictor of infant survival is education and environment (Do not forget about the U5MR (under 5 mortality rate)
Responsible Consumer (RC): an active processor of information and knowledge concerning illness and health. They make impulse and responsible decisions in regards to enhance their well-being with the “everything in moderation” while the Irresponsible Consumer (IC): is sometimes known as “couch potato”.
∙ Should focus on social and the environment as well, not only the individual
AKA Whitehall study and Black Report Relationship between occupation and health: consistently poorer health for unskilled manual labour those in class V (unskilled) are in worse conditions than those in class I (professionals)
∙ Marmot Report: indicated that focusing action on the most disadvantaged with be inadequate, we need fair
distribution for greater success than economic growth.
The Whitehall Studies
• Investigate social class, psychosocial factors, life style as determinants of disease (purpose of the study)
• Whitehall 1 (1960s):– 18 000 men in Civil Service (it is very stable metric, you can see who is higher and who is lower) think of the example of the health gradient – Lowest grades more likely to die prematurely
Men only and a lack of context are limitations
• Whitehall 2 (started 1985): – Causes of social gradient
– Include women– 10 000 nonindustrial civil servants– Ongoing followup with surveys and medical exams
Whitehall Study 2 results
∙ Imbalance between demands and lacking control in terms of their environment lead to illness – High demand, low control
∙ Support theories of effect of work stress on mental & physical health ∙ Can be buffered by social support, effort reward balance, job security, organizational stability
Germ theory (necessary to understand the interventions, such as ecoli is a contaminant and can cause health outcome and death, you wont know how to deal with it to stop the spreading) interventions, testing water for example.
Social Darwinism– Note link of ontology and policy! (natural selection, on a certain context) It is something innate, not in their nature, how you intervene on a individual level and global level) sterilization.
Communicable: disease spreads from one person to another or from one animal to person. It may happen through airborne viruses or bacteria but also through blood and body fluids. Terms such as infection and contagious are used to describe this type. EX: influenza, HIV, malaria etc.
Non-Communicable (Chronic): generally of long duration and slow progression. They are the leading cause of death in the world, 63% of all annual deaths.
EX: cardiovascular and respiratory diseases.
Epidemiological Transition reduction in prevalence of communicable diseases and increase of those that are chronic occurring because the country affected becomes stronger economically leading to unhealthy conditions and lifestyles (UK, USA) while those in lower and middle class have incidence of both (India)
Four Explanations for Health Inequalities
1. Artefact: relationship between social position are the artifact of measurement method
2. Natural & Social Selection: the social gradient of health is due to those who are already unhealthy, falling downwards while those who are healthy are rising upwards.
3. Materialist & Structuralist: emphasize the role of economic and socio-structural factors
4. Cultural/Behavioral Differences: often focus on the individual as the unit of analysis thinking that unhealthy behavior is the main determinant in this case.
Psychosocial Explanation the individual (micro) and social (macro) level systems.
∙ For the micro system, it is thought that the cognitive process of comparison, relative deprivation is thought to contribute to high levels of stress and ill health along with having no control over working conditions.
∙ For the macro system, they focus on impaired bonds between social and limited civic participation creating income inequality (social capital).
Neo Material Explanation focus on the importance of income and living conditions.
∙ Micro: it is argued that those who have less access to resources have vulnerability to their health.
∙ Macro: high income inequality leads less investment in the social and physical environment, ignoring in which the problems are nested.
Lay Explanation Researcher’s found that working class individuals, especially women are reluctant to accept that they are less healthy than middle-class individuals. Those who did accept it say it is different access to health care. Professional women accept the health gradient indicating that it does attribute to poorer health.
∙ Definition: unfavorable reaction towards people when perceived to possess attributes that are denigrated.
∙ Stigma Power: instances where exploitation, control and exclusion of others enable people to obtain what they want. ∙ Stigmatization devalues the entire person with a negative identity even when the stigma disappears. Consequences include: physical and psychological abuse, denial of opportunities etc. They may internalize the stigma with feeling guilt and shame and changing the way they see themselves.
∙ Health care professionals are as likely to stigmatize as anyone else.
∙ Discredited: the stigma is visible
∙ Discreditable: the stigma is not visible but get stigmatized when found out.
