psych150

Define social determinants of health.

Social determinants of health describe how an individual's environment impacts their capacity to achieve a healthy well-being.

What social determinants of health are we focusing on?

1. Economic Stability
2. Education
3. Health & Healthcare
4. Neighborhood and Built Environment
5. Social and Community Context

How are income and risk for cardiovascular disease related?

Studies found that low-income individuals (less than $35,000) had a higher risk of cardiovascular disease than individuals in higher income strata.

Moreover, they found that individuals whose income decreased experienced a higher risk for cardiovascular disease.

How are education and risk for cardiovascular disease related?

Individuals with higher educational attainment had a lower risk of cardiovascular disease. In contrast, individuals with lower educational attainment had a high risk of cardiovasuclar disease. The relationship is inverse.

What is health literacy?

Health literacy refers to an individual's ability to understand and navigate the healthcare system.

What groups are most likely to have low health literacy?

1. Non-English speakers
2. Racial and ethnic minorities
3. Individuals living in poverty
4. Individuals over the age of 65

Low health literacy is correlated with low adherence to treatment regimens and emergency service usage, which can exacerbate health disparities.

What factors contributed to the lifespan difference between Walnut Park and Cudahy in LA County?

1. Cudahy has a higher poverty rate.
2. Walnut Park residents are more likely to own homes, which contribute to community cohesion and thus social support.
3. Cudahy residents are more exposed to pollution than Walnut Park residents because of their proximity to freeways and industry.

Studies found that greater access to green space is associated with a lower risk of mortality. What can explain this relationship?

1. Green space can reduce air pollutants, such as carbon dioxide.
- Fewer pollutants can lower the risk of respiratory and related diseases
2. Green space is associated with reductions in stress levels
- Chronic stress can have negative impacts on health because of an overactivation of the stress response.

What factors contribute to food access?

1. Distance from the grocery store
2. Funds to purchase food
3. Equitable prices of food (economico)
4. Time to allocate for grocery shopping, transportation, and cooking
5. Knowledge about healthy eating and its benefits

How is discrimination associated with health outcomes?

Discrimination is associated with worse mental and physical health outcomes, which include
- Onset of psychological disorders
- Poor physical health
- Increased risk for chronic health conditions

What can explain the relationship between discrimination and worse health outcomes?

Discrimination "gets under the skin" because

1. They are appraised as stressful and can chronically trigger the stress response
- Leads to biological dysregulation
2. It can be the onset of maladaptive coping (WIP)
3. People are less likely to engage with healthcare services

How can we promote equity in health?

Strategies we can use to promote equity in health are
- Implement more green spaces in areas that lack them
- Increase government involvement in the regulation of healthcare equity
- Bolster mutual aid networks in underresourced communities for greater access to basic needs

What factors contribute to differences in healthcare costs across communities?

1. Type of insurance
- Medicare, as a federally funded insurance, has the authority to set hospital prices
- Private insurance usually pays higher and more varied hospital prices

2. Number of tests and treatments given
- Pay for services model

3. Inefficiency
- Patients are placed in the ICU, which is an expensive stay, when it is not necessary

4. Consolidation of hospitals
- Results in monopolies
- Have the power to set higher prices, which most people will pay because consolidated hospitals are usually the only ones available

What population is going to be the priority in the future of healthcare?

Older adults over the age of 65.

What are the unique health risks of older individuals?

Older adults typically struggle with chronic health conditions and require specialized care.

What is telemedicine?

Telemedicine describes the use of digital technologies to deliver healthcare services, such as diagnosis, treatment, and health education.

Provide examples of telemedicine.

1. Connected healthcare tools
- Collect health data and deliver it to providers
- Include blood glucose meters, blood pressure monitors, weight scales, and pulse oximeters

2. In-home dispenser
- Delivers pre-packaged medications
- Provides visual and auditory reminders
- Reduces adherence barriers with convenience
- Notify providers of medication use or lack thereof

What are the features of a patient-provider relationship?

