EXAM #3 : Chapters [ 10-13 ]

Examine adult ages between…

25 to 65 years

The adult years represent critical transitions in terms of roles and responsibilities in three

interrelated areas:

1. Developing skills and contributing productively to one’s community

2. Partnering and parenting

3. Living a lifestyle that optimizes health and well-being throughout the adult years

Adulthood represents the period of peak productivity:

Generating income to support the economic needs of themselves and their family

Adults comprise the “sandwich” generation—providing financially for three generations:

• The working adults themselves

• Growing children

• Aging parents

Adulthood is the period for :

• Marriage

• Creating families

• Child-rearing

Adult parents:

• Provide nurturing care that is essential for healthy child development

• Determine the health of their children’s environment

• Role-model and impart health behaviors to their children

Social determinants of health pervasively influence the…

health and disease states

Adults who engage in health-promoting behaviors look forward to…

ongoing robust health

Adults who engage in health-compromising behaviors experience…

diagnosable clinical disorders and disease conditions within a short few decades

Adoption of the wildly popular new product of the early 1900s, the tobacco

cigarette:

• Catapulted lung cancer from obscurity to prominence

• Created a new disease, chronic obstructive pulmonary disease (COPD)

Heavy alcohol consumption in Russia (especially vodka):

30% of all-cause mortality is attributable to alcohol consumption

Adulthood Life Roles and Responsibilities : Three transitional areas

• Becoming financially responsible and productive

• Being responsible for others as a partner and parent

• Being responsible for self and personal health-related actions

Adulthood is the period of life characterized by:

• Entry into the workforce or a profession

• Occupational advancement

• Wage generation

• Productive contribution to society

Emerging adulthood

Age range:

• 18 to 29 years

Characterized by:

• Accepting responsibilities

• Taking on new roles

• Making independent decisions

• Achieving a degree of self-sufficiency

Bidirectional relationship between health and income generation:

• First, persons who enjoy good health generally are able to earn more income.

• Second, increased income is associated with lower rates of disease, disability, and

premature death

• Third, persons with higher income levels have better health across a range of indicators.

• Fourth, health status is influenced both by income and wealth.

• Fifth, lower income is a social determinant of poor health and a risk factor for early death.

Bidirectional relationship between health and income generation: First

Persons who enjoy good health generally are able to earn more income.

Bidirectional relationship between health and income generation: Second

Increased income is associated with lower rates of disease, disability, and

premature death

Bidirectional relationship between health and income generation: Third

Persons with higher income levels have better health across a range of indicators.

Bidirectional relationship between health and income generation: Fourth

Health status is influenced both by income and wealth.

Bidirectional relationship between health and income generation: Fifth

Lower income is a social determinant of poor health and a risk factor for early death

Persons with higher incomes (compared with those with lower incomes) are much more

likely to report:

• Good health

• Less psychological distress

• Less sadness, hopelessness, and worthlessness

Prevalence of adult chronic diseases is demonstrably higher in…

Lower-income households

Rates of difficulties in physical functioning are strongly associated with…

Income

Income and wealth are key determinants of…

individual and population health

Income Production and Health Correlates

• First, lower-income persons are much less able to access and pay for quality health

services

• Second, many lower-income persons do not have health insurance

• Third, persons living in poverty are much less likely to receive preventive care.

• Fourth, persons in lower socioeconomic status (SES) strata face a range of health-

compromising hardships and barriers.

• Fifth, the home and neighborhood environments of low SES persons are often hazardous

to health

Income and Habitual Diet

Persons living in low-income settings have minimal access to healthy foods.

Income and Physical Activity

Lower-income persons are geographically constrained to live in places that are both

unhealthy and unsafe.

Income and Access to Education

Education provides a potential escape route from poverty.

Educational attainment is a strong predictor of health and well-being…

Independent from income

During emerging adulthood (ages 18–29): Health Implications

• Many emerging adults begin or continue to explore their sexuality.

• Sexual partnering often occurs without forming committed relationships.

• Risks for sexually transmitted infections (STIs) are elevated.

• Rates of unplanned pregnancies are elevated

Adulthood is the period for : Health Implications

• Pairing

• Parenting

• Child-rearing

In the child-rearing role, adults are the primary caregivers:

• Delivering nurturing care for the next generation of young children

• Providing guidance to optimize healthy behaviors and wise decision-making for their

adolescent children

Tasks that mark the first years of adulthood—taking on occupational and parental roles:

• Milestones in the life course

• Imperative for species survival

Adult years can be exhilarating and also highly stressful :

• The current cohort of working adults pulls the financial weight for three generations.

• Responsibilities of child-rearing are daunting.

