PSCI 103H Exam 1 Study Guide

What are the three leading causes of death in the U.S. currently and in the past?

1900: Pneumonia, tuberculosis, diarrhea and enteritis. Deaths were rooted in public or community health problems

2023: Heart disease, cancer, unintentional injuries. Most deaths are related to individual behavior and lifestyle

What are some main ethnic differences in health and life expectancy?

Life expectancy for European Americans = 47th. Life expectancy for African Americans = 117th. The life expectancy difference doesn’t apply to Hispanics

What are some reasons why there may be differences between ethnicities in health?

Income (10% of European Americans live below the poverty level compared to 32% of African Americans and 26% of Hispanic Americans), education (86% of EA receive high school diploma vs 81% AA and 59% HA), and access to medical insurance and care. Subjective measures of socioeconomic status have a stronger relationship with health than objective measures

What is the Hispanic paradox?

Hispanics in the U.S. tend to paradoxically have substantially better health outcomes than the average population despite what their aggregate socioeconomic indicators would predict. The specific cause of the phenomenon is poorly understood

What are the biomedical and biopsychosocial models of health?

Biomedical: Disease is a simple result of exposure to a specific pathogen (disease-causing organism). Initiated by development of drugs and technology oriented towards removing pathogens and curing diseases. Fits with the types of disease that were common 100 years ago

Biopsychosocial: Holistic approach to medicine. Considers biological, psychological, social, and even spiritual factors in health and disease. Views health as a positive condition

What are placebos and nocebos?

Placebo: Inactive substance or condition that has the appearance of an active treatment and that may cause participants to improve or change due to the belief in the placebo’s ability to make a difference. Anywhere from 7-43% of pain patients improve with placebo. Works because of expectancy

Nocebo: Negative effects that can be produced by a placebo. Example - Taking a sugar pill and believing it’s an active drug, you may experience side effects that you think would be part of the side effects of an actual drug

What is the sham knee surgery study and what did it find?

Arthroscopic (small incisions) knee surgery on patients who were experiencing knee pain. Everyone in the study received anesthesia. Half of the participants got real knee surgery, and half got a sham knee surgery (only a cut). Participants didn’t know which they got for years. The sham surgery was at least as effective as the actual surgery in relieving knee pain

Research Designs (Single/Double Blind)

Single Blind: Participant doesn’t know which condition they’re in but the researcher does

Double Blind: Neither participant nor experimenter know what condition the participant is in

What is the difference between experimental and correlational studies?

Experimental Design: Studies relationship between independent variable and dependent variable by manipulating the independent variable and comparing experimental group and control group on dependent variable. Best for determining causality but needs random assignment

Correlation Study: Designed to assess the strength of the relationship between two variables. 1.00 = a perfect positive relationship. 0.00 = no relationship. -1.00 = a perfect negative relationship

What is the difference between longitudinal and cross-sectional studies?

Longitudinal: Following the same participants over an extended amount of time. Allows researchers to identify trends and determine direction of relationships

Cross-Sectional: Comparing two or more separate groups at only one time. Faster and cheaper

What is epidemiology?

The study of factors contributing to the occurrence of a disease in a particular population. Forerunner of much health psychology research. Evolved into a scientific discipline during the 19th century and played an important role in the fight against infectious diseases

Who was John Snow and how did he help reduce the rates of cholera?

Found of modern epidemiology. Cholera epidemic in London in 1848. Theory at the time suggested cholera was spread through miasma (foul air from sewers, swamps, etc.). Cholera death rate was 5x higher in homes receiving water from specific companies. Removed the handle of the pump nearest to most fatal cases. Ultimate source of outbreak was a dirty diaper that contaminated the water supply

What is prevalence and incidence?

Prevalence: The portion of the population affected by a particular disease at a particular time. How much water is in the tub

Incidence: The number of new cases of a disease during a particular time, usually one year. Water flowing into the tub

Diseases can be low prevalence and high incidence (colds - low percentage of population now, but more new cases every year) as well as high prevalence and low incidence (high blood pressure - high percentage of the population now, but not as many new cases every year)

What are risk and protective factors?

