Health-Compromising Behaviours

 

Goals: Know what factors are involved in adolescent smoking, how can people quit unhealthy habits, issues around unsafe sex, know the bio-psycho-social factors involved in obesity, why are eating disorders gender biased, application of stages of change model to health compromising behaviours.


Overview 

Substance Abuse

            Smoking

            Alcohol Use

            Illicit Drug Use (prescription drug use)

Unsafe Sexual Behaviours

Obesity

            Biological factors that contribute to obesity

            Psychological factors that contribute to obesity

            Sociocultural Factors that contribute to obesity

            Prevention and treatment of obesity

            Pharmacological treatment of obesity

            Behavioural treatment of obesity

            Surgical treatment of obesity

Eating disorders

            Biological, cultural and psychological contributors to eating disorders

            Treatment for eating disorders


 

 

Health-Compromising Behaviours

 


 

Substance Abuse

 Smoking - clearly one of the biggest issues in healthcare today.

 1996 Canadian estimates of death due to smoking for ages 35 to 84 are

 about 25%, however smoking rates have been dropping since. 

 

Sociocultural Differences in Smoking

Smoking is related to income, where the lowest income bracket have the

highest rates, and Aboriginal populations have highest rates for 20-29 year olds. 


 Recent immigrants, non-European, have lower rates of smoking.

 

Why do people smoke?  

In spite of the unpleasant experiences that most people have when they first
 try to smoke, many people continue and go one to have a very difficult time quitting.

 

    Beginning to smoke

Usually people begin during adolescence, particularly if their friends smoke
and do so while in social situations.  Girls are more frequently offered cigarettes
than are boys, placing added pressure on them.

 

Thus situational factors play a big role, and apparently also social learning where
those whose parents or older siblings who smoke will be more likely to start.

 

The "image" of smoking is portrayed by family and friends as being desirable or unacceptable.

 

Media also plays a role where movies and TV show portray smoking as a good
or 'cool'  thing to do, not to mention advertisements (i.e., Marlboro Man)
- some estimate 35% of those who start is due to advertising.

 

While these factors appear to be important in getting people to start smoking,
 other personal variable appear to play a more important in ongoing smoking behaviour,
 such as risk taking and rebelliousness.

 

Crisp et al. (1999) have suggested that there are four factors involved in initiation:

1) parental modeling, peer influence, cigarette advertising, and personal characteristics.

   

 

    Becoming a regular smoker

While it has been suggested that smoking is a habit that develops slowly,
first just a few cigarettes, later more,... there also are positive and negative
affect smokers (Tomkins, 1966). 

 

 Positive affect - smoke to relax or decrease stimulation while negative-affect smokers
 tend to smoke to reduce anxiety or other negative emotions.

 

Tomkins also identifies habitual smokers, who smoke due to habit, not emotional benefit,
as well as the addictive smokers who lean heavily on smoking and have a psychological
 dependence over and above their physiological addiction.

 

Nicotine is a highly addictive drug, (see psyc 215 text - Pinel), leading to various theories on nicotine addiction.

    1) Nicotine fixed effect model - addiction through stimulation of brain reward systems. 

    2) Nicotine regulation model - specific levels of nicotine are maintained by smoker.

    3) Mutual regulation model - physiological and psychological (including social) effects of nicotine are present.

    4) Bio-behavioural model - once the chemical alteration of nicotine happens it leads to the release of other chemicals (i.e., acetylcholine, dopamine) that alter cognition, memory, emotion, and behaviour. 

 


 

    Health consequences of smoking

reduces life expectancy and offers twice the rate of premature deaths through CHD & Cancer.

 

        Smoking and CHD & Cerebrovascular Disease - through increased serum cholesterol
and the size of plaques on the arteries and may lead to rapid progression of CHD. 


 As a stimulant it increases heart-rate, blood pressure, and cardiac output, constriction of vessels.

 

        Smoking and Cancer - About 80% of smoking related deaths through cancer of mouth and esophagus, etc.

