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 Leading Causes of Death

Leading Causes of Death

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.

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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