Risk: Any characteristic that occurs with great frequency in people with a disease than it does in people free from that disease. E.g., obesity and heart disease, poverty and poor health

Protective: Any characteristic that occurs with greater frequency in people who do not get a disease than it does in people free from that disease. E.g., Heart disease and exercise, low fat diet, positive emotions

What are Ex Post Facto research designs?

Quasi experimental design in which values of the independent variable are not manipulated but chosen by experimenter after groups have naturally divided themselves. E.g., obese vs normal weight eating habits, obese people tend to eat faster and take larger bites

What is the difference between validity and reliability

Validity: Broadly - how accurate something is. The extent to which a measuring instrument measures what it is designed to measure. Face validity (looks like it is measuring what it is supposed to measure) and construct validity (matches up with other measures of the same construct)

Reliability: Broadly - how consistent something is. The reliability of a measuring tool is the extent to which that tool measures in a consistent fashion. Test-retest reliability (getting the same scores from one administration to another) and inter-rater reliability (two independent raters rate something similarly)

What is disease and illness?

Disease: Process of physical damage within the body, which can exist even in the absence of a label or diagnosis

Illness: Experience of being sick and having been diagnosed as sick

E.g., Someone could have HIV without knowing it, so they have a disease but not an illness

What is illness behavior and sick role behavior?

Illness Behavior: Activities undertaken by people who experience symptoms but have not yet received a diagnosis

Sick Role Behavior: Behavior of people after a diagnosis, whether from health care provider or self-diagnosis

What determines how people respond to symptoms?

Personal factors (level of symptoms is not most important for people seeking medical attention but anxiety about condition, coping resources, and level of functioning), gender differences, age (young and middle-aged people are most reluctant to check out symptoms), socioeconomic status, culture (European Americans more likely than other groups to visit physicians, differences in health insurance coverage), ethnicity, symptom characteristics (visibility, perceived severity, interference with life, frequency and persistence), conceptualization of symptoms, identity of disease, timeline of disease, determination of cause, consequences of disease, controllability of disease

What are the differences between men and women in seeking health care?

Women are more likely to seek treatment when they have physical symptoms. This is because women are often caregivers. They also report more non-threatening symptoms while men will usually only report life-threatening situations

How is stress related to how likely people are to report physical symptoms?

Those with higher levels of stress are more likely to seek treatment. Those with prolonged stress are more likely to seek help for ambiguous symptoms. Women under high stress judged less likely to have disease than men under high stress

What are the differences between people of high and low socioeconomic status in symptoms and health care seeking?

People at higher socioeconomic levels are less likely to have symptoms - less stress, more prevention. But they still seek out health care more because of more money, flexibility, and connections. Knowledge of the implications of symptoms is similar in all groups, but access to care varies with socioeconomic status

How do people without health insurance usually seek health care?

11% of people in the US. Less likely to have a regular physician and often forego or delay seeking medical care. They utilize convenient care clinics (basic health services) which are primarily utilized by physician assistants and nurse practitioners. Hospital emergency rooms

Do people generally prefer male or female doctors? Why?

Both men and women prefer female doctors. Female physicians are more patient-centered, spend 10% more time with patients, employ more partnership behaviors, are more emotionally focused, and are more likely to discuss medical symptoms and psychosocial concerns

What are Medicare and Medicaid?

Medicare: Pays hospital expenses for most Americans over the age of 65

Medicaid: Provides health care based on low income and physical problems, such as disability or pregnancy. Only about half of people living in poverty receive coverage through Medicaid

What is adherence?

The extent to which a person is able and willing to follow medical and health advice

Why is studying adherence important?

125,000 people may die in the U.S. because they fail to adhere to medical advice. To understand why people fail to follow medical advice. To understand what can be done to make it more likely that people will follow medical advice

What shows higher adherence rates: medication treatment or exercise, diet, or other health related behaviors?

