Health Psychology

Global deaths per year

3.3 million

Younger onset of first use …

… has higher likelihood of adult dependency

Dominant view in regards to alcohol

all right in moderation, but harmful in excess

Reasons why alcohol is so prominent

resists marketing regulation, dependent on self-regulation, powerful influence by international drinks companies

Single occasion risks associated with alcohol

Driving, industrial & household accidents, domestic & other violence, STIs from unprotected sex

Risks from regular heavy drinking

Death from liver cirrhosis, irreversible neurological damage, increased risk of cardiovascular disease and some cancers

Social problems associated with alcohol

Difficulties associated with dependence, exacerbation of other problems (depression, family problems), loss of employment or career prospects, child abuse

Risks from drinking during pregnancy

Fetal alcohol syndrome, spontaneous abortion, low birth weight

J-shaped function (alcohol)

Non-drinkers gave up drinking due to health problems, notes correlations and causations, moderate consumption associated with higher SES

Coronary heart disease (alcohol)

Light/moderate drinkers are at significantly lower risk than heavy drinkers and abstainers; there is a substantially increased risk for heavy/binge drinkers

Strokes (alcohol)

Conflicting evidence for light drinking, but substantial increased risk for heavy drinking

Unclear whether light-moderate drinking causes alcohol benefits …

… but at least is not associated with significant risk increase

Psychological effects of alcohol influenced by culture and expectation

Enjoyment, stress reduction and increased sociability

Why do some people develop drinking problems more than others?

Genetic theories, addiction and disease theories learning theories

Genetic theories

inherited predisposition to alcohol dependence; some people “destined” to become alcoholics after first

biological determinism

observed patterns of drinking in families could be genetic or learnt

disease theories

focus on at risk individual (not genetic), emphasis on loss of control, but only to a small number of people

addiction theories (from 1785 onwards)

replaced previous theories of drinks being morally degenerate, focus on alcohol as addictive substance; once addiction is established, individual loses voluntary control to resist urge to drink

disease theories

focus on at-risk individual (not necessarily genetic), emphasize loss of control; but only addictive to small number of people

operant conditioning

gradient of reinforcement; pleasure from addictive substances less than suffering caused; pleasure immediate, unpleasantness after delay

classical conditioning

compensatory conditioned response model; when drug is initially taken, physiological mechanism returns body to equilibrium; in alcohol (depressant) nervous system activated to sustain normal levels; heavy drinking leads to higher tolerance and larger quantities

Bandura

classical and operant conditioning is important, but we also learn from observation

self-efficacy

personality trait relating to confidence in carrying out one’s plans successfully

reduce alcohol related problems through overall reduction in comsumption

higher taxes, restriction on ads & sponsorships, limit on opening hours of bars, control which shops can sell alcohol and when, minimum unit pricing

opposed by drinks industry

sensible drinking through self-regulation of drinks industry, education; should not penalize majority of sensible drinkers to discourage few problem drinkers

drinks industry is disingenuous

education shown to be ineffective to curb heavy drinking, main profit comes from those drinking above recommended health limits

no country known to maintain population levels of consumption, while reducing problems

75% variance of alcohol dependence within region predicted from overall levels of consumption

counter-advertising (warning labels)

research currently limited to participants’ assessments, not actual reduction of alcohol misuse, minuscule compared to advertising budgets

sponsorship and advertising bans

originally thought to be ineffective, but research being revisited (increased consumption leads to bans, decreases to rescinding ban), 5-8% reduction in overall consumption

drink driving laws (with severe penalties) widely and increasingly adopted

universally agreed to reduces fatalities, even has support of drinks industry

health education

improves knowledge and attitudes, but no effects on amounts actually consumed

alcohol treatment in Canada, USA

typical focus on abstinence; specialist treatment centers with medical orientation

alcohol treatment in UK

return to moderate drinking levels

types of treatment

in-patient treatment, alcoholics anonymous, CBT, motivational interviewing, mindfulness-based relapse prevention, acceptance and commitment therapy, brief intervention

ethics

attempts to answer questions of right and wrong, justice and crime, virtue and vice

applied ethics

the application of ethical theory to real-world problems

bioethics

a branch of applied ethics focused on ethical issue in biology, medicine and healthcare

why was biomedical ethics created?

in response to unethical treatment of human subjects, including cases like the Tuskegee Syphilis Study and Beecher’s 1966 examples

