Health Psychology

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Health Psychology
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Health Psychology

• Health Psychology
• Aggregate of educational, scientific, and
  professional contributions of psychology to the
  promotion and maintenance of health, the
  prevention and treatment of illness, and the
  identification of etiologic and diagnostic
  correlates of health, illness, and related
  dysfunction
• Behavioral Medicine
• Elements from the behavioral science disciplines
  that have relevant knowledge that can assist in
  health care, treatment, and illness prevention

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Prevention Health Promotion

• It is estimated that 50 of mortality from 10
  leading causes of death could be attributed to
  lifestyle
• Health impairing habits referred to as behavioral
  pathogens
• Beneficial or health-protective behavioral
  practices have been called behavioral immunogens

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Prevention Health Psychology

• It is estimated that 7 of 10 leading causes of
  death in the US could be significantly reduced if
  individuals could change 5 behaviors
• Smoking
• etoh abuse
• diet
• exercise
• adherence to meds

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Type A

• 2 Cardiologists

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Prevention and Health Promotion

• Behavior is vital to maintaining good health
• Prevention has been labeled jewel in crown of
  health psychology because of all of theories
  methods directed towards preventing or modifying
  behaviors
• Primary
• Secondary
• Tertiary

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Models of health behavior and health behavior
change

• Health Belief model
• One of earliest conceptual approaches to explain
  why people do or do not engage in health behavior
• Proposed that ones motivation to engage in
  health-related behaviors depends on the
  interaction of several factors
• 1) perceived susceptibility to disease
  perceived seriousness of an illness
• 2) ones belief that engaging in health behavior
  will reduce perceived threat
• 3) cost-benefits analysis of engaging in a
  behavior
• 4) Cue to action

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Models of health behavior and health behavior
change

• Theory of Reasoned Action
• We are rational decision-makers
• behavior under voluntary control is determined by
  beliefs and attitudes
• Most immediate influence on behavior
• intention to engage in that behavior
• Behavioral intentions influenced by 2 types of
  beliefs
• persons attitude toward the behavior (favorable
  or unfavorable)
• 2. subjective norm (perceived social pressure to
  or not to perform)
• Uses a mathematical formula to specify how
  different beliefs combine to determine an
  individuals behavior

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Models of health behavior and health behavior
change

• Transtheoretical 5-stage Model (Prochaska
  DiClemente)
• precontemplation
• -No contemplation to change behavior in
  foreseeable future
• Contemplation
• -One begins to think about initiating change but
  doesnt
• Preparation
• -Taking early steps to change
• Action
• -When one modifies his/her behavior to overcome
  his/her problem
• Maintenance
• Work towards preventing slips or relapse

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Tobacco

• Scientists became concerned about health
  consequences of smoking in 1930s
• In 1930
• fewer than 3,000 deaths were attributed to lung
  cancer
• 2000 lung cancer blamed for over 100,000
  deaths/year
• Cigarettes have been linked to
• Cancer
• Serious pulmonary ailments
• CVD

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Tobacco

• Cigarette smoking
• 1 preventable cause of disease death in US
• Responsible for 350,000/yr that is more than
• drugs
• etoh
• traffic-related deaths
• AIDS
• suicides and homicides combined

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Epidemiology

• At least 50 million smokers in US
• Almost ½ of smokers are women, but some say that
  female smokers outnumber male smokers
• Smoking rate of teenage girls is increasing while
  the smoking rate of teenage boys is decreasing
• Years ago, when cigarette smoking was on the
  rise, upper class was at forefront of trend
• Ads showed MDs promoting their favorite brand
• Now well-educated high SES have shown declines
• Less than 20 of all MDs smoke
• 50 of blue-collar workers smoke

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Tobacco and women

• Differences between men women in tobacco use
  from country to country
• In Japan, China, Greece, and Indonesia, women
  smoke much less than men
• In India, 52 of men smoke but only 3 of women
• In Hong Kong, 23 of men smoke 4 for women
• In US, Canada, and England, smoking rates are
  similar for men and women
• Culture influences womens smoking rates

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Tobacco and Women

• Grunber et al (1991) different stages of tobacco
  use may explain gender differences
• The three main stages are
• Initiation
• Women are more likely to experiment with smoking
• Maintenance
• Men are more likely to smoke more cigarettes per
  day and may expose themselves to higher doses of
  nicotine
• Cessation
• Has not been studied well, but men seem to
  respond better to interventions than women

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Mortality

• 2 pack/day smoker between ages of 30-35
• life expectancy 9 yrs shorter than same age
  nonsmoker
• Chances of dying are related to the overall
  lifetime exposure to smoking
• Smokers who quit improve their chances of living
• Takes 10-15 years of quitting before mortality
  rates of former smokers resemble those of
  nonsmokers

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Morbidity

• Smoking related illness each year cause
• 145 million days of disability
• over 80 million days of work lost
• Smoking is leading cause of mortality
• But is the leading cause of avoidable illness

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Cardiovascular Disease

• Men who smoked over a pack a day tripled their
  risk of dying from CVD
• Risk of smoking has been documented in various
  racial ethnic groups women
• While women have lower rates of heart disease
  than men, women who use oral contraceptives
  smoke greatly increase risk of heart disease
• Oral contraceptives increases MI risk twofold,
  but risk is tenfold if woman also smokes
• In most studies, cigar pipe smokers have lower
  risk than cigarettes

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Cancer

• Smokers are 10 times more likely to get lung
  cancer than those who never smoked
• translates into a 1000 higher risk for smokers
• Lung cancer almost unknown at beginning of the
  20th century, but now makes up ¼ of all cancers
• Cancer rates are believed to be on decline, but
  trend is only visible when you remove lung cancer
  from the studies

