Health-Enhancing Behaviours

1. Health-Enhancing Behaviours

2. Body Shape and Weight Concerns • Studies suggest that as many as 80% of 10-year girls have been on a diet; • 50% of girls between 14 and 18 years believe they are too fat; and • 45% of 14 to 18 year old girls are dieting.

3. DSM-IV Criteria – Anorexia Nervosa • Refusal to maintain body weight at or above normal weight for age (i.e., weight loss or failure to gain weight resulting in weight < 85% of expected). • Intense fear of weight gain or becoming fat. • Disturbed body image, undue influence of weight on issues of self-worth, denial of seriousness of weight loss. • Absence of at least 3 consecutive menstrual cycles.

4. DSM-IV Criteria for Bulimia Nervosa (BN) • Recurrent episodes of binge eating characterized by: • Eating an abnormally large quantity of food in a discrete period of time; and • A sense of lack of control over eating. • Recurrent inappropriate compensatory behaviours (e.g., vomiting, laxatives, diuretics, enemas, fasting, vigorous exercise). • The above two occur at least twice a week for at least 3 months. • Self-evaluation unduly influenced by weight.

5. Etiology of AN • 10-15 times more frequent in women than men • Evidence for genetics is inconistent • Family variables include the child being over-controlled by parents. • Sociocultural risk factors

6. Eating Disorders • Not a new disorder • Anorexia nervosa (AN) first described in 1694 • Bulimia nervosa (BN) first identified in 1892 • Usual age of onset is adolescence or early 20s. • 90% or more are females. • Prevalence of AN is 0.5% to 1.0%. • Prevalence of BN is 1.0 to 3.0%.

7. Etiology of Bulimia Nervosa • Bio-psychosocial model proposes that biogenetic predispositions, e.g., depression, combine with familial factors and sociocultural pressures, emphasizing high achievement and thinness, that promote a character structure featuring affective instability and low self-esteem.

8. Etiology of BN continued Negative Self-Evaluation Characteristic extreme concerns about shape and weight Perfectionism and dichotomous thinking. Intense and rigid dieting Negative affect Binge eating Purging

9. Referral Rates for AN and BN to Clarke Institute from 1975 - 1986

10. Healthy Exercise • 3 hours per week (across 3 – 5 sessions) • Warm-up • Stretching and flexibility exercise • Strength and endurance exercise • Aerobics • Rhythmic exercise of large muscle groups • Raise heart rate to moderately high level • Cool down

11. Why is exercise healthy? • Three psychosocial benefits are: • Feel less stressed and anxious • Better work performance and attitudes • More positive self-concept • Physiological benefits • Increased production of endorphins • Improved agility • Improved bone density • Improved strength and flexibility

12. Cardiovascular Benefits of Exercise • Lowers - • systolic and diastolic blood pressure • heart rate and thereby helps protect the heart against heart rhythm disturbances • LDL-cholesterol and raises HDL-cholesterol (the good cholesterol)

13. Potential Risks of Exercise • Accidents • Injuries • Heart exhaustion and heat stroke • May become addictive • Precipitate a heart attack • If using steroids to enhance exercise, number of adverse effects of steroids

14. Who is more likely to exercise? • Men • Whites more than Hispanics and Blacks • Young more than old • Well educated or higher SES groups • Previous exercise history • Those who feel well • Non-smoker

15. Women Small frame – 5’4” ideal weight is 114-127 lbs. Medium frame – 5’4” ideal weight is 124-138 lbs. Men Small frame – 6’ ideal weight is 149-160 lbs Medium frame – 6’ ideal weight is 157-170 lbs Metropolitan Height & Weight Tables

16. Who becomes overweight? • About 40% become overweight • In women, Blacks and Hispanics more likely to be overweight than Whites. • Genetics and familial influences • Prevalence increases with age

17. Why do people gain weight? • Biological factors – • Lower metabolic rate • Malfunctioning endocrine glands • Heredity • Set-point theory • Your body tries to maintain set weight • Thermostat-like mechanism • Hypothalamus involved • May relate to no. and size of fat cells

18. Psychosocial Factors • Eat more when stressed • Alcohol – adds calories to diet and reduces disposal of fat • Watching television may reduce metabolic weight rates below normal resting rates

19. Health Hazard Weight Level • Small risk – 10% over ideal weight • Moderate risk – 20% over ideal weight • Greatly increased risk – 50% over ideal • Distribution of weight – more hazardous if concentrated around the abdomen

20. Healthy Eating • Eating nutritionally balanced meals • Poor nutritional balance has been implicated as factor in many diseases: • Colon, stomach, pancreatic, prostate, and breast cancer. • Hypertension (salt and high body weight) • Hypercholesterolemia (saturated fats) • Diabetes (body weight, sugar, fats)

21. Sleep Disorders

22. Sleep Disorders • Ideal is 7-8 hours a night • Insufficient sleep can cause: • Impaired cognitive functioning • Mood disturbance • Poor work performance • Impaired immune functioning • Poor sleep predicts higher mortality rates

23. Health-Compromising Behaviours

24. Smoking

25. Substance Abuse • Addiction – physical and psychological dependence on a substance following use over a period of time • Physical dependence – body is use to the substance and incorporates the use of the substance in its normal function. • Tolerance – increasing adaptation to the substance so that higher and higher doses need to achieve same result. • Withdrawal – unpleasant physical and psychological symptoms upon withdrawal.

