Health Notes

 Chapter 1: Self, Family, and Community

o Health and Wellness
 Health: a state of complete physical, mental, social, and spiritual well-being
 Not merely the absence of disease and infirmity
 Wellness: an active process of adopting patterns of behavior that can lead to improved health
and heightened life satisfaction


 The wellness continuum.

 Wellness may be conceptualized as a continuum. At one end is terminal illness and
premature death; at the other is a sense of vitality, wellness, and optimal health.
o What Determines Health?
 Sociological model of health and wellness identifies the complex levels and interrelationships
that influence your health
 Individual has a unique set of characteristics, including genetics, age, and knowledge
 Environment is anything external to us: relationships with others, community resources,
physical and built environment, etc.
 Many social determinants of health influence the options you have and the choices you make
o Population Health
 Life expectancy has not increased as fast in the United States as in other countries
 Measuring differences in health outcomes between populations can reveal why gains are not
equally shared
 Demographics: statistical data about populations or groups of people
 Population health: health outcomes of a group of people, and the distribution of those
outcomes within the group
o Health Equity
 Health disparities result from systemic and avoidable social and economic practices and
policies that create barriers for some groups
 Geographical disparities:
 Americans have greater health risks than individuals in other high-income countries
 Health disparities are also seen between U.S. regions
 Ethnic and racial disparities:
 Health improvements are not shared equally
 Ethnicity: sense of identity drawn from common origins
 Race: ethnic groupings based on physical characteristics
 Socioeconomic disparities:
 Socioeconomic status has perhaps the most significant impact on health outcomes
  Age disparities:
 Different ages are associated with critical phases in life, when healthy and harmful
environments have greater impact
o Public Health
 Discipline focused on the health of populations
 Health promotion: actions designed to maintain a current health state or encourage a more
desirable state of health
 Disease prevention: defensive actions to ward off specific diseases and their consequences
 Initiatives must balance the needs and rights of individuals against the needs and rights of
others
o Community Health
 Activities directed toward improving the health of a whole community, or activities employing
resources shared by the members of the community
 Public Health Service, led by Surgeon General and Centers for Disease Control and
Prevention (CDC)
 State and local government programs
 Nongovernmental organizations
o The Healthy People Initiative
 Leading health indicators: priority public health issues to be targeted and measured
 Nutrition, physical activity, and obesity
 Maternal, infant, and child health
 Tobacco
 Substance abuse
 Reproductive and sexual health
 Mental health
 Injury and violence
 Environmental quality
 Clinical preventive services (such as immunizations)
 Access to health care
 Oral health
 Social determinants of health
o Individual Choice Versus Societal Responsibility
 Ethical questions:
 Are individuals responsible for their health choices, given the powerful influence of their
environment?
 Should individuals be held accountable for costs to society of poor health choices?
 Is government justified in enacting health-related laws, regulations, and policies?
 Should society take action to prevent people from taking risks?
 Is health a basic right?
o Health-Related Behavior Choices
 Choices concerning physical, mental, emotional, spiritual, social well-being
 Areas where individuals have the most control over managing their health
o The Health Belief Model
 Health behaviors are influenced by:
 Perceived susceptibility (risk for a problem)
 Perceived seriousness of consequences
  Perceived benefits of specific action
 Perceived barriers to taking action
 All these considerations enter into your decision-making process when making health-related
behavior change decisions
o The Stages of Change Model
 Stages of Change Model, or Transtheoretical Model (TTM), takes into account thinking,
feelings, behaviors, relationships, and many other factors
 Precontemplation
 Contemplation
 Preparation
 Action
 Maintenance
 Termination
 Relapse, backsliding into a former health state, is the rule rather than the exception


o Creating a Behavior Change Plan
 Accept responsibility for your own health and make a commitment to change
 Set goals
 Develop action steps
 Identify benefits
 Identify positive enablers
 Sign a behavior change contract
 Create benchmarks
 Assess accomplishments and revise, if necessary
o Being an Informed Consumer of Health Information
 Develop health literacy: the ability to read, understand, and act on health information
 Nine out of ten American adults have trouble interpreting health materials
 Many factors contribute to health risk: the probability of exposure to a hazard that can result
in negative consequences
 Emotional responses affect how we interpret and react to information
  Understanding medical research studies
 Basic medical research, epidemiological studies,
clinical studies
 Careful consideration of health recommendations involves asking a series of critical
questions
 Formal study or expert opinion?
 If formal clinical study, randomized and double-blind?
 People in the study similar to you?
 How many participants?
 Who sponsored or funded the study?
 Published in a reputable, peer-reviewed journal?
o DNA and Genes: The Basis of Heredity
 Nucleus of every human cell contains the entire set of genetic instructions stored in
deoxyribonucleic acid, or DNA
 Body’s instruction book
 Genome: complete set of DNA
 Within the nucleus, DNA is divided into 23 pairs of chromosomes
 One pair of chromosomes is the sex chromosomes:
XX in females; XY in males
 Most cells become specialized, taking on characteristic shapes or functions
 Skin, bone, nerve, muscle
 Process called differentiation
 Stem cells: unspecialized cells
 Present in an embryo (embryonic stem cells)
 Adult stem cells are retained within tissues
 

o Genetic Inheritance
 Mutation: change in a gene
 Alleles: alternate forms of the same gene
 Some mutations are harmful, some beneficial, some have no effect
 Mutations allow for human diversity
 Alternate forms of genes called alleles are responsible for traits such as eye color
 Alleles can be dominant or recessive
 Most characteristics (such as height or skin color) are determined by the interaction of multiple
genes at multiple sites on different chromosomes
 Multifactorial disorders: conditions caused by interactions among one or more genes and the
environment
 Account for the majority of illnesses and death in the developed world
 Heart disease is one example
 Relative contribution of environment and genetics
 

 Genetic and environmental contributions for some common diseases and incidents can be
conceptualized as a continuum, from single gene disorders and chromosomal disorders all the
way to injury and poisoning. Notice that there is no clear distinguishing line between
environment and genetics because the precise roles of each are not always clear.
o Creating a Family Health Tree
 Also called a genogram or genetic pedigree
 Visual representation of your family’s genetic history
 Illustrates the patterns of health and illness within a family
 Pinpoints areas of special concern or risk for you
 What Can You Learn From Your Health Tree?
 Early onset of disease is more likely to have a genetic component
 Appearance of a disease in multiple individuals on the same side of the family is more likely
to have a genetic correlation
 Family member with multiple cancers represents a greater likelihood of genetic association
 Presence of disease in those with good health habits is more suggestive of a genetic cause
 Chapter 2: Mental Health and Stress
o Positive Psychology and Character Strengths
 In recent years, psychologists have become more interested in positive psychology
 Focus on the positive emotions, characteristics, strengths, and conditions that create
happiness
 Six broad virtues that “enable human thriving”:
 Wisdom
 Courage
 Humanity
 Justice
 Temperance
 Transcendence
o Characteristics of Mentally Healthy People
 Characteristics are numerous:
 Possess high self-esteem: positive regard for oneself
 Accept imperfections
 Altruistic: unselfishly concerned for others
 Have a sense of control over their lives
  Demonstrate social competence in relationships, and able to rely on others
 Not overwhelmed by emotions
 Maintain a positive outlook on life
 Have a capacity for intimacy, no fear of commitment
 Are creative, and appreciate creativity in others
 Persevere and take on challenges
 Take reasonable risks in order to grow
 Bounce back from adversity
o The Self-Actualized Person
 Self-actualization: the state attained when a person has reached his or her full potential
 Proposed by Maslow as the level at which people achieve transcendence
 Sense of well-being that comes from finding purpose
and meaning in life
 

o Optimism, Self-Efficacy, and Resilience

 Optimism: a tendency to see problems as temporary and specific rather than permanent and
general
 Self-efficacy: a general sense that you have some control over your life
 Resilience: the ability to bounce back from adverse events
o Happiness and Positive Psychology
 Happiness involves three components:
 Positive emotion and pleasure (savoring sensory experiences)
 Engagement (being deeply involved with family, work, romance, and hobbies)
 Meaning (using personal strengths to serve some larger end)
  Engagement and meaning are the most important in giving people satisfaction and happiness
 Note: some people may have a happiness “set point” determined by genetics
o Emotional Intelligence
 Emotional intelligence: the understanding of emotional experience, self-awareness, and
sensitivity to others
 Daniel Goleman argued qualities such as self-awareness,
self-discipline, persistence, and empathy are more important than IQ
 Leads to more positive relationships, better academic performance, more adaptive decision-
making skills, and greater mental health
 People who are emotionally intelligent can:
 Recognize, name, and understand their emotions
 Manage their emotions and control their moods
 Motivate themselves
 Recognize and respond to emotions in others
 Be socially competent
o Bereavement and Healthy Grieving
 Grieving is a natural response to loss, often expressed by sadness, loneliness, anger, and guilt
 Such intense emotions can have a negative impact on health
 Bereavement typically involves four phases: numbness and shock; separation; disorganization;
reorganization
 Seeking support and keeping a journal can be part of the healing process
 There is no right or wrong way to grieve and no specific timetable
o Facing Death
 Kübler-Ross, in 1969, proposed stages people go through when in the process of dying
 Denial and isolation
 Anger
 Bargaining
 Depression
 Acceptance
 Stages are not linear; people experience them in different orders or may revisit stages
 More modern approaches focus on ways to live with illness rather than prepare for death
o The Brain’s Role in Mental Health and Illness
 Brain is the central control station for human intelligence, feeling, and creativity
 Brain and nervous system mediate all behavior, both normal and abnormal
 Since the 1980s, knowledge of the structure and function of the brain has increased
dramatically
 Advances in imaging technologies (CAT scans, PET scans, MRIs, fMRIs) have allowed for
many new discoveries
o The Developing Brain
 By the age of 6, 95% of the brain is formed
 Just before puberty, a growth spurt occurs in the frontal cortex, where the “executive
functions” of planning, organization, and rational thinking are controlled
 The limbic system becomes more powerful, while the prefrontal cortex that controls impulses
does not mature until the 20s
 By the early to mid-20s, a more mature adult brain has developed
o Mental Illness and the Brain
  Mental illnesses are diseases that affect the brain
 Mental disorders are caused by complex interactions
 Biological factors, psychological processes, social influences, and cultural factors,
especially during early childhood
 Some have a genetic component
 Cognitive mental disorders can be caused by tumors, brain trauma, or stroke
 Imbalances of neurotransmitters seem to be particularly important in a variety of mental
disorders
o Mental Disorders and Treatment
 Mental disorder: a pattern of behavior associated with distress, disability, or significantly
increased risk of suffering, death, pain, disability, or loss of freedom
 A mental disorder is qualitatively different from a psychological problem that can be
considered normal, and it can be diagnosed from a set of symptoms
o Neurodevelopmental Disorders
 Group of conditions that often start before a child enters grade school
 Include limitations of learning and difficulty with behavior control and social skills
 Attention-deficit/hyperactivity disorder (ADHD)
 One of the most common childhood disorders
 Causes remains unclear
 Autism spectrum disorder (ASD)
 A group of developmental brain disorders that can cause social, communication and
behavioral difficulties
 Affects 1 in 68 children
 Five times more common in boys than girls
o Mood Disorders
 Also called depressive or affective disorders
 Among the most common mental disorders around the world
 About 16.1 million adults in the U.S. (6.7%) had at least one major depressive episode in 2015
 Women experience episodes twice as often as men
 Examples include:
 Major depressive disorder (depression)
 Bipolar disorder (with manic episodes)
o Anxiety Disorders
 Along with depression, anxiety disorders are the most common mental disorders
 Panic attack: apprehension or intense fear, in no danger
 Panic disorder: recurrent unexpected panic attacks
 Specific phobia: intense fear of a situation or object, invoking immediate anxiety
 Social phobia: intense fear of social or performance situations
 Generalized anxiety disorder: worry about routine matters
 Obsessive-compulsive disorder: persistent, intrusive thoughts, impulses, or images that cause
intense anxiety or distress
o Addiction
 Addiction: continued, compulsive behavior despite serious negative consequences
 Physiological dependence reduces sensitivity to substance’s effects
 Withdrawal symptoms occur when substance use stops
 Even without physiological dependence, psychological dependence can occur
  Usually associated with substance use, but the
concept of addiction now extended to other areas of compulsive behaviors
o Schizophrenia and Other Psychotic Disorders
 Psychotic disorders: characterized by delusions, hallucinations, disorganized speech or
behavior, and other signs that an individual has lost touch with reality
 Schizophrenia has a strong genetic component
 In most cases, symptoms of the disease can be controlled with medication
o Mental Disorders and Suicide
 Suicide is the second-leading cause of death among college students
 According to a 2016 assessment, about 11.2% of college-aged students seriously considered
suicide, and 2.1% attempted to kill themselves
 Women in the U.S. are more likely to attempt suicide, but men are four times more likely to
succeed
 What leads a person to suicide?
 As many as 90% of those who commit suicide are suffering from a mental disorder, often
depression
 The symptom linking depression and suicide is a feeling of hopelessness
 Depression and alcoholism may be involved in two-thirds
of suicides
 Substance abuse and depression can be lethal
 Sometimes there is no apparent precipitating event or problem
 Behavioral signs that may indicate a person is thinking about suicide:
 Comments about death and threats of suicide
 Increasing social withdrawal and isolation
 Intensified moodiness
 Increase in risk-taking behaviors
 Sudden improvement in mood accompanied by certain behaviors, such as giving away
possessions
 How to help:
 Danger of asking if someone is thinking about suicide (“planting the seed”) is a myth
 Encourage the person to talk, asking direct questions
 Encourage the person to get help through a suicide hotline
or counseling
 Do not agree to keep the situation a secret
 Do not leave a suicidal person alone
o Self-Injury
 Intentional injury to one’s own body, known sometimes as self-harm, self-mutilation, or self-
injurious behavior
 Behaviors include cutting, burning, scratching, branding, and head banging
 Individuals often have a history of physical and/or sexual abuse as well as coexisting problems
such as substance abuse or an eating disorder
o Treatments for Mental Disorders
 Psychotherapy (counseling)
 Psychotherapy: treatment based on the development of a positive interpersonal relationship
between a client and a therapist
 More than 250 different models exist
  Medications
 Antipsychotics
 Antidepressants
 Anxiolytics (antianxiety)
 Use has increased dramatically in recent years, especially among children and adolescents
o What Is Stress?
 Stress: a general state of the body, mind, and emotions when an environmental stressor has
triggered the stress response
 Stressors: events or agents in the environment that can cause stress
 When you appraise an event as positive, you experience eustress, or positive stress
 When you appraise it as negative, you experience distress
o The Stress Response
 A stress response (or fight-or-flight response) is a series of physiological changes that occur in
the body
 All animals, including humans, have the ability to respond to emergencies they perceive as
dangerous
 The stress response is carried out by the autonomic nervous system
 Sympathetic branch: initiates the stress response
 Parasympathetic branch: turns off the stress response and returns the body to normal
o The Relaxation Response
 Homeostasis is a state of stability and balance in which body functions are maintained within a
normal range
 Relaxation response: a series of physiological changes that calm the body systems and return
them to normal functioning
o Acute Stress and Chronic Stress
 Your body can deal with short-term acute stress, as long as you recover afterwards
 Many people live in a state of chronic stress, which is a stress response continuing without
resolution
 Chronic stress increases the likelihood of illness
 Prolonged or severe stress weakens nearly every system in the body
o The General Adaptation Syndrome
 Hans Selye introduced the General Adaptation Syndrome (GAS) to describe and explain the
physiological changes observed in the stress response
 The syndrome has three stages:
 Alarm stage
 Resistance stage
 Exhaustion stage
 
 Homeostasis is the state of stability and balance in which functions are maintained within a
normal range. The body’s responses move furthest from homeostasis in the alarm stage. In
the resistance stage, the body uses energy to cope with the continued stress but is unable to
return to homeostasis. After prolonged exposure to stress, the body may either recover and
return to homeostasis, or enter the exhaustion stage and fall away from homeostasis toward
illness or even death.
o Physical Effects of Chronic Stress
 Stress plays a role in illness and disease in a variety of ways
 Immune system can be suppressed by both brief and long-term stressors
 In the cardiovascular system, the stress response can cause various forms of heart disease
 In the gastrointestinal system, common stomach ailments can be related to stress
 In terms of mental health, both acute and chronic stress can contribute to the development of
psychological illnesses
 Acute stress disorder
 Post-traumatic stress disorder (PTSD)
 Adjustment disorder
o Mediators of the Stress Response
 Different people respond differently to stressors
 Reasons may include past experiences and a person’s overall level of wellness
 Other critical areas include:
 Personality factors
 Habitual ways of thinking
 Inborn or acquired attitudes toward the demands of life
o Personality Factors
 Type A behavior pattern: impulsive, achievement oriented, and highly competitive
 Prime candidates for stress-related illnesses, and increased risk for a number of other diseases
 Key culprit is hostility, an ongoing accumulation of irritation and anger
 Type B behavior pattern: less driven
 More easygoing and less readily frustrated
 Less susceptible to coronary heart disease
 Recent additional personality types:
 Type C personalities: introverted and detail-oriented; may have trouble communicating, and
appear cautious and reserved, with a tendency to please others
 Type D personalities: not very expressive, and hold in negative emotions, with a tendency to
experience anger, anxiety, and sadness while fearing negative judgments from others
o Cognitive Factors
 Your outlook and beliefs about life affect how you deal with stressors in your life
 People with a realistic attitude can take things in stride and reduce the frequency and
intensity of the stress response
 Resilience allows stress-resistant people to focus on immediate issues and explain their
struggles in positive and helpful ways
o Resilience and Hardiness
 Resilience is a factor in the ability to handle stress
 Stress-resistant people also seem to focus on immediate issues and explain their struggle in
positive and helpful ways
 Hardiness: an affective style of coping with stress, characterized by a tendency to view life
events as challenges rather than threats
o Sources of Stress
 Life events that require adjustment and adaptation
 Daily hassles, especially if they pile up
 College stress
 Job pressures and burnout
 Money and financial worries
 Family and interpersonal stress
 Time pressure, overload, and technology
 Anger
 Trauma
 Societal pressures
o Healthy and Unhealthy Ways to Manage Stress
 Unhealthy ways to manage stress include the use of tobacco, the use and abuse of drugs and
alcohol, and the use of food to manage feelings
 Positive but sedentary approaches, such as listening to music, should be balanced with more
active stress management techniques
 What works for one may not be helpful for another
 Practice stress management on a regular basis
 Some stressful events and situations are overwhelming—don’t hesitate to seek counseling
o Stress Reduction Strategies
 Time management
 Improve planning
 Prioritize
 Social support
 The best way to develop a support system is to give support to others
 Healthy lifestyle
 Adopt a nutritious diet
 Exercise
o Relaxation Techniques
 These include:
 Deep breathing
 Progressive relaxation
 Visualization, or guided imagery
 Mindfulness-based meditation
  Yoga
 T’ai chi
 Biofeedback
 Affirmations
 Chapter 3: Social Connections
o Healthy Personal Relationships
 Relationships are at the heart of human experience
 Family
 Community
 Classmates, teammates, colleagues
 Acquaintances, friends, intimate partners
 Relationships are fraught with difficulties
 Divorce
 Single-parent and blended families
 Living alone
 Electronic connections
o A Healthy Sense of Self
 Relationships begin with who you are as an individual and what you bring to the relationship
 Attributes that make successful relationships possible:
 Healthy sense of self
 Reasonably high self-esteem
 Capacity for empathy
 Ability both to be alone and to be with others
o Friendships and Other Kinds of Relationships
 Friendship is a reciprocal relationship based on mutual liking and caring, respect and trust,
interest and companionship
 Considered longer-lasting and more stable when compared to romantic relationships
 Offers a psychological and emotional buffer against stress, anxiety, and depression
 Networks that provide social support also increase one’s sense of self-worth
o Strengths of Successful Partnerships
 Intimate relationships with a partner have similarities to friendships, but also other qualities
 More exclusive
 Deeper levels of connection and caring
 Sexual component
 Some characteristics of successful partnerships:
 Independence and maturity
 Self-esteem and mutual respect
 Understanding of the importance of good communication
 Open expression of sexual affection and respect
 Enjoyment of time together and time alone
 Acknowledge strengths and failings
 Assertive and flexible in wants and needs
 Handle conflict constructively
 Friends as well as lovers, with a focus on unselfish caring
 Good relationships with family and friends
 Shared spiritual values
o Attraction
 People seem to use a systematic screening process when deciding if someone could be a
potential partner
 Factors that promote attraction:
 Proximity—or, sometimes determined by proximity, familiarity
 Physical attractiveness
 Similar characteristics, including values and attitudes
o The Process of Finding a Partner: Dating and More
 Indirectness is not an effective strategy
 People who are straightforward and respectful in developing a relationship are more likely to
get a positive response
 Partners are often found through social connections
 Internet is playing a larger role
 Enlarges the pool of potential partners
 Online social networking
 Importance of caution: How much do you really know about the person?
o What Is Love?
 Similarity theory is based on the concept that we fall in love with people who are similar to us
in important ways
 Social exchange theory suggests that falling in love and choosing a partner are based on the
exchange of “commodities”
 Love, status, property, services
o The Course of Love
 Beginning stages of falling in love can feel like a
roller coaster ride
 “Lovesick”
 Experience of love likely involves increased levels of dopamine
 Causes arousal of the sympathetic nervous system
 Effects subside as lovers become habituated to each other
o Sternberg’s Love Triangle
 According to psychologist Robert Sternberg, love has three dimensions
 Intimacy, the emotional component
 Passion, the sexual component
 Commitment, the decision aspect
 Different combinations of these components produce different kinds of love
 
