Exam 3 Pt. 1

Front 1

Mode 1 for decision making

Back 1

Fast, automatic, frequent, emotional, stereotypic, subconscious

Front 2

Mode 2 for decision making

Back 2

Slow, effortful, infrequent, logical, calculating, conscious

Front 3

Deficit Model

Back 3

experts try to “fix” lay people’s “irrational” thinking by filling in “missing information” (fixing the deficit)

Front 4

why does the deficit model fail?

Back 4

does not acknowledge how experts impose their own values, educating people is difficult in any case, and even facts often disregarded if source not trusted

Front 5

Participatory Model

Back 5

experts & lay people work together inform one another about both facts & values

Front 6

Social Marketing

Back 6

using marketing approaches for public health interventions that account for how people really think & make decisions

Front 7

Compliance with medical regimens

Back 7

“the extent to which a person’s behavior (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice.”

Front 8

What factors associated with noncompliance?

Back 8

More complex regimens; those for asymptomatic or psychiatric regimens; long treatment period; troublesome side effects

Front 9

Doctor-patient interaction

Back 9

clarity of information, relationship quality are at fault

Front 10

Patient health beliefs

Back 10

perceptions about own susceptibility, seriousness of consequences, and side effects

Front 11

the health belief model

Back 11

Model developed in 1950s by social psychologists in US public health service based on modifying variables, perceived seriousness, and susceptibility and they likelihood to engage in health-promoting behaviors

Front 12

Medically-centered perspective

Back 12

focuses on provider giving directions, patients expected to comply – consensual model aligning with Parsons’ perspective, where noncompliance is deviance

Front 13

Health belief model perspective

Back 13

takes patient perspective into account, but assumes rational decision making based on that person’s health beliefs

Front 14

“patient-centered” perspective

Back 14

Patients are active agent in their treatment

Front 15

Why do patients manipulate medication regimen

Back 15

To “test” its efficacy against their own standardsTo assert control over provider-patient relationshipWhen regimens incompatible with context of patient’s life

Front 16

Conrad’s study design & findings

Back 16

He studied noncompliance in regards to patients with epilepsy and the reason why they didn't take their medications

Front 17

Social or patient-centered approaches to non-compliance

Back 17

This approach acknowledges that patient-provider interaction is a short moment with relatively short-term impacts even for the chronically ill – most of life lived outside the health care setting

Front 18

goal of patient-centered perspective

Back 18

Seeks to understand patient behavior on own terms & in context of patients’ lives & meaning-making ex. family, autonomy, pride, identity, as well as time & monetary costs

Front 19

Denscombe: uncertain identities & health-risking behaviour

Back 19

Denscombe argues that these commonly cited factors matter, but also points to problem of “uncertain identities” in social context of late modernity

Front 20

Perceptions of why do contemporary young people smoke cigarettes?

Back 20

peer pressure, perceived invulnerability, stress relief, addiction, susceptibility to advertising, home influence, low self-esteem, enjoyment

Front 21

causes of uncertain self-identities

Back 21

Self-identities are uncertain when old traditions, customs, ascribed identities become less important, greater complexity of social relationships & roles, more agency in defining the self

Front 22

finding of why teens smoke

Back 22

Looking grown upLooking coolLooking “hard”“Girl power”Being in controlA calculated risk

Front 23

Information campaigns and implications on teen health

Back 23

Information about what the reality of what can happen when you go out and drinkTries to deter teens from drinking too much Public images that try to direct people to the realities

Front 24

King, Jennings & Fletcher reading

Back 24

Medical adaptation to academic pressure: schooling, stimulant use & SES

Front 25

Why do kids use stimulants?

Back 25

Stimulants effective because they reduce symptoms & promote academic performance – even improve memory & learning for those without ADHD, offering opportunity for cognitive enhancement for all children who obtain them

Front 26

drug holidays

Back 26

Children more likely to take stimulants during school year than summer

Front 27

medicating and SES

Back 27

Children from high SES families show largest difference between school year & summer useNot because high & low SES kids have different doctorsAuthors argue for differential parental intervention by SES level of families

Front 28

social explanations for medicating

Back 28

Academic performance pressure high for students but also teachers, who recommend ADHD screening to manage classrooms, and parents, who want their kids to do wellPharmaceutical companies have aggressively marketed ADHD & medication treatments directly to consumers

Front 29

Physicians and medicating

Back 29

Physicians now engage with “activated patients” who aggressively manage own care, question doctors’ authority, and request tests and procedures for which there is little evidence of medical benefit.”

Front 30

Documentary: The Medicated Child

Back 30

Concerns over medicating kids-use medication for the children to act normal or to full fit their normal role in societyJAcob- higher SES the recommendation of medication was very prominent —childhood bipolar disease was now being diagnosed to kids these were new diagnoses and new research —the recognition of the disorder has increased the number of people who are diagnosedLower SES family who is reliant on the medication as the only way to function —ate lots of sugar and couldn't tell her was full r not —doctor was interview about the things that he uses to diagnosis his patientsDebate and confusion has led to diagnosis

Front 31

Medicalization

Back 31

is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment.