Medical treatments showed higher adherence rates than exercise, diet, or other health-related behaviors

What are the main factors that predict adherence or compliance to medical and health advice?

Age (middle aged adults are the best), pain, side effects of medication, anxiety and arousal, depression (decreases adherence), personal beliefs, economic factors (being able to pay for medication), social support, culture, patient-doctor miscommunication

What is the behavior approach to improve adherence to medical advice?

Increasing adherence by the use of cues, rewards, and contracts to reinforce adherent behavior. Positive and negative reinforcement and punishment

What is the difference between extrinsic and intrinsic rewards?

Extrinsic: Receiving money or compliments

Intrinsic: Feeling healthier. E.g., feeling good after visiting the dentist

What is the self-efficacy approach to improving adherence to medical advice?

A person’s belief that they can preform specific behaviors that will lead to a desired outcome. Self-efficacy plays a role in exercise rehabilitation, diet, and quitting smoking

Is self-efficacy global or specific to the situation?

Specific to the situation

How can self-efficacy be acquired, enhanced, or decreased?

Performance (enacting behavior such as resisting cigarette cravings), vicarious experience (seeing another person with similar skills perform a behavior), verbal persuasion (listening to the encouraging words of a trusted person), physiological arousal states (feelings of anxiety or stress)

What are the stages of the transtheoretical model?

1. Precontemplation - no recognition of need for or interest in change. Often lack information or are in denial

2. Contemplation - thinking about changing but have not actively decided to change. People are aware of and accept responsibility

3. Preparation - planning for change. People have made a commitment and some may make public announcements

4. Action - adopting new habits. People actively modify behaviors and surroundings

5. Maintenance - ongoing practice of new, healthier behavior. Trying to consolidate changes and deal with lapses

Also possible - termination (people are no longer threatened by the original temptations, problem behaviors don’t return, cope without relapse)

What is the Theory of Planned Behavior? How does this differ from the Theory of Reasoned Action?

Theory of Reasoned Action: The most immediate determinant of behavior is the intention to perform a behavior. Behavioral intention is determined by attitude towards a behavior and subjective norm (value that significant others placed on the behavior)

Theory of Planned Behavior: People are generally reasonable and make systematic use of information when deciding how to behave, thinking about the outcome before making a decision to engage in behavior. Adds your perception of how much control you have over your own behavior

How good are the Theory of Planned Behavior and the Theory of Reasoned Action at predicting who will adhere to an exercise program?

Both theories have some value in predicting who will adhere to an exercise program and who will not, but these theories are only modestly successful. TPB is better a predicting intention than behavior

How frequent is nonadherence?

Average rate of nonadherence was 25% over the past 50 years.

What are some methods for assessing patient adherence?

Ask the doctor (usually the poorest choice, they overestimate), ask the patient (often misreport to seem more adherent), ask other people (constant observation may be physically impossible), monitor medical use (count pills, electronic monitoring when pill cap is taken off - but can easily be faked), monitor use, biochemical evidence (analysis of blood and urine samples - requires frequent monitoring/expensive)

Best method is likely a combination

How can you improve adherence?

Educational Strategies: Impart information about health risk and behaviors that reduce them. Knowledge alone does not equal motivation

Emotion-Focused Strategies: Emotion-arousing way designed to frighten someone into being compliant. E.g., Driver’s education films, Scared Straight, You drink, you drive, you lose. But when someone gets emotional they kind of shut down and don’t internalize the message

Behavioral Strategies: Focus more directly on changing behaviors involved in adherence. Probably the most effective in comparison

Motivational Interviewing: A way of relating that may help another person increase their motivation to make health related changes. If you help a person examine their own motivations, they will often choose the behavior that is best for them

What are the main factors that predict adherence?

