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Lecture 1
Promoting Healthy Behavior Change
HEAL 101: Health and Lifestyle
Kevin Petti, Ph.D.
Department of Natural Sciences,
Health, Exercise Science and Nutrition
San Diego Miramar College
! Define Health and Wellness
! Discuss historical perspective of health
! Discuss health status of Americans and Healthy People 2020
! Evaluate the role of gender in health
! Discuss health challenges faced by people of various racial and cultural backgrounds
! Explain the importance of a global perspective on population health
Objectives
! Provide rationale for focusing on risk behaviors to influence health status
! Evaluate sources of health information! Examine how beliefs, attitudes and significant
others affect a person's behavior changes! Survey behavior change techniques and learn to
apply them! Apply decision-making techniques to your own
lifestyle
Objectives What is Health?
! Think of aspects or characteristics of health! Which words would you use to describe Health?
! Dynamic, multifaceted, and ever-changing process of achieving individual potential in each of the following dimensions:" Physical" Social" Emotional" Mental" Spiritual" Environmental
Health Dimensions of the Health and Wellness Continuum
Dimensions of the Health and Wellness Continuum
Where would you place yourself?
Where would you place others?
Consider two scenarios Athlete vs Paraplegic
Who achieved Wellness?
! 1800s: Health = absence of illness" Medical Model: health care focused on
curing or treating disease
! 1900s: Emerging Ecological or Public Health Model" Began in the middle 1800’s from the
work of John Snow, a British physician investigating cholera
Health: Yesterday and Today
Health: Yesterday and Today
! 1960-1970: Comprehensive Ecological or Public Health Model" Individual's social or physical environment caused health
problems
! Today: Focus on quality of life, evolution toward fitness" Health People 2020
Factors That Influence Health Status A Comparison of LeadingCauses of Death 1900 vs. Today
1900 1. Tuberculosis
2. Pneumonia/Influenza 3. Digestive Disorders Gastritis, Enteritis, Colitis
Why are these no longer top killers?
Medicines, Cleaner Food & Water, Tech. Advances, Refrigeration, Research
Money, Vaccines, Legislation
Are the above responses of others or the
individual?
What Are Vaccines?
• The deliberate stimulation of immunity.
• They mimic what happens during natural infection without causing illness.
• Use altered versions of viruses or bacteria to trigger an immune response.
• Are the most effective means of controlling infectious diseases.
• Not only protect those who get them, but they also help keep diseases at bay in the community; this is called Herd Immunity.
Who Decides Which Vaccines We Get?
• Vaccine recommendations are a group decision between:• Centers for Disease Control and Prevention• American Academy of Pediatrics• American Academy of Family Physicians
• State government decides whether people in that state will be required to get a vaccine.• Influenced by economics and politics
Which Vaccines Do We Get?
• Infants and Children 0 Through 6 Years• Hepatitis B• Rotavirus• Diphtheria, Tetanus and Pertussis• Haemophilus influenzae type b• Pneumococcus• Polio• Influenza• Measles, Mumps and Rubella• Varicella• Hepatitis A
Which Vaccines Do We Get?
• Children and Teens 7 Through 18• Tetanus, diphtheria and pertussis• Human papillomavirus (HPV)• Meningococcus• Influenza
Which Vaccines Do We Get?
• Adolescents and Teens May Need to “Catch-up” on Certain Vaccines• Hepatitis A• Hepatitis B• Poliovirus• Measles, Mumps and Rubella• Varicella
Are Vaccines Dangerous?
! Autism: The MMR vaccine and thimerosal:! In 1998, a British researcher named Andrew Wakefield raised the notion that the
MMR vaccine might cause autism in the medical journal The Lancet.! Researchers around the world performed a series of studies comparing hundreds of
thousands of children who had received the MMR vaccine with hundreds of thousands who had never received the vaccine.
! They ALL found that the risk of autism was the same in both groups. The MMR vaccine didn’t cause autism. The Lancet retracted the study in 2010.
! PBS Frontline Vaccine Wars
A Comparison of LeadingCauses of Death 1900 vs. Today
1900 1. Tuberculosis
2. Pneumonia/Influenza 3. Digestive Disorders Gastritis, Enteritis, Colitis
Why are these no longer top killers?
Medicines, Cleaner Food & Water, Tech. Advances, Refrigeration, Research
Money, Legislation
Are the above responses of others or the
individual?
A Comparison of LeadingCauses of Death 1900 vs. Today
Today 1. Heart Disease
2. Cancer 3. Stroke
Why are these now the top killers?
Are the above responses of others or the individual?
Are these diseases of Lifestyle?