Assisted Dying Bill: adults who are expected to live 6 months or less can request assisted death. 6 months (14 days after it is granted) less than one month (6 days)
Two doctors to determine:
∙ The individual is terminally ill
∙ Capable of making the decision
∙ Has formed a settled intention to die
∙ Bridging: links with diverse groups and provides an opportunity for community members to access power and resources outside their community
∙ Bonding: inward-looking social ties that bond the community together
∙ Both are needed to have a healthy community.
∙ Good social capital increases good health by 27% while reciprocity and trust increased at 32% and 39%.
∙ Promotoras: health leaders who help with the dissemination of health information to community members
∙ Social cohesion was indicated an important predictor of physical activity.
Eastern & Western Beliefs
Question understanding of mindbody relationships
Claims of mental control over physiological processes (heart beat, survive pit burial, regulate body temperature, skin penetration without bleeding) These stories were of great interest.
∙ It is durable and implicit, they tend to reproduce cultural norms, the precepts. Expectations and values of particular times and places. The belief is mediated through that person’s history of social relations.
∙ Popular Sector: lay cultural arena where illness is first defined and health care activities initiated. May appear inconsistent and contradictory.
∙ Professional Sector: organized healing professions, representations and actions
∙ Folk Sector: non-professional, non-bureaucratic and specialist sector that shades into the other two sectors above.
∙ Simpler two-fold division: systematicity, coherence and interdependence.
NOTE: The way we think about health and illness directly affects the treatments, interventions, systems we develop and use
∙ Therese Brousse (1935), travel to India
– Portable electrocardiograph to record yogis’ voluntary control of cardiovascular activity – One case, pulse waves from radial artery decreased to almost zero – Mind does not influence body, the implication that the body and mind are separate and mind and illness and things go wrong biologically
– So the fact we can do things with out mind is revolutionary
What is Culture?
– Fixed system of beliefs, meanings, symbols, belonging to a group that shares common language, possibly common religion & system of medicine Cultural psychology
– Developmental and dynamic systems of signs that exists in continuously changing narratives or stories culture is not a fixed thing, dynamic, organic and flexible, qualitatively.
“Failed” Assumptions in Biomedicine (storybook method) Works to some degree. • Helicobacter pylori
– Discovered 1982 in stomach of patients with gastritis and ulcers (Barry Marshall, Robin Warren)
– Treated with scepticism; common belief at the time that bacteria cannot – and survive in stomach or caused by stress
– Mars hall drank beaker of H. pylori culture to prove hypothesis – Nobel prize in 2005 for this work
Truth didn’t come out through good nature and careful experimentation
Christian Ideas The church’s 7 deadly sins came to be associated with body conditions. EX: pride is associated with tumors and inflammation while sloth lead to dead flesh.
∙ Ascetic Tradition: scorned concern for the body and promoted acts such as fasting and physical suffering which led to spirituality.
Protestant Reformation: the body had been given to the human by God and it was their responsibility (religious duty) to look after and care for their body.
Social Representation Theory suggests that people rarely confine their definition of concepts to the descriptive level and rather include references to explanations. Perceptions of health can be rooted in social experiences while others define it through lifestyle, functionality, and social engagement.
Health Belief System Examples
– Expert or technical belief systems– Traditional folk or indigenous belief (more distributed and more accepted and practiced) systems – Not discrete; interact; constant evolution
– Our own health beliefs are formed within these expert and folk belief systems (but may of course be distinct)
– • Taoism– Balance of yin and yang– Use of acupuncture, herbal medicines – • Confucianism– Belief in destiny, and focus on character
– • Buddhism– Cosmic justice and retribution (karma)
– Used by 70% of population in India, plus large numbers in the rest of the world – Cosmos and human being consists of male and female component – Task of Ayurvedic medicine is to remove blockages of energy flow – Treatments: yoga, diet, meditation, herbs
African Health Beliefs
– Wide variety of traditional medical systems
– Some common elements – Spiritual influences– Communal orientation – Common attribution of illness to ancestors or supernatural forces (witch casting a spell or family not liking you)
– Role of healer to identify source of malignant influence (may also be felt by family) and the role of social support
Homeopathy use of highly diluted substances to trigger the body’s natural healing system. Based on the Latin principle known as “simila similbus curentur” let like be cured by like. Substances used at large doses can be used at small doses as well. Based on harsh procedures such as purging and blood letting. Based in the UK and can be used to treat common illnesses such as asthma, allergies, blood pressure and mental health.
