Environmental Health Chapter 14 Chapter 14 * Environmental HealthPlanet supplies us with: food, water, air, and everything that sustains our life, but also things that destroy and disrupt societyHistorically environmental health focused on preventing infectious diseases spread by water, waste, food, rodents, and insects Modern day definition expanded to include chronic diseases Technology has increased our ability to affect & damage environmentEncompassing all the interactions of humans with their environment and the health consequences of these interactions We should want to pass on to future generations an environment that is better than the one we have today, not worse * Chapter 14 * Classic Environmental Health Concerns Grew out of the efforts to control communicable diseases, due to insects and rodentsPathogens can be transmitted in sewage, drinking water and food Led to garbage collection, sewage treatment, filtration/chlorination of drinking water, food inspection & start of Public Health agencies Cholera, typhoid fever, plague, diphtheria rarely seen todayU.S. has a complex health system devoted to control such health issuesEvery time a natural or human-made disaster occurs, our survival is challenged; even travel to less developed countries Chapter 14 * Clean WaterMost important to human health Water Contamination and Treatment Water-treatment plants (subject water to physical & chemical processes) Fluoridation (reduced tooth decay by 15-40%)Water shortages (from groundwater, lakes and rivers)What You Can Do to Protect the Water Supply Shorter showers, brushing teeth Sink faucet aerators, w/e showerheads Water saving toilets Fix leaky faucets Use organic versus chemical fertilizers Don’t pour toxins down the drain Gardening issues Chapter 14 * Waste DisposalHumans generate large amounts of waste Sewage (prior to 19th century: typhoid, cholera, hepatitis A) Septic system – rural areas, decomposition by bacteria Heavy metals in sludge – lead, cadmium, copper, tin, mercury Polychlorinated biphenyls (PCBs) – industrial chemicals linked to cancer and damage to CNS Solid waste (about 1% is toxic) Garbage – household and industrial Sanitary landfill – buried trash Lined with protective liners to prevent leakage Reduce by recycling e-Waste (about 400 million devices each year) Fastest-growing portion of our waste Junked electronic devices are toxic Contain lead, mercury, other heavy metals Components of Solid Waste Chapter 14 * Chapter 14 * Waste DisposalWhat You Can Do to Reduce Garbage Products with least amount of packaging Products made of recycled paper or recyclable products, avoid disposables Avoid using foam or paper cups Store food in glass jars and reusable plastic containers Recycle newspapers, glass, cans, paper, and any other r ...

1. Environmental Health
Chapter 14
Chapter 14
*
Environmental HealthPlanet supplies us with: food, water, air,
and everything that sustains our life, but also things that destroy
and disrupt societyHistorically environmental health
focused on preventing infectious diseases spread by water,
waste, food, rodents, and insects
Modern day definition expanded to include chronic diseases
Technology has increased our ability to affect & damage
environmentEncompassing all the interactions of humans with
their environment and the health consequences of these
interactions
We should want to pass on to future generations an environment
that is better than the one we have today, not worse
*
Chapter 14
*
Classic Environmental Health Concerns Grew out of the
efforts to control communicable diseases, due to insects and

2. rodentsPathogens can be transmitted in sewage,
drinking water and food
Led to garbage collection, sewage treatment,
filtration/chlorination of drinking water, food inspection &
start of Public Health agencies
Cholera, typhoid fever, plague, diphtheria rarely seen todayU.S.
has a complex health system devoted to control such health
issuesEvery time a natural or human-made disaster occurs, our
survival is challenged; even travel to less developed
countries
Chapter 14
*
Clean WaterMost important to human health
Water Contamination and Treatment
Water-treatment plants (subject water to physical & chemical
processes)
Fluoridation (reduced tooth decay by 15-40%)Water shortages
(from groundwater, lakes and rivers)What You Can Do to
Protect the Water Supply
Shorter showers, brushing teeth
Sink faucet aerators, w/e showerheads
Water saving toilets
Fix leaky faucets
Use organic versus chemical fertilizers
Don’t pour toxins down the drain
Gardening issues
Chapter 14
*
Waste DisposalHumans generate large amounts of waste
Sewage (prior to 19th century: typhoid, cholera, hepatitis A)

3. Septic system – rural areas, decomposition by bacteria
Heavy metals in sludge – lead, cadmium, copper, tin, mercury
Polychlorinated biphenyls (PCBs) – industrial chemicals linked
to cancer and damage to CNS
Solid waste (about 1% is toxic)
Garbage – household and industrial
Sanitary landfill – buried trash
Lined with protective liners to prevent leakage
Reduce by recycling
e-Waste (about 400 million devices each year)
Fastest-growing portion of our waste
Junked electronic devices are toxic
Contain lead, mercury, other heavy metals
Components of Solid Waste
Chapter 14
*
Chapter 14
*
Waste DisposalWhat You Can Do to Reduce Garbage
Products with least amount of packaging
Products made of recycled paper or recyclable
products, avoid disposables
Avoid using foam or paper cups
Store food in glass jars and reusable plastic
containers
Recycle newspapers, glass, cans, paper, and
any other recyclables
Do not throw electronic items, batteries, or lights into the
trash
Start a compost pile

4. Stop junk mail (send request to: http://www.dmaconsumers.org)
Chapter 14
*
Food InspectionPure Food and Drug Act of 1906
Decreased diseases and death due to foodborne illnesses
and toxic food additives
Many agencies inspect food at various points in production
U.S. Department of Agriculture (USDA) – inspects grains &
meat
U.S. Food and Drug Administration (FDA) – ensures
wholesomeness of foods and regulates chemicals used in
foods, drugs, and cosmetics
State agencies inspect dairy herds, storage tanks, processing
plants
Local agencies inspect and license restaurants Overall the food
distribution in the U.S. is safe and efficient, but foodborne
illnesses do occur
Chapter 14
*
Insect and Rodent ControlGreat number of illnesses are
associated with animal and insect contact
Encephalitis - mosquitoes
Lyme Disease - ticks
Rocky Mountain spotted fever – specific tick
Bubonic plague - fleas
West Nile virus - mosquitoesPrevented by spraying insecticides,
wearing protective clothing, exercising caution in
infested areas

5. Chapter 14
*
Population GrowthWorld’s population currently estimated at 7
billion
Increasing by 76 million per year
Approximately 150 people every minute
To exceed 9.1 billion by 2050
First time in history, more older people than young children
People age 60 and over doubling; by 2050 – 3.4 times more
older people than children How Many People Can the World
Hold?
Population’s demand already exceeds earth’s capacity by 20%
Food vs. famine
Available land and water
Energy & depletion of nonrenewable sources
Minimum acceptable standard of living
US has 5% of world’s population but uses 25% energy
India has 16% of population but uses 3% energy
World Population Growth
Chapter 14
*
Chapter 14
*
Factors That Contribute to Population Growth
Must be controlled, but difficult to influence and manage
High fertility rates
Due to poverty, high child mortality, lack of social provisions

6. Lack of family planning resources
Half the world doesn’t use, 300 million can’t get
Lower death rates
Due to public health measures and improved
medical care
Population death rates slower than birth rates in
developing countries
Chapter 14
*
PollutionAny unwanted contaminant in the environment that
may pose a health riskAir pollution (due to man and fires,
pollen, dust storms)
Air quality and smog
Key ingredient – ground-level ozone
Temperature inversion – cold vs. warm air
Air quality index (AQI)-measures air quality
Carbon monoxide (CO) – vehicle exhaust
Sulfur dioxide (SO2) – burning coal and oil
Nitrogen dioxide (NO2) – vehicle emissions
Particulate matter (PM) – various sources
Ground-level ozone – cars, power plants, refineries
Air Quality Index (AQI) for Ozone
Chapter 14
*
Chapter 14
*
The Greenhouse Effect and Global WarmingGlobal warming