Age, pain, side effects of medication, amount of pills, gender, personality, anxiety and arousal, depression, personal beliefs, economic factors, social support, culture, patient-doctor miscommunication

What is the relationship between adherence and the number of times a day a person has to take medication?

One to three times a day has higher adherence. It can match the timing of other events and activities (e.g., meals, morning and night, etc.). Four or more pills a day has a big drop off

How are pain and stress related to adherence to medical advice?

Pain can act as negative reinforcement - taking the medication removes the pain

What is the difference between stress as a stimulus and stress as a response?

Stimulus: Used to describe something that happens to us. E.g., “I have a high-stress job.”

Response: Used to describe our response to what happens to us. E.g., “My heart races when I feel a lot of stress.”

What are three sources of stress?

Cataclysmic events (unique and powerful events that could be intentional or unintentional, most distressing if they’re intentional), changes in a person’s life history (e.g., expected death of a loved one, divorce, break up, retirement, moving, quitting a job), and hassles from everyday life (e.g., arguing with boyfriend, traffic, balancing work and family, physical environment and psychosocial environment)

How are the sympathetic and parasympathetic nervous systems related to the stress response?

Nervous System (secrete neurotransmitters) → Central (Brain and Spinal Cord) and Peripheral → Somatic (controls voluntary movements of skeletal muscles) and Autonomic (controls self-regulated actions of internal organs and glands) → Sympathetic (arousing) and Parasympathetic (calming)

Sympathetic: Arousing. Fight-or-flight. Dilates pupils, accelerates heart rate, inhibits digestion, stimulates glucose release, stimulate secretion of epinephrine and norepinephrine

Parasympathetic: Calming. Rest and digest. Contracts pupils, slows heartbeat, stimulates digestion, contracts bladder

What is the endocrine system and how does it send messages to the body?

Consists of ductless glands throughout the body. The neuroendocrine system consists of those endocrine glands that are controlled by and interact with the nervous system. They secrete hormones (chemicals that move through the bloodstream). Effect is slower and longer lasting. Includes the pituitary gland (located in the brain, produces ACTH - play a role in stress response and acts on the adrenal gland) and adrenal gland (located on the top of each kidney, releases cortisol)

What are the “stress hormones?”

Cortisol (can be used as index of stress, assess in saliva and urine), Norepinephrine (both a hormone and neurotransmitter, produced in many places in body), and Epinephrine (adrenaline, produced in adrenal medulla, used as index of stress, measured in urine)

What body systems are active in the fight-or-flight response?

The sympathetic division of the autonomic nervous system is activated and mobilized

What are the stages of the General Adaption Syndrome? How can this help explain how stress relates to illness?

The body’s generalized attempt to defend itself against a stressor. Alarm reaction (body’s defenses against a stressor are mobilized through activation of the sympathetic nervous system, adrenaline, heart rate and blood pressure increase), resistance (adapting to stressor, if the organism can adapt, this stage lasts a long time, outside normal but inside not normal), and exhaustion (organism’s ability to resist is depleted, breakdown), but more specifically:

Stressor: The stressor may be threatening or exhilarating
Alarm: The body initially responds to a stressor with changes that lower resistance
Resistance: If the stressor continues, the body mobilizes to withstand the stress and return to normal
If NOT resistance, then Homeostasis: The body systems maintain a stable and consistent (balanced) state
Exhaustion: Ongoing, extreme stressors eventually deplete the body’s resources so we function at less than normal
Illness and Death: The body’s resources are not replenished and/or additional stressors occur, the body suffers and breaks down

What does the General Adaptation Syndrome fail to consider?

Ignores situational and psychological facts, may be too simple

What is allostatic load and why is it important?

The physiological costs of chronic exposure to the stress response. Composite index of cumulative strain on multiple organs and tissues. It accumulates via wear and tear associated with acute shifts in physiological activity in response to negative or highly arousing positive stimuli

What is allostasis?