1. Interactions between people with non-equal positions
- Resembles parent-child and teacher-student relationships
2. Can be involuntary
- Unique to patient-provider relationships because, outside of healthcare, people choose who they interact with
3. Discussion of important issues
- Common in any relationship
4. Large emotional stakes
- Common in close relationships, such as familial or romantic
5. Requires close cooperation
- Also resembles teacher-student relationships, but also parent-teacher relationships

What are the three main purposes of a patient-provider relationship?

1. Creating a good interpersonal relationship
2. Exchange information
3. Make medical decisions

What are some key components of a good interpersonal relationship between a patient and provider?

Key components include...
1. Manners, nonjudgmental
2. Empathy and respect
3. Provider and patient lead in their own expertise
- Providers are experts in treatment and diagnosis, while patients are experts in their symptoms, feelings, and behaviors
4. Competence: "My doctor understands my symptoms."
5. Warmth: "My doctor understands me and my life circumstances."

Describe the differences between what patients and providers want/expect in their relationship.

- Usually, patients want all possible information about their medical condition; however, providers withhold information because they fear negative emotional reactions
- Additionally, when cancer patients want an accurate prognosis, providers only give an honest prognosis 37% of the time
- Finally, there are discrepancies in understanding about whether a diagnosis was given and the side effects of treatment options

What is shared decision-making?

Shared decision-making involves the cooperation between the patient and provider to choose what treatments best align with the patient's values and goals.

Provide examples of what shared decision-making can look like.

Shared decision-making can look like...
- The provider uses visual aids while discussing treatment options with patients
- Identifying patient preferences and translating them into a treatment

What is the relationship between shared decision-making and healthcare outcomes?

Shared decision-making is associated with better healthcare outcomes, such as...
1. Greater satisfaction with medical treatment
2. Greater adherence with provider recommendations
- Which is important because many patients do not adhere to medications even in higher-stakes health conditions

How can you be a smart patient?

Ways to be a smart patient include...
1. Taking early morning appointments
2. Write down symptoms
3. Explain family history
4. Take notes during the appointment and ask clarifying questions

What is the placebo effect?

The placebo effect describes when individuals experience benefits from a treatment that is not designed to provide them (it is inert). This usually occurs because they expect to feel better.

What are the psychological mechanisms by which placebos may work?

1. Classical conditioning: learning by association
- Placebos may work because people associate treatments, such as pills or injections, with improved symptomology even in the absence of an active ingredient

2. Mentalistic theory: a person's expectations about the treatment are what make it successful or unsuccessful
- The more believable a placebo is, the more effective it is

What are the biological mechanisms by which placebos may work?

1. Neurotransmitter release: Parkinson's disease occurs because there is a degradation of the dopamine-producing neurons of the brain, which is usually treated with Levodopa
- Placebos increased the amount of endogenous dopamine produced, improving symptoms

2. Hormone release: The body produces natural painkillers, endorphins
- When people receive a placebo and expect it to bring out pain relief, the body can release endorphins

What are honest placebos?

Honest placebos refer to the instance where an individual knows a treatment is a placebo.

Describe the research on honest placebos.

1. Irritable bowel syndrome: compared to individuals who received no treatment, people who received an honest placebo had 2x the symptom relief
- Rivaled the effects of established medications for IBS

2: Chronic back pain: Patients taking an honest placebo had a 30% reduction in max pain and 29% reduction in disability
- These decreases in physical impairment were greater than the pain pills :0

What are the symptoms and disorders in which the placebo effect has been demonstrated?

- Allergies
- Anxiety and Depression
- IBS
- Parkinson's disease
- Nausea

What are the symptoms and disorders in which the placebo effect has not been demonstrated?

- Cancer
- HIV/AIDS
- Hearing and vision problems

What makes placebos more effective?