Aromatherapy use of essential oils from plant extracts based back to Ancient Egypt and China. Gattefose is known as the founder when creating healing properties when he burnt his hand in the laboratory. It can help with pain and digestion.
Reflexology application of pressure and massage to specific reflex areas in the body such as the hands, ears and feet. It is based on the belief that these areas correspond to other parts of the body and can help dissolve the waste blockages and encourage free flow and restore
ying and yang balance.
Health belief systems are important because:
• In multicultural society, need to understand where individuals ‘are coming from’ – Helps us understand and influence our own perceptions.
Facts, knowledge, and research cannot be separated from values (should be controversial to you)
– Psychology has been so antiqualitative methods for many years, been a great debate about this.
– Qualitative researchers tend, therefore, to be concerned with the quality and texture of experience, rather than with the identification of cause–effect relationships
– Answers will very situated within the context of its surrounding and time period. epistemology (how do we know what we know, how do we come to know what we know)
View other methods and information in Chapter 5
∙ What are we primarily concerned with in health psychology?
Sexual Behavior Any activity that arouses sexual arousal for pleasure or procreation. Issues within sexual health are associated with problems of stigma and discrimination.
Incidence & Prevalence of STIs, HIV & AIDS
∙ Common STIs are chlamydia, warts and gonorrhea. Least common ones are syphilis and HIV.
∙ Most common between people aged 16-24, 12% of the population
∙ Young people either think they know it all, or think bad things won’t happen to them (optimistic bias).
o Individual level theories for risk taking (social cognition models) o Reducing risky sexual behaviour: main factor is condom use
o Most is due to not having the right knowledge or a lack of knowledge and social conceptions influencing our decisions, not us making individual decisions.
Individual Level Theories
Health Belief Model (HBM): 4 elements
1. Perceived susceptibility: individual assessment of risk condition 2. Perceived severity: Individual assessment of seriousness of
condition and consequences
3. Perceived barriers: Influences that facilitate or discourage healthy or unhealthy behaviour
4. Perceived benefits: What are the positive consequences of adopting healthy behaviour
NOTE: The likelihood of a behavior is influenced by “cues of action” that are reminders or prompts to take action a consistent with an intension. They can be internal or external. The HBM takes into account these factors to predict the likelihood of implementing health related behavior. In experiments it tends to have modest and inconsistent results. For example, it did not explain condom use among university students. Determinants of condom use were based on subjective norms and perceived behavioral control.
Protection Motivation Theory: When we cope with a health threat (fear), we go through a threat appraisal and a coping appraisal
Appeal to fear to change behaviour
1. Perceived severity of threatened event
2. Perceived probability of occurrence
3. Efficacy of recommended behaviour
4. Perceived selfefficacy
Theory of Reasoned Action (TRA)
Assumption: Individual is likely to do what they intend to do
Doesn’t take into account political or economic constraints, nature of sexual encounters, etc.
Main construct: Behavioural intention
1. Attitude towards action/behavior
2. Subjective norm (other’s beliefs)
Theory of Planned Behaviour (TPB)
Most cited theory in psychology
We are likely to do what we intend to do, but some behaviours are difficult to control in a voluntary way
Added construct to TRA:
1. Perceived behavioural control
2. Reflects past obstacles and successes
Important factors still missing from TPB (religion, culture, gender, age)
InformationMotivationBehavioural Skills Model (IMB)
There are certain prerequisites for good actions:
1. Relevant information about risks
2. Motivation for safe sex
3. Behavioural skills (negotiating condom use, insisting on
Motivational interviewing strategy for building up drive to change behaviour in line with a decision
Common Sense Model (CSM) or the SelfRegulatory Model (SRM) Core construct: Illness representations
We have a representation of an illness in our mind (cause,
consequences, etc.), and that representation affects our response to
The Transtheoretical Model or Stages of Change ∙ Hypothesizes six discrete changes which people are alleged to progress through in making change
∙ Precomtemplation – a person is not intending to take action in the foreseeable future, measured in the next 6 months. ∙ Contemplation – a person is intending to change in the next 6 months
∙ Preparation – Prepared to take action in the immediate future, next month.