26. Nicotine • 22-25% of US smoke, similar rates are seen in Canada with regional variation. • More than 80% of smokers started as youth. • If people do not begin to smoke as youth unlikely they will start as adults. • Nicotine reaches the brain within 7-15 seconds.

27. Why Do People Smoke • Age • Culture • Peer encouragement • More likely if parents smoke • Personality characteristics (rebellious, risk taker) • Smokers image (e.g., cool, mature, glamorous, exciting)

28. Reasons Given for Smoking (Silvan Thomkins) • Positive affect – stimulation, relaxation, pleasure • Negative affect – relieves boredom, stress, depression • Habitual – behaviour becomes a habit • Psychological dependence – use it to regulate emotions

29. Nicotine – Maintaining Factors • Physical addiction • Physical habit • Emotional support • Personal identity • Social habit

30. Cigarette smoke contains • Carbon monoxide – gas that is readily and rapidly absorbed into bloodstream affecting physical functioning • Tars – minute particles of residue – adverse health effects but not related to addictive effect • Nicotine – addictive chemical in tobacco

31. Nicotine • Penetrates cell membranes in nose, mouth, lungs, and blood • Blood rapidly carries nicotine to the brain (within 7 sec) • Brain releases various chemicals that activate both the central and sympathetic nervous system • Increase arousal, alertness, attention, heart rate, and blood pressure • Nicotine levels decrease rapidly

32. Nicotine-Regulation Model • Smoke to maintain a certain level of nicotine • Smoke to avoid symptoms of withdrawal • Addiction not all due to biochemical effects since cravings can continue long after physical addictive effects are gone (up to 5 years)

33. Bio-Behavioural Model • Continue smoking to regulate cognitive-emotional state • Control weight • Nicotine affects chemicals in the brain (acetycholine, norepinephrine) that increase alertness and decrease tension (and withdrawal symptoms)

34. Relapse • 50 – 80% of those who quit relapse within a year • Stress is primary reason for relapse (smoking seen to help stress) • Social support helps protect against relapse • Self-efficacy is most important factor in quitting

35. Abstinence-violation Effect • Tendency to start smoking again after a lapse because of reduced self-efficacy for quitting and reminder about positive effects of smoking. • Weight-gain often leads to relapse so as to control weight. • Caloric intake increases. • Metabolism decreases.

36. Transtheoretical Model Preparation Contemplation Action Precontemplation Maintenance Relapse (Prochaska & DiClemente, 1992)

37. Processes of ChangeProchaska et al. 1992 Precontemplation ContemplationPreparation Action Maintenance Consciousness raising Dramatic relief Environmental re-evaluation Reinforcement management Helping relationships Counter- conditioning Stimulus control Self- re-evaluation Pros & cons Self- liberation Trial & error

38. Stage-Based Intervention for Smoking Cessation: Prochaska, et al., 1993 • Objective: • To compare four self-help programs for smoking cessation in general population of smokers.

39. Stage-Based Intervention for Smoking Cessation: Prochaska, et al., 1993 • Subject recruitment: • Subjects were 755 volunteers in Rhode Island who responded to a newspaper advertisement seeking participants to test self-help materials developed for smokers in various stages of change.

40. Stage-Based Intervention for Smoking Cessation: Prochaska, et al., 1993 • Interventions: • Standard manuals from American Lung Association (ALA) • TTM-based Manuals (TTM) • Interactive computer assessment and tailored interventions to stage of change (ITTM) • Interactive computer assessment, tailored interventions, and counsellor calls (CITTM)

41. Prochaska et al., 1993Cessation Rates Assessment Points (Months) P < 0.05

42. Alcohol – Who Drinks? • Drinking usually begins in high school • Males drink more but gender gap lessening • White more than Hispanics who are more than blacks • Higher rates amongst Natives, lower in Asians • 60% drink occasionally

43. Problem Drinking • Drinks heavily on a regular basis • Psychologically dependent • Social and/or occupational impairment • 13% of drinkers have a problem • Of these, ¾ are male

44. Alcoholics • About ½ of problem drinkers • Physically dependent on alcohol • High tolerance for alcohol • May suffer black outs and memory losses • Experience delirium tremors from withdrawal (anxiety, agitation, hallucination, tremors)

45. Alcohol Dependence/Abuse • Lifetime prevalence is about 10% in women and 20% in men. • 75% of car accidents at night are due to drinking. • Alcohol-related disorders are associated with 50% of homicides and 25% of suicides. • Genetic link – family history associated with 3-4 times greater risk as well as being associated with more serious alcohol-related problems.

46. Alcohol Dependence/Abuse – Clinical Course • Most exhibit their first alcohol-related problem in late 20s and 30’s. • Most first present for treatment in their 40s. • Die about 15 years earlier than non-alcoholic. • Course of alcohol abuse is fluctuating. • Spontaneous remission in 10-30%.

47. Health Risks from Heavy Alcohol Use • Accidents (alcohol use accounts for the majority of traffic accidents in youth & 50% of traffic accidents of all ages) • Cirrhosis of the liver • Some forms of cancer • Fetal alcohol syndrome in new-born • Retardation and physiological abnormalities in offspring of mothers who drink • Cognitive impairment • Brain damage