o Nonverbal Behavior and Metamessages
 Nonverbal communication includes facial expressions, eye contact, gestures, body position and
movement, and spatial behavior
 Nonverbal and verbal communication cues make up the metamessage, or the unspoken
message you send or receive when communicating
o Building Communication Skills
 Good communication skills help make conflict constructive
 Before you speak, know what you want to say
 Use “I” statements: “I feel…when you…” versus “You make me feel…”
 As a listener, give the other person time and space
 Assertiveness: speaking up for yourself without violating someone else’s rights
 Gender differences in communication patterns can significantly impact relationships
 Gender Differences in Communication
Men Women
Feel oppressed by lengthy discussions Expect a decision to be discussed first and
made by consensus
Do not want to have long discussions, Appreciate the discussion itself as evidence
particularly about what they consider to be of involvement
minor decisions
Are inclined to resist what they perceive as Are inclined to do what is asked of them
someone telling them what to do; do not
want to take orders
Think every question needs to be answered Believe a question is not simply a question
but the opening for a negotiation
Believe they are showing independence by Believe that when men change the subject
not asking probing questions they are showing a lack of interest and
sympathy
Goal is to “fix” the problem Goal is to share, develop relationships, and
listen
o Sex and Gender
 Sex is a person’s biological status as a male or female
 Intersex is a condition in which the genitals are ambiguous at birth
 Gender refers to “masculine” or “feminine” behaviors and characteristics considered
appropriate in a particular culture
o Gender Roles and Gender Identities
 Gender role: a set of behaviors and activities a person engages in to conform to society’s
expectations
 Androgynous: a person who displays characteristics or performs tasks traditionally associated
with both sexes
 Gender identity is an internal sense of being male
or female
 Gender dysphoria: discomfort about one’s own sex
 Transgender: having a sense of identity as a male or female that conflicts with one’s
biological sex
o Sexual Orientation
 Sexual orientation refers to a person’s emotional, romantic, and sexual attraction to a member
of the same sex, the other sex, or both
 Exists along a continuum, influenced by a complex interaction of biological, psychological,
and societal factors
 Heterosexuality: emotional and sexual attraction to members of the other sex
 Homosexuality: emotional and sexual attraction to members of the same sex
 Bisexuality: emotional and sexual attraction to both sexes
o Marriage
 Both a legal union and a contract between the couple and the state
 Confers benefits for the individual and society
 Age at first marriage has risen
 Characteristics of successful or unsuccessful marriages are typically present before the
marriage
 One predictor of a successful marriage: positive reasons for getting married
 Infidelity mars some marriages but does not necessarily
end them
o Gay and Lesbian Partnerships
 Same-sex couples have the same desire for intimacy, companionship, passion, and
commitment
 Reasons for getting married described by same-sex couples are very similar to those of any
other couple; most cite love
 LGBTQ people are twice as likely to cite legal rights and benefits as being important, and
having children as far less important
 Homophobia: irrational fear of homosexuality and homosexuals
o Cohabitation
 Cohabitation is when two people of the opposite sex live together as unmarried partners
 Incidence has increased ten-fold since the 1960s
 More than 60% of marriages are preceded by a cohabiting relationship
 Individuals may choose cohabitation as a path to marriage or as an end in itself
o Divorce
  First marriages have a 40 to 50% probability of ending in divorce
 Many are ill-prepared to handle the challenges of married life
 Divorce is a leading cause of poverty and is one of the most stressful life events a person can
experience
 Especially hard on children
 Best served by continuing contact with both parents, as long as parents get along
o Blended Families
 In blended families, one or both partners bring a child or children from a previous marriage
 It takes time to achieve a level of cohesion and for stepparents and stepchildren to build
relationships
o Singlehood
 Many young adults are delaying marriage
 Increasing number of people view singlehood as a legitimate, healthy, and satisfying
alternative to marriage
o Keeping Your Relationships Strong and Vital
 Cohesion is the dynamic balance between separateness and togetherness in both couple and
family relationships
 Relationships are strongest when there is a balance between intimacy and autonomy
 Flexibility is the dynamic balance between stability and change
 Communication is the tool that partners and families use to adjust levels of cohesion or
flexibility when change is needed
o Communities
 Community: group of people connected in a way that transcends casual attachment
 Typically, shared common goals and a sense of belonging
 Being active in a community is likely to have a positive impact on health
 Positive relationships within a community are essential to personal health and growth
 Improve self-esteem
 Improve social capital: sharing and exchanging of resources
o Community Starts Within
 Fulfilling community participation requires an understanding of your beliefs and how you fit
into a particular community
 Knowing what your values are, what gives meaning to your life, and what you want to
accomplish
 Values: a set of criteria for judging what is good and bad that underlies moral principles and
behavior
o Finding a Community That Works for You
 Religious and spiritual communities
 Spirituality: experience of connection to self, others, and community at large, providing a
sense of purpose and meaning
 Spiritually connected people stay healthier and live longer
 Social activism and the global community
 Social causes can unite people from diverse backgrounds for a common good
 “Dragonfly effect”: how social media has been used to facilitate social change
 Volunteering
 People who give time, money, and support to others are likely to be more satisfied with their
lives
  One-on-one contact and direct involvement are key to experiencing positive effects
 Service learning
 Service learning: form of education that combines coursework with community service
 Meant to teach students how to extend themselves beyond their enclosed world, taking the
risk of getting involved in others’ lives
 Arts
 Enjoying and appreciating the arts allows you to embrace diverse cultures past and present
 Expressing yourself creatively can forge a connection between yourself and the natural world
 Internet communities
 Virtually limitless in number
 Have a global reach, connecting with international social and political movements
 Chapter 4: Sleep
o Sleep
 Circadian rhythm: internal daily 24-hour cycle of waking and sleeping
 Most adults need about 8 to 9 hours of sleep each night
 Typical college student sleeps only 6 to 7 hours a night on weeknights
o Sleep and Your Health
 Sleep is a period of rest and recovery from the demands of wakefulness
 It can be described as a state of unconsciousness or partial consciousness from which a person
can be roused by stimulation
 We spend about a third of our lives sleeping
o Health Effects of Sleep
 Sleep is strongly associated with overall health and quality of life
 Restoration and growth take place during the deepest stages of sleep
 Natural immune system moderators increase during sleep and promote resistance to viral
infections
 Short sleep: less than 7 hours; increases risk of negative health outcomes
 Long sleep: 10 hours or more; has not been found to have negative health consequences
 Sleep, or the lack thereof, affects many systems and functions of the body
 Metabolism and weight
 Safety
 Cardiovascular function
 Immune function
 Cancer risks
 Mental health
 Neurodegenerative diseases
o Health Effects of Sleep Deprivation
 Sleep deprivation is the lack of sufficient time asleep,
a condition that impairs physical, emotional, and cognitive functioning
 Affects all domains of functioning
 Emotional effects, including heightened irritability and difficulty handling stress
 Reduced motivation
 Reaction time, coordination, and judgment
 Memory impairments
 Chronic sleep deprivation damages brain cells and impairs debris removal, accelerating brain
aging
  Sleep debt is the difference between the amount of sleep attained and the amount of sleep
needed to maintain alert wakefulness during the daytime, when the amount attained is less than
the amount needed
 Can’t be made up for with extra sleep on weekends
 May disrupt sleep structure
 Prescription stimulants are not a healthy solution
o What Makes You Sleep?
 Circadian rhythms are maintained by the suprachiasmic nuclei (SCN) in the brain
 Internal “biological clock” that controls body temperature and levels of alertness and activity
 SCN signal the release of hormones, including signaling the pineal gland to release
melatonin, which increases relaxation and sleepiness; and the pituitary gland to release
growth hormone during sleep to help repair damaged tissues
 External environmental cues such as light are also important
o The Structure of Sleep
 Brain cycles into two main states of sleep:
 Non-rapid eye movement (NREM)
 Rapid eye movement (REM)
 NREM sleep:
 Stage 1: relaxed, half-awake sleep
 Stage 2: brain activity slows and movement stops
 Stages 3 and 4:
 Blood pressure drops
 Heart rate slows
 Blood supply to brain minimized
 Stage 4 is referred to as deep sleep
 In REM sleep, brain activity becomes more like being awake
 Dreams are most likely to occur in this stage
 REM sleep paralysis: periods of no muscle tone and immobility
 Appears to give the brain the opportunity to “file” ideas and thoughts into memory
 Creative and novel ideas may be more likely to flourish
 Insufficient REM sleep may impair memory and the ability to learn new skills
 REM rebound effect: when long sleep is possible after inadequate sleep for several nights, you
will have longer and more frequent REM sleep
 Demonstrates the importance of REM sleep to the brain
o Sleep Cycles
 After the first REM period, you cycle back and forth between REM and NREM stages
 Repeats about every 90 to 110 minutes until waking
 Children and adolescents experience large quantities of “deep sleep”
 As people get older, high-quality deep sleep becomes more elusive
 Structure is essentially the same for men and women
 Women have more slow-wave sleep (NREM stages 3 and 4) and experience more insomnia
 

 One night’s sleep cycles.

o Insomnia
 Insomnia: difficulty falling or staying asleep
 Can be caused by stress, anxiety, medical problems, poor sleep environment, noisy or restless
partners, and schedule changes
 Distress over inability to fall asleep also contributes
 Improved sleep habits and exercise have been shown to improve sleep quality for chronic
insomnia
o Sleep Apnea
 Sleep apnea: periods of nonbreathing during sleep
 Almost 40% of the U.S. population may have some form of sleep apnea
 Some 80 to 90% of cases are undiagnosed
 Central sleep apnea: brain fails to regulate the diaphragm and other breathing mechanisms
correctly (rare)
 Obstructive sleep apnea: upper airway is obstructed during sleep
 Person is typically unaware of the typical pattern of snoring and gasping
 
 Obstructive sleep apnea.
 (a) Normally, the airway is open during sleep. (b) When the muscles of the soft palate,
tongue, and uvula relax, they narrow the airway and cause snoring. (c) If these structures
collapse on the back wall of the airway, they close the airway, preventing breathing. The
efforts of the diaphragm and chest cause the blocked airway to become even more tightly
sealed. For breathing to resume, the sleeper must rouse enough to cause tension in the
tongue, which opens the airway.
 Obstructive sleep apnea is potentially dangerous, even fatal
 Associated with high blood pressure and increased risk of heart disease and stroke
 If not severe, sleep apnea can be addressed with behavioral strategies
 More severe cases are often treated with a continuous positive airway pressure (CPAP)
machine
 Through a mask, pressurized air is gently blown into the patient’s nose
o Sleepwalking Disorder
 Sleepwalking disorder: a person rises out of an apparently deep sleep and acts as if awake
 Episodes typically last less than 10 minutes
 Most sufferers have no family history of the disorder
 May be brought on by excessive sleep deprivation, fatigue, stress, illness, excessive alcohol,
and use of sedatives
o Sleep-Related Eating Disorders
 Sleep-related eating disorder (SRED): a person rises from bed during the night and eats and
drinks while asleep
 Night eating syndrome: a person eats excessively during the night while awake
 Repeatedly awakens during the night to eat, then eats very little during the day
o Evaluating Your Sleep
 Sleep latency: amount of time it takes a person to fall asleep
  Track your personal sleep latency
 Check for symptoms of a sleep disorder
 Review behavior-change strategies for getting a good night’s sleep
 If you still experience sleep problems, consult your health provider
o Getting a Good Night’s Sleep
 Most people experience disordered sleep at some point, experiencing the symptoms of sleep
disorders, but less frequently and less severely
 Ways to ensure healthy sleep patterns include moderating technology use and adopting other
sleep-friendly habits and behaviors
o Taking a Break from Technology
 Artificial blue light from computers, televisions, and phones blocks the production of
melatonin, the hormone that induces sleep
 If possible, turn off electronic devices at least 2 hours before going to sleep
 Alternately, dim brightness levels or adjust light sources from blues to reds
 Answering texts and calls interrupts sleep architecture and can also lead to awkward and
embarrassing communications
o Establishing Good Sleep Habits
 Maintain a regular sleep schedule
 Be smart about napping
 Create a sleep-friendly environment
 Mattress, sheets, and pillow
 Noise and temperature levels
 Air quality
 Body position
 Chronic pain
 Avoid eating too close to bedtime
 Avoid caffeine, nicotine, and alcohol
 Exercise regularly, but not close to bedtime
 Manage stress and establish relaxing bedtime rituals
 Consider your bed partner
o Sleeping in Unfamiliar Environments
 Unihemispheric sleep: one brain hemisphere is awake during sleep
 Typical for birds and aquatic mammals
 Humans may experience unihemispheric sleep
 Their first night in an unfamiliar bed
 At home if their sleeping partner is absent
 Sleep scientists conjecture that unihemispheric sleep is an evolutionary mechanism
o Using Sleep Aids and Sleep Apps
 Frequently prescribed sleep medications induce sleep but suppress both deep sleep and REM
sleep
 Daytime side effects include decreased memory and intellectual functioning
 Many OTC medicines contain antihistamines
 Can cause dehydration, agitation, constipation
 Rebound insomnia can occur, worse than before medication was taken
 Variety of smartphone apps can be calming and help induce sleep, or will track your sleep
quality
  Some wristband fitness devices can also track and record the wearer’s sleep pattern
 Many complementary and alternative products aim to address sleep problems
 Herbal products, most commonly valerian
 Can interact with other medication and drugs
 Dietary supplements, especially melatonin
 Aromatherapy, using certain scented oils
 Relaxation drinks, or anti-energy drinks
 Because of the potential for adverse affects, it is important to consult with your health provider
 Chapter 5: Nutrition
o Understanding Nutritional Guidelines
 Dietary Reference Intakes (DRIs): four sets of dietary recommendations
 Suggested intake levels of essential nutrients for optimal health
 Recommended Dietary Allowance (RDA): average daily amount of any one nutrient needed to
protect against nutritional deficiency
 Acceptable Macronutrient Distribution Range (AMDR): intake ranges of essential nutrients
that provide adequate nutrition and reduce risk of chronic disease
 Dietary Guidelines for Americans: scientifically based diet and exercise recommendations
 MyPlate: graphic nutritional tool that translates DRIs and Dietary Guidelines into healthy food
choices, published by the USDA
 Daily Values: standards used on food labels to indicate how a particular food contributes to the
recommended daily intake of major nutrients in a 2,000-calorie diet
o Types of Nutrients
 Essential nutrients: needed to build, maintain, and repair tissues and regulate body functions
 Macronutrients: needed in large amounts
 Water, carbohydrates, proteins, fats
 Micronutrients: needed in small amounts
 Vitamins, minerals
o Water—The Unappreciated Nutrient
 Functions:
 Digests, absorbs, transports nutrients
 Helps regulate body temperature
 Carries waste out of the body
 Lubricates our body parts
 Right fluid balance—the right amount of fluid inside and outside each cell—is maintained by
electrolytes
 Minerals that carry electrical charges and conduct nerve impulses
 Water supply in the U.S. is generally well regulated and very safe
 FDA regulates bottled water only if it is shipped across state lines
 RDA for water:
 1 to 1.5 milliliters per calorie spent
 For 2,000 calories spent: 2 to 3 liters, or 8 to 12 cups
of fluids
 Water needs can vary depending on several factors, such as foods consumed and activity
level
o Carbohydrates—Your Body’s Fuel
 Body’s main source of energy
  Fuel most of the body’s cells during daily activities
 Used by muscle cells during high-intensity exercise
 Only source of energy for brain cells, red blood cells, and some other types of cells
 Divided into simple carbohydrates (sugars) and complex carbohydrates (starches and dietary
fibers)
 RDA for carbohydrates:
 130 grams for males and females aged 1 to 70 years
o Simple Carbohydrates
 Simple carbohydrates are easily digestible, and are composed of one or two units of sugar
 Glucose, fructose, galactose, lactose, maltose, sucrose
 Glucose travels to the liver, where it can be stored as glycogen for future energy needs
 Sucrose (table sugar) scores 1.0 as the benchmark for sweetness
 High fructose corn syrup (HFCS) also scores 1.0
 Stevia sugar substitute: 300.0
 Americans consume 22.5 teaspoons of sugar per day,
mostly in sweetened beverages
 Too many simple carbohydrates leaves you with a “sugar high,” followed by a feeling of
depletion and a craving for more sugar
 Added sugars have been linked to the epidemic of overweight and obesity
 Dietary Guidelines recommends less than 10% of calories come from added sugars
 Artificial sweeteners are often touted as alternatives
 May result in weight gain due to their effect on appetite and insulin response
o Complex Carbohydrates
 Complex carbohydrates are composed of multiple sugar units and include starches and dietary
fiber
 Starches occur in grains, vegetables, and some fruits
 Whole grains are preferred over refined carbohydrates (plant sources whose fiber has been
processed away)
 Provide more nutrients
 Slow digestive process
 Make you feel full longer
o Fiber
 Dietary fiber: complex carbohydrate, found in plants, that cannot be broken down by the
digestive tract
 Allows for passage of food quickly through the intestines, which helps prevent hemorrhoids
and constipation
 Functional fiber: natural or synthetic fiber added to food
 Total fiber: combined amount of dietary fiber and functional fiber
 Soluble fiber dissolves in water and lowers cholesterol
 Insoluble fiber passes through the digestive tract unchanged; serves as natural laxative
 RDAs for fiber:
 25 grams/day for women (aged 19 to 50)
 38 grams/day for men (aged 14 to 50)
 Best obtained through diet, not pills or supplements
 Good sources are fruits, vegetables, dried beans, peas and other legumes, cereals, grains, nuts,
and seeds
o Protein—Nutritional Muscle
 Functions of protein:
 Build and maintain muscles, bones, and other body tissues
 Form enzymes that facilitate chemical reactions
 Constructed from 20 different amino acids
 Essential amino acids: the 9 amino acids the body cannot produce on its own, so they must
be supplied by foods
 Complete proteins have ample essential amino acids
 Complete protein sources: animal proteins (meat, fish, poultry, milk, cheese, and eggs)
 Incomplete proteins contain small amounts or some of the essential amino acids (grains,
legumes, nuts, seeds, and vegetables)
 Complementary proteins: proteins that in combination provide essential amino acids
 Mutual supplementation: nutritional strategy of combining two incomplete protein sources to
provide a complete protein
 For example, beans and rice
 AMDR for protein: 10 to 35% of daily calories, or about 0.36 grams per pound of body weight
o Fats—A Necessary Nutrient
 Fats are the body’s principal form of stored energy
 Provide essential fatty acids
 Help produce other fatty acids and vitamin D
 Provide the major material for cell membranes and for the myelin sheaths that surround nerve
fibers
 Assist in absorption of the fat-soluble vitamins
 Affect the texture, taste, and smell of foods
 Provide an emergency reserve when we are sick or when our food intake is diminished
o Types and Sources of Fat
 Saturated fats: lipids that are the predominant fat in animal products and other fats that remain
solid at room temperature
 Beef
 Pork
 Poultry
 Whole-milk dairy products
 Certain tropical oils (coconut and palm)
 Certain nuts (macadamia)
 Monounsaturated fats: found primarily in plant sources, are liquid at room temperature, and are
semisolid or solid when refrigerated
 Olive, safflower, peanut, and canola oils
 Avocados
 Many nuts
 Polyunsaturated fats: commonly referred to as “oil”; liquid at room temperature and when
refrigerated
 Corn and soybean oils
 Fish, including trout, salmon, and anchovies
o Cholesterol
 Cholesterol: waxy substance that is needed for several important body functions
  Body produces it from the liver and obtains it from animal food sources (meat, cheese, eggs,
milk)
 Too much can clog arteries and lead to cardiovascular disease
 LDLs (low-density lipoproteins) are the “bad” cholesterol, while HDLs (high-density
lipoproteins) are considered “good”
 Recommended: consume no more than 300 milligrams per day
o Trans Fats
 Trans fatty acids: liquid vegetable oils chemically changed through the process of
hydrogenation to extend the shelf life of processed foods
 Pose a risk to cardiovascular health by raising LDL levels and lowering HDL levels
 Foods high in trans fatty acids:
 Crackers, cookies, chips
 Cakes and pies
 Doughnuts
 Deep-fried foods like french fries
o Omega-3 and Omega-6 Fatty Acids
 Omega-3 fatty acids: contain alpha-linolenic acid, help slow the clotting of blood, decrease
triglyceride levels, improve arterial health, and lower blood pressure
 Fatty fish; vegetable oils; dark green leafy vegetables
 Omega-6 fatty acids: contain linoleic acid and are also important to health, though Americans
often consume too much in proportion to omega-3
 Note: there are concerns about fish consumption due to contamination with mercury and
other pollutants
o Dietary Recommendations for Fat
 AMDR for fat: 20 to 35% of daily calories
 Less than one-third from saturated fats and trans fats
 Most adults need only 15% of their daily calorie intake in the form of fat, whereas young
children should get 30 to 40%
 These recommendations are designed to help improve cardiovascular health and prevent heart
disease
 In the U.S., 34% of daily calorie intake comes from fat
 Strategies to reduce intake of dietary fat:
 Limit intake of saturated fat by consuming vegetable oils instead of animal fats
 Reduce the amount of fat used in cooking
 Choose leaner cuts of meat and poultry or fish over beef
 Limit fast foods, because they are high in saturated fat
o Minerals—A Need for Balance
 Minerals are naturally occurring substances needed by the body in small amounts
 Build strong bones and teeth, and help carry out metabolic processes and body functions
 Body needs 20 essential minerals
 Macrominerals (need at least 100 milligrams per day)
 Calcium, chloride, magnesium, phosphorous, potassium, sodium
 Microminerals (need less than 100 milligrams per day)
 Chromium, cobalt, copper, fluorine, iodine, iron, zinc, manganese, nickel, and others
 Balanced diet provides all the necessary essential minerals
o Vitamins—Small but Potent Nutrients
  Vitamins are naturally occurring organic substances needed by the body in small amounts
 Serve as catalysts for releasing energy from carbohydrates, proteins, and fats while
maintaining other body components
 Your body needs at least 11 specific vitamins
 A, C, D, E, K, and the B-complex vitamins
 Vitamins can be found in a variety of foods, so supplements are often unnecessary
o Overview of RDIs


o Other Substances in Food: Phytochemicals

 Phytochemicals: substances naturally produced by plants
 May keep cells healthy, slow tissue degeneration, prevent carcinogens, reduce cholesterol,
protect heart, maintain hormone levels, and keep bones strong
 Three important types of phytochemicals:
 Antioxidants: neutralize the effects of free radicals
 Phytoestrogens: lower cholesterol and reduce risk of heart disease
 Phytonutraceuticals: may inhibit growth of cancer and heart disease
o The color wheel of foods.
 