∙ Action – Has been making effort within the last 6 months ∙ Maintenance – Working to prevent relapse, 6 months to 5 years ∙ Termination – zero temptation and 100% self-efficacy OR relapse – return to the original behavior
Social Cognitive Theory
Focuses on the examination of social origins of behaviour
Goes beyond just the cognition and thought processes
Asks: Where did those thought processes come from?
1. Observational learning
Applications of theory: Use of role models in mass media to shape attitudes & behaviour
∙ People can learn by watching or observing others
∙ Step 1: attentional processes including certain model characteristics that may increase the likelihood of the behavior being attended to and the observer characteristics.
∙ Step 2: retention processes including the observers ability to remember and make sense of what has been observed
∙ Step 3: motor reproduction processes including the capabilities that the observer has to perform the behaviors that are being observed
∙ Step 4: motivational processes including external reinforcement, vacarious reinforcement and self-reinforcement.
Evaluation of Theories
– Bias that individualistic
– Lacks validity
– Does not take into account, culture, religion and gender
– Motivation is very complex
Food has a richer role than the biological aspect.
Where does the government come in?
Definition & Prevalence
∙ Obesity has been defined as: chronic, relapsing and neurochemical disease.
∙ It manifests itself by an increase in size and number of fat cells (adipose tissue) and is measured through BMI.
∙ Greater or equal 25 is classified as overweight and greater or equal to 30 is classified as obese.
∙ Obesity is a marker for insulin resistance, diabetes, and metabolic syndrome that include hypertension and other cardiovascular risks.
How are Overweight & Obesity Measured?
∙ Body consists of four compartments: bone, muscle, subcutaneous fat (80%) and visceral fat (20%).
∙ BMI does not distinguish between these four parts. ∙ DXA: used to measure bone density and total body composition. Can determine abdominal fat mass.
∙ Waist circumference/belt: 40 for men and 35 for women is considered to be excess fat
∙ Skin Fold Thickness
∙ hypertension or high blood pressure;
∙ coronary heart disease;
∙ Type 2 diabetes;
∙ gallbladder disease;
∙ sleep apnea and other breathing problems;
∙ some cancers such as breast, colon and endometrial cancer; and ∙ mental health problems, such as low selfesteem and depression.
– Total calorie intake increased as food has become more processed and energy dense Problems of obesity also becoming increasingly common in developing countries ( the poorer countries are having an issue)
– But note that obesity also associated with lower SES – Restrictions on budget mean less being spent on quality of food
– Thus, it is a problem of one, that it does not occur because someone is too rich. Good quality food that is lacking, NOT FOOD in itself.
– Agricultural revolution & Industrial revolution
Ecological theory: daily energy expenditure of human population needs to be increased, while daily energy consumption is reduced
Causes of Obesity
∙ Early humans have been traced to sites in Africa dating around 2.5 million years ago.
∙ Tool making (homo habilis) handyman lived in Olduvai, they were hunter gathers and killing and processing their food with weapons and tools fashioned from volcanic matter.
∙ Natural ecosystems provide a diet of wild plant based foods that are both varied and plentiful. Insects and fish for meat were also consumed.
∙ Until they moved into villages, individuals were only consuming unprocessed and only natural foods.
∙ Heritability is the proportioned of observed differences in a trait among individuals that is due to genetic differences.
∙ Authors found that environmental changes over time do not have a big impact as once thought suggesting a greater genetic influence in BMI changes over the years.
∙ While it may be biological it is important to note that the human genome has not altered in the last few hundred years.
Energy Balance Theory
∙ States: energy intake = internal heat produced + external work + energy stored
∙ Energy is consumed in the diet through three macronutrients: protein, carbohydrate and fat. Translating this equation in terms of fat it becomes the following Rate of change of fat stores in the body rate of fat intake – rate of fat oxidation
∙ Calorie: energy needed to increase the temperature of 1kg of water by one degree
∙ Fat content of a food is based on four different types of fat: saturated, trans, poly and mono saturated.
∙ Eating itself burns calories known as the thermic effect of food (bite, chew and swallow).