Front 32

ambiguous diagnosis

Back 32

open to more than one interpretation; having a double meaning, unclear or inexact because a choice between alternatives has not been made.

unclear medical diagnosis

Front 33

What’s the population perspective & why is it different?

Back 33

Focus is on population composition, distribution & change

Front 34

Population perspective on health distinct from individualistic

Back 34

Individual/medical perspective: “Why do some (these) individuals have hypertension?” Population perspective: Why do some populations have so much hypertension, whilst in others it is rare?

Front 35

Factors to consider when identifying information about populations

Back 35

cohort/age/period and fertility/mortality/migration

Front 36

Birth cohorts

Back 36

usually people born in the same calendar years (often a decade, such as 1990-1999, but not always) Ex. “Baby boomer”

Front 37

Period and population health

Back 37

consider How are people of all ages/cohorts affected by period events at a point in time?

Front 38

Demographic shift

Back 38

change in makeup of a population over time – such as increase in average age of US residents, or increase in ethnic & racial diversity

Front 39

Population projections

Back 39

try to predict changes in population size over time, assisted by historical measures of growth, understanding of changes in social structures, analysis of demographic information (e.g., birth, death & migration rates)

Front 40

Population pyramids

Back 40

provide a histogram of the population size of age cohorts, usually stratified by sex

Front 41

Malthusian Theory: Dire predictions about population growth

Back 41

Focuses on how exponential growth of population could outpace arithmetic growth of agricultural productionIf population growth exceeded food supply, a “natural” check on population growth would occur

Front 42

Total fertility rate

Back 42

average number of children that would be born to a woman over her lifetime if:She were to experience the exact current age-specific fertility rates (ASFRs) through her lifetime, andShe were to survive from birth through the end of her reproductive life

Front 43

Fertility rates

Back 43

slowed down but are highest in lower SES areas

more children survive childhood and less infant mortality rates

Front 44

Immigration

Back 44

movement into a new geographic space

Front 45

emigration

Back 45

movement away

Front 46

Push factors

Back 46

negative attributes of a location that encourage emigration

Front 47

pull factors

Back 47

increase immigration to a new place

Front 48

Rose: Sick individuals

Back 48

Determinants of individual cases often the focus of physicians: why did THIS patient get THIS disease at THIS time?

Front 49

“risk factors”

Back 49

identify certain kinds of individuals as more susceptible to disease

often occurs WITHIN a given population

Front 50

Rose …and sick populations

Back 50

Within populations, it’s hard to show correlation between diet & serum cholesterol, but across populations it’s easierThis is because there is often more variation in level of causal factors across societies than within localities

Front 51

health promotion: 
High risk strategy

Advantages

Back 51

Intervention appropriate to individualSubject motivationPhysician motivationCost-effective use of resourcesBenefit-risk ratio favorable

Front 52

health promotion: 
High risk strategy

Disadvantages

Back 52

Difficulties & costs of screeningPalliative & temporary – not radicalLimited potential for individual or populationBehaviorally inappropriate

Front 53

Or the population strategy? (change environments/norms, small changes for all)

Advantages

Back 53

Radical!Large potential for population Behaviorally appropriate

Front 54

Or the population strategy? (change environments/norms, small changes for all)

Disadvantages

Back 54

Small benefit to individual – “prevention paradox”Poor motivation of subject & physicianBenefit to risk ratio worrisome

Front 55

Thaler & Sunstein: Nudge

Back 55

we’re not homo economicus, we are homo sapiens & don’t always choose rationally for health

Front 56

Choice architect

Back 56

organizes context in which people make decisions

Front 57

Libertarian paternalism

Back 57

people should be free to do what they like, but it’s legitimate for choice architects to try to influence people’s behavior to make lives longer, healthier

Front 58

Nudge

Back 58

any aspect of choice architecture that alters behavior in predictable way without forbidding any options or significantly changing economic incentives

Front 59

Social influences that underlie power of nudges

Back 59

information, peer pressure & priming

Front 60

A Traffic-Light Label Intervention and Dietary Choices in College Cafeterias: Seward, Block & Chatterjee

Back 60

6 cafeterias at Harvard University, in Cambridge, Massachusetts, we implemented a 7-week intervention including traffic-light labeling (red: least nutrient rich; yellow: nutrient neutral; green: most nutrient rich), choice architecture (how choices are presented to consumers), and “healthy-plate” tray stickers.

Front 61

Conclusions

Choices in College Cafeterias

Back 61

Although many students reported using traffic-light labels regularly and wanted interventions to continue, cafeteria interventions did not demonstrate clear improvements in dietary quality.

Front 62

computational model for a nudge

Back 62

developed a decision-analytic model to simulate and quantify how placement of healthy beverage (placement in beverage cooler closest to entrance, distance from back of the store, and vertical placement within each cooler) affects the probability of adolescents purchasing non-SSBs.

Front 63

results of computational model

Back 63

non-SSB purchases were 2.8 times higher when placed in the “optimal location” – on second or third shelves of front cooler – compared to the worst location on the bottom shelf of the cooler farthest from the entrance.