1. Setting (medical > nonmedical)
- The professionalism legitimizes the efficacy of the treatment
2. Instructions (complicated > simple)
- Complex instructions suggest there is a lot of science behind the treatment
3. Cost of medication (expensive > cheap)
- A higher price is equated with efficacy (higher quality)
4. Route of administration (injection > pill)
- The requirement for more direct administration also elicits a sense of complexity
5. and green pills are more sedative, while red, yellow, and orange pills are more stimulating

What is a nocebo effect?

A nocebo effect occurs when an individual experiences adverse side effects despite the treatment being a placebo. This usually occurs because they expect to feel unpleasant.

What are some implications for placebo and nocebo effects for healthcare providers?

1. Placebo: healthcare providers can take advantage of the placebo effects in drug substitution
- If patients who abuse morphine are given saline and told it elicits a similar effect, providers can successfully help patients gradually decrease the use of morphine for a safer alternative

2. Nocebo: healthcare providers must balance the ethics of mentioning the adverse side effects of treatments
- Patients with and without lactose intolerance were given glucose under the impression that it was lactose, and 44% of people with lactose intolerance reported GI symptoms
- Moreover, it also occurs with active treatments. Men were given finasteride to treat prostate enlargement. One group was informed of adverse side effects (e.g., erectile dysfunction) while the other was not. The men who were informed of adverse side effects reported them more often than uninformed men.

It is the expectation of harm that results in unpleasant experiences.

Explain Dr. Crum's study on doctor characteristics and placebo effects.

In their study, participants received a histamine prick on their forearm, which causes an allergic reaction. Then, participants were given a placebo cream but were randomly assigned to receive two types of news: 1) that it was an antihistamine cream or 2) a histamine agonist. They found that the development of the rash corresponded to the news participants received.

Furthermore, the warmth and competence of the doctor applying the cream mediated the results. When the doctor was high in warmth and competence, the effects of the news were stronger. However, when the doctor was low in warmth and competence, there was no difference in the effects of the news.

What are the key aspects of the Health Belief Model (HBM)?

The Health Belief Model focuses on what factors encourage or discourage people from engaging in a health behavior. These factors include...

1. Health Threat Belief
- Level of concern
- Determining your vulnerability
- Degree of severity
2. Belief that a behavior can reduce threat
- Effectiveness
- Benefits exceed the costs of engagement in behavior (e.g., inconvenience, effort, etc.)

What are the strengths and weaknesses of the HBM?

Strengths
- Useful constructs
- Focuses on subjective beliefs, which can guide behavior

Weaknesses
- Assume people make rational decisions
- Assumes people can change their behavior
- Neglects social or economic contexts
- Emphasis on preventative measures

What are the key aspects of the Planned Behavior Model (PBM)?

The Planned Behavior Model highlights how intentions can lead to behavior engagement. Behavioral intention form using the following criteria...

1. Attitude: Do you view the behavior as good, bad, or neutral?
2. Subjective norms: Would people approve of this behavior?
3. Perceived behavioral control: Do you think engaging in the behavior is within your control?

What are the strengths and weaknesses of the PBM?

Strengths
- Includes social contexts, such as interpersonal relationships
- Does not assume people want to engage in health behaviors
- Recognize how people's perception of control can influence the degree of behavior engagement

Weaknesses
- Neglects economic and environmental factors
- Emphasis on intentions; not everyone follows through on them

What are the key aspects of the Transtheoretical Model (Stages of Change)?

The Transtheoretical Model underscores how behavior change is a process. The phases of this process include...

1. Precontemplation: a person does not recognize a behavior problem
2. Contemplation: a person recognizes a behavior problem but is weighing the pros and cons of changing it
3. Preparation: getting ready to take action within 30 days
4. Action: modifying behavior for at least 6 months
5. Maintenance: sustaining behavior
6. Relapse: returning to old behaviors

What are the strengths and weaknesses of the Transtheoretical Model (Stages of Change)?