∙ Claims that obesity is caused by a chronic elevation in insulin in a diet that contains too much carbohydrate.
∙ Three distinct propositions:
∙ Basic proposition that obesity is caused by a regulatory defect in fat metabolism so a defect in the distribution of energy than one in intake and expense.
∙ Insulin plays a primary role in this fattening process and compensatory behaviors of hunger and lethargy.
∙ The third is that refined carbohydrates, fructose and amount of sugar consumed are prime suspects of this constant elevation ∙ Glycemic Index: produces insulin in turn causes the body to store fat. Examples include rice, wheat, potatoes, natural sugars etc.
The Obesogenic Environment
∙ Today’s modern food environment has become engineered to maximize the scale’s as most are processed foods. Most select these foods due to their convenience, palatability and cost.
∙ Increased this by increasing the amount of sugar, fat and flavorings.
∙ Obesity is seen as the end product of an obesogenic environment created by the food industry that has been given free reign to promote fattening and unhealthy foods.
∙ It is in the category of non-communicable diseases ∙ Many pointed out that the industry of self-regulation and public private partnerships have shown a complete lack of effective control and safety. Only public regulations and intervention can be effective in preventing harm caused by obesity and others that are the result of direct unhealthy commodity industries. ∙ Widespread availability of fast food and snacks, eating habits and portion sizes (supersizing).
∙ Couch potato diet: red meat, potatoes, chips and cola ∙ Hairy Shirt Diet: veggies, grains, fruits, nuts and yogurt.
∙ Society places a high value on the ideal thin body image with little body fat.
∙ People seek this not only to be fit but to be part of the cultural ideal.
∙ Two assumptions: body is malleable and everyone can reach the ideal and reward is waiting for those who get to that ideal. ∙ Biological variables (genetics) are influential in terms of body weight and shape regulation.
∙ The thin ideal is decreasing as obesity is increasing making the thin idea hard to keep.
∙ Starts as young as 5 years of age and driven through the mother’s perception.
∙ Concluded that interventions with those who are overweight should focus on body satisfaction
∙ But body stigma and shaming is still very common and is detrimental to mental and physical health.
Emotion, Personality, Body Dissatisfaction & Depression One psychological hypothesis to explain obesity is that it has been attributed overeating to emotions.
Emotional distress is associated with snack eating and emotional eating is related to percentage overweight based on a study. Dieters were found to be more extreme emotional responders with an internal source of arousal.
Obese individuals may have a heightened response when it comes to external cues and may lead to eating more when bored, anxious or depressed.
High scores on neuroticism, extraversion or lower sources of conscientiousness with neuroticism leading to weight fluctuations while low agreeableness and impulsivity lead to greater BMI across the lifespan.
Some studies found that a restraint can create a rebound in terms of binge eating and body dissatisfaction was associated with all negative outcomes.
Obesity at baseline depression followed by follow up increased by 55% but not over time
Culture Clash found that GPs, believed that obesity was the patients responsibility rather than a medical issue creating a detrimental problem between the patient and doctor
Other GPs say it is not within their domain
Drug Therapies & Bariatric Surgery
Amphetamine, and orlistat (negative side effects such as poor tolerance and lack of safety)
Participants attributed their failure to lose weight to the medication and emphasized the medication model
Surgery is the most effective in removing 20% of fat. – the greatest variable is the persons investment in the operation and failure being attributed to hedonic motivation to consume more food.
This surgery also creates a high demand for contouring surgery as well to take away their old identity for a new changed lifestyle.
For behavior, weight gain after 4 years
∙ Where can we intervene? Not the same as when and how?
∙ Dramatic differences in opinion around the causes
∙ Temperant societies: complete abstinence and completely against alcohol, late and professional circles
∙ Dominant view: alcohol all right in moderation; harmful in excess ∙ Excessive drinking:– Regular heavy drinking (alcohol dependence) – Binge drinking (younger people and leads to different kinds of health problems) ∙ Men: max 3 drinks per day, women 2
Single occasion risks– Driving, industrial & household accidents– Domestic & other violence (victim & perpetrator) – STI from unprotected sex
Risks from regular heavy drinking– Death from liver cirrhosis– Neurological damage (irreversible)– Increased risk of cardiovascular dis, some cancers
∙ View Case Study on Page 196
NOTE: does not matter on exposure unlike alcohol the only way we start to see differences is with heavy drinking)
Common factor: powerful influence of international drinks companies (tax, hours, prices, advertising)
∙ “J” shaped functions for epidemiological studies of some diseases Healthiest people tend to be the ones who drink a little bit while those who don’t drink at all are to be a little more unhealthier and those who drink all the time are a lot unhealthier.