o Planning a Healthy Diet
 When food is metabolized, it fuels our bodies
 Energy provided by food is measured in kilocalories, commonly shortened to calories
 One kilocalorie equals the amount of energy needed to raise the temperature of 1 kilogram of
water by 1 degree centigrade
 Fats provide 9 calories per gram
 Carbohydrates and protein provide 4 calories per gram
o 2015-2020 Dietary Guidelines for Americans
 Five overarching concepts:
 Follow a healthy eating pattern across the lifespan
 Focus on variety, nutrient density, and amount
 Limit calories from added sugars and saturated fats and reduce sodium intake
 Shift to healthier food and beverage choices
 Support healthy eating patterns for all
 Three food patterns:
 Healthy U.S.-style pattern based on typical American foods, but in nutrient-dense forms and
appropriate amounts
 Healthy Mediterranean-style pattern contains more fruits and seafood and less dairy; more
than half the fat calories are from olive oil
 Healthy vegetarian-style pattern includes more legumes (beans and peas), soy products, nuts
and seeds, and whole grains; contains no meats, poultry, or seafood
 Individual calorie requirements are calculated based on sex and age at three activity levels:
 Sedentary: only light physical activity
  Moderately active: equivalent to walking 1.5 miles per dayat 3 to 4 mph
 Active: more than 3 miles per day at 3 to 4 mph
 Americans of all ages should strive to meet the Physical Activity Guidelines for Americans to
promote health and reduce the risk of chronic disease
o Basics of a Healthy Eating Pattern


o Estimated Calorie Requirements


o MyPlate
 Visual icon that illustrates the five food groups as a reminder about maintaining a healthy diet
  Emphasizes foods high in nutrient density: the proportion of nutrients to total calories in a
food
 Diet of nutrient-dense foods from each food group allows for a discretionary calorie allowance
that can be consumed as added fats, sugars, alcohol, or other foods
 At the 2,000-calorie level, 270 discretionary calories—about 2 cans of regular cola or 30
potato chips
o The USDA MyPlate


o The DASH Eating Plan
 Dietary Approaches to Stop Hypertension
 Developed by the National Heart, Lung, and Blood Institute
 More emphasis on sodium reduction
 Adds a nuts, seeds, and legumes group to the food groups in a healthy diet
o Limiting Red Meats
 Research supports a link between red meat consumption and heart disease, cancer, and diabetes
 Pork as well as beef, lamb, and veal
 American Cancer Society recommends no more than 18 ounces (cooked) of red meats per
week and avoiding or limiting processed meat
 Processed meats are high in sodium and saturated fat
 U.S. males aged 19 to 50 get more protein than
they need and should consume more vegetables and other foods
o Vegetarian Diets
 These diets may offer protection against obesity, heart disease, high blood pressure, diabetes,
digestive disorders, and some forms of cancer
 Vegetarians need to make sure their diets provide the energy intake and food diversity
necessary to meet dietary guidelines
o Traffic-Light System
 Traffic-light labeling system provides visible and easy-to-understand nutrition information
 Adopted by some college cafeterias
 Foods and beverages are classified by color, from the most heathy (green) to the least (red)
 Evidence that the traffic-light system improves healthier diet choices has been mixed
o Diet for a Healthy Brain
 Scientific studies support the idea that diet plays an important role in maintaining a healthy
brain
  Diets in Mediterranean countries, Scandinavian countries, and Japan have been shown to
protect brain mass and share some similar characteristics:
 Lower levels of sugar and sodium; fewer processed foods; and moderate amount of meat
 Rich in fruits, vegetables, whole grains, and fish
 Docosahexaenoic acid (DHA) may be the primary nutrient contributing to brain health; this
omega-3 comes primarily from seafood
o The Nutrition Facts Label
 Regulated by the FDA
 Lists serving size and number of servings
 Gives total calories per serving
 Shows % Daily Value (DV): the percentage that a nutrient in a serving of food contributes to
a daily diet
 Shows the DV for key vitamins and minerals
 Look for foods with no more than 30% of calories from fats and no more than 10% from added
sugar


o Claims on Food and Dietary Supplement Packaging
 Some food descriptors and health claims on food packaging are regulated by the FDA; others
are not yet well regulated
  Light can be used if the product has one-third fewer calories or half the fat of the regular
product
 Dietary supplements are less regulated than foods
 Information can be misleading and confusing
o Claims on Food and Dietary Supplement Packaging
 Some food descriptors and health claims on food packaging are regulated by the FDA; others
are not yet well regulated
 Light can be used if the product has one-third fewer calories or half the fat of the regular
product
 Dietary supplements are less regulated than foods
 Information can be misleading and confusing
o Restaurant Menu Labels
 2010 Affordable Care Act includes a requirement
that all chain restaurants provide calorie counts on their menus
 Studies show only a marginal change in calorie consumption
 Researchers have also found symbols indicating healthy choices are more likely than numbers
to be effective
o “Sell By” Labels
 Most Americans find “Sell by” labels confusing
 Food manufacturers in the past used 10 different kinds of “Sell by” labels
 The USDA is encouraging them to use only two
 “Use by”: perishable foods are no longer safe to eat
 “Best if used by”: a subjective guess by food manufacturers as to when a food is at peak
flavor and looks presentable on store shelves
 91% of U.S. consumers are confused by these labels and unnecessarily throw out food that
has passed the “Best if used by” date
o Overconsumption of Soft Drinks
 Diet sodas are no better and may be worse for health
 Nearly all contain high levels of caffeine
 Soda drinkers consume less milk and fruit juices
o Overconsumption of Salt
 May be a factor in causing hypertension; can damage the brain and hinder cognitive functions
 Many packaged foods, convenience foods, and restaurant foods are heavily salted
 You can reduce the amount of salt in your diet by emphasizing whole foods, like grains,
vegetables, and fruits, which are naturally low in sodium
o Food allergies and food intolerances
 Eight foods are responsible for 90% of food allergies: milk, eggs, peanuts, tree nuts, fish,
shellfish, soy, and wheat
 Typical symptoms of allergic reactions include skin rash, nasal congestion, hives, nausea, and
wheezing
 Food intolerances such as lactose intolerance are less severe
 There is no treatment or cure for food allergies or intolerances
o Celiac Disease and Gluten
 Celiac disease is an immune reaction to gluten, which is found in wheat, barley, rye, and
triticale
  Over time, the immune system’s reaction to gluten causes inflammatory damage to the small
intestine lining
 Symptoms include weight loss, bloating, and occasionally diarrhea
 In 2013, the FDA released a new labeling law that makes it much easier for people with celiac
disease to avoid gluten
o Gluten Sensitivity
 Empirical evidence does not support any special benefits for gluten-free diets for people who
do not have celiac disease
 Those who are sensitive to gluten tend to be sensitive to other foods like eggs and cow’s milk
 Evidence suggests that gluten-free diets may damage the gut of those who do not have celiac
disease
o Energy Bars and Energy Drinks
 Energy bars are more healthy than candy bars and other snack foods, but they can be high in
calories and sugar
 Energy drinks are not considered a health risk if consumed in recommended amounts, although
there is some concern about acid damaging to tooth enamel
 Mixing hard alcohol and energy drinks can result in greater intoxication than intended, can
pose a danger to heart muscle fibers, and can cause extreme dehydration
o Probiotics, Prebiotics, and Synbiotics
 Probiotics are living bacteria that may aid digestion; prebiotics are nondigestible carbohydrates
that fuel probiotics
 Synbiotics combine the two
 Scientific studies have not confirmed health benefits
o Fast Foods
 Fast-food meals are high in calories, fat, sodium, and sugar and low in vitamins, minerals, and
fiber
 Don’t supersize
 Go easy on toppings
 Order grilled chicken or fish on whole wheat
 Order dressing on the side or choose fat-free
 Order vegetables instead of other choices
 Have orange juice, low-fat milk, or water instead of soda
 For dessert, order yogurt and fruit
 

o Food Deserts
 There are more fast-food restaurants in low-income neighborhoods than in affluent ones
 Food deserts: low-income areas where more than 500 people or 33% of the population have
low access to a supermarket or large grocery store
 More than 1 mile from a store in urban areas and more than 10 miles in rural areas
o Food Insecurity on the College Campus
 Food insecurity: a lack of affordable access to sufficient quality and quantity of affordable
healthy food
 48% of U.S. college students have faced food insecurity
 College students who are food insecure are more likely to have difficulty paying rent or
utilities
 Solutions for this problem will take a collaborative effort by state governments, college and
university administrations, and local communities
o Organic Foods
 Organic foods are plant foods grown without synthetic pesticides or fertilizers and animal
foods raised on organic feed without antibiotics or growth hormone
 USDA regulates labeling
 Research has not demonstrated health benefits, but environmental benefits are clear
 Look for foods that are not only organic but also locally grown
 Wash organic produce thoroughly
o Foodborne Illnesses
 Food intoxication: food is contaminated by natural toxins or by microbes that produce toxins—
for example, botulism
 Food infection: food is contaminated by disease-causing microorganisms, or pathogens
 Norovirus, E. coli, salmonella, campylobacter
 Pet food can contain salmonella
 Use safe food practices and store food safely, especially leftovers
o Genetically Modified Foods
 Genetically modified (GM) organisms: genetic makeup has been changed for desirable traits
 Modern biotechnology is faster and more refined than selective breeding
 Many crops are already GM
 Sixty percent of processed foods in supermarkets contain one or more GM ingredients
  Safety is assessed by the FDA’s Center for Food Safety and Applied Nutrition (CFSAN)
 Chapter 6: Fitness
o What Is Fitness?
 Physical fitness: ability of the body to respond to physical demands
 Skill-related fitness: ability to perform specific leisure or sport skills
 Health-related fitness: ability to perform daily living activities with vigor
o Benefits of Physical Activity and Exercise
 Physical activity: activity that requires any type of movement
 Exercise: structured, planned physical activity, often used to improve fitness
 People who are active are healthier than those who do not exercise
 Physical benefits of longer lifespan and improved functioning of body systems
 Cognitive benefits of preventing or slowing
age-related declines, along with improved learning, concentration, and abstract reasoning
 Psychological and emotional benefits of improving mood, decreasing risk of depression and
anxiety, and relieving stress
 Molecular-level benefits of stabilizing blood glucose levels, among other benefits
o General Guidelines for Physical Activity
 Department of Health and Human Services (HHS) issued physical activity guidelines in 2008
 150 minutes (2 hours and 30 minutes) of moderate-intensity exercise each week
 75 minutes (1 hour and 15 minutes) of vigorous-intensity exercise each week
 An equivalent amount of both moderate-intensity and vigorous-intensity exercise
 Aimed at promoting and maintaining health and preventing chronic diseases and premature
mortality
 American College of Sports Medicine (ACSM) issued similar guidelines in 2011
 Moderate-intensity exercise for at least 30 minutes on five or more days a week (for a
minimum of 150 minutes of moderate-intensity exercise a week), or:
 Vigorous-intensity for 20 to 25 minutes on three or more days a week (for a minimum of 75
minutes of vigorous-intensity exercise a week)
 Example of Activities
 

o Components of Health-Related Fitness

 Fitness training programs can improve each of the components of health-related fitness
 Cardiorespiratory fitness
 Musculoskeletal fitness (muscular strength, muscular endurance, flexibility)
 Body composition
 Amount of exercise, or overload, is significant
 Too little, your fitness level won’t improve
 Too much, you may be susceptible to injury
 Four dimensions of your exercise sessions—FITT— affect overload:
 Frequency (number of sessions per week)
 Intensity (level of difficulty of each exercise session)
 Time (duration of each session)
 Type (type of exercise in each session)
o Cardiorespiratory Fitness
 Cardiorespiratory fitness: ability of the heart and lungs to efficiently deliver oxygen and
nutrients to the body’s muscles and cells via the bloodstream
 Increase in oxygen-carrying capacity of the blood
 Improved extraction of oxygen from blood by muscles
 Increase in the amount of blood the heart pumps with each heartbeat
 Increased speed of recovery to resting heart rate
 Improved muscle and liver function
 Decreased resting heart rate, resting blood pressure, and heart rate at any work level
o Cardiorespiratory Training
 Frequency: exercise at least twice a week, ideally three times; more if weight control is a
primary concern
  Intensity: target heart rate (THR) zone is the
point at which you stress your cardiorespiratory system for optimal benefit without overdoing
it
 Heart rate reserve (HRR): difference between maximum heart rate and resting heart rate
 Maximum heart rate formula
 Breathing test
 Perceived exertion test
 Time: sessions should last 30 minutes on average
 Type: two types of aerobic exercise
 Those that require sustained intensity with little variation in heart rate response (running,
rowing)
 Those that involve stop-and-go activities (basketball, soccer, tennis)
 Training progression
 To continue to receive benefit from exercise, the duration and intensity must be altered every
so often
 High-intensity interval training (HIT)
 Alternates high- and low-intensity exercise so your body is never given the chance to plateau
 To avoid injury, start out slowly and gradually build up your endurance
 Select activities you enjoy
 Developing your own regular cardiorespiratory training program
 Start out slowly to avoid injury
 Gradually build up your endurance
 Build sessions of at least 30 minutes, 3 times a week
 If you have any medical conditions, or if you have been sedentary and are over the age of 40,
see your physician for a checkup before starting
 Selecting activities that you enjoy will help you stick with your program
o Muscular Fitness
 Muscular strength is the capacity of a muscle to exert force against resistance
 Muscular endurance is the capacity of a muscle to exert force repeatedly over a period of time
o Strength Training
 Strength training is a type of exercise in which the muscles exert force against resistance
 Free weights; exercise resistance machines
 Frequency and type: two to three resistance training sessions a week, exercising each muscle
group during a session
 To develop strength, exercise at a higher intensity for a shorter duration
 To develop endurance, exercise at a lower intensity for a longer duration
o Gender Differences in Muscle Development
 Muscle mass growth is influenced by the hormone testosterone
 Women produce testosterone at about 10% of the levels seen in men
 Women’s increase in muscle mass is lower
 There is also a wide range of individual variability
 Somatotype: body type
 Mesomorphic: stocky, muscular; higher levels of testosterone
 Ectomorphic: tall, thin
 Endomorphic: short, fat
o Other Types of Muscular Fitness Training and Equipment
  Muscular power: amount of work performed by muscles in a given period of time
 Train for muscular power by performing any exercise faster
 Plyometrics: program that trains muscles to reach maximum force in the shortest period of
time
 Crouching and jumping
 Core-strength training: strength training that conditions the torso from the neck to the lower
back
 Pilates
 Unstable surfaces; resistance cords; stability balls
o Breathing and Safety
 Oxygen flow is vital for preventing muscle fatigue and injury during resistance training
 Inhale when your muscles are relaxed, and exhale when you initiate the lifting or push-off
action
 Never hold your breath while performing resistance exercises
o Flexibility
 Flexibility: ability of joints to move through the full range of motion
 Maintains posture and balance
 Makes movement easier and more fluid
 Prevents low back pain and injuries
 Much of the loss of flexibility that results from aging can be reduced by stretching programs
o Types of Stretching Programs
 Static stretching: stretching until you feel tightness,
and holding the position for a set period of time
 Passive stretching: a partner applies pressure, producing a stretch beyond what you could do
on your own
 Ballistic stretching: stretching the muscle in a series of bouncing movements; recommended
for experienced athletes only
 Proprioceptive neuromuscular facilitation: therapeutic exercise that causes a stretch reflex in
muscles
o Developing Your Own Flexibility Program
 ACSM recommends stretching for all the major joints
 Neck, shoulders, upper back and trunk, hips, knees, ankles
 2 to 3 days a week or more
 Stretch to a point of mild discomfort (not pain), hold for 10 to 30 seconds; do 2 to 4
repetitions to accumulate 60 seconds for each stretch
 Greatest improvement in flexibility is seen if stretching is done after other exercise, when
muscles are warm and less likely to be injured
o Neuromotor Fitness
 Neuromotor fitness, also called functional fitness, uses motor skills to improve balance,
coordination, gait, agility, and proprioceptive training
 Training examples: tai chi, qigong, yoga
 Commonly used equipment in functional fitness training: fitness balls, kettle balls, and free
weights
o Body Composition
 Body composition: relative amounts of body fat and lean body mass
  Recommended proportion, expressed as percent body fat:
21 to 35% for women and 8 to 24% for men
 Two types: essential fat and storage fat
 Storage fat is further subdivided into visceral fat (in the abdomen) and subcutaneous fat (just
under the skin)
 Too much storage fat is associated with overweight and obesity, heart disease, diabetes, and
cancer
 Increased physical activity can help you control body weight, trim body fat, and build muscle
tissue
o Combining Fitness Activities
 Cross-training: participation in one sport to improve performance in another, or use of several
different types of training for a specific fitness goal
 Advantages of cross-training:
 Avoids boredom
 Reduces risk of overuse injuries
o Physical Activity Recommendations


o Falling Out of Shape

 Stopping exercise for two weeks can lead to reduced cardiovascular fitness, lean muscle mass,
and muscle insulin sensitivity
 For two months or longer, can cause total loss of fitness gains
o Improving Your Health through Moderate Physical Activity
 Make daily activities more active
  Ride your bike to class instead of taking the bus
 Take the stairs instead of the elevator
 Walk for fitness
 Inactive people take 2,000 to 4,000 steps per day
 10,000 steps (about 5 miles) per day controls weight
o Get the Most from Cardio Exercise Equipment
 Set the treadmill incline to two degrees to more accurately simulate outside walking or running
 Accuracy of calorie counts on cardio exercise machines varies widely
 Consistently use the same model and brand of equipment
 Wear a heart rate monitor to increase your workload more accurately
 Do not lean on handle bars
 Enter your accurate weight
 Mix up your exercise workout
o Exergaming and Other Replacements for Sedentary Technology
 Replace television, computer time, and traditional video games with physical activities that are
fun and engaging
 Exergaming uses video games to enhance physical activity
 Can track calories burned and progress over time
 Fitness video games should not be considered a substitute for active outdoor play and physical
activity
 Keep track with fitness apps
o Warm-Up and Cool-Down
 Begin with proper warm-up and cool-down activities
 Warm-up helps to maximize the benefits of a workout and minimize the potential for injuries
 Light calisthenics, walking or slow jogging, and gentle stretching of the specific muscles to
be used in the activity
 Cool-down activities, usually the exercise activity at a lower intensity, allows blood vessels to
gradually return to their normal smaller diameter
o Fatigue and Overexertion
 Indications of fatigue
 Psychological: depression can cause feelings of fatigue
 Physiological: overheating, dehydration, energy debt
 Indication of overexertion
 Similar to signs of a heart attack
 Pain or pressure in the left midchest, jaw, neck, left shoulder or arm; sudden nausea,
dizziness, cold sweat; abnormal heartbeats
 If you experience any of these overexertion symptoms, consult a physician before exercising
again
o Soft-Tissue and Overuse Injuries
 Injuries to soft tissue are usually result from a specific incident: tears, sprains, strains, and
bruises
 Overuse injuries are caused by the cumulative effects of motions repeated many times:
tendinitis, bursitis
 Treating injuries: R-I-C-E
 Rest: stop doing the activity
 Ice: apply ice to the affected area
  Compression: wrap with an elastic bandage
 Elevation: helps to reduce blood flow to the area
o Effects of Heat and Cold on Exercise and Physical Activity
 How to adjust for environmental conditions that affect physical activity:
 Heat: wet head or body with cold water, and take in extra fluids before activity
 Cold: dress in several thin layers, and take in extra fluids before activity
 Hypothermia: dangerously low body temperature
o Heat-Related Disorders