 

        Smoking and Chronic Obstructive Pulmonary Diseases  - bronchitis and emphysema
account for 4% of all deaths, damage from smoking is particularly experienced when exhaling with force.
 

    Environmental Tobacco Smoke - (second-hand smoke -or third hand) leads to increased risk
 from cardio-vascular disease rather than lung cancer. Other concerns are in
 pregnancy-low birth weight, risk of SIDS etc.

 

    Quitting Smoking  - the fact that addiction leads to withdrawal
(unpleasant feelings when the drug is not present).
 

        Quiting on one's own  - most people who quit, do so this way,
                                            even though they likely won't succeed on their first attempt.

 

        Quiting with therapy - Various methods have been used here with some degree of success:
                1) Nicotine Replacement theory - Suggests that the body has a need to maintain levels of nicotine,
                so gradual reduction of levels is done through "weaning off" with the patch or gum.

                2) Aversion therapies - are used to make smoking unpleasant and reduce the desire to smoke,
                    in light of the addictive power it has, e.g., electric shock, aversive scenes and rapid smoking.

                3) Self-management strategies - are also used to develop insight into the
                     behaviour that will help one quit.

                    E.g., Self-monitoring (recording each time with mood), Stimulus control  (cue removal),  &
                    Behavioural contracting where contracts are signed leading to rewarded (financially) or punishment.

        TCM - acupuncture to remove cravings

       

<see Box 9-1 >   Campaigns
 

Alcohol Use

Alcohol Consumption - over 50% of Canadians drink at least once per month, while those who drink the most tend to be of higher income brackets. Average age is also dropping where 40% of 13 year olds have drunk and 80% of 17 year olds.

Aboriginals have a higher incidence of alcohol problems, particularly from some communities.

 

The Effects of Alcohol -  It has a main effect of being a depressant of the CNS, including the dis-inhibition of brain centres to give the appearance of it being a stimulant.

 

Excessive alcohol use (abuse) can lead to liver and digestive diseases, CHD, & Cancer.

 

Extremely dangerous to take alcohol with barbiturates as they has a cumulative effect that could significantly shut down parts of the CNS, leading to death.

 

While risks and liabilities are debated, it appears that low consumption leads to health benefits (lower risk for CHD) while higher consumption leads to various health risks.

 

Explaining Drinking Behaviour
- once again several models have arisen, including various disease models such as the alcohol dependency syndrome model that suggests salience and tolerance lead to higher levels of consumption, based primarily on the physiological affects of alcohol.

 

The tension reduction hypothesis suggests that alcohol helps to avoid tension or stress.
        There is little evidence to support this model.

 

Self-awareness modelsuggests that alcohol consumption is done to avoid self-awareness, similarly to the alcohol myopia model that suggests drinking alcohol reduces one's breadth of concerns and enables "drunken relief" from worry.

 

Social Learning model suggests that we learn to drink from observing others and modeling our behaviour after their's.

 

Preventing & Treating Alcohol Abuse

Public policy has been used to limit access through prohibition and age restrictions.  Twelve-step programmes also are used to help people stop, but does not appear to be more affective than other techniques.

 

Sometimes drugs are used to treat alcohol consumption, in the 1950s LSD was used in places like Hollywood hospital and the Alan Memorial Institute to gain insight into what alcohol does.

 

More recently other drugs have been used such as antabuse (disulfiram) as an aversive therapy.

 

 

Illicit Drug Use

    Cannabis - health risks of smoking, CHD, Cancer along with altered perceptions. It also has been heralded as a positive drug for apetite stimulation, glaucoma, pain relief, & nausea reduction.

 

    LSD, PCP, MDMA - all hallucinogens (as is Cannabis) - effects may last 8 - 24 hours (or more).

 

    Cocaine - stimulant that leads to Cardiovasular changes and is addictive giving rise to strong withdrawal symptoms.


Unsafe Sexual Behaviours - Safe sex is important to reduce unwanted pregnancies as  well as other more serious health issues such as HIV/AIDS and other STDs (or STIs).  Aboriginal populations have 4 times higher rates than general population for STDs. 