7. (due to CO2, CFCs, methane, NO, ozone)
Caused mostly by human activity Possible Consequences
Increased rainfall and flooding
or drought
Increased mortality from heat, air
pollution, tropical diseases
A poleward shift of about 50-350
miles affecting crops, irrigation
demands, forest productivity, insect
diseases
Alterations of ecosystem, possible
species extinction
Melting of polar ice caps
The Greenhouse Effect
Chapter 14
*
Global Warming: Car Analogy
Chapter 14
*
Trend in Annual Mean Temperature
Chapter 14
*
Ozone Layer and Energy Use Thinning of the Ozone Layer
Chlorofluorocarbons (CFCs) www.theozonehole.com/cfc.htm

8. Largest ozone hole is above Antarctica
More UV light interferes with photosynthesis, can kill
phytoplankton, and alter climate systems
More UV light for humans – increase in skin cancer, wrinkling
and aging of skin, cataracts and blindness, reduced immune
responseEnergy Use and Air Pollution
Americans are second biggest energy consumers in the world
Primary cause of smog, acid precipitation (sulfuric and nitric
acids), and greenhouse effect
Extreme energy sources
Deepwater oil rigs, tar sands oil extraction, fracking
Renewable energy sources
Wind power, solar power, water and wave power,
geothermal power, biomass and biofuels
Chapter 14
*
Chapter 14
*
Indoor Air PollutionCan trigger allergic responses and some
linked to cancer
Environmental tobacco smoke (ETS)
Carbon monoxide and other combustion by-products
Woodstoves, fireplaces, gas ranges
Volatile organic compounds (VOCs)
Gases emitted from paints, cleaning supplies, aerosols,
building materials, furnishings, and office
equipment
Biological pollutants
Bacteria, dust mites, mold, animal dander
Chapter 14

9. *
What You Can Do To Prevent Air PollutionCut back on driving
or use fuel-efficient vehicleKeep your car tuned up and well
maintained, save energy when drivingBuy energy-efficient
appliances, use only when necessaryReplace incandescent bulbs
with fluorescent bulbsHomes well insulated, use shades and
curtainsPlant trees and shrubs, they recycle CO2Proper disposal
of ozone-depleting appliances and refrigerantsKeep house well
ventilated, use houseplants to naturally rid air of harmful
pollutantsDon’t smoke or let others smoke in your homeClean
and inspect chimneys, furnaces and other appliances
Chapter 14
*
Chemical PollutionAsbestos (used for fire protection &
insulation)Lead (lead-based paints, old pipes &
faucets)Pesticides (DDT)
Biomagnification (increase in concentration in
food chain)Mercury (from coal-fired power plants, mining)What
You Can Do to Prevent Chemical Pollution
Read labels of products purchased, buy least toxic or nontoxic
Proper disposal of household products, don’t burn trash
Buy organic produce, wash and scrub before eating
Lock-up pesticides from children and pets
Use licensed exterminators for pest control
Chapter 14
*
RadiationNuclear Weapons (most serious health risk)Nuclear
Energy (although nuclear power generally
safe, accidents do happen – Chernobyl)Medical Uses of
Radiation (X-rays, cancer therapy, radioactive

10. iodine)Radiation in the Home and Workplace
Results inconclusive on microwave ovens, computer monitors,
cell phones, high-voltage power lines
Radon (radioactive gas in certain soils, rocks, building
materials; 2nd leading cause of lung cancer)What You Can Do
to Avoid Radiation
Only get X rays if really needed
Check local and state health department about radon testing
Use sunscreen to protect against sun’s UV radiation
Electromagnetic Radiation
Chapter 14
*
Chapter 14
*
Noise PollutionDecibels
Sounds above 80-85 can cause permanent
hearing loss, if exposed repeatedly, or tinnitus
Two common sources of excessive noise
Workplace
Large gatherings of people at a concert or sporting eventThe
Occupational Safety and Health Administrations (OSHA)
standardsWhat You Can Do to Avoid Noise Pollution
Wear ear protectors (pain threshold for loudness is 120
decibels)
Listen to music on a headset with a volume at or below 6
Avoid loud music, even in your car
Avoid exposure to painfully loud sounds, especially repeatedly
above 80 decibels

11. Intensity of Selected Sounds
Chapter 14
*
Chapter 14
*
Healing The EnvironmentEveryone can make some changes in
their life that could affect global problemsBecome educated
and demand changes from large corporationsShare what you
have learnedJoin, support, or volunteer
your timeContact your elected
representatives
Environmental Health
What will YOU do to protect your environment?
Chapter 14
Cardiovascular Disease and Cancer
Chapter 12
*

12. Cardiovascular IntroductionCardiovascular Disease
(CVD)Leading cause of death in the U.S.Claims one life every
34 seconds, more than 2,500 Americans every dayCVD is
primarily a lifestyle disease, linked to many
of our lifestyle choices
Chapter 12
*
*
Chapter 12
*
The Cardiovascular SystemPulmonary circulationRight side of
the heart pumps blood to and from the lungsSystemic
circulationLeft side of the heart pumps blood through the rest of
the bodyTotal blood volume for a 150 pound person is about 5
quarts, which circulates once every minute
Chapter 12
*
Cardiovascular System Systole The heart’s contraction Diastole
The period of relaxation HeartbeatSequence of contractions of
the heart’s four chambers, controlled by electrical
(nerve) impulses in the right atrium
(sinoatrial node)
Cardiovascular System
Chapter 12

13. *Red blood – combination
of copper, iron
and O²Blue – no O²
Chapter 12
*
Cardiovascular SystemHeart, blood vessels, hormones, enzymes
and wastesFour chambers (size of a fist)Upper chambers
(atria)Lower chambers (ventricles)Vena cava (largest vein in
body)Pulmonary arteries and veins
(to and from lungs)Aorta (largest artery in
body)Coronary arteries and cardiac veins
(to and from heart muscle)Veins (small, thin walls, to
heart)Arteries (thick elastic walls, away from heart, oxygenated
blood)Capillaries (tiniest vessels, O₂, nutrients, waste
exchange)
*
Chapter 12
*
Circulation in the Heart
Blood Supply to the Heart
Chapter 12
*

14. Chapter 12
*
Major Risk Factors For Cardiovascular DiseaseModifiable risk
factorsSix major risk factors that can be changedTobacco use
High blood pressureHigh levels of cholesterolPhysical
inactivityObesity Diabetes
Chapter 12
*
Tobacco Use1 in 5 deaths from CVD is a smokerIf 2nd hand
smoke, risk increases up to 30%Smokers have 2-3 times higher
risk of death from a heart attack, than non-smokers Damages
the lining of the arteriesIncreases blood pressure & heart
rateReduces HDL’s, raises LDL’sCO displaces O2 in
bloodIncreases fatty deposits in arteriesCauses platelets to
become sticky & cluster; increases blood thickness leading to
fatty deposits in arteries
*
Chapter 12
*
High Blood PressureContributing factors (obesity, stress,
alcohol, inactivity, diet)Short periods of HBP are normal,
chronic is a health riskHypertension (equal or greater then
140/90) Too much pressure against arterial
wallsAtherosclerosisHeart has to work harder, weakens,
enlarges, arteries narrow, scar and hardenSee Table 12-1

15. for blood pressure classification for healthy adults
(less than 120/80)
*
Chapter 12
*
High Blood PressureTachycardias100 or more beats per
minuteCompromises the ability of the heart to pump
effectivelyVentricles can not completely fill
Chapter 12
*
Low Blood PressureBradychardia60 or less beats per
minutePoor circulation of the blood Lack of 02 throughout to
body and brain
Chapter 12
*
CholesterolFatty, wax-like substance in blood; a component
of:Cell membranes, sex hormones, and vitamin DFluid that
coats the lungsProtective sheath around nervesNaturally
manufactured by our bodies in the liver, and from the foods we
eatEssential for proper functioning of our bodyExcess
cholesterol
Clogs the arteries
Increases the risk of CVDLDL’s and HDL’s or good versus bad