o Exercising in Dirty Air

 Sources of dirty air include motor vehicle traffic, plant pollen, wind-blown dust, construction
sites, power plants, and many more
 Over an extended time, exposure to air pollutants can cause or exacerbate many negative health
issues
 When exercising in dirty air conditions
 Follow community air-pollution alerts
 Time your workouts to avoid peak pollution times
 Avoid high air-pollution areas
 Opt to exercise indoors
o Exercise for People with Disabilities
 Physical activity and exercise are especially beneficial for people with disabilities and chronic
health problems
 Counteract detrimental effects of bed rest and sedentary living patterns
 Maintain optimal functioning of body organs or systems
o Physical Activity for Life
 Make a commitment to change
 Precontemplation and contemplation stages: the biggest challenges are barriers to exercise
  Preparation stage: assess yourself
 Action stage: set achievable and sustainable goals
 Maintenance stage: when you have been physically active almost every day for at least six
months
 Termination stage: exercise has become entrenched as a lifelong behavior
 Use social and community support
 Chapter 7: Body Weight and Body Composition
o Overweight and Obesity
 Overweight: body weight that exceeds the recommended guidelines for good health
 Obesity: body weight that greatly exceeds the recommended guidelines
 No sex, age, state, racial group, or educational level is spared from these problems, although
they are worse for the young and the poor
 Overweight and obesity are associated with serious health problems
o What Is a Healthy Body Weight?
 There is no ideal body weight for each person, but there are ranges for a healthy body weight
 Healthy body weight is defined as:
 Acceptable Body Mass Index (BMI)
 Body composition with an acceptable amount of body fat
 Fat distribution that is not a risk factor for illness
 Absence of any medical conditions that would suggest the need for weight loss
o Body Mass Index
 Body mass index (BMI) is a measure of body weight in relation to height (see Table 7.1 in
text)
 BMI = Weight in kilograms / (height in meters squared)
 There appears to be a U-shaped relationship between BMI and risk of death, with the lowest
risk in the 18.5 to 25 range
 Underweight: BMI less than 18.5
 Healthy weight: BMI between 18.5 and 24.9
 Overweight: BMI between 25 and 29.9
 Obese: BMI of 30 or greater
 Body Mass Index
 BMI may incorrectly estimate risk for some people
 For those with muscular build, BMI may overestimate body fat
 For the elderly or others with low muscle mass, BMI may underestimate body fat
o Body Composition
 Different groups have different body fat expectations
 Healthy range for a typical male is 8 to 24%; male athletes, 5 to 10%
 Healthy range for a typical female is 21 to 35%; female athletes, 15 to 20%
 Below a certain body fat threshold, hormones cannot be produced and health problems can
occur
 Body fat percentage can be measured by:
 Immersion (most accurate), X-ray, skinfold measurement, and bioelectrical impedance
o Body Fat Distribution
 Where you carry your body fat is important in determining your health risk
 Large abdominal circumference is associated with high cholesterol levels and higher risk for
heart disease, stroke, diabetes, and hypertension
  Obese men tend to accumulate abdominal fat
 Obese women tend to accumulate hip and thigh fat; however, the onset of menopause shifts
weight gain to the abdomen
 If your BMI is in the healthy range, a large waist may signify an independent risk for disease
o Issues Related to Overweight and Obesity
 Obese people are four times more likely to die before their expected lifespan and have
increased risk for:
 High blood pressure
 Diabetes
 Elevated cholesterol levels
 Coronary heart disease
 Stroke
 Gallbladder disease
 Osteoarthritis
 Sleep apnea
 Lung problems
 Certain cancers, such as uterine, prostate, and colorectal
o Diabetes and Obesity
 Rates of obesity and diabetes in the U.S. have risen in parallel
 About 90 to 95% of people with diabetes have Type-2, the form strongly associated with
obesity
 About 80% of American youth with Type-2 diabetes are obese
 At any age group, small reductions in weight through diet and exercise reduce the risk of
developing diabetes
o Discrimination and Obesity
 Overweight children are often teased or bullied
 Weight-related bullying does not stop with adulthood
 Those that are overweight face discrimination in hiring practices, lower wages, and social
stigma
 One study found the overall, tangible cost of obesity for a woman was $4,879 per year, and
for a man, $2,646
o The Problem of Underweight
 Sudden, unintentional weight loss without a change in diet or exercise level may signify an
underlying illness and should prompt a visit to a physician
 If you have difficulty keeping weight on, to gain weight you need to change your energy
balance
 Eat more frequent and energy-dense meals
 Add nutritional supplements as snacks
 Reduce aerobic exercise and increase resistance or weight training
o What Factors Influence Your Weight?
 Many factors contribute, both individual and environmental
 For most people, obesity is a multifactorial condition:
a person’s susceptibility is due to a complex interaction among multiple genes and his or her
environment
o Genetic and Hormonal Influences
 Your risk of becoming obese if both your parents are obese is 80%
  Hundreds of genes have been associated with BMI
and obesity
 In most cases, multiple genes may predispose toward obesity, but interactions with the
environment determine outcome
 Genetic affects on hormone levels result in alterations in appetite or energy expenditure
 Stress response also affects eating patterns
 Body releases several hormones, and in response, fat cells release fatty acids and
triglycerides and increase circulating glucose
 When stress is chronic, the constant presence of these hormones increases the amount of fat
deposited in the abdomen
 Stress also affects eating patterns
 Thyroid disorders can be associated with weight gain or weight loss
 Thyroid gland controls much of your metabolic rate through hormone production
 When it is overactive, weight loss will likely result
 When it is not active enough, weight gain will likely result
o Age and Gender
 Poor childhood eating habits are believed to be a major cause of the recent surge in overweight
and obesity
 Healthy body fat percentage changes as we age
 Children, 12%
 Male adults, 15%; female adults, up to 25%
 Between the ages of 20 and 40, both men and women gain weight
 Older adults are susceptible to weight gain and need to be attentive to their lifestyle in order
to maintain a healthy weight
o Obesogenic Environments and Lifestyle
 Our chances of becoming obese are significantly influenced by our environment
 Choice in food is driven by exposure, as well as cost and convenience
 In general, unhealthy foods are more convenient and less expensive than healthy foods
 Eating out has become a part of daily life
 These foods tend to be higher in fat and calories and lower in fiber than a home-cooked
meal
 When confronted with large serving sizes, people eat more and don’t realize it
 Our car-friendly, pedestrian-unfriendly communities mean people are less likely to walk
 Americans spend much of their leisure time on sedentary entertainments like TV and the
Internet
 Less sleep, not more, is associated with weight gain in young adults
 If your friends gain weight, you are more likely to do so
 Weight cycling—repeated cycles of weight loss and weight gain as a result of dieting—
contributes
o The Key to Weight Control: Energy Balance
 Energy balance: the relationship between caloric intake (in the form of food) and caloric output
(in the form of metabolism and activity)
 If you take in more calories than you use through metabolism and movement (positive energy
balance), you store these extra calories as body fat
 If you take in fewer calories than you need (negative energy balance), you draw on body fat
stores to provide energy
o Estimating Your Daily Energy Requirements
 You can estimate your daily energy expenditure by considering the:
 Thermic effect of food
 Energy spent on basal metabolic rate, and
 Energy spent on physical activities
 Thermic effect of food: an estimate of the energy required to process the food
 Estimated at 10% of energy intake
 Basal metabolic rate (BMR): rate at which the body uses energy to maintain basic life
functions, such as digestion, respiration, and temperature regulation
 About 60 to 70% of energy consumed
 Between 10% and 30% of the calories consumed each day are used for physical activity
o Adjusting Your Caloric Intake
 Reasonable weight loss of 1 pound to 2 pounds per week is a healthy goal
 1 pound of body fat stores 3,500 calories
 To lose 1 pound in a week, you need to decrease your total intake for the week by that 3,500
calories
 Faster weight loss tends to include loss of lean tissue and a decrease in your basal metabolic
rate
 Foods high in complex carbohydrates have a greater thermic effect and take more energy to
process than high-fat foods
o Fad Diets
 Popular fad diets promote rapid change but are not associated with long-term weight loss
 Most follow a pattern of altering the balance of carbohydrates, protein, and fat
 Many label certain foods as “good” or “bad” or prescribe certain “fat-burning foods”
 Most dietitians and physicians encourage more balanced options and self-monitoring concepts
o Weight Management Organizations
 Weight management organizations offer group support, nutrition education, dietary advice,
exercise counseling, and other services
 Weight Watchers: a commercial program
 Take Off Pounds Sensibly (TOPS): a free program providing group support; focuses on
teaching
 Overeaters Anonymous: a free program providing group support; more suitable for binge
eaters or others with emotional issues related to weight
o The Medical Approach
 Very-low-calorie diets
 Aggressive option that requires a physician’s supervision
 Maintaining weigh loss is challenging
 Prescription drugs
 Two types: those that act in brain to reduce food intake,
and those that act elsewhere in the body to reduce food absorption
 Side effects are an issue
 Surgical options
 Gastric surgery is never a first-line approach
 Typical weight loss ranges from 20% to 30% of weight
 Nonprescription diet drugs and dietary supplements
 Diet teas, bulking products, starch blockers, diet candies, sugar blockers, benzocaine, etc.
  There are many safety concerns
 Manufacturers of dietary supplements do not have to submit proof of their efficacy or safety
to the FDA
o The Size Acceptance Movement
 Seeks to decrease negative body image, encourage self-acceptance, and end discrimination
 Emphasizes that people of any size can become more fit and benefit from healthier food
choices
 Goal is to find a balanced approach that combines personal acceptance with promotion of a
healthy body composition
o Tasks for Individuals
 Emphasize components of a healthier lifestyle
 Balanced diet emphasizing fruits, vegetables, and whole grains in appropriate portion sizes
 Weekly, 150 minutes of moderate-intensity physical activity
 Reduced time spent in sedentary activities
 Target improvement in areas such as blood pressure, cholesterol, and blood sugar level
 Inclusion of peer support
 Self-acceptance of body size
 Follow-up evaluation by a health professional
 Set SMART goals
 Specific, Measurable, Attainable, Realistic, Timely
 Is the goal specific?
 Is the goal measurable?
 Is the goal attainable, through action on your part?
 Is the goal realistic, using small, gradual changes?
 Is the goal timely, in that you set a timeline for when you will reach it?
 Choose an appropriate diet approach, based on specific goals
 Lose or gain a small amount of weight
 Maintain weight loss long-term
 Replace unhealthy eating and exercise behaviors with more healthy behaviors
 Reduce risk or controlling symptoms of diabetes (including maintainable short-term weight
loss)
 Improve heart health
 Strategies for Changing Body Composition
 

 Evaluate the support and obstacles in your environment, asking yourself if your change in diet
is:
 Realistic
 Moderate and flexible
 Safe
 Holistic, incorporating regular exercise
 Compatible with your relationships
 Affordable
 Research-based
  Use tools to help change your patterns
 Stimulus control: identify environmental cues associated with unhealthy eating habits
 Self-supervision: keep a log of the food you eat and the physical activity you do
 Social support and positive reinforcement: recruit others to join you in your healthier habits
 Stress management: use healthy techniques and problem-solving strategies to handle stress
 Cognitive restructuring: moderate any self-defeating thoughts and emotions; redefine your
body image by thinking about what your body can do
o Tasks for Society
 Changes in social policies are also needed to combat the obesity epidemic
 Promote healthy foods, lowering the price of low-fat, nutritious food to increase the rates at
which people choose them
 Support active lifestyles through community planning
 Support consumer awareness
 If consumers don’t buy the products depicted in ads, or if they complain about the content of
ads, food manufacturers will eventually respond
 Encourage health insurers to cover obesity prevention programs
 Chapter 8: Body Image
o What Shapes Body Image?
 Body image is the mental representation that a person has of his or her own body, including
perceptions, attitudes, thoughts, emotions, and actions
 Culture has a strong influence on body image
 Advertising industry and the media are relentless in selling the American consumer an image
of the ideal body
o Positive Body Image
 Positive body image is associated with enhanced well-being, body satisfaction, and healthy
eating behaviors
 Developing body appreciation means focusing on the features and functions of your body
that you consider assets
 Appreciate what you can do physically, socially, spiritually, and intellectually and don’t
think of your body as simply an object to be observed and manipulated by others
 Allows for self-care because you see your body as part of you
 Essential to maintaining a positive body image is interpreting information in a body-protective
manner
o Gender and Body Image
 Western social constructs for females and males have long been presented in binary,
stereotyped ways
 Historically, women faced societal pressures to submit to anything to reach the ideal of beauty
 Despite progress, our culture still strongly values its ideal of beauty with a focus on a
woman’s appearance rather than her abilities or performance
 When women internalize narrow media presentations of the “ideal,” they are less accepting
of and satisfied with of their bodies
 For men the opposite is true; historically, masculine imagery has emphasized body function
and achievement rather than appearance
 Today, there is a greater focus on a man’s physique over his accomplishments
 Society’s “ideal” male body shape has become more unrealistic, distorted, and extreme
  Men who buy into this cultural stereotype are more likely to have feelings of inadequacy and
body dissatisfaction
o Race, Ethnicity, and Body Image
 Intersecting identity roles are critical to the way people internalize media messaging
 White women typically experience greater body dissatisfaction and eating disturbance
 African American men and women fairly consistently report less body image dissatisfaction
 Black women often describe beauty more holistically, encompassing personality traits, not
just physical ones
 Studies about Asian American and Hispanic women are inconsistent
o Life Stages and Body Image
 Adolescence is a critical phase of identity formation
 Exploring new relationships and new friends, sexual experiences, and peer dynamics
 Beliefs and concerns about what is attractive to partners start to develop and gain importance
 Formation of gender identity and sexual identity
 Physical changes of puberty happen alongside sexual identity and gender identity formation
 For girls, body fat increases from about 12% to about 25% moving them away from the
female image “ideal”
 For boys, puberty increases muscle mass and definition, moving them toward the male image
“ideal”
 Timing of puberty appears to play a role in the development of body appreciation
 Majority of research on body image, disordered eating, and eating disorders has focused on
cisgender youth
 Identify with the gender assigned at birth
 For trans or gender-conflicted youth, puberty presents an increased risk in many areas
 Conflict between their biological and desired gender
 Developing sex characteristics can be very stressful and lead to disordered eating patterns
and other forms of self-harm in attempts to control these changes
 Changes in physical activity levels for females
 Decrease physical activity and participation in sports
 However, those that participate at elite levels, but not at nonelite levels, have an increased
risk of eating disorders
 Lifelong participation in noncompetitive activities have both physical and psychological
benefits
o Disordered Eating and Eating Disorders
 Disordered eating behaviors are common and widespread
 Restrictive dieting, skipping meals, binge eating and purging, laxative abuse, etc.
 May occur in response to emotional stress, an upcoming athletic event, concern about
personal appearance, etc.
 Disordered eating behaviors may or may not develop into a full-blown eating disorder
 Eating disorders are chronic illnesses characterized by severely disturbed eating behaviors,
distorted body image, and low self-esteem
 Jeopardize physical and mental health
 Occur primarily among people in Western industrialized countries
 Occur in all ethnic, cultural, and socioeconomic groups
 More prevalent when food is abundant and has taken on symbolic meanings such as comfort,
love, belonging, fun, and control; and where being attractive means being thin
o Contributing Factors
 Risk for eating disorders involves more than exposure to the thin ideal and social pressures to
be thin
 Gender is a risk factor, with being female increasing risk
 Gay and bisexual men may be at greater risk than heterosexual males
 Family history of eating disorders, depression, substance abuse, anxiety, obsessive-compulsive
disorder, or obesity increases risk
 There are links to depression and anxiety, although the relationship appears complicated
o Diagnosing Eating Disorders
 Anorexia nervosa: distortion of body image and refusal to maintain a minimally normal body
weight
 Restriction of energy intake relative to requirements
 Intense fear of gaining weight or becoming fat even though underweight, or interfering with
weight gain
 Disturbance in the way body weight or shape is experienced, undue influence of body weight
on self-evaluation, or denial of the seriousness of low body weight
 Bulimia nervosa: distortion of body image and repeated episodes of binge eating, usually
followed by purging
 Recurrent episodes of binge eating accompanied by a sense of lack of control
 Recurrent inappropriate compensatory behavior, such as
self-induced vomiting, misuse of medications, fasting, or excessive exercise
 Episodes occurring at least once a week for three months
 Self-evaluation unduly influenced by body shape and weight
 Binge eating disorder: binge eating behavior without the vomiting or purging of bulimia
 Individuals afflicted can be normal weight or overweight, but if undiagnosed, they often
eventually become obese
 Recurrent episodes of rapid binge eating alone, when not hungry and until uncomfortably
full; and feeling disgusted, depressed, or guilty about overeating
 Marked distress about binge eating
 Episodes at least once a week for three months
 Binge eating not associated with inappropriate compensatory behaviors
o Health Consequences of Eating Disorders
 Anorexia carries the highest death rate of all psychiatric diagnoses
 Some complications may not be reversible
 Decreased bone calcium (osteoporosis) is one of the most serious long-term effects
 Bulimia is associated with electrolyte imbalance and can be deadly due to low potassium
 Consequences of binge eating disorder are related primarily to obesity
o Treating Disordered Eating and Eating Disorders
 Aside from osteoporosis, most of the negative health conditions associated with anorexia and
bulimia are reversible
 Keys to recovery are:
 Early intervention
 Lower incidence of purging behavior
 Support and participation of family members and loved ones
 Lack of other diagnosed psychological problems
 First step is to recognize the problem
  Effective treatment often involves a multidisciplinary or multimodality team
 Severe weight loss or another medical abnormality may require hospitalization
 Once weight is stabilized:
 Psychotherapy
 Behavior relearning and modification
 Nutritional rehabilitation and education
 In some cases, medication
o Body Dysmorphic Disorder
 Body dysmorphic disorder: preoccupation with an imagined or exaggerated defect in
appearance
 Perceived flaw not observable or appears slight to others
 Repetitive behaviors or mental acts in response to appearance concerns
 Preoccupation causes significant distress or impairment and is not accounted for by another
mental disorder
 Preoccupation in men tends to be about genitals, muscle mass, and hair
 Preoccupation in women tends to be about breasts, thighs, and legs
 Muscle dysmorphia is a subcategory that appears predominantly in men obsessed with working
out
 May be related to obsessive-compulsive disorder
 Some people turn to cosmetic surgery to correct the supposed flaw in their appearance
 Not everyone who uses cosmetic surgery has this disorder
 Cosmetic surgery can also have psychological and physical benefits
 Some people use body art to express themselves
 Among people with tattoos, about one in five is dissatisfied
o Exercise Disorders
 Exercise disorders, on the rise, may exist in conjunction with eating disorders or by themselves
 Excessive exercise is often not supported by calorie intake
 Treatment is similar to that for eating disorders, with a focus on increasing caloric intake or
decreasing activity level until a balance is reached
 Female athlete triad: interrelated conditions of disordered eating, amenorrhea (cessation of
menstruation), and osteoporosis
 Excessive exercise to lose weight or attain a lean body appearance to fit a specific athletic
image or improve performance
 Female athletes need to understand the importance of good eating habits and moderation in
exercise
 Male athletes are susceptible to a similar condition
o Promoting Healthy Eating and a Healthy Body Image
 Individual attitudes and actions:
 Value yourself based on your goals, talents, and strengths rather than your body shape or
weight
 Look critically at the images and messages you receive from people and the media
 Develop healthy stress-management skills
 Avoid judging yourself or others
 Challenge others to speak positively about their bodies
o College Initiatives
 Prevention efforts should include both individual measures and campus-wide activities
  Residence advisors, professors, coaches, trainers, and other college staff can be trained to
watch for problems
 Health and counseling services can be visible and accessible
o Public Health Approaches
 Focus on raising awareness about eating disorders and changing widely accepted social norms
 Develop organizations and programs to promote healthy body image and lifestyle patterns
 Chapter 9: Alcohol and Tobacco
o Understanding Alcohol Use
 Alcohol is a psychoactive drug, which means it causes changes in brain chemistry and alters
consciousness
 Intoxication: altered state of consciousness as a result of drinking alcohol or ingesting other
substances
 It can have wide-ranging effects on all aspects of our thinking, emotions, and behavior
o Patterns of Alcohol Use
 About 71% of American adults drink at least occasionally
 About 25 to 30% are abstainers
 Of those who do drink, 25% are at-risk drinkers
 Low-risk drinking:
 For men, no more than 14 drinks per week and no more than 4 on any one day
 For women, no more than 7 drinks per week and no more than 3 on any one day


 Each drink contains about 0.5 ounce (or 15 grams) of alcohol
o Who Drinks?
 People are more likely to drink at certain stages in the lifespan
 Adolescence and early adulthood; threshold of middle age; and following retirement
 Older adults drink less than younger adults
 Women drink less and start later than men
 Adults who had at least one heavy drinking day in the past month by ethnicity: White 7.4%,
Hispanic/Latino 5.7%, and Black 5.2%
  Differences in consumption among ethnic groups are strongly influenced by sociocultural,
environmental, and economic factors
 Alcohol use is generally lower among African Americans
 Among Native Americans, alcoholism is recognized as the number one health problem
 Asian Americans have lower consumption rates than White Americans, possibly due to
genetic biological reactions referred to as the flushing effect
o Why Do Some People Have Problems with Alcohol?
 Individual, psychological, and sociocultural factors
 Family history of alcoholism
 Family dysfunction in general
 Cultural attitudes
 Economic factors
 Laws
o Drinking on the College Campus
 About 24% of high school students are binge drinkers
 Rates are lower among those who plan to go to college
 About 20% of college students who didn’t drink heavily in high school do so during their
college years
 Up to 80% of college students drink
 Those under 21 less likely to drink, but if they do they are more likely to:
 Binge drink
 Drink just to get drunk
 Injure themselves
 Encounter trouble with the police
o Binge Drinking and Extreme Drinking
 Binge drinking, or heavy episodic drinking: within two hours, 5 or more drinks for men, 4 or
more for women, at least once in a two-week period
 Survey from the National Institute on Alcohol Abuse and Alcoholism found that 40% of
college students aged 18 to 22 binge drank in the previous 30 days
 Extreme drinking is now used to describe alcohol consumption that goes well beyond binge
drinking
 10 to 15 drinks a day for men and 8 to 12 drinks a day for women
o Consequences of Binge Drinking in College
 Consequences can be serious
 Injury
 Commission of a crime or falling victim to crime
 Driving while intoxicated
 Unintended and unprotected sexual activity
 Decreased academic performance
 Increased risk of alcohol abuse and dependence 10 years
after college
 “Secondhand effects” for other students, such as arguments, assault, property damage,
interrupted sleep or studying, unwanted sexual advances, etc.
o Why Do College Students Binge Drink?
 To ease social inhibitions and fit in with peers
 In imitation of role models
  Stress reduction
 To deal with negative emotions and cope with academic pressure
 Mistaken belief that alcohol increases sexual arousal and performance
 Social norms and the campus culture
o Pre-Gaming Drinking
 Pre-gaming is the excessive consumption of alcohol prior to attending an event or activity in
which alcohol will be served
 High-risk because it involves heavy consumption in a short period of time
 Freshmen are more likely to pre-game
o Spring Break Drinking
 Spring break environment is made to be conducive to excessive drinking
 Males average 18 drinks per day and females 10 per day
 75% of college men and 44% of college women reported being drunk daily during spring
break
 Collapse, sexual assaults, and unprotected sex are common
o Powdered Alcohol
 Powdered alcohol was approved at the federal level for sale in 2015 and is available in diverse
flavors
 Marketed as convenient for outdoor activities and travel
 Banned by more than half the states because of its potential to increase underage drinking
o Flavored Alcohol
 Flavored alcoholic beverages have increased in popularity
 Malt-based (7.8% alcohol)
 Ready-to-drink cocktails (14.2%)
 Supersized alcopops (10.8%)
 Popularity of flavored alcohol and its high alcohol volume content are of concern, since these
drinks disproportionately contribute to alcohol-related emergencies
o Addressing the Problem
 Strategies for addressing the problem:
 Screening interviews to identify high-risk students
 Enforcing college alcohol policies
 Punishing students who violate policies or break the law
 Mandating treatment for substance-related offenses
 Educating students to resist peer pressure
 Helping students cope with stress and time management issues
 Targeting prevention messages to high-risk events
o Effects of Alcohol on the Body
 Alcohol is quickly distributed to all the cells of the body
 Once it reaches the brain, alcohol alters brain chemistry and neurotransmitter functions
 Alcohol is a central nervous system depressant that impairs thinking, balance, and motor
functions
 As alcohol concentrations increase, more functions are depressed, and greater impairment
occurs
o Alcohol on the Brain
 Wernicke-Korsakoff syndrome, or “wet brain,” is a form of brain disease tied to severe
amnesia, confabulation (distorted memory), and possibly dementia
  Caused by a severe deficiency of thiamine (vitamin B1)
 Stages of the disorder
 First stage: Wernicke’s encephalopathy
 Second stage: Korsakoff’s psychosis
o Alcohol Absorption
 Many factors affect alcohol absorption
 Food in the stomach
 Gender and age
 Body fat
 Drug interactions
 Cigarette smoke
 Mood and physical condition
 Alcohol concentration
 Carbonation
 Artificial sugars from diet soda
 Individual tolerance level
o Alcohol Metabolism
 Small amount of alcohol is metabolized in the stomach; but 90% is metabolized by the liver
 Between 2% and 10% is not metabolized at all but
is excreted unchanged through the skin, urine, or breath
 Liver allows conversion of alcohol to acetaldehyde by
an enzyme, alcohol dehydrogenase (ADH)
 If more alcohol arrives than can be processed, it circulates through the brain, liver, and other
organs
until enzymes are available
o Blood Alcohol Concentration
 Blood alcohol concentration (BAC): the amount of alcohol in grams in 100 milliliters of blood,
expressed as a percentage
 100 milligrams of alcohol in 100 milliliters of blood is equivalent to a BAC of 0.10%
 Amount of body water and body fat influences the BAC levels in the body
 Breath analyzers are valid based upon alcohol concentrations in the breath that correspond
well to levels of alcohol in the brain
 