Sexual Health Education - Sue Johanson  S&G S2 for 35 years

 The information-motivation-behavioural skills model is used to understand what it takes to have safe sex.

Here it is suggested that:
 1) there must be recognition of being sexually active;
2) must develop a "sexual & reproductive health agenda" ;
3) must be capable of carrying out behaviours that achieve this strategic goal.


 

Obesity
    What is it?   A condition of excess body fat, greater than the average expected levels of 25% for women and 18% for men.  It is typically calculated ( see http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm - (Kg)/(m)2  or (lb. x 700)/(in). with the Body Mass Index (BMI)     (yet-John Taveres 6'1''-209; Sidney Crosby 5'11''-200 show limitations of the BMI)

 

 

Prevalence for it is around 15% of adult Canadians (stats Can) meaning one of seven.   Relative risk at 40 is two to six times those at 24 (Calle, et al., 1998).

 

Underweight individuals also have an increased risk. This is particularly seen in anorexia nervousa. 

 

Other social issues are related to obesity, prejudice and discrimination, self esteem as well as the economic (healthcare) costs and reduced income.

 

            Biological factors that contribute to obesity -
                Heredity - Poole et al report that BMI correlations for families are as follow:

monozygotic 0.74 siblings  0.25 adoptive relatives 0.06
dizygotic  0.32 parent-offspring pairs 0.19  

 

                Hormones & The Brain - Set point theory suggests an optimum level of body weight, that is self-regulating.  Zhang, et al. (1994) report that leptin (a protein hormone) activates the hypothalamus in feedback of body weight, since it varies in the blood relative to levels in fat cells. Cellular fat increases are systemically regulated through this leptin>hypothalamic activation.

                <case 10-1>

Brain Centers - Hypothalamus (endocrine)
      lateral hypothalamus (lh) - stimulation initiates eating, even in full animals,
          ablation leads to complete disinterest in food.

      ventromedial (vmh) - stimulation leads to cessation of eating,
          ablation leads to ravenous eating.

Mechanism:appears to be the monitoring of Leptin,
            a protein produced by fat cells that are full.

Obese rats (and people) have high levels of leptin which increases metabolism and decreases hunger,
likewise Obestatin (from stomach), and PYY (digestive tract).

While Orexin (from hypothalamus) triggers eating, Ghrelin (empty stomach) initiates hunger.

Set Point theory suggests that our body weight is maintained around a 'genetic' specific point.

Eating (hunger) and & basal metabolic rate (glucose/glycogen) adjust to maintain the set point, however these settling points may adjust up or down.

 

            Psychological factors that contribute to obesity

                Stress & Eating
- some people tend to increase eating in response to stress while others tend to decrease eating. Some studies suggest that people tend to prefer salty foods when under stress.

 

 

            Sociocultural Factors that contribute to obesity

While much of our eating and body weight appears to be determined by heredity, families, friends and cultures also have a significant impact on what, when and how much we eat. While economics (international and local) play a role on food availability, customs and sharing of food also play important roles in our diet.

 

The specific food we eat at rituals of the family (birthday, coming of age, wedding, funeral), to religious rituals (christmas, lent, easter, ramadam, divali, hanukah, moon festival) and national ones (Canada day, New Year's, NHL playoffs) is shaped by our culture.  <discuss what food your ritually eat>.

 

                Environmental & hunger Cues  - We also take cues of when to eat from the environment, the clock, daylight, sights, signs, & smells. It has been suggested that obese people tend to draw more heavily on external environmental cues to eating while non-obese tend to make use of internal cues such as hunger pangs or fullness.

 

                    <focus on Canadian Research>  No restraint - as that leads to over eating.

 

            Prevention and treatment of obesity
- balanced food and health exercise

 

Listen to the CBC the Current interview of "the diet fix" a discussion of the obesogenic envirnoment that we live in and how to promote "best weight", a weight of comfort, health and happiness (Freedhoff, 2014).

Losing 5% of body weight is significant and can have important health benefits.

This is also the basis of the Don't change much campaign.