16. *
CholesterolRecommended blood cholesterol levels and who
benefits from treatment, see Table 12-2LDL’s - less than 100
mg/dl (from liver to organs and tissues)HDL’s - greater than 60
mg/dl (unused back to liver, recycled)Total cholesterol should
be below 200 mg/dlLevels over 240 mg/dl indicates high risk of
CVDTriglycerides – blood fats, less than 150 mg/dl Reliable
predictor of heart diseaseFor energy or fat storageBenefits of
controlling cholesterol Cut heart attack risk by about 2% Can
reverse deposits of LDL’s on arterial walls to
healthy levels
Chapter 12
*
How Cholesterol Is Made
Chapter 12
*
Chapter 12
*
Physical InactivityMinimum 30 min/day, moderate
intensityClosest thing to a ‘magic bullet’ to fight against heart
diseaseExercise reduces risk by:Controlling blood
pressureLowering LDL’sIncreasing HDL’sMaintaining

17. weightImproves condition of blood vessels Helps prevent or
control diabetes
*
Chapter 12
*
Obesity
More than 30% above recommended weight BMI equal to or
greater than 30Increased strain on the heartStrongly associated
with:HypertensionHigh cholesterol levelsInsulin
resistanceDiabetes Physical inactivityIncreasing ageEndothelial
cell dysfunction (helps regulate blood flow to the heart and
keeps platelets from sticking to arterial walls)Coronary arteries
constrict, limiting blood flow, instead of dilating when the heart
needs more bloodIncreased inflammatory markers
Chapter 12
*
Diabetes
Elevated blood glucose levels due to low insulin supplyDoubles
the risk of CVD for menTriples the risk of CVD for womenLoss
of 5-10 years of your lifeHigher
riskHypertensionObesityUnhealthy blood lipid levels (high
triglyceride & low HDL levels)Elevated blood glucose and
insulin can damage the endothelial cells lining the arteriesMore
vulnerable to atherosclerosisPlatelet & blood coagulation
abnormalities

18. Chapter 12
*
Contributing Risk Factors That Can Be ChangedHigh
triglyceride levels (blood fats) Due to excess body fat, physical
inactivity, smoking, Type 2 diabetes, excessive alcohol, very
high carbohydrate dietsPsychological and social
factorsStressChronic hostility and angerSuppressing
psychological distress Depression AnxietySocial isolationLow
socioeconomic status (due to lifestyle & access to health care)
Alcohol and drug use
*
Chapter 12
*
Major Risk Factors That Can’t Be ChangedHeredity - CVD has
a genetic component; high cholesterol levels, hypertension,
blood clotting, diabetes, and obesityAge - over the age of
65Gender - men have higher risk earlier in life (estrogen may
protect premenopausal women)Ethnicity - African Americans
have higher risk of hypertension, heart disease, and stroke;
Hispanics greater risk of HBP and angina; Asians have lower
rates of CVD
*
A.A. men and women have higher risk of hypertension;
Hispanic greater risk of high blood pressure and angina, Asian
low rates of CVD

19. Chapter 12
*
Possible Risk Factors Currently Being StudiedInflammation
and C-reactive proteinWhen artery injured by smoking, high BP,
cholesterol, CRP is released, so higher levels in the blood and
elevated risk of heart attack and strokeInsulin resistance and
metabolic syndromeEating carbohydrates raises blood glucose,
pancreas secretes insulin, cells use glucose for energy. If obese
and inactive, muscles and liver don’t use insulin properly
Homocysteine (an amino acid in blood)Damages lining of blood
vessels; causing inflammation and fatty deposits on
artery walls, can lower with fruit, vegetable, and
grainsInfectious agentsA form of pneumonia
*
Possible Risk Factors Currently Being StudiedLipoprotein(a)
(especially with high LDL or low HDL levels)LDL particle size
(small, dense particles)Fibrinogen (protein essential in
forming blood clots)Blood viscosity (thickness)
and high levels of ironUric acid (increases inflammation
& platelet aggregation)Time of day and time of year
Chapter 12
*
Cardiovascular Disease in the U.S.
Chapter 12

20. *
Percentage of Adult Americans with CVD
Percentage of Deaths Due to Heart Disease
Chapter 12
*
Major Forms of Cardiovascular DiseaseAtherosclerosis –
thickening and hardening of the arteries, narrowed by fatty
deposits, often begins during childhood Heart Attack – coronary
thrombosis, coronary occlusion, or
myocardial infarction, coronary
arteries of the heart become blocked,
about 1/3 have no chest painAngina (Chest pain) – arteries
narrowed by disease; while under stress,
heart not receiving enough oxygenArrhythmias and Sudden
Cardiac Death – electrical conduction system is disrupted, heart
beating too fast, too slow, or irregular Sudden Cardiac Death –
caused by ventricular fibrillation
*
Stages of Plaque Development
Chapter 12

21. *
Chapter 12
*
Helping a Heart Attack VictimMost deaths occur within 2 hours
from initial symptomsChewing one adult aspirin (325 mg) has
immediate anti-clotting effectIf no pulse, start cardiopulmonary
resuscitation (CPR) until EMT’s arriveRefer to Box “What to
Do in Case of a Heart Attack, Stroke, or Cardiac Arrest” (page
283)
Chapter 12
*
Detecting and Treating Heart
DiseaseElectrocardiogram (ECG or EKG)Checks heart’s
electrical activity while under stress Electron-beam computed
tomography (EBCT) (detects calcium in the
arteries)Echocardiograph (sound waves)Magnetic Resonance
Imaging (MRI)If tests show symptoms: Angiogram (catheter &
dye)If problem found:Balloon angioplasty & stentCoronary
bypass surgeryMedication
Chapter 12
*
Stroke or Cerebrovascular Accident (CVA)Ischemic stroke
(87%) - blockage in blood vesselsThrombotic stroke - clot
forms in a narrowed or damaged cerebral artery;
hypertensionEmbolic stroke - wandering blood clotHemorrhagic
stroke – blood vessel ruptures in the brainSubarachnoid
hemorrhage (3%)On surface of the brain, bleeding

22. between the brain and the skullIntracerebral hemorrhage
(10%)Rupture within the brainAneurysmBlood filled bulge in
brain
*
.
Types of Stroke
Chapter 12
*
Chapter 12
*
The Effects of a Stroke700,000 Americans per year
affectedOne-third die within a yearThose who survive have
some lasting disability depending on area of brain
damagedParalysisWalking disabilitySpeech impairmentMemory
lossChanges in behaviorEarly treatment can reduce severity of
disability
Chapter 12
*
Detecting and Treating StrokePrompt recognition of symptoms:
Sudden numbness or weakness of face, arm, leg, or one side of
the body
Loss of speech or difficulty speaking
Dimming or loss of vision in one eye
Unexplained dizziness in relation to other symptoms or trouble
walking

23. Sudden, severe headacheRefer to “Stroke Warning Signs” (page
283)Say: “Give me a smile.” “Hold your arms out.” “Say this
for me.”
Chapter 12
*
Detecting and Treating StrokeTransient ischemic attack (TIA)
(mini strokes) Produces temporary stroke-like
symptomsComputed tomography (CT) (assesses brain damage
and type of stroke)Carotid endarterectomy surgery – plaque is
removed from the arteryMedicationRehabilitationPhysical
therapySpeech and language therapyOccupational therapy
*
Peripheral Arterial DiseasePAD – atherosclerosis in the leg (or
arm) arteries, which can limit or block the blood flow, also
known as peripheral vascular diseasePatient’s typically also
have coronary artery disease or cerebrovascular disease10
million people in the U.S. have PADRisk
factors:SmokingDiabetesHypertensionHigh cholesterolLeading
cause of amputation in people over 50
Chapter 12
*
Chapter 12
*
Congestive Heart FailureNumber of conditions can damage