Nuremberg Code (1947)

ethical guidelines for human experimentation created after Nazi war crimes

Beneficence

acting to benefit others'/promote well-being

non-malfeasance

avoiding harm to others

justice in biomedical ethics

fairness in treatment and distribution of resources

autonomy

respecting individual’s rights to make their own decisions

examples of biomedical advances raising ethical concerns

organ transplantation, assisted suicide, IVF, life support technology, PGD, saviour siblings

how do new technologies affect ethics?

they change social relations and force society to rethink beliefs about right and wrong

why involve psychology in biomedical science?

to address ethical, legal and social implications of health research participation

ELSI

ethical, legal and social implications of biomedical research

three key ELSI areas in modern health research

genetic research, biobanks/cohort studies, electronic health records

incidental findings

unexpected findings discovered during research that may have health implications

ethical dilemma of incidental findings

obligation to inform participants versus respecting autonomy

GWAS

Genome-Wide Association Studies

biobank

a collection of human tissue used for research, criminal investigation, identification or other purposes

where do biobanks exist?

hospitals, university, research institutions, private companies

why are biobanks importants?

they may transform understanding of disease development and medical research

current interest in biobanks is driven by

bioinformatics, genomic advances, capital investment, commercialization, international collaborations

how do biobanks help research?

they allow scientists to conduct research without recruiting participants for each projects

potential outcomes of biobank research

genetic diagnostic markers, drug response differences, identification of environmental toxins

why are traditional REB protocols challenged by biobanks?

they were developed before modern biobank trends emerged

main informed consent issue in biobanks

future uses of samples may be unknown when consent is given

problem with re-contacting participants

it may be prohibitively expensive

withdrawal of consent issue

it may be difficult or impractical once samples are used/stored

collective research issue

debate over individual versus community consent

privacy risks in biobanking

denial of healthcare/insurance, possible identification through DNA

why isn’t anonymization foolproff?

DNA can later be linked back to individuals

return of results

informing participants of health-related findings discovered in research

issue with returning results

samples cannot be fully anonymized if researchers need to identify with participants

ownership issue in biobanking

debate over who owns tissue after removal from the body

benefit sharing

whether participants deserve compensation if profits are made from their tissue

Henrietta Lacks

famous case highlighting ethical concerns over tissue ownership/profit

Electronic Health Record (EHR)

ongoing collection of personal health information used for healthcare and research

examples of EHR information

hospital records, prescriptions, physician data, psychological services

ethical concerns with EHRs

privacy infringement, lack of informed consent, safeguarding data, deciding what is included

Public Policy Question

who gets to make decisions that affect society?

why involve the public in policy decisions?

decisions affecting society should include input from diverse publics

public deliberation

a framework for involving citizens in science, technology and health policy discussions

key features of deliberation

discussion by ordinary citizens, argumentations, evidence presentation, consideration of alternatives, consensus-building

goal of deliberation

to work toward common ground/consensus

deliberative forum

citizens learn about a topic, debate it and collectively recommend policy

principles of deliberative forums

respectful engagement, justification/challenge of views, finding common ground

deliberative hopes

better decisions, better-informed citizens, increased political engagement/social capital

deliberative fears

dominant voices overpowering others, polarization, bias, inefficiency

major value trade-offs in biobanking

privacy vs research facilitation; individual control vs community decisions

why does biobanking need deliberation?

complex issue, public unfamiliarity, democratic deficit

three questions in designing public engagement

who participates? how is deliberation structured? what is done with results?

mini public

small but diverse providing meaningful policy input

why recruit diversity?

to include varied experiences, values and discursive styles

biobank deliberation format

4 days over 2 weekends, small/large group discussions, documented conclusions

purpose of first weekend

identify interests and values related to a BC biobank

purpose of second weekend

rank values, rate policy choices, identify controversies

risk

key concept in medicine, health promotion, psychology, engineering and finance; often probabilistic and morally/socially interpreted

screening

examining sections of population at higher statistical risk for disease to identify early signs of that disease

purpose of screening

early detection of disease to improve health outcomes

population-level rational for screening

to manage health risks by focusing on higher-risk groups

problems with screening programs

technical issues, reluctance in adoption, negative side effects, debates about effectiveness

screening effectiveness depends on:

invasiveness, disease prevalence, cultural beliefs, economics, treatment availability, disease progression

pap smear recommendation

every 3 years for sexually active individuals ages 25-69; HPV test every 5 years

mammogram recommendation

every 2-3 years for women ages 50-74

colon cancer screening recommendation

for adults ages 50-74

lifetime breast cancer risk

about 1 in 8 women

why is breast cancer screening emphasized?

high prevalence and better outcomes with early detection