HEALTH PSYCHOLOGY notes from weeks 1-2
HEALTH PSYCHOLOGY notes from weeks 1-2 Psyc 400
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This 12 page Class Notes was uploaded by Samantha Riley on Thursday January 28, 2016. The Class Notes belongs to Psyc 400 at Humboldt State University taught by Carrie Aigner in Winter 2016. Since its upload, it has received 106 views. For similar materials see Health Psychology in Psychlogy at Humboldt State University.
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Date Created: 01/28/16
Week One Class Notes: Tuesday, 19 January 2016 Introduction to Health Psychology: I. Life Expectancy: a. Leading cause of death before the mid-1900s i. Infectious Diseases: caught and spread through poor sanitation 1. Pneumonia 2. Tuberculosis 3. Gastrointestinal Diseases b. Life Expectancy in 1900 = about 47 years i. The average was dragged drastically down by infant mortality and child deaths c. Leading Cause of death today (2015) i. Lifestyle and chronic diseases 1. Heart Disease 2. Cancer 3. Respiratory Disease 4. Stroke ii. The big 3 lifestyle choices that increase the risks of the above 1. Sedentary life 2. Poor Nutrition 3. Smoking d. Biggest increase in life expectancy in the US over the past 100yrs is due to i. Control of infectious diseases 1. Vaccination 2. Safer drinking water 3. Better disposal of sewage 4. Focuses on Public Health e. Today’s life expectancy = about 79 years i. Not doing well compared to other developed nations 1. Who’s leading? a. Hong Kong, China b. Japan ii. There is a weird life expectancy distribution within the US 1. 3 peaks- based on race, class and location 2. Two distinct age groups fro life expectancy: a. One group lives on average to 65 b. Another to 85 3. Slight increase in mortality from degenerative diseases a. Alzheimer’s b. Parkinson’s c. Pneumonia II. **Discussion Point** a. Why have we seen an increase in these diseases? i. People live long enough now to develop this degenerative disease. Thursday, 21 January 2016 Infant Mortality and Healthcare in the US *Keep in mind how everything in the course relates back to life expectancy I. Infant Mortality Rates: a. Deaths of infants after birth per 1,000 births i. Japan lowest in world= 2.6 ii. US = 6.6 iii. Afghanistan = 79.3 b. US ranks below a few other developed nations i. 6.6 deaths per 1,000 live births 1. Not equal across racial/ethnic groups a. African-American = 31.8 per 1,000 b. Euro & Hisp = 6.2 per 1,000 2. Why the disparity? a. More teenage pregnancies b. Pre-term births i. A&B both more prominent in Af.Am. population c. STDs d. Lack of access to quality prenatal care i. Leads to a decrease in mother’s health and nutrition ii. C&D prominent among low income families II. Healthcare in the US a. Costs of healthcare are rising b. Medical care costs = about 15% of Gross Domestic Product (GDP) i. It’s the highest in the world c. Have goals that match up with other developed countries i. Low rates of disease ii. Higher life expectancy iii. Lower infant mortality d. But, costs are still higher, and US ratings are still lower than those other countries e. An important distinction is that the US has a high focus on high tech, costly interventions, but neglects basic healthcare for the people who cannot afford the high end technology f. III. **Discussion Point** a. How can this distinction help us to think about life expectancy in the US? i. We miss out on personal interaction ii. Follow-through on health suggestions on health isn’t always done iii. Basic level care isn’t available to everyone 1. But, we have fancy equipment for whom can afford it… IV. Statistics Break a. Understand the statistics i. What was the unit for infant mortality? 1. “per 1,000 live births” ii. Given that countries have different populations, this gives comparable values 1. The news likes to not adjust for population differences b. Always look for units c. Be careful of absolute numbers (“total number”) V. Prevention a. To treat cancer with: i. Chemo ii. Radiation iii. Medication iv. Rehab/physical therapy v. Even with insurance patients can still owe about $1-2million b. Attributable to lifestyles i. 70% cancer risk ii. 90% cardiovascular risk 1. These could be reduced by managing a. Diet b. Stress c. Exercise d. Smoking e. Education c. Most funding goes to treatment, NOT prevention i. Cancer PREVENTION is highly underfunded VI. Class Discussion a. Why is treatment the focus, and not prevention? i. People are so worried about getting their families fed that they don’t worry about the cancer risk of the food they are feeding them ii. People don’t focus on illness until they are faced with it iii. There is little money in prevention iv. ‘Hero’ mentality of curing something if someone discovers a cure 1. outcomes of prevention are hard to access 2. harder to see what someone has done in prevention v. As humans we have gotten lazy 1. Pills are easier 2. We avoid “long-term” envisioning VII. The Role of Psychology in Healthcare a. There has been a paradigm shift i. From biomedical (find the pathogen and eliminate it) à Biopsychosocial (all aspects of living must be considered; focus not jut on absence of disease, but wellness) b. Signs of Change i. The American Medical Association (AMA) is altering training for medical student to focus more on 1. communication 2. understanding health systems 3. social and cultural components of the practice c. Application of Psychological Principles to Physical Health i. Diet & Exercise Promotion ii. Addressing the social, cultural and psychological components of wellness iii. Managing pain iv. Increasing medication adherence v. Moderating other risky behaviors vi. Quitting smoking VIII. **Discussion Point** a. What’s the difference between true interdisciplinary care and the consultant model of integrating psychology into medical settings? i. In interdisciplinary it allows a team to discuss a patient’s case and collaborate, instead of consulting and recommending a completely different specialist- working separately. Week Two Class Notes: Tuesday, 26 January 2016 Research Methods in Health Psychology I. Correlation a. Degree of relationship between two variables b. Range from -1 to 1 i. Strongest correlations are -1 or 1 ii. 0 means no correlation iii. Positive correlation- variables move in the same direction (both go up, both go down) iv. Negative correlation- Variables move in opposite directions (one goes up, ones goes down) v. Ex: 1. Height and Weight? Usually Positive 2. Rainfall and River Volume? Positive 3. Time lectured, time left in lecture? Negative vi. In psychology, you will almost never see a perfect correlation 1. A good correlation example = about 0.2 or 0.3 (statistically significant) 2. Reason being that people are complex c. Correlation doe NOT equal causation d. Confounding Variable- 3 variable that could be causing both instances occurring i. Example: Ice cream sales and violent crimes were positively correlated during a summer in a town 1. Rise in temperature could be causing both II. Experimental Design a. Experimental Study i. Experimental Group and Control Group 1. Placebo 2. Different level of Independent Variable 3. Waitlist control ii. Random assignment iii. Manipulate Independent Variable iv. IV à Dependent Variable b. RCT (Randomized Controlled Trials) i. Highest standard of experiment ii. Random assignments iii. Group equivalence iv. Control for confounding variables v. Placebo control group (expectancy factors) vi. Double blind model c. Exeperimental Design Advantages and Disadvatages i. Advantage: can make inferences about cause and effect ii. Disadvantage: May not be feasible 1. Due to ethical or practical concerns iii. May not be generalizable III. **Discussion Point** a. Why can’t they be generalizable? i. Too many confounding variables 1. Culture 2. Location 3. Socioeconomics 4. Etc… ii. Real world is too complicated to control for every possible instance IV. Epidemiology: a. Terms to know: i. Epidemiology – Studies the factors that contribute to health and disease in a particular population ii. Prevalence – proportion of the population that has a particular disease at a specific time 1. Ex: Diabetes prevalence in 2012: 9.3% of the population iii. Incidence – Frequency of new cases in one year 1. Ex: Diabetes incidence in 2012: 1.7 million new cases/year V. Risk Factor Approach: a. Relative Risk (RR) – Ratio of disease in exposed group to that in the unexposed group i. RR=1.00 means same risk in both groups ii. RR=1.5, then 50% more likely to develop the disease iii. RR=0.7, rate of disease is 70% that of the unexposed group (‘exposure’ here might be a treatment) iv. What is the RR for lung cancer mortality among smokers vs. non- smokers? 1. 23.3 (23 times more likely to die from lung cancer) a. from lifetime heavy rates of smoking Thursday, 28 January 2016 Research Methods in Health Psychology CONT… I. Effect size a. Effect size = Mean of experimental group – mean of control group (divided by) standard deviation i. Small = 0.10 ii. Medium= 0.30 iii. Large = 0.50 iv. Ex: Antidepressant drug trial, outcomes: depression scores 1. What happens to effect size when there is a lot of variability in scores? 2. Standard deviation would go up, effect size would go down II. Meta-analysis a. Summarizes all of the findings in the field b. Computes overall effect size c. Media doesn’t rely on meta-analysis enough i. Causes a lot of flip-flopping of media reported information III. More Examples of media, ethics and research a. Autism and Vaccinations i. Original study published in 1988 by Andrew Wakefield and colleagues was fraught with errors 1. The study was done poorly 2. The study was retracted 3. Not autism diagnosis was officially given (no formal assessment) a. Beginning of symptoms was speculated from memory b. Not controlled for confounding variables c. Information was only correlation d. Sample size is not representative of child population receiving vaccines 4. Follow-up a. Dr. Wakefield had serious undisclosed financial conflicts: he was funded by lawyers involved in lawsuits against immunization manufacturers and was applying for a new vaccine patient b. Dr. Wakefield’s medical license was revoked in the UK c. At least 20 higher-quality studies have since failed to show a link between vaccines and the development of autism d. The retraction has been published in multiple news sources, including The Guardian, ABC News, NY Times, BBC and many others. 