24. heart Pulmonary edema - fluid accumulates in the lungs,
interferes with breathingHeart can not maintain regular pumping
rate and force; fluid begins to back upControlled by: Reducing
cardiac loadEliminating excess fluidRestriction of salt Drug
therapyRisk increases with age and being overweight
*
Chapter 12
*
Other Forms of Heart DiseaseCongenital heart disease
Malformation of the heart or major blood vesselsHypertrophic
cardiomyopathy (HCM)Most common cause of sudden death in
athletes younger than 35Inherited condition causing heart
muscle to enlargeRheumatic heart disease (RHD)Untreated
streptococcal infections can cause permanent damage to the
heart muscle and valvesStrep throat needs to be treated, primary
cause of rheumatic fever if not treatedHeart valve
disordersCaused by age, previous heart attack, congenital
defects, infectionsValve fails to open fully or close
completelyMitral valve prolapse (leakage at valve site)
*
Chapter 12
*
Protecting Yourself Against CVDEat heart-
healthyDecreased fat and cholesterolTotal fats less than 30% of

25. total daily caloriesLow saturated and trans fatsIncreased dietary
fiberDecreased sodium intake and increased potassium
intakeModeration of alcohol Women – one drink per dayMen –
two drinks per day
Chapter 12
*
Other Dietary FactorsOmega-3 fatty acids (fish, shellfish,
nuts)Plant stanols and sterols (trans fat-free margarines)Folic
acidVitamins B-6 and B-12Calcium (low-fat & fat-free dairy
products)Soy protein Healthy carbohydrates (whole grains,
fruits, non-starchy vegetables) Reduce total calorie intakeDASH
Dietary Approaches to Stop HypertensionLow in fat, high in
fruit, vegetables, and low-fat dairy products
Strategies to Reduce Risk of CVD
Chapter 12
*
Chapter 12
*
Protecting YourselfExercise regularlyAvoid tobaccoKnow and
manage your blood pressure (monitored once every two
years)Know and manage your cholesterol levels (at least once
every five years)Develop effective means of controlling stress
and anger

26. Cancer IntroductionCauses about 580,000 deaths in the U.S.
each year, more than 1,600 every dayLeading cause of disease-
related death among people under age 65Second most common
cause of deathEvidence supports that more than half of all
cancers could be prevented by simple lifestyle changes
Genes, age, and environmental factors also play a role in the
development of the diseaseTobacco is responsible for about 1/3
of all cancer deathsPoor diet and exercise habits account for
another 1/3 of cancer deaths
Chapter 12
*
Percent of Cancer Deaths Linked to Risk Factors
Chapter 12
*
Chapter 12
*
What is Cancer?Definition: an abnormal and uncontrollable
growth of cells or tissue that can lead to deathTumor: a mass of
tissue that serves no purposeBenign versus malignant
tumorsBenign tumor: mass of cells enclosed in a membrane
that prevents their penetration into other tissuesDangerous only
if presence interferes with body functionsMalignant tumor:
(Neoplasm) cancerous, can invade surrounding tissues and
spread to other sitesEvery case of cancer begins as a change in a
cell that allows it to grow and divide when it should not
Stages of Tumor Development
Chapter 12

27. *
Chapter 12
*
How Cancer SpreadsMetastasis: Primary tumor: the original
location, spreading of cancer cells occurs because cancer cells
do not stick to each other as strongly as normal cells Cells
break away from primary tumor and invade surrounding tissues
or travel through the blood and lymphatic system Secondary
tumor or metastases: new tumors formed by
traveling and seeding of
free-floating cancer
cells
Chapter 12
*
Types of Cancer
Classified according to the types of cellsInitially retain some of
the original properties of the host cellCarcinomas: most
common - arises from the epithelial tissue that covers external
body surfaces (skin), glands, lining of internal organs and
cavities (breast, prostate, lungs)Sarcomas: arise in connective
and fibrous tissues (bone, muscle, cartilage, and membranes
covering muscle or fat)Lymphomas: cancers of the lymph
nodes, the body’s infection-fighting systemLeukemia: cancer of
the blood-forming cells in bone marrow
Chapter 12
*
The Incidence of Cancer1.6 million Americans are diagnosed

28. yearlyMore than half will be curedAbout 36% will die as a
result of cancer More under age 65 die from cancer than from
heart disease 1 in 2 men and 1 in 3 women will develop cancer
during their lifetimeAmerican Cancer Society estimates90% of
skin cancer could be prevented87% of lung cancer could be
prevented
Chapter 12
*
Cancer Cases and Deaths by Site and Sex
Chapter 12
*
Lung CancerMost common cause of cancer death in the
U.S.160,000 deaths per yearRisk factorsTobacco smoking
contributes to 90% of death casesCombined with environmental
carcinogens, multiply by a factor of 10Long-term exposure to
ETS increases the risk of lung cancerDetection and treatment
(difficult to detect)Symptoms usually not detected until cancer
has reached the invasive stagePersistent cough, chest pain, or
recurring bronchitisDiagnosis - chest x-ray or sputum
examination, fiber-optic bronchosectomy
Chapter 12
*
Lung CancerTreatment:Difficult to treat, hard to cure If caught
early, treated by surgeryMajority diagnosed when in advanced
stageOnly 15% are detected prior to spreadingRadiation and
chemotherapy are used in additionDetected early, 52% of

29. patients are alive 5 years after diagnosisOverall, the survival
rate is only 16%Phototherapy, gene therapy, and
immunotherapy (vaccines) are being studied to improve survival
Chapter 12
*
Colon and Rectal CancerThird leading cancer causing deathRisk
factorsDirectly linked to diet, especially high in red and
processed meats, and genetic predisposition91% of cases occur
after 50 yr. of ageHeredity – gene mutationsLifestyleUp to 1/3
of the population is genetically proneExcessive alcohol use and
smokingDetection and treatment Regular screening after the age
of 50 (can reduce risk by 76-
90%)Sigmoidoscopy or colonoscopy
Colon and Rectal CancerTreatmentIf precancerous polyps found
Removal before they become malignant or spread
Diet low in fat and high in fruits, vegetables, and whole grainsIf
cancer detectedSurgeryRadiationChemotherapy5 year survival
rate is 90% if detected early, overall 64%
Chapter 12
*
Chapter 12
*
Breast CancerMost common cancer in women1 in 8 American
women will develop it during her lifetime (232,000 annually)2%
occur in women under age 35, 50% in ages 45-651 in 30 will die
from the disease (40,000 deaths)Risk FactorsMost common in
women over 555 year survival rate is 90%“Disease of

30. Civilization” due to diet and exercise habitsCommon causes:
Genetic predisposition, high fat, high calorie diet, sedentary
lifestyle, alcohol use, early onset of menstruation, late onset of
menopause, first child after 30 or no children, obesity and
hormone replacement therapy useEstrogen exposure in estrogen-
responsive sites (breast & uterus)Fat cells also produce
estrogen, so estrogen levels higher in obeseAlcohol interferes
with estrogen metabolism in liver, so higher levels in
bloodEstrogen promotes growth of cells, especially in
responsive sites
Chapter 12
*
Breast Cancer
Detection and treatment
Early detectionMonthly breast self-exam for all women over 20
(pg. 295)Clinical breast exam by a physician every 3 years (age
20-39)Mammography: every year if over 40 (80-90%
detected)If high risk, also MRI
annuallyTreatmentUltrasonographyBiopsied 90% are cysts, if
not: lumpectomy, mastectomy, radiation,
chemotherapy Survival rate98% if the cells did not
metastasize90% for all stages at 5 yearsNew strategies for
treatment and prevention A number of new drugs have been
developedTamoxifen blocks action of estrogen in breast tissue,
so no re-occurrenceRaloxifene reduces invasive breast cancer
risk in postmenopausal women
Chapter 12
*
Prostate CancerMost common cancer in men, second leading
cause of cancer death in men239,000 new cases per yearMore

