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Health and Society Exam 3
Terms in this set (71)
teenagers from high income families tend to have higher rates of anxiety and depression and substance use; achievement pressures, perfectionist strivings, having parents who emphasized accomplishments over personal character, isolation from adults, upper class parents more reluctant to seek help because of embarrassment, privacy, school psychologists are less likely to intervene because of fear of backlash
How do levels of anxiety, depression, and substance use differ between teenagers from low-income vs. high-income families? What explains these results?
stressful lives, difficult childhood, more ACEs, possible over diagnosis of mental illness
what explains the disparity that people who live in poverty are at increased risk of mental illness
Major shifts in aspirations and values toward materialism; The goal of getting into a top college is more competitive than ever, The strength of friendships is threatened by competition for highly sought-after goals, Lack of childhood leisure time without a scrutinizing adult audience, Parental overestimation of control over children's accomplishments
Why do students from high SES families appear to be at more risk for mental health problems today than their counterparts in the past?
growing up in poverty is a risk factor for physical and mental health problems; Significant problems have been documented at both ends of the socioeconomic spectrum for youth in particular
Describe the overall relationship between mental health and socioeconomic status.
In 1967, 86% of college freshmen rated "developing a meaningful philosophy of life" as an essential life goal. In 2004, only 42% of college freshman agreed
How has mental health on college campuses changed over the past decade or so?
affluent suburban high schoolers; Significantly higher rates of use of cigarettes, alcohol, marijuana, and hard drugs compared to national norms & inner-city samples; Higher rates of anxiety and depression; For boys, popularity with classmates was linked to high substance abuse; Among affluent youth, but not inner-city youth, substance use was linked to depression and anxiety; More likely to persist vs. "experimental" use
cohort 1 of children of the affluent study
affluent suburban middle schoolers; The 6th grades were doing great, Problems emerged in 7th grade, Among girls, the rates of clinically depressive symptoms were twice as high as those in national samples, No boys in 6th grade had used alcohol or marijuana, but by 7th grade, 7% reported becoming intoxicated about once a month
cohort 2 in children of the affluent study
affluent suburban middle and high schoolers; The 6th grades had lower levels of depression & anxiety compared to national samples and inner-city youth, Trouble emerged around 7th grade, Depression and anxiety, Substance use, especially among those who were popular with peers
cohort 3 in children of the affluent study
Closeness to mothers - similar; Closeness to fathers - similar; Parental values emphasizing integrity - similar; Regularity of eating dinner with parents - similar; Parental criticism - advantage for suburban kids; After school supervision - advantage for suburban kids; Parental expectations - advantage for inner city kids
7 aspects of parenting studied in cohort 3 comparing affluent 6th graders to inner-city youth
Tobacco, Poor diet and physical inactivity, Alcohol consumption, Microbial agents, Toxic agents, Motor vehicle crashes, Firearms incidents, Sexual behaviors, Illicit drug use
What are the top actual causes of death in the US?
Energy intake vs. energy expenditure
body mass index; normal 18.5-24.9; benefits: better measurements, ease, can not paint the full picture-- athletes have more muscle which is heavier than fat, so BMI might say they are overweight
How is obesity defined in a public health context? Explain the benefits and drawbacks of this approach.
increased; in 1985, 10-14% or less than 10% in most states, in 2010 20%-29% or over 30% for all states
obesity has _________ in prevalence in america since 1985
higher; even higher
hispanics have ______ rates of obesity than white adults in america, and black adults have ______ _______ than hispanics
which states show the highest rates of obesity in 2010
an urban area in which it is difficult to buy affordable or good-quality fresh food
What is a "food desert"?
america has ______ rates of obesity AND overweight for male and female in comparison to other countries
The overall goal of the strategy is to promote and protect health through healthy eating and physical activity;
4 main goals: Reduce risk factors for chronic diseases that stem from unhealthy diets and physical inactivity through public health actions, Increase awareness and understanding of the influences of diet and physical activity on health an the positive impact of preventive interventions, Develop, strengthen and implement global, regional, national policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive and actively engage all sectors, Monitor science and promote research on diet and physical activity.
what is the main goal of the Global Strategy on Diet, Physical Activity, and Health and what are the 4 main objectives
which areas experience more food deserts
Nutritionism is an ideology that the food industry has adopted and fully embraced. It turns the focus almost completely on the nutrients in the food-- what good ones are present and what bad ones are not. This gives the illusion that the understanding of nutrients in food is synonymous to the understanding of food. While nutrients are a part of food that are useful to know when analyzing health benefits, they doesn't paint a complete picture.