The body’s maintenance of an appropriate level of activation under changing circumstances. Adaptation in the face of stressful situations and stimuli involves activation of neural, neuroendocrine, and neuroendocrine-immune interactions. “Maintaining stability through change”

What is the tend-or-befriend response and how is it different from the fight-or-flight response?

Argument that women exhibit neuroendocrine responses to stress that differ from men’s reactions, possibly due to oxytocin which is influenced by estrogen. Women’s behavioral responses to stress are better characterized as “tend and befriend” than “fight or flight.” Women respond with nurturing responses and by seeking and giving social support. Women seek out of the company and comfort of others when stressed more than men

What does Lazarus think is the most important part of stress?

Lazarus saw a person’s perception of an event as more important than the event itself. Not the environment or the person’s response. Emphasizes psychological factors including perception or appraisal, vulnerability, and coping

What are three types of appraisals of stress people make?

Primary Appraisal: Person determines whether event is irrelevant, benign-positive (good), or stressful

Secondary Appraisal: A person determines whether they can successfully apply coping strategies to alleviate stress

Reappraisal: Person incorporates any new information

What are the effects of discrimination on health?

Racial and ethnic discrimination are the most studied. Discrimination has been linked to health problems. Discrimination may increase blood pressure and cardiovascular reactivity. The stress from discrimination may lead to worse health behaviors - poor eating, less exercise, more smoking and drug use

How does stress differ by gender and how are effects of marriage on health different for men and women?

Working women often have multiples roles of employee, partner, and mother. While men do more housework than a generation ago, they still do about half as much as women. Men get more benefits in marriage than women. Men have more health problems when losing their spouse

What are two ways stress is measured? Discuss their advantages and disadvantages

Physiological Measures: Blood pressure, heart rate, galvanic skin response, respiration rate. Advantages = reliable and direct. Disadvantages = process may produce stress itself, expensive

Self-Report Measures: Life Event Scale - checklist of life events (e.g., marriage, death, traffic violations). Everyday Hassles Scale - measures daily hassles, experiences of every day living that may be threatening to a person’s well-being (e.g., traffic, concerns of weight, household chores). Advantages = scales can predict occurrence of stress-related symptoms (e.g., good predictive validity). Disadvantages = people may overreport or underreport

What are the main types of coping and how are they different?

Strategies that people use to manage distressing problems and emotions in their lives

Problem-Focused Coping: Changing the source of stress. E.g., failing a test and then making a study schedule to follow

Emotion-Focused Coping: Changing your emotional response to the stressor. E.g., failing a test and deciding to eat chocolate or drink beer

Flexibility: The best approach, using problem-focused in situations you can change and emotion-focused in situations you can’t

Proactive Coping: Taking steps to avoid an anticipated stressor. E.g., not taking a job that is too stressful. Downside is that it can hold you back from taking necessary risks

What is relaxation training and what is it effective in treating?

Diaphragmatic breathing (deep and slow breathing with your “belly”), progressive muscle relaxation (go through muscle groups throughout the body, first tense and then relax, then just relax), guided imagery (think of a calm, peaceful image and concentrate on it with all senses or when feeling stressed), biofeedback (mind-body therapy)

What is cognitive-behavioral therapy and what is it effective for?

Based on the assumption that a change in the interpretation of an event can change people’s emotional and physiological reaction to that event. Attempts to get the patient to think differently about stress/pain and increase their confidence in coping ability. Has helped rheumatoid arthritis, irritable bowel syndrome, cancer, heart disease, AIDS, diabetes, lower back pain, headaches

What is emotional disclosure and what is it effective for?

A therapeutic technique whereby people express their strong emotions by talking or writing about a stressful or traumatic event that caused the emotions. People are usually told to write 3-4 times a week for 15-20 minutes about their deepest thoughts and feelings about the event. Strongest effects have been in reducing feelings of emotional distress (anxiety and depression), reducing physical symptoms, improving immune function, reducing blood pressure, and reducing health care visits

There’s also positive disclosures - writing about something positive to be found in stressful events