o Gender Differences in Alcohol Absorption and Metabolism
 Women are generally more susceptible to the effects of alcohol and have a higher BAC than
men
 Generally smaller than men
 Higher body fat percentage
 Metabolize alcohol less efficiently
 As a result, women are more vulnerable to health consequences
 Liver disease
 Heart disease
 Brain damage
o Rates and Effects of Alcohol Metabolism
 Because alcohol is metabolized more slowly than it is absorbed, the concentration of alcohol
builds when additional drinks are consumed
 Person with a BAC of 0.08% is considered legally drunk in all states, but people experience
impairment at different BAC levels
 Visible effects of alcohol consumption include deeper wrinkles, red cheeks, and weight gain
 Acute alcohol intoxication: life-threatening blood alcohol concentration that can produce a
collapse of vital body functions
 Blackout: period of time during which a drinker is conscious but has partial or complete
amnesia about events
 Stages of Effects of Alcohol
 

o Effects of Alcohol Ingestion Fads

 Up to 28% of college students mix alcohol and energy drinks, despite it being dangerous
 Three times more likely to leave a bar drunk
 Four times more likely to drive drunk
 Increased risk of sexual assaults
 Two alcohol ingestion fads that bypass the digestive tract are vaporizing and the alcohol enema
 Alcohol is absorbed through the lungs or the intestines, bypassing the buffering effect of the
digestive tract
 Poses a serious risk of alcohol poisoning
o Hangovers
 Hangovers are a result of a common reaction to alcohol toxicity, characterized by headache,
stomach upset, thirst, and fatigue
 There is little research on prevention and cure, but borage seed oil, tolfenamic acid, and yeast
preparation show promise
 Be cautious of using analgesics to treat hangovers
 Acetaminophen (Tylenol, Anacin-3) can damage your liver when alcohol is in your body
 Aspirin, either six hours before or after alcohol consumption, may lead to a higher BAC and
gastrointestinal distress
o What Happens When You top Drinking Alcohol?
 

o Medical Problems Associated with Alcohol Use

 Fetal alcohol syndrome (FAS): set of birth defects associated with use of alcohol during
pregnancy
 Heart disease and stroke
 Alcoholic cardiomyopathy: disease of the heart muscle
 Heart arrhythmias (irregular heartbeat) and coronary heart disease
 Liver disease
 Fatty liver: liver swells with fat globules
 Alcoholic hepatitis: inflammation of the liver
 Cirrhosis: scarring of the liver tissue
 Cancer
 Several types of cancer, particularly cancers of the head and neck, cancers of the digestive
tract, and breast cancer
 Brain damage
 Heavy alcohol consumption causes anatomical changes in the brain and directly damages
brain cells
 Lung damage
 Recent studies suggest that alcohol abuse causes dysfunction in lung cells
o Social Problems Associated with Alcohol Use
 Reduction of inhibitions, which may lead to high-risk sexual activity and a lowered likelihood
of practicing safe sex
 Violence, including robbery, assault, rape, domestic violence, and homicide
 Risk of injury
 Drunk driving
 Suicide risk
o Alcohol Misuse, Abuse, and Dependence
 Alcohol misuse: consumption to the point of physical, social, and moral harm to the drinker
  Problem drinking: pattern of use that impairs the drinker’s life, causing personal difficulties
and difficulties for others
 Alcohol abuse: continued use of alcohol despite negative consequences
 Alcohol dependence: a strong craving for alcohol,
the development of tolerance, and symptoms of withdrawal if alcohol consumption stops
abruptly—also known as alcoholism
 Chronic, progressive, and often fatal disease
o Another View: Health Benefits
 Moderate alcohol consumption may have some
health benefits
 Anticlotting effect on the blood
 Enhances body’s sensitivity to insulin
 Stress reduction
 Diuretic effect of beer may help prevent kidney stones
 Increase in HDL cholesterol
 Pattern of drinking is key
 Binge drinking has no protective benefits and can increase the risk for heart disease
o Treatment Options
 Brief interventions
 Alcohol Skills Training Program; Brief Alcohol Screening and Intervention for College
Students (BASICS); AlcoholEdu
 Inpatient and outpatient treatment
 Residential facilities
 Detoxification and withdrawal
 Medications
 Counseling
 Self-help programs
 Support groups (AA, Al-Anon, Alateen, Adult Children of Alcoholics, others)
 Harm reduction: approach, policies, and laws
 Focuses on reducing the harm associated with drinking, both to the individual and to society
 One example is controlled drinking, which emphasizes moderation rather than abstinence
 Minimum drinking age laws, drunk driving laws, ankle bracelet breathalyzers, ignition
interlock device, restrictions on liquor sales and outlets, taxes on alcohol
 Fake IDs
 Using a fake ID is now classified as a serious crime
 IDs are now more difficult and costly to counterfeit
o Are You at Risk?
 “Yes” to one or more questions on the CAGE questionnaire suggests you may be at risk
 C for cut down: Have you ever tried to cut down on your drinking?
 A for annoyed: Have you ever been annoyed by criticism of your drinking?
 G for guilty: Have you ever felt guilty about your drinking?
 E for eye-opener: Have you ever had a morning “eye-opener”?
o Developing a Behavior Change Plan
 Following a behavior change plan can assist you with reducing alcohol consumption
 Record behavior patterns
 Analyze your drinking diary
  Establish goals
 Implement your plan
 Evaluate your results
o Be an Advocate
 You can also be an advocate for both abstinence and responsible drinking
 Boost Alcohol Consciousness Concerning the Health of University Students (BACCHUS
Network)
 Run by student volunteers
 Promotes both abstinence and responsible drinking
 Greeks Advocating the Mature Management of Alcohol (GAMMA)
o Understanding Tobacco Use
 Use of tobacco causes an array of health problems, both for users and for those around them
 Tobacco is the leading preventable cause of death in the United States
 Almost 1 in 5 adult Americans smokes
o Who Smokes? Patterns of Tobacco Use
 About 18% of the adult population in the United States are smokers, down from nearly 42% in
1965
 Decline is largely because of public health campaigns about the hazards of smoking
 Rate of decline has slowed since 1990
 More men than women smoke, and rates are higher among young people
 About 15% of college students smoke
o Substances in Tobacco
 Tar is a thick, sticky residue formed when tobacco leaves burn, containing hundreds of
chemical compounds and carcinogenic substances
 One of the most hazardous gaseous compounds in burning tobacco is carbon monoxide, an
odorless gas that interferes with the ability of red blood cells to carry oxygen to vital body
organs
 Nicotine is the primary addictive ingredient; it is both a poison and a powerful psychoactive
drug
o Cigarettes
 Cigarettes are by far the most popular tobacco product and account for 95% of the tobacco
market
 In 2009, the U.S. Congress passed the Family Smoking Prevention and Tobacco Control Act
 Gave the FDA power to regulate tobaccos
 Fruit- and candy-flavored cigarettes are now prohibited
 Also banned are clove cigarettes and bidis
o E-cigarettes
 Sales of e-cigarettes may surpass those of regular cigarettes by 2025
 Although marketed as a safe cigarette, they still contain nicotine and have other health risks
 Secondhand heath effects, especially on children, are of particular concern
 “Smart packs” are a new type that can connect to others and share owners’ information
o Hookahs
 Hookahs are a potentially greater risk than cigarettes because of the frequency and number of
puffs
 About 19% of college students smoke a hookah
 African Americans have higher rates of hookah-only and dual hookah and cigarette smoking
  World Health Organization and the CDC warn, however, that hookah use can pose even
greater dangers than cigarette smoking
o Cigars
 Cigars have more tobacco and nicotine than cigarettes, take longer to smoke, and generate
more smoke and harmful combustion products
 Nicotine absorbed in the mucus membranes of the mouth presents a higher risk for oral
cancers
 Cigar smokers who do not inhale have lower mortality rates than cigar smokers who do
 Black & Mild cigarillos are popular among teens, young adults, and African Americans
o Pipes
 Pipe smoke has more toxins than cigarette smoke
 Pipe smokers who do not inhale are at less risk for lung cancer and heart disease than are
cigarette smokers
 Pipe smokers are just as likely as cigarette smokers to develop cancer of the mouth, larynx,
throat, and esophagus
o Smokeless Tobacco
 Also called snuff, chewing or spit tobacco, and snus
 Use of spit tobacco is believed to cause about
10 to 15% of oral cancers
 Spit tobacco also causes gum disease, tooth decay and discoloration, and bad breath
 Amount of nicotine absorbed from smokeless tobacco is two to three times greater than that
delivered by cigarettes
o Dissolvable Tobacco Products
 Small pellets, sticks, or strips that consist of finely ground and pressed tobacco
 Ingested orally like a breath mint
 These products can contain a potent level of nicotine
 Health risks are similar to those associated with other oral tobacco products, particularly oral
cancer
o Why Do People Smoke?
 Nicotine is a highly addictive psychoactive drug
 Some health experts believe it is the most addictive of all the psychoactive drugs
 Increases in release of the neurotransmitter dopamine produce feelings of pleasure and a
desire to repeat the experience
 Behavioral dependence develops
 Many smokers have a harder time imagining their future life without cigarettes than they do
dealing with the physiological symptoms of withdrawal
 Weight control is one of the major reasons young women give for smoking
 Nicotine suppresses appetite and slightly increases basal metabolic rate
 People who start smoking often lose weight, and continuing smokers gain weight less rapidly
than nonsmokers
 Tobacco marketing and advertising has an effect
 Because most smokers get hooked in adolescence, children and teenagers are prime targets of
tobacco advertising
o Short-Term Effects
 Nicotine effects can reach the brain within 7 to 10 seconds, producing stimulation and sedation
 Smoke quickly affects heart rate, blood pressure, and body temperature
  Tar and toxins damage cilia, the hair-like structures that prevent toxins and debris from
reaching delicate lung tissue
 Cardiovascular system cannot effectively deliver oxygen to muscle cells
o Long-Term Effects
 Cardiovascular disease and cancer
 Chronic obstructive pulmonary disease
 Emphysema: abnormal condition of the lungs that enlarges the alveoli (air sacs) and
decreases elasticity
 Chronic bronchitis: mucus secretion, cough, and increasing difficulty breathing
 Asthma: respiratory disorder characterized by difficulty breathing, wheezing, coughing, and
thick mucus
 Premature skin wrinkling, increased risk during surgery, and other health problems
o Special Health Risks for Women
 Fertility problems, menstrual disorders, early menopause, problems in pregnancy, lung cancer,
heart disease, and respiratory diseases
 Smoking during pregnancy increases risk for miscarriage, stillbirths, pre-term delivery, low
birth weight, and perinatal death
 Infants are at increased risk for sudden infant death syndrome (SIDS)
o Special Health Risks for Men
 Greater use of other forms of tobacco (cigars, pipes, smokeless tobacco) places men at higher
risk for cancers of the mouth, throat, esophagus, and stomach
 Men may also experience problems with sexual function (impotence) and fertility (motility and
number of sperm)
o Special Health Risks for Ethnic Minority Groups
 Mortality rates from several diseases associated with tobacco use—including cardiovascular
disease, cancer, and SIDS—are higher for ethnic minority groups than for Whites
 African American men and women are more likely to die from lung cancer, heart disease, and
stroke than are members of other ethnic groups, despite lower rates of tobacco use
o Benefits of Quitting
 Risks for many health problems are reduced when smokers quit
 Health benefits begin immediately and are more significant over time
 Respiratory symptoms decrease quickly
 Recovery from illness is more rapid
 Taste and smell return
 Circulation improves
o When You Quit Smoking
 


o Effects of Environmental Tobacco Smoke
 Environmental tobacco smoke (ETS): smoke from other people’s tobacco products, also
known as secondhand smoke or passive smoke
 Significant evidence indicates that inhaling ETS has serious health consequences
 Infants and children are especially vulnerable to the effects of ETS
  Pets are even at risk from ETS
o Quitting and Treatment Options
 Treatment programs to quit smoking
 Of smokers who enter good treatment programs, 20 to 40% are able to quit for at least a year
 Medications
 Nicotine replacement therapy (NRT)—transdermal patch, nicotine inhaler, nicotine patch,
hand gel (Nicogel)
 Prescription drugs—Zyban, Wellbutrin, Chantix
 Experimental vaccine—NicVax
 Quitting on your own can be aided by developing a behavior change plan
 Record and analyze your smoking patterns
 Establish goals
 Prepare to quit
 Implement your plan
 Prevent relapse
o What to Expect When You Quit


 

o Confronting the Tobacco Challenge

 Tobacco has been part of the economy of the country since colonial times
 It is a multibillion-dollar industry with tremendous lobbying power and a huge impact on the
nation’s economic health
 Significant inroads have been made in confronting the challenge posed by tobacco in the U.S.
o Lawsuits and Court Settlements
 In the 1990s, tobacco companies began to face class action suits, cases representing claims of
injury by hundreds or thousands of smokers
 States began suing tobacco companies for losses incurred by state health insurance funds
 1998 Master Settlement Agreement (MSA): tobacco industry agreed to pay $206 billion to 46
states over a 25-year period
o Limiting Access to Tobacco
 Access to tobacco can be limited by increasing cost, reducing physical availability, and
regulating tobacco-marketing campaigns
 Raising cigarette taxes and restrictions on tobacco marketing reduces demand
 Laws restricting sales to minors
 States are required to conduct random, unannounced inspections of places where tobacco is
sold
o FDA Regulation of Tobacco
 Should college campuses be tobacco free?
 1,620 of 6,000 are now smoke- or tobacco-free
 Real enforcement—warnings and then fines—may be necessary to make policies effective
 Chapter 10: Drugs
o Who Uses? Patterns of Illicit Drug Use
 Rates of illicit drug use vary by age, gender, race and ethnicity, education, employment status,
and geographical region
  Among Americans aged 12 or older, more than 47% report having used an illicit drug in their
lifetime
 Most commonly used drug is marijuana
 There is also a substantial misuse of psychotherapeutics (prescription-type drugs)
 Number of college students who abuse prescription drugs has increased dramatically in the past
decade
 Pain relievers (e.g., OxyContin, Vicodin, Percocet): use increased by 343%
 Stimulants (e.g., Ritalin, Adderall): use increased by 93%
 Tranquilizers (e.g., Xanax, Valium): use increased by 450%
 Sedatives (e.g., Nembutal, Seconal): use increased by 225%
o What Is a Drug?
 Drug: substance other than food that affects the structure or function of the body through its
chemical action
 Psychoactive drugs change brain chemistry and alter consciousness, perception, mood, and
thought (intoxication)
 Drug of abuse: medical drug used for nonmedical (recreational) purposes, or a drug that has no
medical uses
 Substance: drug of abuse, a medication, or a toxin; the term is used interchangeably with drug
o Types of Drugs
 Drugs are classified in several different ways
 Legal drugs include:
 Medication prescribed by physicians
 Over-the-counter (OTC) medications
 Herbal remedies
 Pharmaceutical drugs are developed for medical purposes, whether over-the-counter or
prescription
 Illicit drugs are unlawful to possess, manufacture, sell, or use
o Drug Misuse and Abuse
 Drug misuse: use of prescription drugs for purposes other than those for which they were
prescribed or in greater amounts than prescribed, or the use of nonprescription drugs or
chemicals for purposes other than those intended by the manufacturer
 Drug abuse: use of a substance in amounts, situations, or a manner such that it causes
problems, or greatly increases the risk of problems, for the user or for others
 Substance use disorders: defined by the DSM-5 as a number of cognitive, behavioral, and
physiological symptoms that persist even as the individual experiences a number of significant
life-changing substance-related problems
 DSM-5: American Psychological Association’s current version of the Diagnostic and
Statistical Manual of Mental Disorders
 DSM-5 does not separate substance use disorders and dependence
 Many will continue to view substance use problems in terms of drug abuse, addiction,
dependence, withdrawal symptoms, and tolerance
 Addiction is the chronic relapsing brain disease characterized by compulsive drug seeking
and use, despite harmful consequences
 Tolerance is reduced sensitivity to the effects of the drug
 Withdrawal symptoms are uncomfortable feelings when drug use stops
o Routes of Administration
  Oral
 Most drugs are taken orally
 Injection: involves a hypodermic syringe to deliver drug into the bloodstream
 Intravenous injection
 Intramuscular injection
 Subcutaneous injection
 Inhalation: smoking or huffing
 Application to mucous membranes
o Routes of Administration


o Factors Influencing the Effects of Drugs

 Characteristics of the drug
 Chemical properties of the drug and its actions
 Characteristics of the person
 Age, gender
 Body weight and mass; physical condition
 Mood
 Experience with the drug
 Expectations
 Characteristics of the situation or environment
 At home or surrounded by strangers
o Effects of Drugs on the Brain
 Many addictive drugs act on neurons in three brain structures:
 Ventral tegmental area (VTA) in the midbrain
 Nucleus accumbens
 Prefrontal cortex
 Neurons in these structures form a pathway referred to as the pleasure and reward circuit
  Addictive psychoactive drugs activate and cause a
surge in levels of dopamine and associated feelings
of pleasure
 All or nearly all addictive drugs operate via the pleasure and reward circuit
 Some also operate via additional mechanisms
 For example the opioids have a structure similar to that of endorphins, which block pain
when the body undergoes stress
 Individuals trying to recover from addiction must overcome:
 Altered brain chemistry
 Drug-related memories
 Impaired impulse control
o Drugs of Abuse
 Drugs of abuse are usually classified as:
 Stimulants
 Depressants
 Opioids
 Hallucinogens
 Inhalants
 Cannabinoids
o Central Nervous System Stimulants
 Stimulants: drugs that speed up activity in the brain and sympathetic nervous system
 Effects similar to the “fight-or-flight” reaction
 May stimulate movement, fidgeting, and talking, and produce intense feelings of euphoria
and create a sense of well-being
 Examples:
 Cocaine
 Amphetamines
 MDMA (Ecstasy)
 Bath salts
o Central Nervous System Depressants
 Depressants slow down activity in the brain and sympathetic nervous system
 Can be deadly if misused, especially when mixed with alcohol
 CNS depressants carry a high risk of dependence
 Examples:
 Barbiturates and hypnotics
 Anti-anxiety drugs (benzodiazepines)
 Rebound effect: when a person stops using a drug and experiences symptoms worse than
those before taking the drug
 Rohypnol and GHB (gamma hydroxybutyrate)
o Opioids
 Opioids: natural and synthetic derivatives of opium
 Currently prescribed as pain relievers, anesthetics, antidiarrheal agents, and cough suppressants
 Produce feelings of pleasure and block pain
 Examples:
 Morphine
 Heroin
  Synthetic opioids (OxyContin, Vicodin, Demerol, Dilaudid, Percocet, Percodan)
 With low doses, opioid users experience euphoria followed by drowsiness
 At high dosages, users can experience depressed respiration, loss of consciousness, coma, and
death
 Opioids have a high potential for dependence
o Hallucinogens and Dissociative Drugs
 Hallucinogens: alter perceptions and thinking, intensifying and distorting visual and auditory
perceptions and producing hallucinations; also known as psychedelics
 Alter perceptions and thinking in characteristic ways
 Intensify and distort visual and auditory perceptions and produce hallucinations
 Examples:
 LSD (lysergic acid diethylamide)
 Phencyclidine (PCP) and ketamine
o Inhalants
 Inhalants: breathable chemical vapors that alter consciousness, producing a state that resembles
drunkenness
 Active ingredients are all dangerously powerful toxins and carcinogens
 Most significant negative effect for chronic users is widespread and long-lasting brain damage
 Examples:
 Paint thinner, gasoline, glue, and spray-can propellant
o Cannabinoids
 Marijuana is the most widely used illicit drug in the United States
 Derived from the hemp plant, Cannabis sativa
 Active ingredient is delta-9-tetrahydrocannabinol (THC)
 Use produces mild euphoria, sedation, lethargy, short-term memory impairment, increase in
appetite, distorted sensory perceptions, distorted sense of time, impaired coordination, and an
increase in heart rate
 Researchers have found that THC has a variety of effects on the brain, perhaps accounting for
some impairments in problem solving and decision making
 Many people support medical uses of marijuana
 Treatment for glaucoma, for the pain and nausea of cancer and chemotherapy, and for weight
loss associated with AIDS
 Opponents argue legalization implies approval and will encourage abuse of all drugs
 Like alcohol, marijuana affects the skills required to drive a car safely
o Emerging Drugs of Abuse
 Newest set of drugs being experimented with include:
 Anabolic steroids—performance enhancing drugs
 Synthetic cannabinoids such as K2 and Spice
 “Syrup,” “Purple Drank,” “Sizzurp,” and “Lean”—all prescription-strength cough syrup
containing codeine and promethazine mixed with soda
 “N-Bomb,” a synthetic hallucinogen
o Approaches to the Drug Problem
 Supply reduction strategies:
 Interdiction: interception of drugs before they get into the country
 Pressure on supplying countries to suppress production and exportation
 Prevention of domestic production and sales via law enforcement
  Demand reduction strategies:
 Incarceration for drug-related crimes
 More than half the people in U.S. prisons meet the diagnostic standards for substance use
disorders
 Only 7 to 17% who need drug treatment receive it
 Prevention strategies
 Primary, or universal, prevention programs: designed to reach and educate entire population
 Secondary, or selective strategies: focus on subgroups that are at greatest risk for use or
abuse
 Tertiary, or indicated, strategies: target at-risk individuals rather than groups
o Drug Treatment Programs
 Treatment programs range from hospital-based inpatient programs to self-help/mutual-help
groups such as Narcotics Anonymous (NA)
 Treatment is a long-term process, often marked by relapses
 Programs are more successful when they last at least three months
 Matching services to individual needs is critical
o Harm Reduction Strategies
 These are based on the idea that completely eliminating substance use is futile and efforts
should focus on reducing the associated harm
 Needle exchange programs
 Drug substitute programs, such as methadone for heroin addicts
 Controlled availability
 Medicalization
 Decriminalization
 Opponents argue these are forms of drug legalization
 Chapter11: Sexual Health
o Sexual Anatomy and Functioning
 Male and female sex organs arise from the same undifferentiated tissue during the prenatal
period
 Hormones influence the development of male or female organs
 Male and female sex organs are similar, and their purpose and functions are complementary
o