31. than 30,000 deaths per yearRisk Factors Age (60% diagnosed
over age 65)Diet (high in calories, dairy, and animal fats)
Lifestyle, including Type 2 diabetes Genetic predisposition and
family historyHistory of STD’sEarly detection is key, PSA
blood test (prostate-specific antigen) Treatment - surgical
removal of the prostate and radiationSurvivalAll stages nearly
100% after 5 years
Chapter 12
*
Cancers of the Female Reproductive TractCervical cancer -
sexually transmittedMost cases stem from infection by the
human papillomavirus (HPV) - transmitted by unprotected
sexSmokingProlonged use of oral contraceptivesInfection by
genital herpesCervical cancer most common in women in their
20’s and 30’s12,000 new cases each year, about 4,000 die
annuallyFactors: sexual intercourse before 18, multiple sex
partners, cigarette smoking and low socioeconomic
statusScreening:PAP TestCervical dysplasia (abnormal cells)All
sexually active women ages 18-65 should be
testedTreatmentSurgery
Chapter 12
*
Cancers of the Female Reproductive TractUterine, or
Endometrial:Occurs after 55Risk factors similar to breast
cancerDetermined by pelvic examTreatment is surgery,
radiation, hormones, and chemotherapy Survival – if detected
early, about 95% after 5 years, 67% if it has spread beyond the
uterusOvarian Cancer: Difficult to detect and diagnosis, no
warning signsFamily history, genetic factors, never being
pregnant, obesityDetermined Pelvic ultrasound examBlood test

32. – tumor marker called CA-125Treatment is surgery, radiation
and chemotherapySurvival – all stages, only about 44%
Cancers of the Female Reproductive TractDES
(diethylstilbestrol):Synthetic hormoneHelped prevent
miscarriage (given from 1938 – 1971)DES daughters have an
increased risk of vaginal or cervical cancer, anatomically
abnormal reproductive organs, and problems with fertility and
miscarriageDES sons have an increased risk of testicular cancer,
abnormalities to reproductive organs including undescended
testicles which is a risk factor for cancerNew studies have
suggested a possible increased 3rd generation cancer risk
Chapter 12
*
Chapter 12
*
Skin CancerMost common type of cancer3.5 million cases per
year76,000 are melanoma, most serious typeEasily detected and
highly curableExposure to ultraviolet rays, UVA and UVB,
especially during childhoodCommon cause - sunburns and
suntansTypes: Basal and Squamous – about 95% of skin
cancersUsually found on face, neck, hands, and armsMelanoma
- most dangerous form due to spreadingPreventionAvoid long
term overexposure to sunlightBlistering and peeling sunburns,
and suntansDetection and treatmentSurvival – if tumor
localized, 98% after 5 yearsABCDE screen test
ABCDE Test for Melanoma

33. Chapter 12
*
Testicular CancerVery rare, about 8,000 cases per year
(1%)Risk factorsMost common in men aged 20-35More common
among whites than other ethnicitiesFamily historyMen with
undescended testiclesDetection and TreatmentSelf exam helps
in early detection (pg. 299)Surgery and chemotherapy (radiation
rarely used)5 year survival rate is 95%
Chapter 12
*
Pancreatic CancerUsually well advanced before
diagnosed45,000 cases annually, nearly 38,000 deathsRisk
factorsSmoking, male, African American, obese, sedentary, over
age 60, family history, diabetes, diet high in fat and meat and
low in vegetablesDetection and TreatmentMost are detected
after it has already spreadFewer than 20% suitable for surgery,
cancer often returnsChemotherapy and radiation provide few
benefitsUsually fatal
Chapter 12
*
Chapter 12
*
Other CancersHead and Neck Cancers (from smoking and
alcohol)Easy to detect but hard to cure; surgery, chemotherapy,
and radiation, many develop another oral cancer2X greater in
men than women5 year survival is about 61%Stomach
CancerRare is US, most over 65, from diet

34. and bacteriaNo screening test, usually diagnosed
after it has spread5 year survival is only 28%
Other CancersBladder Cancer3X more common in men than
womenSmoking is key risk factorNo screening test, first
symptom is blood in urine, but that could be a urinary tract
infectionWith early detection, 90% of cases are curableKidney
CancerFew controllable risk factors, anyone can develop
itDifficult to treat, 5 year survival is about 71%Brain
CancerMost develop for no apparent reason and most not
curableAbout 23,000 cases annually, with 14,000 deaths
Chapter 12
*
LeukemiaCancer of the white blood cellsStarts in the bone
marrow but spreads to the lymph nodes, spleen, liver, other
organs and CNSAbnormal production of immature white blood
cells; rapidly growing cells displace red blood cell
precursorsImmature WBC’s cannot fight off infectionsRisk
factors are unknown 20% of cases of adult leukemia are related
to smoking
Chapter 12
*
Change in Cancer Rates
Chapter 12
*

35. Other Common CancersLymphomaArising from the lymph cells,
may spread to almost any part of the bodyHodgkin’s
diseaseNon-Hodgkin’s disease (more common & more
deadly)Sixth most common cancer in USMultiple
MyelomaMalignant plasma cells produce tumors in the bone
marrow, crowding out normal marrow cellsUsually grows in
multiple sitesLeads to anemia, excessive bleeding and decreased
resistance to infection
Chapter 12
*
Chapter 12
*
Causes of CancerThe Role of DNAEach cell has 23 pairs of
chromosomes that contain DNA Each controls the way a cell
will workGene - a section of a chromosomeDNA Mutations and
CancerChanges the way the cells functionMutagens – radiation,
certain viruses and chemical substances in the air
(a carcinogen)Oncogenes – a gene involved in the
transformation of a normal cell into
a cancer cellTumor suppressor genes – type
of oncogene that controls cellular growth
Chapter 12
*
Cancer PromotersDo not directly produce mutations, they
accelerate the growth of cells without damaging or permanently
altering the DNA Estrogen stimulates cellular growthCancer
initiators – carcinogenic agents that cause mutational changes in
DNA of oncogenes (UV radiation)Cigarette smoke is a complete

36. carcinogen because it is a cancer initiator and promoter
Chapter 12
*
Dietary FactorsDiet is one of the most important factors in
cancer prevention or in increasing your cancer riskAffect cancer
riskDietary fat and meatDiets high in fat and meat have a direct
impact on rates of certain cancersAlcoholFried foodsCancer
preventionDietary fiberFruits and vegetablesAnticarcinogens
(destroy or block carcinogens; Vitamins C
and E, and selenium)Carotenoids (act as antioxidants, block
cancer formation; Vitamin A)Antioxidants versus free radicals
(damage DNA)Phytochemicals (protect against chronic
diseases)
Foods with Phytochemicals
Chapter 12
*
Inactivity and Obesity170,000 cancer deaths per year linked to
diet and sedentary lifestyleLinked to breast and colon cancer
and othersBenefits of physical activitySpeeds the movement of
food through the digestive
systemStrengthens the immune
systemDecreases blood fat levelsPrevention of obesity
Chapter 12
*