What is "nutritionism"? Why is it a problem?
▶Just 1 in 10 adults meet the federal fruit or vegetable recommendations.
▶2015, just 9 percent of adults met the intake recommendations for vegetables, ranging from 6 percent in West Virginia to 12 percent in Alaska.
▶Only 12 percent of adults met the recommendations for fruit, ranging from 7 percent in West Virginia to 16 percent in Washington, D.C.
▶Results showed that consumption was lower among men, young adults, and adults living in poverty.
body image for both men and women being strong is important
social context-- how does media contribute to body image and weight
Poor diet and physical inactivity are serious concerns to the U.S. population
▶Both factors are influenced by their
▶Economic context◻Access to food and activity
▶Social context◻Body-type driven fitness and diet culture
▶As with pharmaceuticals, industry interests are not necessarily aligned with health outcomes
▶"Nutritionism" and medicalization
summary of obesity/overweight
avoid edible food-like substances-- have loud and eye-catching packaging, often advertising the "health benefits" that are provided with the product. Almost all of the time, these claims are misleading.
buy produce-- no loud, attention-grabbing health claims;
"quieter the food, the healthier the food."
Walking through a grocery store, what should we buy and what should we avoid for optimal health, according to Pollan?
Over time, the public has deemed certain foods and nutrients as "evil" and detrimental to your health; however, the idea of what is good and bad for you is constantly changing. In the late 19th century and early 20th century, protein was thought to be terrible for you health. The "protein" of this era is fat. "evil" nutrients of this time period are gluten, saturated fat, high fructose corn syrup, and sugar. The more praised "blessed" nutrients include vitamin C, fiber, antioxidants, and Omega-3.
Explain the history of the war between nutrients. What would you say are the current "blessed" vs. "evil" nutrients?
hunter gatherers, se what the environment has to offer for food rather than the resorting to the highly processed foods we consume in America; In comparison to Western meat, the animals haven't been deprived of the nutrients in their diet, so their meat is naturally packed with more health benefits. Rather than satisfying their sweet tooth with processed white sugar, they eat natural honey.
what was the Hadza tribe from Tanzania do that led them to live healthy lives free of Western disease
He admits that he isn't positive if the same effect will be seen with soda, but is "excited" for the opportunity to try this method. In Mexico, a reduction in soda consumption has been seen with this method, and Pollan is hopeful that we will see the same effect in America.
How does Pollan evaluate laws and regulations that, for instance, limit the size of soft drinks restaurants can sell?
Health Policy RecommendationsThe CDC recommends at least 10 hours of sleep per night for school-age children and 7-8 hours per night for adultsReports show that only 31% of high school students report at least 8 hours of sleep and nearly 30% of adults report an average of 6 hours of sleep or less per nightThe lack of sleep has implications for physical health, mental health, cognitive outcomes, work performance, and sleep safety
School schedules are not consistent with healthy sleep patterns◦School start times are set in ways that conflict with circadian rhythms◦Late adolescence is characterized by a shift in the circadian rhythm toward being a "night owl"◦The American Academy of Pediatrics (AAP) recommends that middle schools and high schools start no earlier than 8:30am◦Only 17.7% of public middle and high schools do so
Many work schedules are not consistent with healthy sleep patterns◦Shift work means some employees are working the night shift, in direct opposition to their circadian rhythms◦This makes it difficult to get sufficient sleep outside of work◦Night shift work increases the risk of obesity, type 2 diabetes, cancer, and motor vehicle accidents
Even small and infrequent changes can produce harmful effects, such as the spring and fall time changes to transition into and out of daylight saving timeDaylight saving time has been associated with a host of negative outcomes◦Increased heart attacks◦Increased workplace injuries◦A spike in workplace injuries◦Increased "cyberloafing"◦Hindered moral decision makingSleep habits are also suffering due to the increasing popularity of digital devices emitting blue light, which can inhibit melatonin production when used before sleep
What evidence do scholars such as Christopher Barnes and Christopher Drake cite to back up the claim that the US is facing a public health crisis due to lack of sleep?