o Sexual Response
 Sex drive, also known as sexual desire or libido, is a biological urge for sexual activity
 Testosterone is the principle hormone responsible for the sex drive in both men and women
 Produced by the testes in males and by the adrenal glands in both sexes
 People typically seek to satisfy the sex drive through physical stimulation and release, either
with a partner or through masturbation
o Sexual Arousal
 Sexual arousal on the physiological level involves vasocongestion and myotonia
 Vasocongestion: the inflow of blood to tissues in the erogenous areas
 Myotonia: the voluntary or involuntary muscle tension that occurs in response to sexual
stimulation
o The Human Sexual Response Model
 Excitement stage: arousal
 Plateau stage: leveling off of arousal immediately before orgasm
 Orgasm stage: rhythmic contraction in the genital area and a sensation of intense pleasure
 Resolution stage: return of the body back to an unexcited, relaxed stage
  Men enter a refractory period, lasting from minutes to hours
 Women do not experience a refractory period, and can experience multiple orgasms

 

o Orgasm
 Orgasm: physiological reflex usually felt as waves of intense pleasure accompanied by
contractions in the penis, vagina, or uterus
 Also influenced by physical, emotional, psychological, interpersonal, and environmental
factors
 Can be localized or generalized throughout the body
 About a third of women reach orgasm via intercourse, but many women need direct stimulation
of the clitoris to reach orgasm
 Some people pretend to reach orgasm
o Sexual Development and Health Across the Lifespan
 Biology of sexual and reproductive development is directed by hormones:
 Androgens: male sex hormones secreted by the testes
 Estrogens and progestins: produced by ovaries
 Stages of sexual development:
 In boys, voice deepens, facial hair grows, and onset of ejaculation occurs at puberty
 In girls, breasts develop, body fat increases, and menarche—onset of menstruation—occurs at
puberty
 Menses: flow of menstrual blood; the menstrual period
 Menopause: cessation of menstruation
 Men do not experience as dramatic a change in reproductive capacity in midlife as women
  These biological changes have only a marginal effect on sexual interest and activity
o Sexuality and Disability
 Most people with disabilities can have a rewarding sex life
 As an example, a person with a spinal cord injury may not be able to have an orgasm, but he or
she may be able to have intercourse, experience sensuous feelings in other parts of the body, or
have a child
 As in any relationship, the key is nurturing emotional as well as sexual intimacy
o Common Forms of Sexual Expression
 Rather than thinking in terms of “normalcy,” social scientists think of behavior as typical or
less typical
 Typical forms of sexual behavior and expression:
 Celibacy and abstinence
 Erotic touch (foreplay)
 Kissing
 Self-stimulation (autoerotic behaviors; masturbation)
 Oral-genital stimulation (cunnilingus; fellatio)
 Anal intercourse
 Vaginal intercourse (coitus)
o Atypical Sexual Behaviors and Paraphilias
 Atypical sexual behaviors are practiced by consenting partners
 Paraphilias are practiced by an individual
 Most have victims and are illegal, and many are classified as mental disorders
 Treatment focuses initially on reducing the danger to the patient and potential victims, and
then on strategies to suppress the behavior
 Examples of atypical sexual behaviors:
 Sexting
 Enacting sexual fantasies
 Sex toys
 Phone sex
 Bondage and discipline
 Sensory deprivation
 Examples of paraphilias:
 Making obscene phonecalls
 Exhibitionism
 Voyeurism
 Telephone scatologia
 Sexual sadism/masochism
 Pedophilia
 Sexual addiction is a compulsive, out-of-control sexual behavior that results in severe negative
consequences
 Sexual anorexia involves an intense fear of sexual contact or intimacy, a preoccupation with
sexual matters, rigid and judgmental attitudes toward sex, and shame and self-hatred over sex
o Sexual Dysfunctions
 Sexual dysfunction: disturbance in sexual drive, performance, or satisfaction that may occur at
any point in the sexual response cycle
 Most forms are treatable
o Female Sexual Dysfunctions
 Common sexual dysfunctions in women:
 Pain during intercourse (vaginismus)
 Kegel exercises may be recommended
 Sexual desire disorder and sexual discrepancy
 Female sexual arousal disorder
 Orgasmic dysfunction
 One approach to treatment is testosterone replacement therapy
 Another is Addyi, approved in 2015, which affects the neurotransmitter balance
o Male Sexual Dysfunctions
 Common sexual dysfunctions in men:
 Pain during intercourse
 Sexual desire disorder
 Erectile dysfunction (ED)
 Ejaculation dysfunction (premature ejaculation)
 Treatment often relies on testosterone and other medications; correcting unhealthy lifestyles
and working on relationships is also important
o Protecting Your Sexual Health
 Safer sex practices prevent the exchange of body fluids during sex
 “Outercourse” involves sex acts such as kissing and rubbing or stroking that do not involve
genital contact or penetration
 Another key to safeguarding your sexual health is communicating with your partner or
prospective partner about sex
o Using Condoms
 Condom (or male condom) fits over the erect penis and provides a barrier against infection or
pregnancy
 Female condom is inserted into the vagina and covers more of the genital area
 Spermicidal foam may also be used
 Pre-exposure prophylaxis (PrEP) pills taken in combination with condoms are used for people
at high risk for HIV
 Dental dams should be used during oral sex
o A New Generation of Condoms
 Primary advances have been the change to latex condoms and the inclusion of a reservoir tip
 Inconsistent use of condoms is a problem
 Non-use of condoms is a major contributor to increased HIV infections among gay men
 College students are more likely to have unprotected sex as they progress from freshmen to
seniors
 Gates Foundation is funding development of a new generation of condoms with the aim of
increasing their use and their effectiveness
o Communicating About Sex
 Communication is another key to safeguarding
your health
 Questions to ask:
 Are you having sex with anyone else?
 Have you ever had an STI?
  How many sexual partners have you had? As far as you know, did any of them ever have an
STI?
 When was the last time you were tested for STIs? Would you be willing to get tested along
with me?
 Are you willing to use condoms?
o Sex and Culture: Issues for the 21st Century
 Hooking up: casual sexual contact between nondating partners without an expectation of
forming a committed relationship
 Hook-up culture forgoes traditional dating in favor of attending parties or going to bars in
large groups to party, then hooking up for sex with casual friends or strangers
 Between 66% and 80% of college students hook up at some point in their college careers
 Theme parties and alcohol fuel hook-ups
o Abstinence
 Running counter to the hook-up culture are college students who are in favor of sexual
abstinence
 These students can be stigmatized, marginalized, or alienated
 Growing number of groups of conservative college students believe in abstinence until
marriage
 Princeton’s Anscombe Society
 Harvard’s True Love Revolution
 The Love and Fidelity Network
o Condom Accessibility on College Campuses
 Eighty-seven percent of college students report having had intercourse
 Only about half of college students engaging in vaginal sex use a condom
 Condom dispensers provide a low-cost, high-impact way to distribute free condoms on
college campuses
o Stealthing: Is it a Criminal Act?
 Disturbing new trend is stealthing: intentionally removing a condom during sex without
consent or knowledge of the sexual partner
 Law has been largely silent on stealthing
o Cybersex and Sexting
 Cybersex: virtual sexual encounters on the Internet including online porn, real-time
interactions, and multimedia software
 Sexting: sending nude, sexually explicit messages electronically, mostly by cell phone
 About 80% of college students engage in sexting
 Risk embarrassment or career damage if their phone is misplaced, stolen, or hacked
o Internet Pornography
 Internet has vastly increased pornography’s availability
 According to one report, one in four Internet users looks at a pornography website in any
given month
 Some sexual health experts argue that Internet pornography reduces health-risk behaviors by
managing sex drive effectively and safely
 Viewing pornography does seem to have negative effects on relationships
 Internet infidelity is an emotional or physical relationship from Internet usage that is viewed
by one partner as a breach of their relationship intimacy contract
o Revenge Porn and Revenge Sex
  Revenge porn: uploading explicit photos by a jilted
ex-lover/partner or someone seeking to humiliate or expose the victim
 Most common form is publishing a sext from one former lover to another
 Most states do not view the posting of a person’s personal information and photos without
their consent a crime
 Revenge (rebound) sex: sex to compensate for hurt feelings associated with getting “dumped”
 Tendency to indulge in it declines over time
o College Students and Sex Trafficking
 Sex trafficking: the use of force, fraud, or coercion to push a person into commercial sex
exploitation
 Commercial sex exploitation includes the promotion of sex acts that include prostitution,
pornography, and sexual performance for money, drugs, shelter, food, or clothing
 Many are not aware that it is a public health problem or that college students could be
victims of it
o The Future of Sex
 Sex technology has been evolving with the help of several innovations
 Virtual reality: immersive entertainment
 Teledildonics: remote use of sex toys via the Internet
 Augmented reality: an advanced virtual reality
 Direct neurostimulation: skin sensors enable users to see, hear, taste, smell, and feel sexual
pleasure
 Affective technology: sensors that may enable online users to share their degree of sexual
arousal with each other
 Sex robots: some envision lifelike pleasure robots by 2050
o Misuse of ED Drugs by Young Men
 Viagra and ED drugs are taken by young men who mistakenly believe they will quickly and
easily attain an erection that will allow them to have sex for hours
 Any effect these drugs seem to have is more likely a placebo effect
 Combining ED drugs with alcohol or illicit substances can be life-threatening
o Aphrodisiacs
 Aphrodisiacs include drugs, perfumes, and some foods resembling male and female anatomy
used as the magic potion for enhancing sexual pleasure
 Use of drugs for sexual pleasure has long been a part of the American culture
 Scientists have mixed views about their effectiveness
 Use of crystal meth in “party-and-play” sex marathons
 Often result in trauma to sex organs that increases risk for STIs
 Crystal meth can also cause erectile dysfunction
 Chapter 12: Reproductive Choices
o Reproductive Choices
 Are you ready to be a parent?
 Safe and effective methods of contraception are available
 Steps can be taken to increase the likelihood that pregnancy is a positive experience and the
baby is healthy
o Choosing a Contraceptive Method
 About half of all pregnancies in the United States are unintended
  Unintended pregnancies nearly always cause stress and life disruption and are associated
with poorer health outcomes
 Women with unintended pregnancies are less likely to receive adequate prenatal care and are
more likely to have babies with low birth weight
o Communicating About Contraception
 You and your partner should decide together how to protect each other from STIs and
unintended pregnancy
 Consider abstinence from intercourse if you cannot have a frank and open conversation on this
topic
o Which Contraceptive Method Is Right for You?
 Considerations:
 Effectiveness
 Cost
 Convenience
 Permanence
 Safety
 Protection against STIs
 Consistency with personal values
 Questions to consider when choosing a contraceptive method:
 How challenging would it be if you or your partner became pregnant now?
 Do you sometimes have sex under the influence of alcohol or drugs or have partners whose
sexual history you do not know?
 Do you already have the children you want or know you do not want children at all?
 How much can you afford to pay for contraception?
 Are you worried about the safety and health consequences of contraception?
 Is your choice influenced by your religious, spiritual, or ethical beliefs?
o Abstinence
 Abstinence is the only guaranteed method of preventing pregnancy and STI transmission
 In heterosexual couples who have vaginal intercourse and use no contraceptive method, 85%
of the women will become pregnant in one year
 Abstinence requires control and commitment
 Both partners should be free from sexual coercion
o The IUD
 Intrauterine device (IUD): small T-shaped device inserted into the uterus
 Long-acting reversible contraceptive
 Believed to work by altering the uterine and cervical fluids to reduce the chance that sperm
will move up into the fallopian tubes
 Women who choose this birth control method are taught how to check that the IUD is
properly located each month
 T-shaped IUD correctly positioned in the uterus.
 
o Contraceptive Implant
 Contraceptive implant: flexible plastic rod that contains progesterone inserted under skin of the
upper arm that slowly releases hormones
 Can be left in place for 3 years
 The most common side effect is irregular menstruation
 Many women will then stop having periods altogether
o Hormonal Contraceptive Methods
 Hormonal contraceptives deliver hormones to prevent ovulation and discourage implantation
of fertilized ova
 Prescribed or administered by a health care provider
 Advantages: effectiveness, ease of use, limited side effects, and do not permanently affect
fertility
 Disadvantages: no protection against STIs, minor side effects, rare serious side effects more
common in older women
 Types of hormonal contraceptive methods
 Birth control pills
 Transdermal patch, releasing hormones via the skin
 Vaginal contraceptive ring, placed in vagina
 Injectable contraceptive (Depo-Provera), every 3 months
 No hormonal methods are available for men
o Barrier Methods
 Barrier methods of contraception physically separate the sperm from the female reproductive
tract
 Condoms—male and female—are the only form of contraception that decreases the risk of
STIs
 Male condom is a sheath rolled down over the erect penis
 Female condom is a pouch inserted into the vagina
 Vaginal diaphragm: rubber dome inserted into the vagina
 Cervical cap: cuplike device that covers the cervix
 To increase effectiveness, the diaphragm and cervical cap should be used with spermicide, a
chemical agent that kills sperm
  Contraceptive sponge: small foam device presaturated with the spermicide nonoxynol-9,
moistened, and inserted into the vagina
 Use of the diaphragm.


 (a) With clean hands, place about 1 tablespoon of spermicide (jelly or cream) in the
diaphragm, spreading it around inside the diaphragm and on its rim. (b) Using the thumb
and forefinger, compress the diaphragm. Insert it into the vagina, guiding it toward the back
wall and up into the vagina as far as possible. (c) With the index finger, check the position
of the diaphragm to make sure that the cervix is covered completely and the front of the rim
is behind the pubic bone.
o Fertility Awareness–Based Methods
 Fertility awareness–based methods are based on abstinence during the window of time around
ovulation when a woman is most likely to conceive
 Standard days method is a calendar-tracking method used only by women who consistently
have a regular cycle that is 26 to 32 days
 Other methods of determining when ovulation has occurred are the temperature method
based, cervical mucus method, and symptothermal method
 
o Withdrawal
 Withdrawal, or coitus interruptus: the man removes his penis from the vagina before
ejaculating
 Success is dependent on a man’s ability to tell when he is about to ejaculate and to have the
self-control to withdraw with impending orgasm
 Because sperm can be present in pre-ejaculate, this method can fail even if a man withdraws
prior to ejaculation
 This method does not protect from STIs
o Emergency Contraception
 Emergency contraception (EC): morning-after pill, post-sex contraception, backup birth
control
 Reduces the chance of pregnancy by preventing ovulation
and fertilization
 Most effective if taken within 48 to 72 hours and must be taken within 5 days of unprotected
intercourse
 Useful when another method fails (condom breaks, or diaphragm or cervical cap slips)
 Useful in cases of forced sex—rape and incest
 ECs are not an abortogenic (abortion-causing) agent
o Permanent Contraception
 Permanent contraception: surgical procedures that permanently prevents future pregnancies
 Vasectomy: male sterilization procedure, involving tying off and severing the vas deferens to
prevent sperm from reaching the semen
 Tubal ligation or occlusion: female sterilization procedure involving severing and tying off or
sealing the fallopian tubes to prevent ova from reaching the uterus
 Vasectomy


 Tubal ligation


o Unintended Pregnancy
 It is important to see your physician or health provider as soon as possible to discuss options
 Carry the pregnancy to term and raise the child
 Carry the pregnancy to term and place the child with an adoptive family
 Terminate the pregnancy
o Signs of Pregnancy
 Prior to the classic sign of pregnancy—missing a period—there are others:
 Breast tenderness and swelling, fatigue, nausea and vomiting, light-headedness, mood swings
 Ectopic pregnancy: rare and potentially life-threatening complication of early pregnancy
 Signs include severe lower abdominal pain or cramping and vaginal spotting
  If you experience these signs, see your physician or go to the emergency room immediately
o Deciding to Become a Parent
 Are you ready to become a parent? Here are some questions to consider:
 What are your long-term plans?
 What is the status of your relationship?
 Do you feel emotionally mature enough?
 What are your financial resources?
 If you are the father, do you plan to be involved?
 How large is your social support system?
 What is your health status and age?
o Adoption
 Adoption provides a permanent family for a child in need
 Open adoption: biological parents help to choose the adoptive parents
 Closed adoption: biological parents do not choose the parents, and the adoption records are
sealed
 All forms of adoption require both biological parents to relinquish all parental rights
 For couples wanting to adopt, international adoptions are becoming increasingly popular in
America
o Elective Abortion
 Since Roe v. Wade (1973), terminating a pregnancy through elective abortion has been legal in
the U.S.
 Distinguished from spontaneous abortion, or miscarriage
 Some restrictions apply as the pregnancy advances through three trimesters
 Debate over abortion is one of the most highly charged political issues of our time
 Sixty-one percent of women having an abortion have one or more children already
 Surgical abortion: surgical removal of the contents of the uterus to terminate the pregnancy
 Vacuum aspiration is most common method
 Medical abortion: use of a medication to terminate the pregnancy
 Mifepristone (formerly known as RU-486)
o Fertility Care
 About 6% of couples attempting pregnancy are unable to conceive within a year and are
considered to have infertility
 Causes vary
 Genetics, infections, and environmental, chemical, or occupational exposures
 Low sperm count or lack of sperm motility
 Scarring of the fallopian tubes, endometriosis, or irregular ovulation
 Other, unknown causes
 Treatment ranges from counseling and advice
to surgery
 Open blocked fallopian tubes
 Correct anatomical problems
 Fertility (hormonal) drugs
 Intrauterine (artificial) insemination
 In vitro fertilization
 Gamete intrafallopian transfer
 Zygote intrafallopian transfer
o Pregnancy Planning
 Events and conditions during pregnancy influence the child’s development throughout life
 Best time to have a child is influenced by many factors: educational and career plans,
relationship status, health issues, and others
 Lowest health risk is when women have pregnancies between the age of 18 and 35
 Male fertility also declines with age
o Pregnancy Counseling
 Prepregnancy counseling typically includes an evaluation of current health status, health
behaviors, and family health history
 People who smoke, use drugs, or drink alcohol will be encouraged to quit before trying to
become pregnant
 Existing health conditions will be treated and medications adjusted to the safest options for
pregnancy
o Nutrition and Exercise
 Healthy lifestyle factors before conception help ensure required nutrients are available
 Folic acid in food or a supplement is recommended to reduce the risk of neural tube defects
 Foodborne infections can have more serious effects in pregnant women, so certain foods
should be avoided
 Weight gain during pregnancy varies; regular exercise is recommended to maintain muscle
strength and circulation
o Infection and Pregnancy
 Women should be up-to-date on routine vaccinations before pregnancy
 Especially important are vaccinations for rubella and hepatitis B
 Hepatitis B can be transmitted to the child during pregnancy and delivery (via vertical
transmission)
 Some infections during pregnancy increase risk of complications for a developing fetus
 Toxoplasmosis
 Zika
o Chronic Health Conditions
 Most substances the mother ingests eventually reach the fetus
 Teratogens cause physical damage or defects
 Tobacco and alcohol are the most commonly used drugs during pregnancy
 Alcohol use is linked to fetal alcohol syndrome (FAS)
 Tobacco use in the home is linked to sudden infant death syndrome (SIDS)
 Illicit drugs have a variety of effects on a fetus, depending on the chemical action of the drug
o Prenatal Care and Delivery Choices
 Pregnant women should visit their health care provider regularly for prenatal care
 Midwives usually take patients who are at low risk for medical or pregnancy complications
 Your family physician may provide pregnancy-related care, and some deliver babies in
birthing centers or hospitals
 Obstetricians are trained to handle all kinds of pregnancies, from low risk to high risk
o Complications of Pregnancy
 U.S. rates of maternal and infant death are higher than the rates in 16 peer countries
 Approximately 15 to 50% of all pregnancies end in miscarriage, most during the first trimester
 Gestational diabetes occurs in some women midway thought the pregnancy
  Women with gestational diabetes are advised to exercise, control their diet, and monitor
glucose levels
 Preeclampsia: dangerous condition characterized by high blood pressure, fluid retention,
possible kidney and liver damage, and potential fetal death
 Signs include facial swelling, headaches, blurred vision, nausea, and vomiting
 Can progress to eclampsia, a potentially life-threatening condition marked by seizures and
coma
 Complications of pregnancy for the child:
 In a third of fetal deaths, no cause is clearly identified
 In the other cases, the loss was most commonly related to abnormalities in the placenta; the
fetus being affected by complications in the mother’s health; or congenital abnormalities of
the fetus
 After birth, the leading cause of death are preterm birth, low birth weight, and SIDS
 There has been a recent increase in Black infant mortality
 The rate of death from preterm birth and low birth weight is four times higher for Black
infants than for White infants
o Fetal Development
 Within 30 minutes of fertilization the single-celled fertilized ovum (zygote) starts to divide
 Week 2 to week 8 is the embryonic period: formation of embryo, placenta, and amniotic sac
 By 8 weeks, all major body systems and organs are present in rudimentary form
 By 16 weeks, the mother can feel fetal movements
 By 26 weeks, eyes are open
 At 30 weeks a layer of fat begins forming under the skin
 Fetus has excellent chance of survival at 36 weeks
 Full term at 38 weeks
o Diagnosing Problems in a Fetus
 About 5% of babies born in the United States have a birth defect
 Several tests have been developed to detect abnormalities in a fetus prior to birth
 Ultrasound
 Chromosomal analysis
 Amniocentesis
 Chorionic villus sampling (CVS)
o Labor and Delivery
 Labor begins when hormonal changes in the fetus and the mother cause strong uterine
contractions
 Early first stage: cervix thins and begins to open
 Second stage: baby moves downward through the pelvis, cervix, and into the vagina; head
emerges, followed by the shoulders and body
 Third stage: contractions continue, and placenta (afterbirth) is expelled
 Certain difficulties for mother and baby suggest use of a cesarean section (C-section): surgical
delivery
 