Also how to avoid "post-traumatic diet disorder" - feeling like a failure for not keeping off weight lost during dieting.

Rather keep a food diary to account for the foods consumed and knowing what one eats then one can make small adjustments and changes (& getting them reinforced).

Physical activity also matters a great deal to maintain wellness and manage weight.

Geographic and social factors - large suburban development without recreation and shopping facilities nearby creates need to drive distances for eveything.

Food regulators allow high fructose corn sugars as food additives to increase caloric intake from processed foods.

 

               

            Pharmacological treatment of obesity  
 - Stimulants (pharmaceutical or 'natural') are used to speed up metabolism and reduce feelings of appetite. Dangers of course are their added risk on health through the hyper state they induce as well as their addictive properties.

               

            Behavioural treatment of obesity
- Stimulus control, self-monitoring, self-control, social support, contingency contracts.

               

            Surgical treatment of obesity - gastric bypass is a serious operation and has been shown to be of limited success where about 25% of the weight lost is kept off.

 

Diabetes is often the result of poor dietary and exercises habits. however sometimes it is a condition develop genetically or congenitally.

 

 


 

Eating Disorders
Anorexia nervosa - is an eating disorder where people starve themselves and express a fear of becoming fat and often think they are fat in spite of being underweight.

Causes for anorexia (and Bulemia) have been broken down into social and cultural, family and individuals.

Social & cultural factors include media, peers influence and cultural notions regarding food abundance and dieting.

Media has also been blamed for images that have been propagated
 from Barbie to Kate Moss  showing an obsession with slimness. Killing us Softly
with photoshop.

Societies that have great food abundance also tend to have emphasis on dieting.  This may led to a sense of body dissatisfaction.

Often for me getting bigger is the case as with GI Joe (and body dismorphic disorder-see Bigger, Stronger Faster

Peer pressure and 'friendship cliques' may emphasis this more as in the case of pro-ana groups.

Family factors include genetics heritability, parents with eating disorders and also family dynamics.

ED families tend "to be enmeshed, intrusive, hostile, and negating" of person's emotional needs and overly concerned about parenting (Polivy & Herman, 2002, p. 194).

There may be insecure/anxious attachment present and a critical family environment involving coercive control.

Mothers tend to display more dissatisfaction with the family system and and critical of their daughters, thinking they should lose weight and describe daughters as less attractive than others, while also being image conscious.

Fathers tend to be more distant, over-involved with work, often prone to alcohol abuse.

Individual factors include body dissatisfaction, possible abuse and teasing, lower self esteem, anxiety and depression as well as experiencing a significant life -stress.

May have obsessive thoughts (similar to OCD) usually around food, strive for perfectionism and may exhibit dissociation. Also often exhibit distorted cognition (bias) around food and body image.

Some suggest that it is one way to gain control in one's life and that it becomes self-reinforcing or somewhat addictive behaviour.

Others take an evolutionary perspective where it is seen as having has some type of evolutionary adaptive value in the past, such as the need to stave off puberty and menstruation in order to develop better skills at acquiring a good mate (Anderson & Crawford, 1992).

As such there are distal (ultimate) factors which are believed to be part of the evolutionary past as well as proximal factors that are immediate cues or triggers in the present environment.

Bulimia neurosa is characterized by binge eating and purging. Often with the use of laxatives or self-induced vomiting, feel guilty and frequently have depression, alcoholism and obesity.

       

Treatment for eating disorders - weight restoration, cognitive behavioural therapy, family therapy, individualised to the person, recentlt deepbrain stimulation of OCD and additction areas.

 


 

Zhu (Chapter 15-Help for your Will Power)

Weight Control
- various conditions including damp phlegm & heat type; Liver qi stagnation; Spleen & Kidney deficiency.
    Home remedies: Hawthorn & Cassia tea, cucumber sandwiches, or winter melon in soup.

Smoking

    Acupuncture - ear and body points

Drug Addiction - help with withdrawal symptoms as well as  rehabilitation.

Alcohol Abuse - some herbal and aroma therapy.