Establish national standards for middle and high school start times that are later in the day
◦Studies show that this leads to an increase in sleep along with improvements in attendance, tardiness, grades, scores on achievement tests, and a drop in teen driver car crashes
Stronger regulation of work hours and schedules
◦Some industries are developing policies that use sleep science to create guidelines for shift work
◦The Federal Aviation administration (FAA) and National Transportation Safety Board (NTSA), provide these recommendations for the transportation industry
End daylight saving time policy
◦Hawaii and most of Arizona do not practice it
Improve education about sleep habits
Improve access to treatment for sleep disorders
What policies do Christopher Barnes and Christopher Drake recommend to address this problem of sleep crisis?
setting an earlier bedtime by 30 minute increments, thrive buddy, saying no to things, reducing screen time by turning off devices and not keeping them in the bedroom
What are some downstream approaches to solving the problems associated with lack of sleep?
barnes and drakes approach to fixing the sleep crisis is
While the methods that Huffington suggests can prove effective, they can easily be derailed by individual behavior.
What can be gained from downstream approaches to solving sleep problems? What remains unsolved?
caring for the elderly is not exactly desirable;Their conditions and disabilities often require doctors to be patient and understanding.; typically bear many ailments that don't point towards an end-goal. Hospitals and doctors are placing less importance on geriatrics because of its inconvenience; the shortage of geriatricians does not allow existing ones to take the time to really focus on patients and give them the support they need. The outlook of elderly care needs to be changed.
Why do so few physicians specialize in geriatrics? What do you think is needed to change this?
Modern medicine has allowed people to live much longer and free of disability than ever before; we look for the treatment that allows us to live the longest regardless of the quality of life we will be living, Doctors often give patients and their families false hopes; as a result patients are choosing harmful treatments that decrease their quality of life for a small chance of increasing its longevity.
In what ways has modern medicine improved old age and dying? In what ways is it failing old age and death?
Gawande's main argument against medical facilities such as nursing homes is that they take the independence from the patience. They follow strict routines in efforts to keep the patients as healthy and safe as possible; however, this comes with the risk of the patient losing their sense of self. Gawande argues that assisted living is a better option; it gives patients their own space which allows them to feel at home in their daunting situation. By focusing less on strict regimes, patients end up having more control over their care.
Dr. Gawande critiques the standard nursing home model on the grounds of its safety vs. autonomy tradeoff. Explain this criticism. What better model is possible? Where do you think the line between safety and autonomy for the elderly should be drawn?
Sara had gone through months of painful suffering, enduring chemotherapy in her first months with her newborn. Seeing her pain being subdued by morphine to help her breathe, her family decided to halt medical care. While her last moments were spent next to her husband without being treated, she could've been saved from a lot of suffering in her last months.
How was Sara Monopoli's health care handled in the last few days of her life? Was it handled effectively? How could it be improved?
difference between hospice care and standard medical care is all about the difference in "priorities" behind the two. With standard medical care, the goal is to lengthen life as much as possible with no regards to the quality of life. However, with hospice, the focus is on giving dying people the best life possible while they are still living
What is the difference between hospice care and standard medical care, as explained by Dr. Gawande?
The main idea is for everyone-- doctors, patients, and families-- to get used to the idea of dying. Doctors could be trained to give correct and realistic guidance for terminally ill patients; they need to ask the patient what they care about and what they want out of their last days, patients and their loved ones need to be prepared to have these conversations. Loved ones need to be aware of the patient's hopes and fears and be respectful of them.
Based on the themes of this book, how could the experience of death be improved for the dying? For loved ones of the dying?
Talking about plans, hopes, and needs for death and the time leading up to it can assure the patient control over their condition; "Who would you like to speak for you if you can't speak for yourself?", "Who would you like to make decisions if you can't?"
What types of questions about the end of life are important for family members to bring up with each other?
LGBQ: lesbian, gay, bisexual, or queer; those who do not identify as straight
Who are sexual minorities?
