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84 Cards in this Set
- Front
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social determinants of health and illness |
Individual’s personality, social factors enmeshed in the fabric of society, and cultural influences |
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Social Epidemiology |
Influence of a person’s position in the social structure upon the development of disease the branch of epidemiology that studies the social distribution and social determinants of states of health |
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Behavioral Epidemiology |
behavioral factors in health |
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behavioral factors |
tobacco use, physical activity, risky sexual behavior, and consumption of unhealthful foods |
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Behavioral Medicine |
applicationof behavioral factors to specific clinical interventions ,bio-behavioral approaches to management of hypertension non-pharmacologic treatment methods e.g., exercise, maintenance of desirable weight, changes indiet, and meditation |
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Psychosocial Epidemiology |
Relating to the interrelation of social factors and individual thought and behavior psychosocial influences on health social epidemiology |
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Topics Covered in the Field |
Stress and stressful life events Personality factors Culture Personal behavior Social support Mental and physical health status (linked to psychological, social, and behavioralfactors |
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Adverse physical and social conditions |
poor sanitation, water pollution, poverty, declining economy, overcrowding |
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Independent variables |
exposure or risk factor variables hypothesized causal factor in a model |
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Moderating (Intervening) variables |
Intermediate variables in the causal process between independent and outcome variables |
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Dependent variables |
Outcome variables in a model Independent variables affect or influence dependent variables (via the pathway of moderating variables) |
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Multiple Causation |
given health state or health-related process may have more than one cause A combination of causes or alternative combination of diseases |
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Research Designs |
Case control cohort cross sectional |
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Needed |
Longitudinal,prospective studies Studies of women and minority groups Valid and operationalized measures |
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Longitudinal, Prospective Study |
•Early Stages of Psychopathology Study followed 3,021 adolescent and young adult residents of Munich, Germany. |
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Community-Based Participatory Research (CBPR) |
method relevant to psychological and social epidemiologic studies alliance between community organizations and research units investigate health-related issues of interest to the community |
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Social Context of Health |
regulation of psychosocial influences upon health |
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Global Burden of Disease Study |
Assesses the worldwide consequences of disease. |
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disability-adjusted life year (DALY) |
combines information on mortality with information on morbidity for specific causes |
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Lower respiratory infections |
leading cause of global DALYs. |
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The Whitehall Study |
higher likelihood of premature death among the lowest employment grades |
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Whitehall Study |
Contributed significantly to “. ..the importance of psychosocial factors such as work stress, unfairness, and work-family conflict to socio-economic inequalities |
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Independent Variables |
General concepts of stress Social incongruity theory Person-environment fit Stressful life events Stress process model |
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General Concepts of Stress |
appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being |
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Homeostasis |
tendency toward stable equilibrium among physiological processes |
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Allostasis |
how the organism achieves stability (or homeostasis) through continual change |
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Allostatic load |
Consequences of sustained activation of primary regulatory mechanisms serving allostasis overtime |
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General Concepts of Stress: Walter Canon |
changes in gastrointestinal function accompanying stressful events |
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General Concepts: Selye |
stress is a change in the environment of the organism |
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General adaptation syndrome specified three stages of response to stress |
Alarm reaction stage of resistance stage of exhaustion |
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General Concepts: Crider |
adverse environmental events produce stress. –noxious stimuli–removal of reinforcement–conflict situation executive monkey experiments demonstrated physiological effects (e.g., gastric ulcers)associated with stress |
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Social Incongruity Theory |
Either social mobility or status incongruity may be associated with morbidity Correlates of changes in residence Intragenerational mobility husband-wife discrepancy in status. |
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Cobb,et al. (1969) |
discrepancy between husband and wife in social and educational status as associated with rheumatoid arthritis |