3/6/2011 Page 1
Rank1Cause of death (Based on the Tenth Revision, International Classification of
Diseases, Second Edition, 2004) and State Number
Percent of total
deaths Rate
United States
... All causes 2,423,712 100.0 803.61 Diseases of heart (I00-I09,I11,I13,I20-I51) 616,067 25.4 204.32 Malignant neoplasms (C00-C97) 562,875 23.2 186.63 Cerebrovascular diseases (I60-I69) 135,952 5.6 45.14 Chronic lower respiratory diseases (J40-J47) 127,924 5.3 42.45 Accidents (unintentional injuries) (V01-X59,Y85-Y86) 123,706 5.1 41.06 Alzheimer's disease (G30) 74,632 3.1 24.77 Diabetes mellitus (E10-E14) 71,382 2.9 23.78 Influenza and pneumonia (J09-J18) 52,717 2.2 17.59 Nephritis, nephrotic syndrome and nephrosis (N00-N07,N17-N19,N25-N27) 46,448 1.9 15.4
10 Septicemia (A40-A41) 34,828 1.4 11.511 Intentional self-harm (suicide) (*U03,X60-X84,Y87.0) 34,598 1.4 11.512 Chronic liver disease and cirrhosis (K70,K73-K74) 29,165 1.2 9.713 Essential hypertension and hypertensive renal disease (I10,I12,I15) 23,965 1.0 7.914 Parkinson's disease (G20-G21) 20,058 0.8 6.715 Assault (homicide) (*U01-*U02,X85-Y09,Y87.1) 18,361 0.8 6.1... All other causes (Residual) 451,034 18.6 149.5
Alabama
... All causes 46,696 100.0 1,009.01 Diseases of heart (I00-I09,I11,I13,I20-I51) 11,926 25.5 257.72 Malignant neoplasms (C00-C97) 10,025 21.5 216.63 Cerebrovascular diseases (I60-I69) 2,747 5.9 59.44 Accidents (unintentional injuries) (V01-X59,Y85-Y86) 2,542 5.4 54.95 Chronic lower respiratory diseases (J40-J47) 2,530 5.4 54.76 Alzheimer's disease (G30) 1,517 3.2 32.87 Diabetes mellitus (E10-E14) 1,313 2.8 28.48 Nephritis, nephrotic syndrome and nephrosis (N00-N07,N17-N19,N25-N27) 1,051 2.3 22.79 Influenza and pneumonia (J09-J18) 898 1.9 19.4
10 Septicemia (A40-A41) 769 1.6 16.611 Intentional self-harm (suicide) (*U03,X60-X84,Y87.0) 592 1.3 12.812 Chronic liver disease and cirrhosis (K70,K73-K74) 505 1.1 10.913 Assault (homicide) (*U01-*U02,X85-Y09,Y87.1) 480 1.0 10.414 Essential hypertension and hypertensive renal disease (I10,I12,I15) 475 1.0 10.315 Parkinson's disease (G20-G21) 321 0.7 6.9... All other causes (Residual) 9,005 19.3 194.6
LCWK9. Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each State, 2007[Rates per 100,000 population. New ICD-10 code J09 (Influenza due to identified avian influenza virus) was added to the category Influenza and pneumonia in 2007; there were no deaths due to J09 in 2007]
Source: CDC/NCHS, National Vital Statistics System1 Rank based on number of deaths... Category not applicable
Cancer Death Rates for Women
0
20
40
60
80
100
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Lung
Colon & rectum
Uterus
Stomach
Breast
Ovary
Pancreas
Rate Per 100,000
Cancer Death Rates for Men
0
20
40
60
80
100
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Lung
Colon & rectum
Prostate
Pancreas
Stomach
Liver
Rate Per 100,000
Leukemia
Causes of Cancer
Diet = 35%
Tobacco = 30% Lung, Oral, Bladder & Pancreatic
Sun, STD's & Alcohol/Tobacco = 25% HSV-Cervical/Penile HPV-Penile/Vulvar HIV-Kaposi's Sarcoma
Total = 90% Cancers are Lifestyle
Leading Causes of Death in WHO Africa Region
0
4.50
9.00
13.50
18.00
82 84 86 88 90 92 94 96 98**
Dea
ths
per
100
,000
Po
pu
lati
on
Year
Trends in Age-Adjusted* Rates of Death due to HIV Infection,USA, 1982-1998
Major Conclusions:
• After rapidly increasing since the 1980s, the annual rate of death due to HIV infection leveled between 1994 and 1995, and then decreased rapidly through 1998. • HIV infection remains a leading cause of death among persons 25-44 years old, particularly for blacks and Hispanics.
• Persons dying from HIV infection increasingly consist of females, blacks (>50% since 1997), and residents of the South.
Major Health Risks
! Tobacco Use! Alcohol Abuse! Stress! Hypertension! Poor Dietary Habits! Sedentary Lifestyle! Irresponsible sexual behavior! Poor Safety Skills
Is the Individual In Control of Any of the Above?
! Mortality (death rate) statistics and morbidity (illness) rates show people are living longer and contracting fewer illnesses
! Healthy People 2020" Goal: to eliminate health disparities, increase the
lifespan and quality of life, promote health environments
! Focus on wellness, health promotion & disease prevention for all Americans
New Directions for Health What is Health People 2020?
3 www.healthypeople.gov
Healthy People 2020 Framework
Graphic Model of Healthy People 2020 The FIW developed a graphic model to visually depict the ecological and determinants approach that Healthy People 2020 will take in framing the national health objectives. This particular graphic was designed to emphasize this new approach, and is not meant as a comprehensive representation of all public health issues and societal domains. The graphic framework attempts to illustrate the fundamental degree of overlap among the social determinants of health, as well as emphasize their collective impact and influence on health outcomes and conditions. The framework also underscores a continued focus on population disparities, including those categorized by race/ethnicity, socioeconomic status, gender, age, disability status, sexual orientation, and geographic location.
!
!
Factors Influencing Health Behavior
! Self Esteem! Alienation Social Isolation, Normlessness, Powerlessness
! Locus of Control" Internals - Feel In Control" Externals - Feel Not In Control
! Values! Social Influences - Peer Pressure
! Other Influences - Age, Gender, Income, Social Status, Family, Occupation, Health Knowledge
Where Do YouGet Your Health Information?
! Our beliefs will influence our behavior! The popular press?
" Which magazines?
! Scientific Journals?" Peer reviewed research reported in popular press?
! What makes it science?" Explaining/understanding natural phenomena
# A search for The Truth" Direct observation, hypothesis, controlled experimentation,
produces theory" Other concerns: sample size, reproducibility
Behavior Change TechniquesFor Self Assessment Paper
! Social Support! Contracting
! Reminder Systems! Charts and Logs
! Chaining! Realistic and achievable goals
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