Trans-- transgender: does not identify as sex assigned at birth-- assigned female at birth (AFAB) or female to male (FTM) (e.g., trans man), assigned male at birth (AMAB) or male to female (MTF) (e.g., trans woman); Non-binary: typically included under trans umbrella, does not identify as male or female--e.g. gender nonconforming (GNC), genderqueer, agender, FTX, MTX
Who are gender identity minorities?
An umbrella term used for those born with a reproductive or sexual anatomy that doesn't fit standard definitions of male or female
What does it mean to be intersex?
the older the age group, the less people who identify as LGBTQ
How does the proportion of people who identify as LGBTQ differ by age group?
A socially constructed category; Considers external genitalia, internal reproductive systems, hormones and chromosomes; Classifies individuals as Female, Male, Intersex
a persons internal sense of their gender
how one presents themselves through their behavior, mannerisms, speech patterns, dress, and hairstyle; may be on a spectrum
whom you are physically and emotionally attracted to, how you identify your sexuality
sexual and gender minorities more likely to be in worse health (experience suicidality, depression anxiety, chronic illness, cancer, etc) on avg less report to be in excellent or very good health, experience more psychological distress, HUGE increase in thoughts about suicide among trans people; less research or focus medical care for SGMs; structural stigma
Provide a brief overview of the health disparities that exist between the LGBTQ population and the straight cisgender population. What explains these disparities?
Sexual and gender identity minorities have stigmatized sexual and gender identities
•Structural stigma is stigma on the macro (societal) level, measured by level of stigma in one's environment
•Typically, level of prejudice or policies
•Higher levels of structural stigma predict poorer health and shorter life spans for LGBTQ individuals •But: higher structural stigma also predict higher risk of premature death heterosexuals! (although the effect is small in comparison)
How does structural stigma explain LGBTQ health disparities?
Sexual (and gender) minorities face unique stressors related to their stigmatized identities, specifically:
•Distal: Objective bias-based violence, discrimination, and prejudice
•Proximal-Hypervigilance: perceived stigma, or anticipated prejudice, Internalized homophobia (and transphobia), identity concealment
•These measures independently and collectively predict worse mental health outcomes within LGB groups and between LGB & heterosexual group comparisons
How does the minority stress model explain LGBTQ health disparities?
When providers did not recognize—or made incorrect assumptions about—patients' identities and/or embodiments, healthcare interactions were disrupted.
disengagement, sorting, denial, discipline
providers response to embodied disruption
◦Exchange-based ◦Comprehensive coverage
◦Deductible > $1300 for individuals; > $2600 for families
◦Medicare (age 65+)
◦Children's Health Insurance Program (CHIP)
◦Military health care
Explain the difference between private and public insurance. Give some examples of each type.
americans-- private - 69.2%, public- 20% uninsured- 12.4%
texans-- uninsured-- at least 14%
What proportion of Americans are insured and insured? What percent of Texans?
which race has the highest percentage of uninsured people
Under this model, health care is financed entirely through taxation, Patients never receive a bill, Most hospitals are government-owned, Many doctors are government employees, The NHS is the largest employer in Europe; The UK, Spain, The Nordic countries, New Zealand, Hong Kong, Cuba; in US-- The VA health care system for military veterans
Describe the basic elements of the Beveridge model of health care. What are some countries that use this model? What part of the US health care system resembles this model?
This model uses a private insurance system "sickness funds", Usually financed jointly through employee and employer contribution, Doctors and hospitals are usually private; Germany, France, Belgium, The Netherlands, Switzerland, Japan; in US-- Most employed Americans and their families
Describe the basic elements of the Bismarck model of health care. What are some countries that use this model? What part of the US health care system resembles this model?
has elements of the Beveridge and Bismarck models-- It uses private insurance providers (similar to the Bismarck model), Payments comes from a government-run insurance program that everyone pays into (similar to the Beverdige model), Costs are controlled by limiting the services the system will pay for, and in some cases, instituting waiting lists for non-acute care, No marketing, no profits, and sorting of claims also means far lower administrative costs than in for-profit health care; Canada, South Korea, and Taiwan; in US-- Americans over the age of 65 on Medicare
Describe the basic elements of the National Health Insurance model of health care. What are some countries that use this model? What part of the US health care system resembles this model?