37. Chapter 12
*
Carcinogens in the EnvironmentMicrobes (viruses, bacteria, and
parasites)Ingested chemicals (nitrates & nitrites in
food)Environmental and industrial pollutionRadiation - UV rays
or man made
Chapter 12
*
Detecting, Diagnosing, and Treating CancerDetecting:
Self-monitoringCAUTION acronymDiagnosing:
BiopsyMagnetic resonance imaging (MRI)Computed
tomography
(CT)UltrasonographyTreatment:SurgeryChemotherapyRadiation
therapyNew and Experimental:Gene therapy (manipulating
genes in cells)Bone marrow and stem cell transplantsBiological
therapies (cancer vaccines)Proteasome inhibitors (halt cell
division & kill cells)Enzyme activators/blockers
(caspase/telomerase)
Seven Major Warning Signs of Cancer
Chapter 12
*
Living with Cancer13.7 million cancer survivors in U.S.
todayMust live with fear of recurrenceMany deal with long-term
consequences or side effects from cancer therapyFace prejudice
from health insurersPsychological support is importantFinancial
impact
Chapter 12

38. *
Chapter 12
*
PreventionLifestyle choicesAvoid tobaccoControlling diet and
weightRegular exerciseProtecting skin from the sunAvoiding
environmental and occupational carcinogens Recommended
screening testsBe aware of the early signs and symptoms
Strategies to Reduce Risk of Cancer
Chapter 12
*
Cardiovascular Disease and Cancer
How will you protect yourself against these diseases?
Chapter 12
*
Psychological Health
Chapter Three

39. Psychological HealthIf not severely mentally disturbed, then
must be mentally healthyEnd up ignoring common problems,
thoughMajority of people do not suffer from any mental
illnessHave to deal with daily stress, interpersonal conflicts,
and difficult emotionsWhat is the extent to which we
are able to function optimally in the face of
every day challenges
Chapter Three
*
Chapter Three
*
Defining Psychological HealthNegative definition (absence of
sickness)Positive definition (presence of wellness, encourages
you to fulfill your own potential) Abraham Maslow’s
“Toward a Psychology of Being” (an ideal of mental
health)Hierarchy of needsStudied very successful people
who seemed to have lived to their
fullest human potential (Self-
actualization)Abraham Lincoln, Henry David
Thoreau, Ludwig van Beethoven,
Eleanor Roosevelt, and Albert Einstein
Hierarchy of Needs & Self-Actualization Self-
actualized people share certain qualitiesRealismDeal with world
vs. demandAcceptance (of themselves)Health self-esteem,
feelings, value, positive self-
conceptAutonomy (self-
directed)IndependentAuthenticityGenuine, not afraid to be
themselvesIntimacy (capable of)Physical & emotional, able to
communicate feelingsCreativityOpen to new

40. experiences
Chapter Three
*
Positive PsychologyAble to define positive goals and identify
concrete, measurable ways of achieving them through
happinessThe pleasant lifeMaximizing positive emotions,
minimizing pain and negative emotionsThe engaged
lifeCultivating positive personality traits, living in the moment,
having emotional intelligenceThe meaningful lifeWorking with
others toward a meaningful end
Chapter Three
*
Chapter Three
*
Psychological HealthWhat Psychological health is not..Not the
same as psychological normality (being close to average; all
your ideas make life interesting and help you to respond to
life’s challenges)Never seeking help for personal problems
(don’t want to reveal problems to others, fear what friends
might think, also, just because you seek help, doesn’t mean your
mentally ill)“Mentally ill” vs. “mentally healthy” (based solely
on presence or absence of symptoms)Peoples appearance (the
way they look, complaining vs. suffering in silence)
*

41. Chapter Three
*
Meeting Life’s ChallengesCoping Successfully, Growing Up
PsychologicallyAdult identity to enhance self-esteem, autonomy
is developedDevelop as we interact with the world Personal
identity or identity crisisRole models – early ones:
parentsIntimacySharingOpen communicationLong-term
commitmentsLove Values and purpose in lifeConsider your
options, what is good vs.
what is badWhat would your obituary say about you
*
Erikson's Eight Stages of Personality
DevelopmentCharacterized by a major crisis or turning
pointNeed to master each or else failure later in life
Chapter Three
*
Chapter Three
*
Achieving Healthy Self-EsteemDeveloping a Positive Self-
ConceptBegins in childhood (within and outside of family,
being loved)Integration (personality characteristics,
mannerisms, own self-concept)Stability of self (ideal self, no
mixed messages)Meeting Challenges to Self-EsteemChallenge
your self-conceptA goal might end in failureAcknowledge
something has gone wrong & try againNotice your patterns of
thinking (cognitive distortions)Making events worse than they
really are (ie: a late date)Develop realistic self-talk (dispel

42. negative thinking)Be less defensive (re-examine coping
mechanisms)Be optimistic (dispute negative thoughts)
Chapter Three
*
Achieving Healthy Self-Esteem (cont.)Maintain honest
communication (be assertive)Dealing with loneliness (being
happy alone or with others)Dealing with anger (not rage or
overt hostility, higher risk of heart attack)Managing your own
anger (reframe & distract: what are you thinking, cool off until
anger subsides)Dealing with anger in other people (be calm)
Chapter Three
*
Psychological DisordersAnxiety Disorders (fear of
something)Simple phobia or specific phobiaSometimes from a
bad experienceFear of something definite (spiders, blood,
lightening)Most common and most understandableSocial phobia
Fear of humiliation or embarrassment while being observed by
others, such as speaking in publicPanic disordersFear of crowds
or closed placesSudden unexpected surges in anxietyRapid and
strong heart beatShortness of breathLoss of physical
equilibriumFeeling of losing mental control and can’t escape
Chapter Three
*
Psychological DisordersGeneralized anxiety disorder
(GAD)Nervousness and depressionReaction to future threats is
to worry (Will I pass exam?)Worries have taken over, going
around in circlesObsessive-Compulsive disorder

43. (OCD)Obsessions – recurrent, unwanted thoughtsCompulsions –
repetitive, difficult-to-resist actionsFear of germs so constantly
wash handsPost-Traumatic Stress disorder (PTSD)Reaction to a
severely traumatic event (war, rape, Katrina)Treatment for
anxiety disorders Medications, cognitive-behavioral therapies
Attention-Deficit/Hyperactivity DisorderOne of the most
common disorders of childhood and adolescenceInterferes with
one’s functioning or development, occurring before age 12, in
two or more settingsInattentionHyperactivityImpulsivenessNo
cure, working on different treatmentsCurrently,
trying to find ways to prevent it
Chapter Three
*
Chapter Three
*
Mood DisordersDepression (most common, strongly linked to
brain chemistry)6.7% of US annually, about ½ of all college
students)Demoralization (don’t need to have all)Feeling of
sadness and hopelessnessLoss of pleasurePoor appetite and
weight lossInsomnia or disturbed sleepRestlessness or
fatigueThoughts of worthlessness and guiltTrouble
concentratingThoughts of death or suicideDysthymic disorder
(Major depression for 2 yrs or longer)TreatmentCombination of
drug therapy and psychotherapyElectroconvulsive therapy
(ECT)Seasonal affective disorder (SAD) – light therapySuicide
(National rate: 10.8 per 100,000 people)Warning signs (3X
more women attempt, yet 3X more men succeed)

44. Rates of Suicide in U.S. - 2003
Chapter Three
*
Chapter Three
*
Recognizing the Warning Signs of SuicideExpressing the ‘wish’
to be deadIncreasing social withdrawal/isolationSudden
inexplicable lightening of moodRisk Factors:Previous history of
attemptsSuicide by a family member or friendReadily
available means of committing suicideHistory of substance
abuse or eating disordersSerious medical problems
*
See Figure 3-2 on suicide rates in the United States
See box “Depression, Anxiety, and Gender”
See box “Myths About Suicide”
Chapter Three
*
Psychological DisordersMania and Bipolar DisorderMania –
less common mood disorderRestless, lots of energy, little sleep,
talk non-stopBipolar – alternating between depression &
maniaOpposite poles, treat with drugs to prevent future mood
swingsGender differencesEqual numbers of men and women
suffer, women twice as likely as men to be clinically depressed
due to reporting & hormonesSchizophrenia (1 in every 100
people)Uncertain about what causes itGeneral characteristics
Disorganized thoughts, vague/confusingInappropriate emotions
or noneDelusions (false beliefs)Auditory
hallucinationsDeteriorating social and work function -