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Involuntary Smoking

• The nonsmoker who is most affected by the smoke
  of others is the unborn child
• Mothers who smoke have more low-birth weight
  babies
• Low birth weight is risk factor for spontaneous
  abortion, fetal death and neonatal death
• After birth, children who have smoking parents
  continue to be affected
• They have more respiratory sx
• They have more illness in general

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Pathophysiology

• Three major components of tobacco smoking are
• Nicotine, Tar, and Carbon Monoxide
• Nicotine produces the release of norepinephrine
  which increases resting heart rate, systolic BP
  and diastolic BP
• Nicotine promotes disturbances in cardiac rhythms
  that may increase risk of fibrillation
• Nicotine causes a rise in free fatty acids in the
  blood
• Nicotine increases platelet stickiness which
  promotes clotting

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Smoking Cessation

• Quitting smoking is the easiest thing I have
  ever done. Ive done it a thousand times
• Almost 90 of current smokers would like to quit
• Almost all made at least 1 serious attempt
• While success of quitting on your own is 5, most
  who quit did so w/o any formal program
• Smokers quit or try to quit for many reasons
• Health problems
• are more successful at quitting
• Social pressure, , set good example for kids

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Smoking Cessation

• Smoking cessation methods based on research
  concerning influences on smoking
• Pharmacological studies in smoking
• nicotine chewing gum
• gradual fading of nicotine to prevent the
  withdrawal syndrome.
• Conditioning influences has led to
• stimulus control procedures
• reinforcement for nonsmoking
• aversive conditioning for smoking

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Maintenance or Relapse

• Marlatt Gordon proposed CBT model of relapse
• If ex-smoker has a cigarette, it is a cognitive
  emotional reaction termed the abstinence
  violation effect
• This effect has two parts
• guilt from smoking, which is discrepant from the
  new self-image as a nonsmoker
• attribution that smoking episode was due to
  personal weakness
• The abstinence violation decreases self-esteem
  the will to keep trying
• M G teach clients to separate a slip from a
  relapse. A slip is temporary, a relapse is long
  term

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Maintenance or Relapse

• Interventions based on this model try to identify
  high-risk situations, develop coping strategies,
  counteract abstinence violation w/ thoughts
• There is evidence that smokers can identify their
  high-risk situations these situations are
  related to relapse
• One study had subjects in a smoking cessation
  program rate their self-efficacy in resisting
  smoking in high-risk situations
• Months later, results showed those who reported
  low self-efficacy in certain situations were more
  likely to relapse

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Treatment

• Which programs are the most effective at helping
  them quit permanently?
• Recent studies have shown that multi-component or
  broad spectrum programs
• Reducing Psychological Dependence
• Aversive Approaches
• Attempt to alter the environment so that smoking
  behavior is punished instead of reinforced
• Electrical aversion (not effective)
• Covert sensitization
• Involves having the smoker imagine an aversive
  event such as throwing up, each time he/she takes
  a puff (not effective)

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Treatment

• Reducing Psychological Dependence
• Aversive Procedures
• When ones desire for something is satiated,
  continued exposure to that stimulus becomes
  punishing
• In 1970s, rapid smoking tx involved having
  smokers sit in a closed room and take a puff
  every 6 seconds until they could smoke no more
• Relatively effective at producing long-term
  abstinence, it is rarely used in practice because
  of the side effects
• Focused smoking
• Smoke at a normal rate while instructed by
  therapist to concentrate on negative sensations
  associated with smoking
• Is no more risky than regular smoking, and while
  it was found to be effective in earlier studies,
  it hasnt been replicated
• Smoke holding
• Smoke is held in mouth, and one concentrates on
  negative sensation (bad taste, irritated mouth)
  showed good efficacy

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Treatment

• Reducing Psychological Dependence
• Controlled Smoking
• If they wont quit, help them reduce their intake
  by helping them to learn to control
• Rate of smoking
• Nicotine content of cigarette
• Frequency of puffs, depth of inhalation
• Puff duration
• Amount of cigarette smoked
• Fairly effective in not increasing their rate of
  smoking or exposure to nicotine or carbon
  monoxide
• However, there is a tendency for smokers of
  low-nicotine cigarettes to take more frequent
  puffs to maintain former nicotine intake

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Reducing Physiological Dependence

• Nicotine Fading (tapering)
• Smokers shift to brands of cigs w/ progressively
  lower levels of nicotine decrease of cigs
• When nicotine intake is reduced, a milder
  withdrawal response is expected
• If the smoker is unable to stop, then he/she will
  be prepared to achieve controlled smoking
• Evidence suggests that alone, nicotine fading has
  minor effect on cessation

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Reducing Physiological Dependence

• Nicotine Replacement
• Drugs mimic an effect of nicotine responsible for
  maintaining tobacco use treat physio addiction
• Unlike cigs, gum does not contain noxious tars
  gases that have severe health consequences
• Gum is used only during the first 3-6 months
  after cessation, and then the gum is withdrawn
• B/c it takes 20-30 minutes to reach peak nicotine
  levels in blood after chewing gum as opposed to 7
  seconds for cigs, w/drawal from gum isnt
  difficult
• gum is ineffective if not combined with other
  behavioral treatment

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Maintenance or Relapse

• 90 cessation w/ aversive smoking technique
• misleading since relapse is a problem
• Booster sessions do not appear to be effective
• Social support CBT relapse prevention
• Social support in environment is consistently
  found to predict success of smoking cessation
• CBT program includes
• identifying high risk situations, practicing
  coping strategies, avoid turning slips into
  relapses, incorporating pleasant activities, and
  self rewards
• Fared better than an unstructured discussion
  group