• Achieving “work-life balance” is elusive for most adults

Stress acts on both sides of this equation:

• Stress contributes to disease

• Disease contributes to stress

Grappling With the Burden of Stress During Adulthood

1. Stressors cause significant harm to human health, both physical and mental.

2. Exposures to stress are not equally distributed:

• Contributing to physical and mental health disparities

3. Stress effects are lessened for persons who gain mastery in their key life roles.

Chronic stress translates into…

disease states

States is a…

biquitous, defining feature of 21st-century living

Stress burden is related to increased rates of:

• Coronary heart disease

• Hypertension

• Type 2 diabete

Many adult diseases are viewed as…

Developmental disorders

• ( Begin early an “ eco-biodevelopmental” framework

Early life interventions could:

• Alleviate childhood adversity

• Decrease toxic stress

Diminish health disparities that persist into adulthood:

• Learning impairments

• Behavioral deficits

• Psychological distress progressing to psychiatric disorders

• Physical debility and disease

• Diminished well-being

Weight gain that starts during the early years of adulthood and continues into middle

adulthood predicts:

• Increased risks for major chronic diseases

• Decreased chances of healthy aging

Because the primary burden of drug use is experienced during the adult years, we need to:

• Approach drug use as a chronic condition

• Build treatment systems to deliver disease management

• Provide continuity of care

Coordination is needed across diverse systems and settings where drug users receive their treatment:

• Criminal justice

• Mental health

• Welfare

• Healthcare

Adulthood is the life course period when NCD risk factors exert:

• Cumulative effects

• Multiplicative effects

The following risk factors increase in prevalence with age, particularly during the adult

years:

• Overweight and obesity

• Systolic and diastolic blood pressures

• Elevated blood glucose

• Type 2 diabetes

Cardiovascular Disease ( CVD ) provides potent examples of how:

• Unhealthy lifestyle behaviors interact to produce new-onset disease.

• Disease progression across the life course of individuals affects population health over periods of decades

Cardiovascular Disease ( CVD ) is a major contributor to disability :

• The proportion of U.S. persons currently living with diagnosed CVD increases throughout the adult year

• This pattern extends through adulthood and continues into the older agesb

Cardiovascular Disease emerged during the…

1900s as primary contributors to population-wide patterns of disease and death

• This represents a seismic change in human health risk profiles

Unhealthy lifestyle are the primary drivers of risk for…

Cardiovascular Disease

• Both coronary heart disease and stroke

Seven action steps for cardiovascular health:

• Manage blood pressure.

• Control cholesterol.

• Reduce blood sugar.

• Get active.

• Eat better.

• Lose weight.

• Stop smoking

Manage blood pressure:

Risk: elevated systolic and diastolic blood pressure

Control cholesterol:

Risk: Elevated blood lipids ( e.g., total cholesterol, low-density lipoprotein [ LDL ] cholesterol )

Reduce blood sugar:

Risk: Elevated blood glucose leading top type 2 diabetes

Get Active:

Risk: Sedentary lifestyle, physical inactivity

Eat Better:

Risk: High-calorie, high-sugar, high-fat, high-sodium, lower-fiber diet

Lose Weight:

Risk: Overweight and obesity

Stop smoking

Risk: Cigarette smoking and using nicotine products

CVD Risk factors operate individually and in concert:

First: Each of these seven specific risk factors is potentially modifiable.

Second: Individually, each of these seven risk factors increases the risk for CVD.

Third: The effect of each individual risk factor is cumulative over time

Fourth: The effect of an individual risk factor may become worse—or riskier—over time.

Fifth: Almost all adult world citizens have at least one of these seven risk factors

Sixth: These lifestyle risks tend to cluster, meaning that a person with one risk factor has a

greater-than-chance likelihood of having two or more risk factors.

Seventh: The presence of two or more (multiple) risk factors increases CVD risk not just

additively but “synergistically.”

Eighth: Vast numbers of adult world citizens have at least two of these seven risk factors.

Ninth: Several of the seven AHA-specified risk factors are diseases themselves.

Tenth: Individuals are nested within families, neighborhoods, and communities.*

Interventions for these upstream diagnosable medical conditions may have preventive

effects on the later onset of CVD as a…

Downstream condition

Good news:

Major progress has been made to reverse the detrimental effects of CVD population health

Modification of population patterns of risk behaviors:

1. Marked reductions in smoking rates have been achieved.

2. Population mean cholesterol levels have declined significantly.

3. The proportion of persons whose high blood pressure has been detected, treated, and

controlled has risen

The Healthy People Approach : Healthy People’s First 40 Years

• Takes on U.S. health one decade at a time

• Provides 10-year, evidence-based objectives for promoting health and preventing disease

for all Americans

• Presents an iterative and continuously improving approach

• Establishes hundreds of specific goals with measurable benchmarks

The Healthy People Approach : Healthy People 2030

Healthy People focuses on approaches to:

• Promoting optimal health

• Decreasing disease occurrence

• Extending healthy lifespan and longevity

• Improving access to quality health services

• Stimulates collaborations among communities

• Empowers individuals to engage in healthful lifestyle choices

• Encourages individuals to use health services preventively

• Quantitatively monitors the outcomes of prevention activities

Health People 2030: Action Steps

• Set national goals and measurable objectives to guide evidence-based policies,

programs, and other actions to improve health and well-being.