∙ Strokes: – Conflicting evidence for light drinking – Substantial incr. risk for heavy drinking
∙ Dementia & cognitive decline: – “J” function for light drinkers (thought to be the same as the curve explained above)
∙ Inconsistencies in studies make it difficult to establish limits for safe drinking, but moderate drinking not associated with significant health risk
∙ Inherited predisposition to alcohol dependence
∙ Extreme belief: some people ‘destined’ to become alcoholics after first drink ∙ Biological determinism – note attractiveness of position to drinks industry your make up has the determinance of what happens to you in life
∙ Observed patterns of drinking in families could be genetic or learnt ∙ Twin studies:– Concept of heritability – Metaanalysis: 3036% ∙ Genetic basis likely to be complex– Rates of metabolisation– Subjective
experience of taste– Genetic differences in (e.g.) anxiety leading to different drinking patterns (not strong to determine on their own)
∙ No evidence to support notion of ‘born alcoholics’
∙ Overall, environmental influences likely to carry more weight
Addiction & Disease Theory
• Addiction theories (from 1785 onwards)
– Replaced previous theories of drinkers being morally degenerate – Once addiction is established, individual loses voluntary control to resist urge to drink
– Blames the substance, not the individual
– Focus on at risk individuals such as peer groups and home environment (not necessarily genetic) not the alcohol (only a small percentage are at risk) – Like addiction theories, emphasise loss of control
– But, only addictive to small number of people
Alcohol Dependence Syndrome
∙ Distinction between physical addiction and psychological dependence removed – Psychophysiological disorder (symptoms p.205)
∙ Hard to get rid of that distinction of those that are physical
∙ Notion criticised for difficulty of associating criteria for diagnosis with particular cases
∙ Although there are problems with dependence theories, must acknowledge phenomena of physical dependence – Extremely unpleasant symptoms: tremors, sweating, nausea, vomiting hallucinations, convulsions, fatalities
• Drinking problems & normal drinking result of same learning process – Particular differences owing to personal histories • Operant conditioning
– Little recent interest in alcohol field (cf. other drugs)
– Pleasure from addictive substances on the whole is less than suffering caused
– Pleasure immediate, unpleasantness after delay (except for the hangover, we’re talking about severe health consequences)
∙ Operant conditioning: providing rewards once they do the correct response
∙ Gradient of Reinforcement: reinforcement occurs rapidly after the response is much more effective in producing learning than learning delayed reinforcement
∙ Classical Conditioning: response occurs as a natural reflex that can be conditioned When drug is taken initially, physiological mechanism (puts your system out of whack (part of the pleasurable experience) then returns to its equal)
∙ Compensatory Conditioned Response Model: uses the principles of classical conditioning to account for addiction, tolerance, dependence and withdrawl. Think of the homeostatic mechanism within the body.
∙ Self-Efficacy: having confidence in one’s ability to carry out one’s plan successfully.
∙ Secondary Gain: alcohol has the double function of releasing the inhibitions that might otherwise prevent the impulse from being acted on while simultaneously being held to blame as if it was the drink that performed the act and not the drinker.
– Bandura: classical and operant conditioning important, but we also learn through imitation
– Concept of selfefficacy: personality trait relating to confidence in carrying out one’s plans successfully Peer pressure
– Parents seem to have strongest influence on initiation of adolescent drinking behaviour; peers on subsequent frequency
Causes of Problem Drinking
Addiction, Disease & Dependence
Those who drink heavily may development a dependence that can only be cured by long-life abstinence.