Strengths
- Realistic
- Practical (?)

Weaknesses
- Ignores social context
- People are in a stage for different reasons
- Fails to explain how people move on to different stages

What are nudges? Provide examples.

Nudges involve changing how we present options to increase the likelihood that people choose the most beneficial one. Examples include...
- Placing healthy items at a checkout line
- Making a healthy option the default

How do people feel about nudges?

A study found high approval rates for nudging. It was particularly high when the nudges came from experts

What kind of mindset is most likely to promote physical activity and healthy eating?

According to the Boles et al. study, an appeal-focused mindset is more likely to promote engagement in these health behaviors. For example, an appeal-focused mindset led to greater fitness class attendance and greater fruit/vegetable consumption during a nutrition class.

How does physical activity influence health outcomes?

Physical activity can delay all-cause mortality. However, most adults do not get enough physical activity to reap these benefits.

What are barriers to engaging in physical activity?

Barriers to engaging in physical activity include...
- Stress
- Lack of time
- Fatigue
- May interfere with daily activities

What are the facilitators to engaging in physical activity?

Facilitators to engaging in physical activity include...
- Social support
- Easily accessible spaces for physical activity
- Chunking activities

What are the short-term effects of exercise?

The short-term effects of exercise are better cognition and sleep.

What are the long-term effects of exercise?

The long-term effects of exercise are better blood pressure and a healthier metabolism.

What is the relationship between sedentary behavior alone and mortality?

Sedentary behavior is associated with an increased risk of all-cause mortality.

What is the relationship between sedentary behavior in combination (or interaction) with physical activity and mortality?

If an individual engages in maximum moderate-to-vigorous physical activity and maximum sitting, they still have a lower risk of all-cause mortality.

What is a non-experimental way of studying eating behavior?

A non-experimental way to study eating behavior is to have participants report what they eat through questionnaires or recall.

What are the pros and cons of non-experimental methods of studying eating behavior?

Pros
- External validity or generalizability, as researchers are not controlling eating habits

Cons
- Participants may forget what they ate (recall bias)
- The questionnaires are not universal and do not account for all types of foods or food preparation styles
- A given day may not be representative of an individual's diet

What is an experimental way of studying eating behavior?

An experimental way to study eating behavior is to have participants eat in the lab and measure food consumption.

What are the pros and cons of experimental methods of studying eating behavior?

Pros
- Can make a causal conclusion

Cons
- People may change their eating behavior because they are being watched (Hawthorne Effect)
- People may change their eating behavior in a socially acceptable way (Social Desirability Bias)

How does the body respond to stress-induced eating?

When people are stressed, their adrenal glands secrete cortisol. Cortisol stimulates our appetite and influences what we choose to eat. We usually desire highly palatable foods because it has a soothing effect on the brain, namely in the form of dopamine production.

What is a body mass index (BMI)?

A body mass index quantifies a person's weight while taking their height into account.

What are the limitations associated with using BMI or weight as a health indicator?

Some limitations include...
1. BMI does not distinguish between excess fat, muscle, and bone density
2. Does not measure excess fat directly
3. Does not accurately reflect health status
- Individuals with a "normal" BMI may be unhealthy metabolically, while individuals who are obese under the BMI are healthy metabolically

Define weight stigma.

Weight stigma describes the negative stereotyping, discrimination, and prejudice toward people with heavier body types.

How does weight stigma impact health outcomes?

Weight stigma results in....
- More eating
- Reduces self-regulation
- Increases cortisol levels
- Correlates with exercise avoidance
- Predicts weight gain

What is the relationship between weight-loss diets and health outcomes?

Researchers found that weight-loss diets had little effect on health indicators, such as cholesterol and blood pressure. Moreover, the changes that did occur were not associated with weight loss. They may have been associated with physical activity, social support, or engagement with the healthcare system.