• Provide data that is accurate, timely, accessible, and can drive targeted actions to

address regions and populations with poor health or at high risk for poor health in the

future

• Foster impact through public and private efforts to improve health and well-being for

people of all ages and the communities in which they live.

• Provide tools for the public, programs, policy makers, and others to evaluate progress

toward improving health and well-being

• Share and support the implementation of evidence-based programs and policies that are

replicable, scalable, and sustainable.

• Report biennially on progress throughout the decade from 2020 to 2030

• Stimulate research and innovation toward meeting Healthy People 2030 goals and

highlight critical research, data, and evaluation needs.

• Facilitate development and availability of affordable means of health promotion, disease

prevention, and treatment.

Depression is a serious mood disorder that can:

• Affect the way that individuals think and feel

• Disrupt sleep patterns

• Affect relationships

• Diminish productivity and output

• Decrease an individual’s capacity for experiencing pleasure and satisfaction in life

Life Course Perspective

brings the time dimension to understanding how health is

produced

Ages 0–14

perinatal, infancy, and childhood periods

Ages 15–24

adolescent and young adult years

Ages 25–64:

adulthood

Ages 65 and older:

older adulthood

Perinatal Period

The period of pregnacny leading up to labor

The life course approach:

• Focuses on the flow of health from earliest years into later years

• Represents one aspect of upstream–downstream thinking

Health influences that are encountered upstream, earlier in life:

• Exert immediate effects

• Set in motion currents of downstream influences that play out throughout subsequent years

Children currently at risk of not reaching their developmental potential:

• 250 million children worldwide

• 43% of those younger than 5 years of age

• Primarily living in low- and middle-income countries

All children require…

nurturing care

Five essential domains of nurturing care:

• Health

• Nutrition

• Security and safety

• Responsive caregiving

• Early learning

Nuturing care can help…

overcome disadvantage

Womb environment provides the developing fetus with:

• Physical protection

• All means of sustenance

Intertwined physiologies of the pregnant mother and fetus react in tandem to:

• How a mother rests

• How she moves

• What she breathes, eats, drinks, or smokes

To optimize the expectant mother’s health during pregnancy, she should eat a…

diet that balances energy and protein intake.

American College of Obstetrics and Gynecologists’ lifestyle recommendations for pregnant women:

• Healthy diet

• Regular exercise

• Plenty of rest

• Avoidance of alcohol, tobacco, and drugs

In less than two centuries, the likelihood of surviving childhood (ages birth through 14 years) has

increased dramatically:

• Two centuries ago: childhood survival probability: less than 2 in 3

• Current childhood survival probability: greater than 97 in 100

Nurturing care and meeting the child’s foundational physiological needs:

• Optimizes infant growth and maturation

• Diminishes risks for childhood disease

As the infant explores and learns from the richness of its environment, there is rapid development of:

• The brain

• Nervous system

• Endocrine system

• Immune system

Breastfeeding:

• Prevalent across cultures

• Confers health benefits to both the child and mother alike

• Breastfed children benefit from decreased rates of common medical condition

Mothers who breastfeed for a lifetime total of 12 months or more personally experience:

• Improved cardiovascular disease risk factor profiles

• Lower rates of onset of type 2 diabetes

• Lower rates of cardiovascular diseases

Breastfeeding creates extended benefits that are measurable over the life course:

• Higher IQ scores

• Higher levels of educational attainment

• Increased income in young adulthood

Primary causes of stunting during the first years of life:

• Poor nutrition

• Exposure to infectious diseases

• Poverty and low socioeconomic status

Filling a baby’s stomach with food or formula does not guarantee they are receiving the…

complete balance of essential nutrients needed for healthy growth and development

Well-being of young children is influenced by social support and social interactions with:

• Parents

• Siblings

• Nurturing relatives

• Peers and their parents

• Community-based caregivers

The reverse—social isolation—is extremely detrimental to health and related to:

• Lower levels of educational performance and attainment

• Lower socioeconomic status

• Higher rates of psychological distress in adult life

Young children depend upon adults for:

• Survival needs

• Social interaction

How well the family is functioning predicts:

• The child’s own behavior

• Lifelong health

• Learning

• Well-being

• Productivity and attainment

Stability is…

foundational for childhood development

Contributors to a stable base:

1. Family income that is comfortably above the poverty line

2. Esteem-building and well-paying employment for parents

3. Supportive relationships with emotionally available and child-attentive parents and caregivers

4. Safe and secure housing

5. Quality educational opportunities in home, childcare, early childhood education, and school settings