Mechanisms of conditioning and social learning can explain the development of excessive
consumption, symptoms and
DNA variations can be associated with metabolism of alcohol mean where certain persons are more likely to develop problems if they drink
Freud’s concept of secondary gain, as extension of learning theory – you get something that is not directly related to the activity
Cf. hypochondriacs avoiding work & sufferers of neurosis gaining attention Attribution of behaviours to alcohol may work as excuse for evading responsibility (e.g., sexual harassment)
Drinks Industry versus Health Research
• Critics of Drinks Industry: drinks industry is disingenuous, as:
– Education shown to be ineffective– Main profit comes from those drinking above recommended health limits
• In many countries policy more influenced by drinks industry than alcohol experts – Risk of unpopularity if advocating population based policies?
– Most comes from the heavy drinking
– How many drinks per day per capita is what you want to ask
Sophisticated marketing techniques:– Aimed at young drinkers– Lifestyle advertising; sports; rock concerts; fashion – Tailored products: alcopops; premix cocktails Counteradvertising (e.g., warning labels) effective but we do not have enough of it
Intervention & Prevention
Type of Treatment
Drying out centres and private clinics that focus on the alleviation of withdrawal symptoms followed by counseling and therapy to maintain abstinence following discharge
12 step facilitation program
Counseling & Psychotherapy
Aim of helping clients to achieve insight into the causes and effects of problem drinking as an
essential bias for change
Cognitive Behavioral Therapy
Based on learning theories and aims at trying to reduce drinking levels rather than promoting abstinence.
Advice given by GPs and other health professionals and
opportunistic interventions for those who have assessed
screening programs for other reasons rather than alcohol
Mindfulness-Based Relapse Prevention based on stress reduction
∙ The most effective way for reducing population levels of consumption is related to increased taxation.
∙ In the first century of BC, the Mayans were alleged to have smoked tobacco in religious ceremonies with the Aztecs following while Raleigh is supposedly the one to have shown potatoes and tobacco to England. He popularized tobacco in court saying that it was a good cure for coughs.
∙ Was introduced later during Napoleonic campaigns during the early 1800s.
∙ Tobacco tax makes a great contribution to wealth, exceeding its treating costs.
∙ Sudden Infant Death Syndrome: main cause of post-natal death in the first year of life.
∙ Counts for more than 440,000 deaths per year and one in every five deaths and more deaths are caused by tobacco than everything else combined.
∙ Lung cancer is 22 times higher for men and 12 times higher for women compared to those who never smoked.
∙ Carcinogens: initiate a series of genetic mutations that stimulate cells uncontrollably with a delay of several years generally not developing cancer for 20-30 years until after exposure.
∙ Cigarette smoking is exclusively linked too: leukaemia, cataracts, pneumonia, cervix, kidney, pancreas and stomach cancer. ∙ Quitting has immediate long-term benefits such as by stopping at 65% they have a 50% less chance of dying from a smoking related problem.
∙ Nicotine: main active ingredient in tobacco if taken in large quantities can be toxic and even fatal. But in small doses such as cigarettes it is able to provide weight loss, tranquilization, increase alertness and improved cognitive functioning.
∙ Overtime, there is a physical dependence on the nicotine. It is absorbed within 7-10 seconds but through pipe it goes more slowly.
∙ It is addictive because it activates pathways in the brain that regulate pleasure.
∙ Key chemical is dopamine in which nicotine increases once the effects wear off in a few minutes making them redo the action to avoid withdrawal symptoms.
∙ It is rewarded and reinforced thousands of times over their lifetime.
∙ MAO shows a decrease when smoking which is responsible for breaking down dopamine
∙ Twin studies show a genetic link to smoking and can create how an addiction unfolds.
∙ The most frequently used model for smoking is based on learning theory.
∙ Argues that people become smokers because of the positive reinforcement they obtain from smoking, then they generalize to other settings and discriminates between situations that give them reward and others that give them punishment. (conditioned stimuli).
∙ It can be used to escape or avoid certain aversive states. ∙ Affect Management Model that showed six smoking motivation factors: reduction of negative affect, habit, addiction, pleasure, stimulation and sensorimotor manipulation for women it was negative affect and pleasure. T home boredom and family life frustration while at work was for routine and social was habit. ∙ Sensation Seeking: was designed to maintain a certain base level of physiological arousal insisting that smokers have a low level of tonic arousal and seek intense stimulation and score higher on levels of extraversion. Possibly associated with hostility and it has been found to be associated with stress
∙ Many researchers stated that smoking had different meanings in different social settings.