45. withdrawing
Prevalence of Psychological Disorders in US, 2011
Chapter Three
*
Models of Human Nature and Therapeutic ChangeFour different
perspectives applied to problems
1. Biological (the brain)
Pharmacological therapy (antidepressants,
antipsychotics, mood stabilizers, stimulants, sleeping pills)
2. Behavioral (what people do)
Stimulus (what causes response), response (reaction), and
reinforcement (some form of reward)
Practice exposure to feared situation (fear of flying)
3. Cognitive (what people think)
Ideas, attitudes, behaviors and feelings (real vs. unreal)
4. Psychodynamic (how past shapes present)
Unconscious thoughts and impulsesEvaluation of the
modelsCombining different therapies for best results
Chapter Three
*
Chapter Three
*
Getting HelpSelf HelpBooksWriting a journalReligiousSocial
groups or networkingPeer counseling and support
groupsProfessional Determine the need Choosing a mental
health professionalPsychiatrists (MD’s – experts if medical
disease)Clinical psychologists (PhD’s – experts in behavior

46. and cognitive therapiesSocial workersLicensed
CounselorsClergyTreatment Team
Dr. Randy Pausch Video
http://www.youtube.com/watch?v=o8uZBKyrKTU
Chapter Three
*
Psychological Health
How is Yours?
Chapter Three
Stress: The Constant Challenge
Chapter Two
Stress LevelWe all need some stress to challenge us; helps
promote optimal performance and well-being Too little Not
challenged enough so we won’t improveToo muchReal stress
that impairs health – both emotional and physical
Chapter Two
*

47. Stress Level, Performance, and Well-Being
Chapter Two
*
*
Chapter Two
*
What is Stress?Physical and emotional states that trigger the
stress response (the actual reaction)Stressor (situations that
produce stress)Physical Responses to StressorsTwo Major
Control Systems affectedNervous systemBrain, spinal cord,
nervesHandles short-term stress Endocrine systemGlands,
tissues, cellsHandles both short (acute) and
long-term (chronic) stress
Chapter Two
*
Actions of the Nervous systemAutonomic nervous system (don’t
control actions – heart rate, breathing, digestion)
Parasympathetic divisionRelaxed, store energyThe
brakeSympathetic divisionEmergency or arousalThe
gasNeurotransmitterNorepinephrine – causes body to prepare
and to respond to a crisis, stop storing energy

48. Chapter Two
*
Actions of the Endocrine System
Glands, tissues, and cells that help control bodily
functionsReleases hormones into the bloodstream that influence
metabolism and other body processesHelps prepare the body to
respond to stress
Chapter Two
*
Nervous and Endocrine Systems Working
TogetherHypothalamus (hormonal control center in brain)ACH
(acetylcholine), released to:Pituitary gland (at base of brain,
regulates release of hormones) ACTH (adrenocorticotropic
hormone), released into bloodstream and goes to:Adrenal
glandsCortisol (stimulates release of glucose for
energy)Epinephrine (adrenaline)BrainEndorphins (pain reliever
– in case of injury)Homeostasis (normal functioning or state of
normalcy)
The Fight-or-Flight Reaction
Chapter Two
*
Chapter Two
*
The Fight-or-Flight Reaction in Modern Life
Sir Walter Cannon 1st described in 1915Survival mechanism
Prepares body for physical action to quickly escape or prepare

49. for battle“Absurdly inappropriate” No physical response needed
for most stressors today (exams, late to
class, no parking places)
Chapter Two
*
Emotional and Behavioral Responses to StressorsEmotional
responsesAnxietyDepressionFearCognitive appraisal How is
stressor viewed?Two factors that reduce stress
responseSuccessful prediction (class syllabi)Perception of
control (locus of control and your reaction)
Chapter Two
*
Emotional & Behavioral Responses to StressBehavioral
ResponseSomatic nervous system (under our control) Effective
responses to stress: learning to control and copePromote
wellnessTalking, laughing, exercise, and time
managementIneffective responses to stress:Impair wellness and
can become stressorsOvereating, substance abuse,
procrastination, expressing hostility
Chapter Two
*
Personality and StressPersonalitySum of cognitive, behavioral,
and emotional tendenciesAffects how people perceive and react
to stressors Personality TypesType A, B, and CType A –
controlling, impatient, driven, ultra-competitive, higher
perceived stress level and less coping, increased risk of heart
diseaseType B – less hurried, contemplative, relaxed, tolerant,

50. risk of heart disease, but less than A’sType C – difficulty
expressing emotions or anger, feelings of hopelessness and
despair, over-exaggerates minor stressors, more cases of cancer
Personality and StressPersonality Type DTends toward negative
emotional states of anxiety, depression, irritability, avoids
social interactions, poor health outcomes including
CVDHardiness Trait (deal more successfully with stress) View
stressors as challenges and opportunities for growth, not
burdens, react less intensely to stress, are in controlResilience
Trait (set goals and face adversity)Associated with
social/academic success in at-risk populations, such as low-
income families, or those with disabilitiesLinked to emotional
intelligence and violence prevention Nonreactive – does not
react to a stressorHomeostatic – reacts strongly to stress but
returns to baseline quicklyPositive Growth – learns and grows
from the stress experience
Chapter Two
*
Personality and StressCultural background (can be a source of
stress, possibly influenced by family)Stereotyping, prejudice,
discriminationGender (anger vs. crying)Men – aggressive,
competitive, more successful with reducing stress than women,
sportsWomen – higher levels of stress, “tend-and-
befriend”Produce more oxytocin and estrogen combo (helps
decrease risk of stress-related disorders, can increase female
longevity)Past ExperiencesUnprepared for speech
Chapter Two
*

51. Chapter Two
*
General Adaptation Syndrome
(G.A.S.)Predictable response pattern to stress Eustress – good
stress (going to a party)Distress – bad stress (bad
grade)Stages:Alarm (more susceptible to disease/injury)Fight or
FlightResistance (new level of homeostasis) Can cope with
normal life and added stressExhaustion (stressor persists
or several stressors occur)Can be life-threatening,
a physiological exhaustionAllostatic loadLong term wear and
tear of stress on the bodyWhen it exceeds your ability to cope,
you get sick
Chapter Two
*
Psychoneuroimmunology (PNI)The study of interactions among
nervous, endocrine, and immune systemsThe relationship
between stress and diseaseComplex network of nerve and
chemical connections between the nervous system, endocrine
system, impairs the immune systemHow stress
affects our bodiesShort term vs. long term
Chapter Two
*
Links Between Stress and Specific ConditionsCardiovascular
diseaseChronic high blood
pressureAtherosclerosisStrokesCardiomyopathy (mimics heart
attack)Altered functioning of the Immune systemColds and
other infectionsAsthma and allergiesCancerChronic disease

52. flare-ups (ie: herpes or HIV)
Chapter Two
*
Psychological ProblemsEmotional and physical
changesDepressionPanic attacksAnxietyEating disordersPost-
traumatic stress disorder (PTSD)Can negatively affect focus and
ability to think clearly
Chapter Two
*
Other Health ProblemsDigestive problems (IBS,
ulcers)Headaches/migrainesInsomnia/fatigue (memory
loss)Injuries (also on-the-job injuries)Pregnancy
complicationsType 2 diabetes (increased cortisol in
bloodstream)Premature aging (DNA & cellular damage to
cells)
Chapter Two
*
Common Sources of StressMajor life changesDaily
hasslesCollege AcademicInterpersonalTime-
relatedFinancialNontraditional students Older, married, have
childrenJob-relatedSocialReal social networksPrejudice,
languageVirtual social networks New
technologyEnvironmentalNatural disasters Violence
Chapter Two