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Syme |
cultural mobility and coronary heart disease |
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Person-Environment Fit Model |
adjustment as the goodness of fit between the characteristics of the person and the properties of [his or her] environment.”(French, et al., 1974 •Lack of adjustment occurs when there are discrepancies between demands from the environment and supplies (resources) to meet those demands. |
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Stressful Life Events |
relationship between the happenings in one’s life and the development of illness |
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Two crucial issues of life events |
determine which attributes distinguish more stressful from less stressful life events refine the knowledge base regarding the pathologic effects of stressful life events |
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Social Readjustment Rating Scale |
Holmes and Rahe(1967) developed 43-item Social Readjustment Rating Scale Represented a life event |
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More severe the life change event and the higher the frequency of the event |
Greater the chance that severe disease will occur |
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Ten Leading Life Change Events |
death of a spouse divorce marital separation jail term death of a close family member personal injury or illness marriage being fired from a job marital reconciliationretirement |
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Pearlin’s Stress Process Model |
guide for stress research process occurring over time Events chain from one another with interconnectedness among various factors |
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Pearlin's Factors |
Social and economic status Life events and chronic strains Moderating resources, e.g., coping skills Stress outcomes, e.g., mental disorders |
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Moderating Factors in the Stress-Illness Relationship |
Type A behavior pattern Personal behavior, lifestyle, and health Social support |
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Type A (Coronary-Prone) Behavior Pattern |
associated with CHD aggressiveness, ambition, drive, competitiveness, and time urgency Interview measure and self-administered measure of Type A are used |
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Social Support |
Refers to perceived emotional support mediator--buffers May enhance immune status |
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Lack of social support |
may contribute to onset and severity of psychological stress |
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Social Networks |
Quantitative concept Refers to the number (and patterns) of ties that one has with other people and organizations May serve to lessen the adverse psychological consequences of stress and reduce levels of depression |
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Buffering Model of Social Support |
Marital status is important in the social support process Increased social contact is associated with increased emotional support and perceptionsof support availability. Interpersonal relationships provide a stress-buffering effect when there is concordance between coping requirements demanded by a particular stressor and specific types of support provided |
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Personal Behavior, Lifestyle, and Health |
Risk taking Dietary practices and exercise levels Smoking Alcohol consumption |
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The Alameda County Study (Breslow) |
moderate food intake eating regularly eating breakfast not smoking cigarettes moderate or no use of alcohol moderate exercise 7 to8 hours of sleep daily |
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Healthy People 2020 |
comprehensive set of disease prevention and health promotion objectives Relatedin part to lifestyle and health |
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Healthy People 2020 topic Areas |
nutrition,physical activity, obesity, substance abuse, and tobacco use |
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HP 2020 Goals |
Attain high quality, longer lives free of preventable disease, disability, injury, and premature death.” Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environment that promote good health for all Promote equality of life, healthy development, and health behaviors across all lifestages.” |
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Smoking and Health Surgeon General’s Report of 1964 |
•Overall there is 70% excess morbidity among smokers compared with nonsmokers. Mortality from smoking increases with quantity of cigarettes smoked Association between smoking and cardiovascular diseases, cancer, pulmonary diseases, pepticulcer disease |
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Smoking and Health The 2004 Surgeon General’s Report |
•Identified an increased number of diseases associated with smoking |
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Alcohol Consumption |
Over-consumptionis a leading cause of preventable death Excessive consumption is a risk factor for cirrhosis, peptic ulcers, gastritis. Leading cause of death in 12-20 age group: Deterioration of family environment and job loss Fetal alcohol syndrome |
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Dietary Practices |
Consumption of refined carbohydrate foods is associated with obesity and diabetes Lack of dietary fiber related to diseases of the bowel Consumption of saturated fats and cholesterol associated with arteriosclerosis and heart disease |
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Sedentary Lifestyle |
Risk factor for CHD and other condition |
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Morris,et al. (1973 |
found vigorous exercise, not light exercise, reduced incidence of CHD |
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Paffenbarger, etal. (1978) |
corroborated findings for vigorous exercise |
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Culture |