5. Go to non-profit disease/public health organizations for more information when you need it r want it on certain issues ii. MMR Vaccinations are still speculated to be causing other concerns for people 1. There have not been enough evidence to indicate that there are a high health risk to get the vaccine instead vs. not getting it b. Update from the CDC i. Measles cases and outbreaks in 2014 1. California lifted the religious exemption for vaccines IV. Building the Evidence a. The turmeric example i. Turmeric: Does it work? 1. Used in medicine in many parts of Asia for over 2,000 years 2. Parts of the world (SE Asia) consume 1-2tsp a day 3. Has the largest amount of evidence to support possible health improving qualities a. Even in preventing cancer 4. Step 1: a. Mouse Models i. Turmeric has been shown to slow cancer tumor progression in mice 1. The mice are bread to carry certain cancers a. Test on mice because researchers can control virtually everything about a mouse’s life, to allow for almost perfect control of controlled variable i. Harder to replicate these affects in humans due to such large amounts of variability 2. Works well in these models as a cancer treatment 5. Step 2: a. Large correlational epidemiological studies i. Is turmeric consumption associated with lower risk of cancer in the population 1. Survey thousands/millions of people on intake, and then draw correlation to cancer rates in those populations 6. Step 3: a. Clinical trials i. Does turmeric slow the growth of tumors in cancer patients? 1. Start feeding more turmeric into the diets of patients to monitor the effect on cancer tumor growth. ii. What does the American Cancer Society say? 1. Lab animal tests look promising, careful study needed to find if curcumin will be useful for treating these conditions in humans a. Usually they will be conservative with their statements, so this kind of hopeful statement is a big deal Seeking Healthcare I. Factors relates to seeking healthcare a. Personal factors- anxiety, coping, knowledge, personality i. Neuroticism = strong emotional reactions to negative events 1. More readily willing to report physical symptoms and seek care b. Gender Differences i. Women report symptoms and seek care more readily than men ii. Possibly due to male gender role iii. Impact of marriage on health in males and females 1. Married people have better health 2. Benefit of marriage on health stronger for men. Why? 3. But the affect of marriage on health seeking is stronger on men than women a. Probably due to the woman (in a heterosexual marriage) urging them to go b. Women more negatively impacted by conflict c. Women may encourage healthy behaviors in husbands 4. The support within marriage could be expanded to other social support systems for research c. Age i. Younger people more reluctant to seek care, in general ii. Older people more likely to seek care if symptoms not attributed to normal aging d. Symptom Characteristics i. Visibility (osteoporosis vs. acne) ii. Symptom severity iii. Symptom interference iv. Symptom persistence e. SES (Socioeconomics) i. Low SES – less likely to utilize medical care 1. Yet more likely to be hospitalized and have more severe illness a. Why? i. People who are uninsured or have little insurance tend to put off seeking care until they absolutely have to. ii. Research Example: Diverse group of women were given vignettes describing symptoms. All identified symptoms correctly and identified similar courses of action iii. Implications: 1. Lack of resources, instead of a lack of knowledge, accounts for differences in seeking healthcare II. Access to care a. Medical Insurance i. Medical bankruptcy (account for half of all personal bankruptcies in US) 1. Occur even among people with insurance 2. New rules of out-of-pocket maximums a. Meant to help not have bills in the millions, but can still happen ii. Article 1. “The Chargemaster” a. Chargemaster = office where prices are set for different hospitals, supplies, etc. b. Supplies from the hospital tends to be extremely high compared to finding it elsewhere i. Hard to do that if you are needing on-site care ii. Insurance company is able to negotiate prices down iii. ASK QUESTIONS when you go to the hospital 1. Ask how much what they want to do to you will cost 2. Ask why they are doing something 3. Will your insurance cover that? This Week Bolded Words From the Book I. Chapter One: • Life Expectancy – the expected number of years a person will live • Chronic Disease - illnesses that are long lasting and usually irreversible • Biomedical Model - the dominant view of twentieth-century medicine that maintains that illness always has a physical cause • Pathogen - a virus, bacterium, or some other microorganism that causes a particular disease, • Biopsychosocial Model - the viewpoint that health and other behaviors are determined by the interaction of biological mechanisms, psychological processes, and social influences • Behavioral Medicine - an interdisciplinary field that integrates behavioral and biomedical science in promoting health and treating disease • Health Psychology - the application of psychological principles and research to the enhancement of health, and the prevention and treatment of illness II. Chapter Two: • Placebo - an inactive substance or procedure that may cause a change in an individual's behavior or health • Nocebo Effect – An adverse effect from a placebo • Double-Blind Design - an experimental procedure whereby neither the subject nor the researcher knows which research treatment the subject is receiving • Single-Blind Design - Participants don't know to which experimental condition they belong but the researcher does. Often used in psychosocial intervention research • Correlational Studies - measuring two variables and determining whether they are associated with each other. Studies related to smoking to lung cancer are correlational, for example • Correlation Coefficient - a statistic that reflects the degree and direction of relationship between two variables; it can range from +1.00, through .00, to -1.00 • Cross-Sectional Studies - method of studying developmental trends by observing different groups of subjects of different ages within a relatively short period of time • Longitudinal Studies - the repeated observation and measurement of the same individuals over a period of time • Experimental Group – the participants in an experiment who are interacting with the independent variable • Control Group – the participants in an experiment who are not interacting with the independent variable, being used as comparison to the experimental group • Independent Variable - The experimental factor that is manipulated; the variable whose effect is being studied. • Dependent Variable - the outcome factor; the variable that may change in response to manipulations of the independent variable • Ex Post Facto Design - one of several types of quasi-experimental studies that do not involve the manipulation of an independent variable. Instead, researchers choose a variable of interest and select participants, who already differ on this variable. They allow comparisons between or among groups, but they do not permit researchers to determine that one variable causes changes in another variable. • Subject Variable – a variable chosen (rather than manipulated) by a researcher to provide levels of comparison for groups of subjects. • Epidemiology - the study of the frequency, distribution, and causes of infectious and noninfectious disease in a population, based on an investigation of the physical and social environment. Ex: epidemiologists not only study who has what kind of cancer but also address questions such as why certain cancers are more prevalent in particular geographic areas than other cancers are • Risk Factor - characteristics or conditions that occur more often among individuals who develop particular diseases or injuries than among those who do not • Prevalence - Describes the number of people who have a particular disease at a given time. New cases+ old cases = total cases= prevalence • Incidence - Describes the number of new cases of a disease within a specified population • Prospective Studies - a research strategy in which people are followed forward in time to examine the relationship between one set of variables and later occurrences. Ex: prospective research can enable researchers to identify risk factors for disease that develop at a later time • Retrospective Studies - a research strategy whereby people are studied for the relationship of past variables or conditions to current ones. Interviewing people with a particular disease and asking them about their childhood health behaviors or exposure to risks can identify conditions leading to an adult disease, for example • Case-Control Studies – a retrospective epidemiological study in which people affected by a given disease (cases) are compared with others not affected (controls). • Clinical Trial – a research design that tests the effects of medical treatment. Many clinical trials are randomized controlled trials that allow researchers to determine whether a new treatment is or is not effective. • Self-Selection - When participants decide to opt into a social study as a respondent or are allowed to choose between being in the experimental group or the control group, this may affect the accuracy of the research results. • Meta-Analysis – a quantitative technique that combines the results of many studies examining the same effect or phenomenon • Absolute Risk – A person's chances of developing a disease or disorder independent of any other people may have for that disease or disorder • Relative Risk - Describes the incidence of a disease among individuals having certain characteristics compared to the incidence of disease among individuals not having that characteristic • Dose-Response Relationship - a direct, consistent relationship between an independent variable, such as a behavior, and a dependent variable, such as an illness. Ex: the greater the number of cigarettes one smokes, the greater the likelihood of lung cancer. • Theory - a tentative explanation of phenomena • Model - A set of statements explaining the relationship between factors or variables contributing to some phenomenon. It’s less formal than a theory. • Reliability - The quality of getting consistent results from a set of questions or observations. • Validity - The accuracy of a test or measurement.
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