53. *
Techniques For Managing StressSocial Support –
sharingVolunteeringCommunicationExerciseNutritionSleep (7-9
hrs/night) Time managementSpiritualityJournal writing
Chapter Two
*
Cognitive TechniquesThink and act constructivelyTake
controlProblem-solveModify your expectationsMaintain
positivityPractice affirmationsCultivate your sense of
humorWeed out triviaGo with the flow
Chapter Two
*
Relaxation TechniquesProgressive relaxation (tense and
relax)Visualization (daydream)Meditation (quiet the mind)Deep
breathingHatha yogaTaijiquan (Tai chi)MusicBiofeedback
Massage
Chapter Two
*
Counterproductive Coping StrategiesCan make you feel more
stressed, plus are addictiveTobacco Nicotine enhances the
actions of
neurotransmittersAlcoholDrugsCaffeine, amphetamines,
marijuana, opioidsUnhealthy eating habits Sugar, fatty foods,
carbohydrates

54. Chapter Two
*
Creating a Personal Plan For Managing StressIdentifying
stressorsJournal for two weeksSpot patternsDesigning your
planTechniques for copingContractGetting helpPeer counseling,
support group, self-help book
Stress: The Constant Challenge
How will you handle it?
Chapter Two
Taking Charge of Your Health
Chapter One
Chapter 1
*
Wellness: The New Health GoalWellness – Optimal health and
vitality…Living life to its fullestHealth – determined/influenced
by factors beyond our controlWellness – determined by
conscious decisions we make
The Dimensions of Wellness (a dynamic process of change and
growth)Physical EmotionalIntellectualSpiritualInterpersonal and
SocialEnvironmental or
PlanetaryCulturalFinancialOccupationalThe nine dimensions of
wellness interact continuously influencing and being influenced

55. by one another.
*
The Wellness Continuum
(Figure 1.1)
Chapter 1
*
*
Examples of Dimensions of WellnessPhysicalEating well and
exercisingAvoiding harmful habits and injuriesPracticing safer
sexEmotionalHaving optimism and trustHigh self-esteem, self-
acceptance, and self-confidenceAbility to accept one’s feelings
and to share your ownIntellectualHaving a sense of humor,
creativity, and curiosityOpen to new ideas, ability to think
critically, capacity to question
thingsInterpersonalSatisfying/supportive relationships, good
support system of friends/familyGood communication skills and
capacity for intimacy Participating in and contributing to your
community and to society
Chapter 1
*

56. *
Examples of Dimensions of WellnessCulturalHow you interact
with others who are different from youAccepting, valuing,
celebrating different cultural ways people interact
SpiritualCapacity to love and care for othersHave compassion,
forgiveness, altruism, joy, and fulfillmentHave sense of
meaning, purpose, and sense of belongingEnvironmental or
PlanetaryReducing pollution and wasteHaving abundant, clean
natural resourcesFinancialAbility to live within your means and
manage your moneyCan balance your income/expenses, stay out
of debt, save for the futureUnderstand your emotions about
money OccupationalEnjoy your work, a connection with others,
take advantage of opportunities to learn and be challenged
Chapter 1
*
*
Chapter 1
*
Ten Signs of Wellness
Persistent presence Positive expectationsHappy
experiencesSpiritual involvementChanging conditionsStress
responsePhysical activityCommunicate
feelingsGenerosityHumor

57. *
Chapter 1
*
New Opportunities, New Responsibilities1900’s versus
TodayInfectious diseaseA disease that is communicable from
one person to another… (small pox, malaria, pneumonia, TB,
etc.)Chronic diseaseA disease that develops and
continues over a long period of time,
usually due to lifestyle choices,
resulting in some sort of impaired life
(heart disease, cancer, chronic
lower respiratory diseases, stroke, etc.)
*
Leading Causes of Death,
1900’s vs. Today
1900’s
Today
Chapter 1
©2008 McGraw-Hill Companies. All Rights Reserved.
*
©2008 McGraw-Hill Companies. All Rights Reserved.
Public Health Achievements

58. Chapter 1
*
*
Chapter 1
*
Leading Causes of Death in the
United States, 2011
Causes of DeathNumber of DeathsHeart
disease596,339Cancer575,313Chronic lower respiratory
diseases143,382Stroke129,180Unintentional injuries
(accidents)118,043Alzheimer's disease83,308Causes of
DeathNumber
of DeathsDiabetes mellitus68,905Influenza/pneumonia53,667
Kidney disease45,731
Suicide38,285
Septicemia (systemic blood infection)35,539Chronic liver
disease33,539

59. *
Chapter 1
*
Key Contributors to Death Among Americans,
2011Number of Deaths per yearPercent per
yearTobacco467,00019.1Obesity216,0008.8Alcohol64,0002.6To
xic agents55,0002.3Microbial agents50,0032.0Illicit drug
use40,2391.3Motor vehicles34,6771.1

60. *
Chapter 1
*
The Healthy People InitiativeNational health goals for each
decadeAimed at preventing diseaseImproving America’s quality
of lifeHealthy People 2020A focus on identifying, measuring,
tracking, and reducing health disparities through determinants
of healthWhat make some people healthy
and others not?Create a society where everyone
has a chance to live a long healthy
life
*
Chapter 1
*
Health Issues for Diverse PopulationsSex and gender (roles,
behaviors, activities)Biology vs. cultureEthnicityIncome and
EducationBest predictors of poor healthDisabilityGeographic
Location Rural vs. urbanSexual Orientation

61. *
Chapter 1
*
Factors That Influence WellnessHealth habitsSmoking, stress,
poor dietHeredity/Family historyEnvironmentAir, water, home,
workAccess to Health carePreventative vs. treatment
*
Chapter 1
*
A Wellness ProfileSense of responsibility for your own
healthManaging stressMentally healthy (self-
esteem)Relationships/sexuality (satisfying?)Toxins (tobacco,
drugs, etc.)Diet/ExerciseHealth care system
(understand?)Understanding illness and when to seek
helpNatural process of aging and dyingUnderstanding the
environment and how it affects your health
*
Chapter 1
*
Getting Serious About Your Health

62. Examine current health habitsChoose a target behaviorOne
behavior change to concentrate onObtain information about
your target behaviorFind outside help
*
Chapter 1
*
Building Motivation for Change
Examine the pros and cons of changeBoosting self-efficacy:
your belief in your ability to take actionLocus of controlInternal
control versus external controlVisualizationSelf-TalkRole
models and social supportIdentify and overcome key barriers to
change
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Chapter 1
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The “Stages of Change Model”
Developed by Carl DiClemente and
James Prochaska (1991)
PrecontemplationContemplationPreparationActionMaintenanceT
ermination
*

63. Chapter 1
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Developing Skills for Change: Creating Personalized Plan
Monitor your behavior and gather data
Analyze the data and identify patterns
Set realistic and specific goals
Devise a strategy or plan of actionSuppliesModify your
environmentRewards
Make a commitment by signing a personal contract
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Chapter 1
*
Putting Your Plan Into Action
Requires commitmentUse all strategiesJournal Analyze your
planRewards
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Chapter 1
*
Putting Your Plan Into ActionStaying with it (avoid
obstacles)Social influences (support group)Levels of motivation
and commitmentChoice of techniques and level of effort (make

64. changes)Stress barriersGames people playProcrastinating,
blaming
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Chapter 1
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Being Healthy For Life
Making changes in your worldIncreased awarenessGreater
responsibility and controlHealthier lifestylesWhat does your
future hold?More active role = greater impact on
present and future wellness
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Take Charge of Your Health
TODAY
Chapter One