set of values to which a group of people subscribes, the way of life of a group of people, or as the totality of what is learned and shared through interaction of the members of a society |
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CHD in Japanese Men: Marmot, et al. (1975) |
•Compared CHD rates among men of Japanese ancestry living in Japan, Honolulu, and SanFrancisco. •Rates lowest in Japan, highest in San Francisco, intermediate in Honolulu. –Possibly due to variations between the two countries in terms of diet, occupation, and the social and cultural milieu |
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Utilization of Health Services |
Preference for health care services varies according to cultural background Persons from traditional cultures may prefer folk medicine and family care Persons from more developed societies may prefer technologically advanced medicalservices |
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Dependent (Outcome) Variables |
physical health, mental health, and affective states |
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Dependent (Outcome) Variables Topics |
Life and job dissatisfaction Mental health and stressors Premorbid psychological factors and cancer Personality and smoking Psychosocial aspects of employment |
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•(Jenkins,1971) Life/Job Satisfaction |
life dissatisfaction is a risk factor for CHD is a promisingone and deserved careful examination in prospective studies |
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Sales and House (1971) |
strong negative correlation between job satisfaction and CHD death rates |
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related to coronary disease. |
Tedious work, feeling ill at ease at work, lack of recognition, difficulties with coworkers, demotion, and prolonged emotional strain Work Overload |
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Mental Health and Stressors |
Epidemiologic research has examined psychological disorders and affective states as outcomes of stress-illness paradigm Psychological disorders: posttraumatic stress disorder and major depression Affective states: depressive symptoms |
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Frerichs, etal. (1982) |
Prevalenceof depression in a representative sample of adults in Los Angeles County was19%. Rates of depression among women higher than men (23.5% vs. 12.9%) Depressed persons reported more ill than nondepressed. |
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Premorbid Psychological Factors and Cancer Fox(1978) |
Two major personality types at increased risk of cancer Yielding,compliant, eager to please Extroverted,non neurotic individuals who tend toward heaviness Fox’s 1995 review showed contradictory findings regarding psychologicvariables and cancer |
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Effects of Major Diseases on Personality |
Severe illness may bring about personality changes in the individual, spouse,children, and coworkers Wives of heart attack victims experience depression, fear, anxiety, and guilt Heart attack victims may experience similar feelings |
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Surgeon General’s Report (1979) |
Personality factors related to smoking behavior may include extroversion, neuroticism,antisocial tendencies, and belief that one is externally controlled Smokersmay show greater risk-taking, impulsiveness, and interest in sex. |
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Habitual Mental Outlook and Health Status |
Habitual mental outlook includes mental health, adult adjustment, cheerfulness, and sense of humor |
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Valliant (1979) |
demonstrated association between good mental health and physical health |
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Psychosocial Aspects of Employment and Health |
Stresses and other psychological aspects of the work environment represent CHD,job stresses and absenteeism due to infectious and chronic diseases, shift work and physical and mental health, and health effects of physical activityat work. |
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Selected Examples of Specializations |
Health services research epidemiology Neuroepidemiolog Injury epidemiolog Coronary heart disease epidemiology Oral/dentalepidemiology |
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Career Roles |
Academic workers Research workersPublic health nurse epidemiologists Epidemiology surveillance workers |
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Examplesof Major Employers |
Centersfor Disease Control and Prevention (CDC) NationalInstitute for Occupational Safety and Health (NIOSH) Other potential employers include–Local governments–Hospitals–Biotechand pharmaceutical companies |
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Professional Associations in Epidemiology (Examples) |
–American College of Epidemiology–AmericanPublic Health Association, Section on Epidemiology–Societyfor Epidemiologic Research–InternationalEpidemiological Association |
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Journals That Publish Epidemiologic Studies |
•American Journal of Epidemiology•AmericanJournal of Public Health•InternationalJournal of Epidemiology•CancerEpidemiology, Biomarkers & Prevention |
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•Four examples of competencies (ten total) |
Identify key sources of data Describe a public health problem Calculate basic epidemiologic measures Draw inferences from epidemiologic data |
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Ethical Guidelines |
Professional role of epidemiologists Welfare of research participants Providing benefits of research studies Ensuring and equitable distribution of risks and benefits Protecting confidentiality and privacy–Obtaininginformed consent |
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Ethical Guidelines (cont’d) |
Submitting proposed studies for ethical review––Maintainingpublic trusts Avoiding conflicts of interest and partiality Communicating ethical requirements Meetingobligations to communities |