Most countries are too poor and too disorganized to provide any kind of mass medical care, The rich get medial care; the poor stay sick or die, Payment to doctors may be in potatoes, or goat milk, or child care, or whatever you can offer, People may go their whole lives without seeing a doctor; Africa, India, China, and South America; in US-- The 30 million Americans (9%) without insurance
Describe the Out-of-pocket model of health care. Which countries use this? What part of the US health care system resembles this model?
What elements of another country's health care system do you believe could successfully be adopted in the US? What elements do you believe would not work well in the US?
up until the last couple years, humans typically didn't have very long lifespans, but with the rise of medicine, people live longer and experience the effects of aging; fewer deaths at younger ages
What do social scientists mean when they say that aging is new?
Retirement at 65 was instituted when life expectancy was lower and 65+ year olds were only a small sliver of the population; Not as reasonable as they approach 20% of the population
We are not planning for old age
◦People are not putting aside savings for old age
◦More than half of the very old live without a spouse
◦People have fewer children
Medicine has been slow to confront the realities of old age; the elderly population is growing rapidly, but the number of certified geriatricians fell by 1/3 between 1998 and 2004; Applications to training programs in adult primary care medicine are plummeting, but applications for radiology and plastic surgery are achieving records numbers
What are some of the social implications of this new phenomenon of aging?
fewer deaths at younger ages; more rectangular shape of the survival curve due to increased survival and concentration of deaths around the mean age at death; more people are alive at older ages and people are having less children
Explain what is meant by the "rectangularization" of survival.
shows the distribution of various age groups in a population; For most of human history, the population structure formed a pyramid-- Many children, Some adults, Few elderly
What is a population pyramid?
study took 568 men and women over the age of 70 who were at risk of becoming disabled, researchers randomly assigned half of them to see a team of geriatric specialists, while the other half were asked to see their usual physician, who was notified of their high-risk status, patients who had been seen by a geriatric team were 1/3 as likely to become disabled, 1/2 as likely to develop depression, and 40% less likely to require home health services
Very simple things--Simplified medications, Made sure arthritis was controlled, Made sure toenails were trimmed, Made sure meals were regular, Looked out for worrisome signs of isolation, Had social workers check to make sure the patient's home was safe
What are the benefits of providing geriatric specialty care to the elderly population? explain study done, how geriatricians accomplished this
Taking care of elderly patients is not glamorous; Patients may have trouble hearing, have poor vision, memory problems; You have to slow down and repeat yourself; There isn't a clear fix for a chief complaint - there are fifteen chief complaints
◦High blood pressure, Diabetes, Arthritis◦Back pain;
Doctors are trained to treat disease and leave the rest to take care of itself
Why are there too few geriatricians?
Eldercare in the US tends to be narrowly focused on safety and medicine, rather than wellbeing; Older Americans often move into retirement homes/assisted living when there is a fear that they can no longer live safely on their own; They move from retirement homes into nursing homes when there is a fear that they can no longer live safely under assisted living; Freedom, wellbeing, and quality of life are considered less important than safety and the need for medical care;
Procedures like coronary artery stents, pacemakers, or hip replacements are not required to save insurers money, but a program that improves well-being does (double standard)
how does US focus on eldercare
There is a slump in happiness around age 40, happiness starts to climb again around age 50
What often happens to well-being as individuals begin to enter middle age? As they begin to exit middle age?
dip in happiness as middle age approaches, rise as leaving middle age; emerges in response to questions about life satisfaction, not mood from moment to moment; The exact shape of the curve and the age at which it bottoms out varies by country, survey question, and method of analysis, and it is not ubiquitous, Still, it turns up frequently across many countries
whats the u curve
Selection bias, Stressors of middle age, Psychology of future expectations;
Young people consistently overestimate satisfaction in 5 years, older people underestimate future satisfaction ◦Longitudinal study of 23,000 Germans (Schwant, 2013)
◦Happiness peaked at ages 23 and 69
"Youth is a period of perpetual disappointment, and older adulthood is a period of pleasant surprise."
what explains the u curve
theory states that with age, a person's social goals shift from being knowledge-related to emotion-related; as a person ages they become increasingly selective with regards to the investment of their time and effort; they focus more on things that bring them joy and satisfaction
Explain socioemotional selectivity theory. How does it explain the greater sense of well-being often reported in old age?
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