o Newborn Screening
 Babies are evaluated at birth to determine whether they require any medical attention or will
need developmental support later
 Apgar scale is used as a quick measure of the baby’s physical condition
 Most babies are pronounced healthy and taken home within 24 to 48 hours of birth
o The Postpartum Period
 First few weeks or months of parenthood are a period of profound adjustment as parents learn
how to care for their newborn (or neonate)
 Issues for the newborn that deserve attention:
 Growth and nutrition
 Illness and vaccinations
 Adjustment and attachment
 Attachment: a deep emotional bond that develops between an infant and its primary
caregivers
 About 13% of women experience depression in the first year after giving birth, referred to as
postpartum depression
 Can be due to hormone changes, broken sleep patterns,
self-doubt, a sense of loss of control, and changes in support systems
 Can contribute to feelings of sadness, restlessness, loss of interest, guilt, difficulty focusing,
and withdrawal
 Effective treatments exist; partners should be aware of signs and symptoms
 Chapter 13: Infectious Diseases
o The Process of Infection
  Infection: disease or condition caused by a microorganism
 Microorganisms are the tiniest living organisms on earth that eat, reproduce, and die
 Infection is considered an illness or disease if it interferes with your usual lifestyle or shortens
your life
 Process of infection often follows a typical course, with the length of each stage depending on
the pathogen, an infectious agent capable of causing disease

o

o The Chain of Infection

 Chain of infection: the process by which an infectious agent, or pathogen, passes from one
organism to another
 Pathogens often live in large communities, called reservoirs
 Some cannot survive in the environment and require a living host
 To cause infection, they must have a portal of exit from the reservoir or host, and a portal of
entry into a new host
 If the transfer from the reservoir or host is carried out by an insect or animal, that organism is
called a vector
 Breaking the chain of infection at any point can either increase or decrease the risk of infection
 Virulence: speed and intensity with which a pathogen is likely to cause an infection
 Epidemic: widespread outbreak of a disease that affects many people
 

o Pathogens
 Viruses: tiny pathogens consisting of a genome (DNA or RNA) and protein covering
 Examples: HIV; common cold (over 200 viruses); influenza; human papillomavirus (warts,
cervical cancer); hepatitis A, B, C; polio; rabies
 Bacteria: single-celled organisms that are spherical, rodlike, or spiral in shape
 Staphylococcus aureus and MRSA; Neisseria meningitides (meningitis); chlamydia;
gonorrhea; tuberculosis
 Prions: organisms believed to consist entirely of protein
 Bovine spongiform encephalopathy (mad cow disease); Creutzfeldt-Jakob disease (CJD);
Kuru
 Fungi: single-celled or multicelled organisms
 Candidiasis (yeast infection); tinea (athlete’s foot, ringworm); histoplasmosis
 Helminths: parasitic worms that live on or in host
 Hookworm; pinworm; tapeworm; liver flukes
 Protozoa: single-celled organisms that generally live independently of host
 Giardia; toxoplasmosis; amebiasis; malaria; trichomoniasis
 Ectoparasites: complex organisms that usually live on the host’s skin
 Fleas; ticks; lice; scabies; bed bugs
o External Barriers
 Physical barriers
 Skin is the body’s first line of defense
 Nasal passages and ear canals are protected by hair
 Lungs are protected by the cough reflex and cilia
 Chemical barriers
 Saliva contains proteins that break down bacteria
 Stomach acids, difficult for most organisms to survive
 Small intestines contain bile and enzymes that break down pathogens
 Vagina is slightly acidic, discouraging the growth of abnormal bacteria
o The Immune System
  Immune system: complex set of cells, chemicals, and processes that protects the body against
pathogens when they succeed in entering the body
 Innate immune system: part of the immune system designed to rapidly dispose of pathogens
in a nonspecific manner
 Acquired immune system: highly specialized response that recognizes specific targets
o Innate Immune System
 Acute inflammatory response: the body’s initial reaction to tissue damage, bringing blood to
the site of injury or infection
 Cells of the innate immune system:
 Neutrophils and macrophages: white blood cells that travel to areas of infection or tissue
damage and digest damaged cells, foreign particles, and bacteria
 Natural killer cells: white blood cells that recognize and destroy virus-infected cells or those
that have become cancerous
o Acquired Immune System
 Develops as you are exposed to potential infections and vaccinations
 Lymphocytes: white blood cells that circulate in the bloodstream and lymphatic system
 If lymphocytes encounter an antigen—a marker on the surface of a foreign substance—they
rapidly duplicate and “turn on” their specific function
 To main types of lymphocytes: T cells and B cells
 T cells monitor events inside cells
 Helper T cells “read” cells’ infection messages and trigger production of killer T cells and B
cells
 Killer T cells attack and kill foreign cells and infected body cells
 Suppressor T cells slow down and halt the immune response when the threat has been
handled
 B cells monitor the blood and tissue fluids
 When they encounter a specific antigen, they mature and produce antibodies: proteins that
bind to specific antigens and trigger their destruction
o Immunity
 After surviving infection by a pathogen, you often acquire immunity to any future infections
by the same pathogen
 B and T cells become memory cells when exposed to an infectious agent, allowing
recognition and quick action to destroy the invader
 b: preparation of weakened or killed microorganisms administered to confer immunity
 Protects you by stimulating an immune response
 Protects society by shrinking the reservoir of infectious agents
o Recommended Adult Immunizations
 Recommended as of 2017 for all persons who meet the age requirement and lack
documentation of vaccination or past infection (all covered by the Vaccine Injury
Compensation Program):
 Influenza: all adults, 1 dose annually; covered by the Vaccine Injury Compensation Program
 Tetanus, diphtheria, pertussis (Td/Tdap): all adults, substitute Tdap for
Td once, then Td booster every 10 years
 Varicella: all adults, lifetime, 2 doses
 Human papillomavirus (HPV), Female: aged 19 to 26, 3 doses
 Human papillomavirus (HPV), Male: aged 19 to 21, 3 doses
  Zoster: aged 60 and over, 1 dose
 Measles, mumps, rubella (MMR): aged 19 to late 50s, 1 or 2 doses depending on indication
 Pneumococcal 13-valent conjugate (PCV13): aged 65 and older, 1 dose
 Pneumococcal polysaccharide (PPSV23): aged 65 and older, 1 dose
 Human papillomavirus (HPV), Male: aged 22 to 26 years, 3 doses
 Pneumococcal 13-valent conjugate (PCV13): aged 19 to 65 years
 Pneumococcal polysaccharide (PPSV23): aged 19 to 65 years, 1 or 2 doses depending on
indication
 Hepatitis A: any age, 2 or 3 doses depending on indication
 Hepatitis B: any age, 3 doses
 Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4): any age, 1 or
more doses depending on indication
 Meningococcal B (MenB): any age, 2 or 3 doses depending on vaccine
 Haemophilus influenza type b (Hib): any age, 1 or 3 doses depending on indication
o Risk Factors for Infection
 Controllable risk factors:
 Eating a balanced diet
 Exercising
 Getting enough sleep
 Managing stress properly
 Receiving vaccinations, when available
 Good hygiene
 Protecting skin from damage
 Avoiding tobacco and environmental tobacco smoke
 Uncontrollable risk factors:
 Age
 There is higher risk at both ends of the lifespan
 Infants have passive immunity—temporary immunity from antibodies in pregnancy and
breastfeeding
 Genetics
 Uncontrollable sociocultural factors
 Overcrowded living environments
 Poverty
o Disruption of Immunity
 Immune system can malfunction
 Autoimmune diseases: the immune system mistakenly identifies a part of the body as
“nonself” and creates an immune response, causing damage to body cells and tissues
 Allergies: the body identifies a harmless foreign substance as an antigen and creates an
immune response
 Anaphylactic shock: life-threatening systemic allergic response requiring immediate
medical attention
 Immunity and stress: long-term stress, especially, can suppress the immune system, leading to
illness
o Changing Patterns in Infectious Disease
 Because of the dramatic declines in the death rate from infectious diseases during the 20th the
U.S. surgeon general in 1969 declared that it was time to close the book on infectious diseases
  He was wrong
 Within a little more than 10 years, HIV was causing perplexity and alarm in hospitals in
several U.S. cities
 Today there are new infections, changes in patterns of old ones, and antibiotic resistance in
still others
o Food-Related Pathogen Transmission
 More than 250 organisms are associated with
food-related illnesses
 Complexity of the U.S. food system means most foods travel a thousand miles or more
before reaching the table
 Risk of contaminated food is increased
 Number of people that can be infected is increased
 Difficulty of tracking infection back to the source also increases
o Behavior-Related Pathogen Transmission
 Travel: SARS outbreak (2003)
 Climate change: changing patterns of infectious disease, especially water-borne and vector-
borne diseases
 Sexual behavior: three key factors in exposure to an STI are partner variables, personal
susceptibility variables, and sex act variables
 Illicit drug use: Use of contaminated needles and syringes; hepatitis C
o Antibiotic Resistance
 Antibiotic: drug that works by killing or preventing the growth of bacteria
 Antibiotic resistance: lessened sensitivity to the effects of an antibiotic
 Two factors are believed to account for antibiotic resistance:
 Frequency with which resistant genes arise naturally among bacteria through mutation
 Inappropriate use of antibiotics in health care, home care, and food production
o Vaccination Controversies
 As vaccine-prevented diseases become less common, people begin to question the necessity
and safety of the vaccines
 Serious reactions to currently recommended vaccinations are very rare
 If rates of vaccination drop, the likelihood of a disease recurrence increases
o Global Infectious Diseases
 Four leading causes of global infectious disease mortality:
 Pneumonia: infection of the lungs or lower respiratory tract; can be viral or bacterial
 Leading cause of death in children after the first month; leading cause of death in low-
income countries; and third most common cause of death for all ages worldwide
 Diarrhea: kills an estimated 499,000 children per year
 Tuberculosis: world’s most common infectious disease
 Latent infection: not currently active but could reactivate
 Malaria: mosquito-borne disease that caused 429,000 deaths in 2015
o Infectious Diseases on Campus
 Pertussis (whooping cough): infection of the respiratory tract that is highly contagious
 Staphylococcus aureus skin infections: from a common bacterium carried on the skin or in the
noses of healthy people
 Urinary tract infections (UTIs): most common bacterial infection in women
o Sexually Transmitted Infections
  Sexually transmitted infections (STI) are spread predominantly through sexual contact
 Preferred terminology over sexually transmitted disease (STD), because often there are no
symptoms
 Primary pathogens: viruses and bacteria
o HIV/AIDS
 Cause: Human immunodeficiency virus (HIV) attacks cells of the immune system, especially
macrophages and CD4 cells (a subcategory of helper T cells)
 Uses the cell’s DNA to replicate itself
 Course of the disease:
 Early symptoms are easily mistaken for other infections
 Eventually the immune system can no longer function fully, signaling the onset of acquired
immune deficiency syndrome (AIDS)
 Opportunistic infections produce symptoms
 Rapid weight loss
 Cough
 Night sweats
 Diarrhea
 Rashes or skin blemishes
 Memory loss
 Methods of transmission:
 Sexual conduct
 Injection drug use
 Contact with infected blood or body fluids
 Mother-to-child transmission
 Universal precautions are taken in health care settings
o HIV Testing
 Many kinds of tests can now be done
 CDC recommends testing at least once for anyone between the ages of 13 and 64
 HIV testing is particularly recommended if you:
 Are pregnant or planning to get pregnant
 Have had sex with someone who is HIV positive or you did not know the person’s status
 Have used IV drugs and shared drug equipment
 Have exchanged sex for drugs or money
 Have been diagnosed with another STI
 Have been sexually assaulted
o Management of HIV/AIDS
 Antiretroviral agents do not cure the infection, but they slow the rate of replication and
destruction, prolonging life and improving quality of life
 Drug cocktails: complicated drug combinations that combat the development of resistant viral
strains
 Complexity, cost, and risk of side effects increase
o Prevention
 Reducing the risk of infection
 Adult male circumcision
 Vaccine trials are under way
 Empowering women
  New prevention strategies continue to be developed
 Treatment as Prevention (TasP)
 Post-exposure Prophylaxis (PEP)
 Pre-exposure Prophylaxis (PrEP)
o Bacterial STIs
 Chlamydia: most common bacterial STI; young women at greatest risk
 Gonorrhea: highest rates in young women; rates in Blacks 4.4 times higher than Whites
 Pelvic inflammatory disease (PID): infection of uterus, fallopian tubes, and/or ovaries
 Syphilis: if untreated, can lead to serious complications
 Bacterial vaginosis (BV): alteration of the normal vaginal flora
o Viral STIs
 Human papillomavirus (HPV):
 Most common STI in the U.S; more than 40 types
 HPV is transmitted by skin-to-skin contact, usually through penetrative vaginal or anal sex,
but it can be transmitted with oral sex and from woman to woman
 Most women with HPV are diagnosed through screening with the Papanicolaou smear (Pap
test)
 Genital herpes
 Two strains of herpes simplex virus are HSV-1 and HSV-2
 HSV-2 is associated with a higher likelihood of recurrent symptoms than HSV-1
 No cure; prevention particularly important
 Hepatitis: inflammation of the liver
 Most common viral causes are hepatitis A, B, and C
 A safe and effective vaccine is available for hepatitis A and B
 Most hepatitis B infections in the U.S. are sexually transmitted
o Other STIs
 Trichomoniasis: caused by a protozoan; transmitted from person to person by sexual activity
 Candidiasis: vaginal yeast infection
 Pubic lice and scabies: in adults, most often sexually transmitted
o Prevention of Infectious Diseases
 Support your immune system by adopting healthy lifestyle practices
 Cover your cough
 Avoid touching your face or mouth
 Get an annual flu shot and booster vaccines as recommended
 Minimize your use of antibiotics
 If exposed, minimize chances of passing it on
 Practice the ABCDs of STI prevention:
 A for abstain: Abstain from sex until you are ready for a
long-term relationship, and abstain between relationships
 B for be faithful: Be faithful and maintain a monogamous relationship
 C for condoms: Use condoms
 D for detection: Promote detection by being tested and following recommended screening
guidelines
 When you travel, learn about potential infections at your destination
 Take steps to prevent new diseases from taking hold in your community
 Chapter 14: Cardiovascular Disease, Diabetes, and Chronic Lung Diseases
o Cardiovascular disease (CVD): any disease involving the heart and/or blood vessels
 Currently the leading cause of death in the United States, accounting for one in three deaths
 CVD is a general term for diseases that include heart attack, stroke, peripheral artery disease,
congestive failure, and others
 Disease process underlying many forms of CVD is atherosclerosis, or hardening of the arteries
 Percentage of deaths from types of CVD, United States, 2014


o The Cardiovascular System
 Cardiovascular system: the heart and blood vessels that circulate blood throughout the body
 Pulmonary (lung) circulation: the pumping of oxygen-poor blood to the lungs and oxygen-rich
blood back to the heart by the right side of the heart
 Systemic (body) circulation: the pumping of oxygen-rich blood to the body and oxygen-poor
blood back to the heart by the left side of the heart
 Aorta: largest artery in the body
 Leaves the heart and branches into smaller arteries, arterioles, and capillaries carrying
oxygen-rich blood to body tissues
 Inferior and superior vena cava: largest veins
 Carry oxygen-poor blood from the body back to the heart
 Coronary arteries: medium-sized arteries that supply oxygen- and nutrient-rich blood to the
heart muscle
 Sinus node or sinoatrial (SA) node: group of cells in the right atrium where the electrical signal
is generated that establishes the heartbeat
o

o Atherosclerosis
 Atherosclerosis is a common form of arteriosclerosis that involves a thickening or hardening of
the arteries due to buildup of fats and other substances
 Damage to the inner lining leads to formation of a fatty streak—an accumulation of
lipoproteins: a combination of proteins, phospholipids, and cholesterol
 Together with white blood cells, collagen and other proteins form a plaque (accumulation of
debris)
 Reduces the amount of blood that can reach the tissue
 Plaque can break off and completely block artery
 Stretching of the weakened artery wall can also cause an aneurysm that can tear or rupture,
causing sudden death
 
o Coronary Heart Disease and Heart Attack
 Coronary heart disease (CHD): atherosclerosis of the coronary arteries, which can result in a
heart attack
 CHD is the leading form of all cardiovascular diseases
 About 16.5 million Americans are living with CHD
 Those who survive a heart attack are often left with damaged hearts and significantly altered
lives
 Ischemia: insufficient supply of oxygen and nutrients to tissue, caused by narrowed or blocked
arteries
 Myocardial infarction: lack of blood flow to the heart muscle with resulting death of heart
tissue, often called a heart attack
 Coronary thrombosis: blockage of a coronary artery by a blood clot that may cause sudden
death
 Angina: pain, pressure, heaviness, or tightness in the center of the chest caused by a narrowed
coronary artery
o Arrhythmias and Sudden Cardiac Death
 Arrhythmia: irregular or disorganized heartbeat
 Normal adult heart rate is 60 to 100 beats per minute
 Sudden cardiac death: abrupt loss of heart function caused by an irregular or ineffective
heartbeat
 Ventricular fibrillation: type of arrhythmia in which the ventricles contract rapidly and
erratically, causing the heart to quiver or “tremor” rather than beat
o Stroke
 Stroke or cerebrovascular accident (CVA): when blood flow to the brain or part of the brain is
blocked
 Fifth-leading cause of death in the United States and a leading cause of severe, long-term
disability
 Ischemic stroke: caused by blockage in a blood vessel in the brain; accounts for 87% of all
strokes
 Thrombus: blood clot in a narrowed artery
 Embolism: blood clot elsewhere that travels to the brain
 Hemorrhagic stroke: caused by rupture of a blood vessel in the brain, with bleeding into brain
tissue
 Transient ischemic attacks (TIAs), or “ministrokes”: periods of restricted blood supply that
produce stroke symptoms