∙ View examples above
Pharmacological Approach to Cessation
∙ Withdrawal symptoms are relieved not by nicotine placebo but through nicotine replacement therapy (NRT): gum, patch, nasal spray, inhaler, tablet and lozenge.
∙ Bupropion: zyban, is a weak dopamine and noradrenaline reuptake inhibitor. Lasts about 7-12 weeks and inhaling tobacco in 10 days through the course.
∙ Varenicline: champix, is a nicotine acetylcholine receptor partial agonist by blocking the binding and reinforcing effects.
Psychological Approach to Cessation
∙ Two components of counseling are effective: social support and practical counseling concerning problem solving and skills training.
∙ Best associated with 8 sessions of counseling and behavior therapy and medication.
∙ Quit for Life Programme: includes all methods listed on the table (page 236) and encourages a steady reduction over the course of 7-10 days then complete abstinence. Can be through group counseling, and internet. Shows high quit rates among those in lower SES.
Social Approach to Cessation
∙ Many group programs use the buddy system in which they are paired to provide mutual support. Local organizations as well such as the NHS and there are even internet support groups.
– Rational Choice Theory: individuals actions are based out of self interest and the decision making is based on rankings of what is considered to be most important. – They say it is all based on individuals and information. They are separate matters. – It is not the company making them smoke their products with information being available to the consumer and THEY MAKE THE CHOICE
– Further say quitting is a matter of willpower and that it is not addictive.
– Health has become the symbol of a moral responsible self with lay concepts of health being intertwinned with our responsibility
– It is something we demonstrate, not something we have to show our legitimacy culturally and socially.
– Primary health was strongly associated with behavioral and psychological aspects.
– Skeptic about health promotions as it can be healthy one day and not healthy the next.
Narratives of Back Pain
– Something that is not visible to others
– They are seeking objective signs as there is no pathology and the symptoms may not correlate.
– Narrative: restorative value in owning about telling your story and the meaning evolves as the illness does over time.
– It is not about the body but how it THREATENS one’s IDENTITY – Telling their story allows them to discover themselves through the changes – Many tried to justify their condition and want a diagnosis to know it is not their fault.
– Frustration with medical professionals and only want empathy.
– We cannot assume we know everything about it.
Disruption of every day activities
Emotional costs and distress
Types of Narratives
Restitution: most common, healthy to sickness then back to healthy. How they identify and defeat the enemy.
Chaos: lack of order and focuses on the vulnerabilities and evoke fear. Why people avoid talking about it as it denies recognition of suffering and the opportunity to work towards meaning.
Quest: illness is attributed to fate or destiny. We achieve meaning by finding purpose from the experience with the illness and recovery is not essential.
Polyphenic: emphasis is on the present rather than the future, uncertain.
Biographical disruption: experience of people diagnosed with arthritis (RA)/ Disrupts plans and hope for the future and reworking these parameters of everyday life is known as narrative reconstruction
PreWedding Weight Concerns
Should just focus on the “healthy” bride.
Brides appearance is central to the perfect day
Internalized the thin ideal
Most wanted to lose 23 pounds
Wedding showcases may have an impact as well
Age was not correlated for weight loss
1/3 sought advice main suggestion coming from the mom
Those with higher BMI went to laxatives and waist banding.
Every wedding aspect was equally important: good day, appearance and enjoyment.
Closing the Health Equity Gap
Life chances depend greatly on where people are born
Poor health is not confined to those that are worst off
Unequal distribution due to poor programs and policies
Social determinant actions should be based on everything, not only the health sector
Improve daily life conditions
Tackle unequal distribution
Measure issue, public awareness and expand knowledge and more developed trained work force.
Emphasized the importance of early childhood development nutrition, social and psychosocial development.
Policies need to begin with early life greater planning is required PartTime vs. FullTime.
EX SAMPLE QUESTIONS
1. Name four key points (e.g., purpose, methods, main findings, conclusions) of the study about prewedding weight concerns and health and beauty plans of Australian brides by Prichard and Tiggemann? (4)
2. What is the extent of the problem of obesity in Canada? (3) 3. Name and describe one major theory explaining alcohol dependency (3)