 Hemorrhagic stroke: caused by ruptured blood vessels followed by blood leaking into tissue
 Ischemic stroke: caused by blockage in brain blood vessels; potentially treatable with clot-
busting drugs; less serious than hemorrhagic stroke
 Subarachnoid hemorrhage: a bleed into the space between the brain and the skull
 Intracerebral hemorrhage: a bleed from a blood vessel into the brain
 Embolic stroke: caused by emboli, blood clots that travel from elsewhere in the body to the
brain blood vessels
 Thrombotic stroke: caused by thrombi, blood clots that form where an artery has been
narrowed by atherosclerosis
o Congestive Heart Failure
 Congestive heart failure: heart is not pumping the blood as well as it should, allowing blood
and fluids to back up in the lungs
 Can develop after a heart attack or as a result of hypertension, heart valve abnormality, or
disease of the heart muscle
 Person with this condition experiences difficulty breathing, shortness of breath, coughing,
fatigue, and confusion
o Other Cardiovascular Diseases
  Heart valve disorders: when one of the four heart valves does not open well or does not close
tightly
 Congenital heart disease: structural defect at birth
 Peripheral vascular disease (PVD): result of atherosclerosis in the arms and legs
 Cardiomyopathy: disease of the heart muscle
 Dilated cardiomyopathy: enlargement of the heart in response to weakening of the muscle
 Hypertrophic cardiomyopathy: abnormal thickening of one part of the heart, frequently the
left ventricle
o Promoting Cardiovascular Health
 Life’s Simple 7 campaign:
 Four health behaviors contribute to ideal cardiovascular health
 Avoid Tobacco
 Eat a Healthy Diet
 Be Physically Active
 Maintain a Healthy Body Mass Index
 Three measurable health factors also contribute
 Maintain Healthy Blood Pressure Levels
 Maintain Healthy Blood Glucose Levels
 Maintain Healthy Cholesterol Levels
 Avoid tobacco
 Tobacco use is the leading risk factor for all forms of CVD
 Tobacco smoke increases risk in a variety of ways
 Damages the inner lining of blood vessels, speeding up the development of atherosclerosis
 Stimulates the formation of blood clots in the coronary arteries and trigger spasms that close
off the vessels
 Raises blood levels of LDL cholesterol (“bad” cholesterol)
 Decreases blood levels of HDL cholesterol (“good” cholesterol)
 Eat a healthy diet
 Diet should emphasize fruits, vegetables, whole grains, low-fat dairy products, fish, and lean
meat and poultry
 Be physically active
 Physical activity conditions the heart, reduces high blood pressure, improves HDL
cholesterol levels, helps maintain a healthy weight, and helps control diabetes
 Maintain a healthy body mass index
 Excess weight strains the heart and contributes to other risk factors, such as hypertension,
high LDL levels, and diabetes
o Maintain Healthy Blood Pressure Levels
 Blood pressure: exerted by blood against artery walls
 Systolic pressure: produced by the heart contracting and pushing blood out into the arteries;
the top number
 Diastolic pressure: in the arteries when the heart muscle is relaxed and the ventricles are
filling
 Hypertension: high blood pressure, forceful enough to damage artery walls
 Untreated hypertension can weaken and scar the arteries and make the heart work harder; and
increases risk for heart attack, stroke, congestive heart failure, and kidney disease
o Blood Pressure Guidelines
 
o Maintain Healthy Blood Glucose Levels
 Elevated levels of glucose in the body cause damage to artery walls, changes in some blood
components, and damage to peripheral nerves and organs
 People with diabetes are twice as likely to develop cardiovascular disease
o Maintain Healthy Cholesterol Levels
 Low-density lipoproteins (LDLs): “bad cholesterol” associated with atherosclerosis
 Higher the LDL level, the higher the risk
 Cholesterol-lowering statin therapy can reduce risk
 For those with a history of cardiovascular disease
 For those with LDL cholesterol over 190 mg/dl
 For those over 40 with diabetes and LDL cholesterol over 70 mg/dl
 For those with a 10-year risk of heart attack greater than 7.5%
 High-density lipoproteins (HDLs): “good” cholesterol
 Help clear cholesterol from cells and atherosclerotic deposits
o Contributing Factors in Cardiovascular Health
 Triglyceride levels
 Triglycerides: blood fats similar to cholesterol
 High levels are a risk factor for CVD
 Alcohol intake
 Heavy drinking can damage the heart
 Light drinking can increase HDL levels, and therefore may help protect against heart disease
and stroke risk
 Mental well-being
 Acute and chronic psychological stress has significant impacts on health
 Sleep
 Too little or too much sleep is associated with increased risk for cardiovascular disease
 Socioeconomic status
 Low socioeconomic status is associated with an increased risk of CVD and other chronic
diseases
 Lack of access to healthcare, healthy food, and shelter
 Age
 Probably the most important noncontrollable risk factor
  Deaths due to heart disease and stroke rise significantly after age 65, due to the accumulation
of risk factors
 Gender
 Women tend to develop heart disease about 10 years later than men, but after 50 the
difference in risk between men and women starts to decrease
 Postmenopausal status
 Hormone replacement therapy does not reduce risk for CVD and may increase the risk of
CVD in women over 60
 Genetics and family history
 High rates of CVD in a family may be related to genetics or lifestyle patterns or both
o Areas of Interest for Future CVD Research
 Researchers are looking at how the following are associated with CVD:
 Low levels of vitamin D
 High blood levels of homocysteine, an amino acid
 Metabolic syndrome
 Inflammation and high levels of C-reactive protein
 Lower birth weight
o Testing and Treatment
 People with no symptoms of CVD are usually not tested for evidence of disease
 One exception is people in certain occupations, such as airline pilots or truck drivers, whose
sudden incapacity would place other people at risk
o Diagnostic Testing for Heart Disease
 Electrocardiogram (ECG or EKG) to detect abnormal rhythms, inadequate blood flow, and
heart enlargement
 Echocardiogram (like an ultrasound) to visualize the heart structure and motion
 Exercise stress test to evaluate heart functioning
o Diagnostic Testing for Stroke
 CT scan or an MRI can generate images of the brain and blood flow and determine whether a
stroke has occurred
 These tests can also show whether a stroke has been caused by a blockage or by a hemorrhage
 Further testing may be done to find the source of any blockage
o Management of Heart Disease
 Medications, especially anti-arrhythmics, anti-anginals, and anti-coagulants
 Surgeries, such as angioplasty (balloon catheter), a coronary stent, or coronary artery bypass
grafting
o Management of Stroke
 If thrombotic: thrombolytic medications
 If hemorrhagic: it depends on the underlying cause of the bleed; sometimes surgery is
necessary
 Rehabilitation, usually including physical therapy, is an important component
o Diabetes
 Diabetes: a metabolic disorder in which production or use of insulin is disrupted
 Most common disorder of the endocrine or metabolic system, and the seventh leading cause
of death in the U.S.
 Rates of diabetes have been increasing steadily in the past 30 years
  Minority and low socioeconomic populations are disproportionately affected, and in these
populations rates continue to rise
 Normal insulin and glucose uptake, and with Type-1 and Type 2 diabetes
Normal

A healthy person’s body releases a normal amount of insulin from

the pancreas after meals. Insulin binds to receptors on the surface of
a cell and signals special transporters in the cell to transport glucose
inside.

Type-1 diabetes

The pancreas produces little or no insulin. Thus, no signal is sent

instructing the cell to transport glucose, and glucose builds up in the
bloodstream.

Type-2 diabetes

The pancreas produces too little insulin and/or the body’s cells are
resistant to it. Some insulin binds to receptors on the cell’s surface,
but the signal to transport glucose is blocked. Glucose builds up in
the bloodstream.


o Type-1 Diabetes
 Caused by the destruction of insulin-producing cells in the pancreas by the immune system
 Insulin must be provided from an external source to keep blood glucose levels under control
 Onset usually occurs before age 20
 Probably a result of a combination of genetic, autoimmune, and environmental factors
 Physical activity is an important component of control and reduction in long-term
complications
o Type-2 Diabetes
 ed by insulin resistance in insulin receptors
 Pancreas responds by increasing production of insulin, but eventually cannot keep up
 Accounts for 90 to 95% of all diabetes cases
 Incidence rising in parallel with obesity levels
 Prediabetes: fasting blood glucose levels between 100 and 125 mg/dl
  Dietary changes, exercise, and weight loss can prevent or delay onset
o Risk Factors
 Type-2 diabetes is a multifactorial disease with an increased risk if there is a family history of
diabetes and other risk factors
 Higher abdominal fat
 Lack of physical activity
 Being over 40 years old
 Racial and ethnic minorities and people with low socioeconomic status are disproportionately
affected
 Metabolic syndrome is a set of conditions that significantly increases the risk for developing
diabetes and other health complications
 Fasting glucose level at or above 100
 HDL cholesterol under 40 in men, or under 50 in women
 Triglycerides at or above 150
 Waist circumference at or above 40″ for men; or at or above 35″ for women
 Systolic blood pressure at or above 130 and diastolic blood pressure at or above 85
o Prevention and Treatment
 Screening involves tests for blood glucose levels
 Dietary changes, exercise, and weight loss can prevent diabetes, delay its onset, and treat it
 Treatment includes lifestyle modification, oral medications, and eventually insulin
replacement
 Exercise is especially important
 Long-term control is monitored by a blood test called the hemoglobin A1c test
 Closer blood glucose is to the normal range, the lower the risk of complications
o Gestational Diabetes
 Develops in 2 to 10% of pregnancies
 Hormonal changes affect the body’s response to insulin
 Higher risk for pregnancies after age 35
 In 5 to 10% of cases, diabetes becomes an ongoing condition
 Women with a history of gestational diabetes are at a higher risk of developing diabetes in the
next 10 to 20 years
o Chronic Lung Diseases
 Also known as chronic lower respiratory diseases, chronic lung diseases are the third leading
cause of death in the U.S.
 Two most common forms:
 Asthma
 Larger genetic component
 Chronic obstructive pulmonary disease (COPD)
 More typical in older adults
 Both are triggered by smoking, infection, and pollution
 The respiratory system
 
 Air, breathed in, travels down the trachea and enters the lungs through the bronchi
(bronchial tubes)
 Bronchi carry air through bronchioles (a series of branching airways) into alveoli (tiny air
sacs), which are surrounded by capillaries (tiny blood vessels) where gas exchange takes
place
 Oxygen is passed from the alveoli into the blood in capillaries, and carbon dioxide moves
from the capillaries into the alveoli
 Carbon dioxide is then pushed back through the bronchioles and exhaled, while oxygen
travels through the bloodstream to body cells
o Asthma
 Asthma is the most common chronic lung condition
 In asthma, the lining of the airways becomes inflamed and swollen, narrowing the airway
passage, and excess mucus is produced
 Risk factors and triggers:
 Chronic inflammation, obstruction, and constriction of the airways, causing wheezing,
coughing, chest tightness, and shortness of breath
 Attack occurs in response to a trigger—an allergen or an irritant in the air
o Detection and Treatment
 Diagnostic categories:
 Intermittent: no symptoms between episodes
 Mild persistent: symptoms a few times a week
 Moderate: daily symptoms limit some normal activity
 Severe: daily symptoms place extreme limits on normal activity
 Bronchodilators: quick-relief medications used during an attack to reduce symptoms
 Delivered through an inhaler
 For long-term control:
 Inhaled steroid that works within the bronchioles to reduce inflammation
 Avoidance of common triggers such as tobacco smoke, allergens, and air pollution
 Flu shots are recommended if viruses and infections are triggers
 o Chronic Obstructive Pulmonary Disease
 COPD tends to develop from cumulative damage to airways and alveoli; the primary cause is
smoking
 Chronic bronchitis: persistent inflammation of the bronchioles; excess mucus
 Bronchial congestion and a chronic cough
 Emphysema: alveoli become less elastic, and walls between alveoli are damaged or destroyed
 Person is breathless and gasps for air; and the heart is strained
 Cannot be reversed; supplemental oxygen may be necessary at later stages
o Preventing Chronic Diseases
 Review:
 Eat a heart-healthy diet
 Maintain a healthy weight
 Don’t smoke, and avoid secondhand smoke
 Be physically active
 Limit alcohol consumption
 Maintain healthy blood pressure levels
 Maintain healthy lipid levels
 Maintain healthy blood glucose levels
 Manage stress, and take care of your mental, emotional, and social health
 Chapter 15: Cancer
o What Is Cancer?
 Cancer is a condition characterized by the uncontrolled growth of cells
 Develops from a single cell that goes awry; but a combination of events must occur before
the cell turns into a tumor
 Process is called clonal growth: replication of a single cell that produces thousands of copies
of itself in an uncontrolled manner
o Healthy Cell Growth
 Healthy cells have a complicated system of checks and balances that control cell growth and
division
 Healthy cells divide when needed to replace cells that have died or been sloughed off
 Each time a cell divides, there is the possibility of mutation or an error in DNA replication
 Stem cells: undifferentiated cells that can give rise to specialized cells
 Because they do not have a predetermined number of cell divisions they pose a risk for cancer
 Stem cells are located deep within tissues and are protected from factors that increase the risk
of genetic mutations (exposure to the sun, chemicals, and irritation)
o Cancer Cell Growth
 Cancer starts from a single cell that undergoes a critical mutation
 Initiating event in the cell’s DNA allows a cell to evade normal cell restraints
 Error in duplication
 Exposure to a carcinogen (cancer-causing substance)
 Radiation
 Escaping all the control mechanisms to become a cancer may take many years
 Oncogene: gene that drives a cell to grow and divide regardless of signals from surrounding
cells
 Tumor: a mass of extra tissues that may form into either a benign or malignant tumor
 Benign tumor: slow growth, unlikely to spread
  Malignant tumor: capable of spread to surrounding tissues
 Metastasis: cancer that has spread from one part of the body to another
o Classifying Cancers
 Cancers are classified according to the tissue in which they originate, called the primary site
 Cancer still at its primary site is localized
 When metastasized, it is invasive
 Most common sites of metastases: the brain, liver, and bone marrow
 Stage of the disease is a description of how far the cancer has spread
 One common staging system:
 Stage 0: cancer in situ (present only in the layer of cells where it began)
 Stage I: small and localized
 Stages II and III: locally advanced; may involve lymph nodes
 Stage IV: metastasized to distant sites
o Types of Cancer
 Carcinomas: arise from epithelial tissue (skin, lining of the intestines and body cavities, surface
of body organs, outer portions of glands)
 Sarcomas: arise in connective tissue (bone, tendon, cartilage, muscle, fat tissues)
 Leukemias: cancers of the blood that originate in the bone marrow or the lymphatic system
 Lymphomas: cancers that originate in lymph nodes or glands
o Risk Factors for Cancer
 Family history
 Family history of cancer alters some cancer screening recommendations
 Genes interact with environmental exposures and lifestyle behaviors to alter risk
 Lifestyle factors
 Tobacco use
 Nutrition and physical activity
 Overweight and obesity
 Alcohol consumption
 Social and economic factors
 Social determinants of health influence risk behaviors, access to health care, and quality of
health care
 Environmental factors
 Sunlight and other sources of ultraviolet radiation
 Other forms of radiation
 Chemical and physical carcinogens
 Infectious agents
o Cancer Screening
 Treatment is more successful the earlier the cancer is identified
 Screening tests: given to a large group of people to identify a smaller group who are at higher
risk for a specific disease or condition
 Key to early detection of cancer
 With some cancers, no test has been shown to be effective without increasing harm
 Not all groups get screened at the same rates
 Those with the most education, with insurance, and citizens by birth typically have the
highest rates
  Conversely, those with the least education, without insurance, and only just immigrated have
the lowest rates
 Genetic screening can assess cancer risk
 Reserved for members of high-risk families
o Cancer Treatments
 Surgery
 Remove the cancer, remove the affected organ; used to treat cancer that has spread
 Chemotherapy
 Drug treatment administered to the entire body to kill rapidly dividing cancer cells
 Also kills rapidly dividing normal cells including hair, stomach lining, and white blood cells
 Radiation
 Directed to a specific area; used with surgery or chemotherapy, or to control pain
 Biological therapies
 Aim to enhance the immune system’s ability to fight cancer (immunotherapy) or reduce
side effects of chemotherapy
 Bone marrow transplantation
 Initially for cancer of the white blood cells (leukemia, lymphoma); now sometimes used
when bone marrow cells have been killed in chemotherapy
 Gene therapy and genetic testing
 Gene therapy is still in the clinical trials stage
 Genetic testing may become important in “precision medicine”
 Clinical trials
 Research studies to test new drugs and treatment regimens
 Complementary and integrative medicine
 Currently a hot topic for research
 Used at higher rates by cancer patients and survivors, but none have been shown to cure
cancers
 Some supplements may interact with cancer treatments and should be used with caution and
under supervision
o Breast Cancer
 Second leading cause of cancer death in women
 Risk factors:
 Early first menstruation
 Late onset of menopause
 Family history
 Older age
 Higher socioeconomic class
 Having no children or having children after 30
 Obesity
 Hormone replacement after menopause
 More than two alcoholic beverages a day
 Signs and symptoms:
 Persistent lump; skin swelling, redness, or bumpiness; change in nipple appearance or
discharge
 Screening and detection:
 Breast self-exam; mammogram screening; biopsy
  Treatment:
 Lumpectomy: removal of the tumor and some breast tissue around
 Mastectomy: removal of the entire breast
 Five-year survival rate for all stages is 90%
o Lung Cancer
 Leading cause of cancer death in the United States
 Second most commonly diagnosed cancer
 Risk factors:
 Use of tobacco products in any form
 Exposure to carcinogenic chemicals, arsenic, radon, asbestos, radiation, air pollution, and
environmental tobacco smoke
 Signs and symptoms:
 Coughing; blood-streaked sputum; chest pain; difficulty breathing; recurrent lung infections
 Screening and detection:
 No recommended screening for the general population
 Low-dose CT screening for high-risk individuals
 Bronchoscopy: fiber-optic device inserted into the lungs to examine lung tissue for signs of
cancer
 Treatment: surgery, radiation, or a combination of radiation and chemotherapy
 Five-year survival rate is 18%
o Prostate Cancer
 Second most common cause of cancer death in men
 Most commonly diagnosed cancer in men
 Risk factors:
 Age, family history; being Black
 Possibly a high-fat diet
 Signs and symptoms:
 In early stages, usually none
 In advanced prostate cancer, difficulty urinating; pain in the pelvic region; pain with
urination; or blood in the urine
 Screening and detection
 Digital rectal exam; prostate-specific antigen (PSA) test
 Treatment
 In early stages and younger men: surgery and radiation, sometimes in combination with
chemotherapy; and hormonal medication
 In later stages: chemotherapy, radiation, and hormonal medication
 Vaccine approved in 2010 appears to prolong life
 Five-year survival rate for all stages: nearly 100%
o Colon and Rectal Cancer
 Third leading cause of cancer death
 Third most commonly diagnosed cancer
 Risk factors:
 Age
 Personal or family history of colon polyps, inflammatory bowel disease, or colorectal cancer
 Colon polyps: growths that may progress to colon cancer
  Smoking, alcohol use, obesity, physical inactivity, a diet high in fat or red or processed meat
and inadequate fruits and vegetables
 Signs and symptoms:
 Change in bowel movements; change in stool size or shape; pain in the abdomen; blood in
the stool
 Screening and detection:
 Flexible sigmoidoscopy
 Colonoscopy
 Double-contrast barium enema
 CT colonoscopy
 Treatment: surgery; radiation and/or chemotherapy
 Five-year survival rate is 65%


o Skin Cancer
 Basal cell carcinoma, squamous cell carcinoma, and melanoma
 Basal cell and squamous cell carcinomas are often curable
 Melanoma is more likely to be fatal
 All forms are linked directly to ultraviolet light exposure—both UVA and UVB
 Stay out of the sun during midday
 Wear protective clothing
 Use a broad-spectrum sunscreen with a sun-protective factor (SPF) of 30 or higher
 Wear sunglasses with UV protection
o Skin Cancer: Melanoma
 Risk factors:
 Personal history; large number of moles
 Fair skin and sun sensitivity increases risk
 Signs and symptoms: changes in a mole
 Screening and detection: self-exam and evaluation by a health care provider
  Treatment: surgery; chemotherapy and immunotherapy in advanced stages
 Overall five-year survival rate is 92%


o Skin Cancer: Basil Cell and Squamous Cell Carcinomas
 Risk factors:
 Fair skin; blonde, red, or light brown hair; blue, green, or hazel eyes; and freckles and moles
 Cumulative sun exposure and age
 Signs and symptoms:
 Basal cell: a new skin growth; a raised, domelike lesion; or a sore that never heals
 Squamous cell: red, scaly area that does not go away; a sore that does not heal; or a raised,
crusty sore
 Screening, detection, treatment: monitoring and evaluation; local removal and destruction
o Lymphoma
 Cancers that originate in the lymph system, part of the body’s immune system
 Hodgkin’s lymphoma; non-Hodgkin’s lymphoma
 Risk factors:
 Infections, medications, or genetic changes that weaken the immune system, along with
exposure to radiation, herbicides, insecticides, and some other chemicals
 Bacterium H. pylori for stomach lymphoma
 Signs and symptoms:
 Swollen lymph nodes, weight loss, fever, other symptoms depending on where it originates
 Screening and detection:
 No screening for those without symptoms
 Biopsy and imaging studies
 Treatment:
 Often includes a combination of surgery, chemotherapy, and radiation; can sometimes
involve immunotherapy or bone marrow transplant
 Five-year survival rate varies by gender
 Hodgkin’s lymphoma: 87% (females); 85% (males)
  Non-Hodgkin’s lymphoma: 72% (Females); 60% (males)

o

The lymph system
 Structures include the lymph nodes and lymph vessels, the adenoids/tonsils, the thymus
gland, the spleen, and the bone marrow. Clusters of lymph nodes can occur anywhere along
the lymphatic vessels. Prominent areas include the neck (cervical lymph nodes), armpits
(axillary lymph nodes), and groin (inguinal lymph nodes).
o Common Cancers in the Young
 At higher frequency in young people:
 Cancers of the reproductive system
 Leukemia
 Associated behaviors are especially common among young people:
 Oral cancers
o Cervical Cancer
 Risk factors:
 HPV infection, tobacco use, immunosuppression, multiple births, early sexual activity,
multiple sex partners, socioeconomic status, and nutritional status
 Three vaccines are currently available
 Screening and detection: early detection through the Pap test has reduced incidence and
mortality rates
 Treatment: removal or destruction of precursor cells
 Five-year survival rate is 91% if the disease is localized but only 17% if it has spread widely
o Uterine Cancer
 Also called endometrial cancer
 Risk factors: increased estrogen, obesity, diabetes, early menarche, late-onset menopause,
irregular ovulation, infrequent periods
 Signs and symptoms: abnormal uterine bleeding, pelvic pain, low back pain; detected with
endometrial biopsy
 Treatment: hysterectomy; other treatments depending on the stage
 Five-year survival rate is 84% for White women and 62% for Black women
o Ovarian Cancer
 Leading gynecological cause of cancer death and the fifth overall cause of cancer death in
women
 If diagnosed early, however, survival rate is as high as 92%
 Risk factors: family history; personal history; tobacco use; being overweight
 Signs and symptoms: in later stages, swelling of the abdomen, bloating, or vague pain
 Screening tests are being evaluated
 Treatment: surgery, chemotherapy, drug therapy
o Testicular Cancer
 Most common cancer for men aged 20 to 35
 Risk factors:
 History of an undescended testicle; family/personal history of testicular cancer; abnormal
development of the testes; infertility or abnormal sperm
 Signs and symptoms: painless lump; swelling or discomfort; detected through self-exam,
ultrasound
 Treatment: surgery, chemotherapy, and radiation
 Cure rate at all stages is 95%
o Leukemia
 Group of cancers originating in the bone marrow or other parts of the body where white blood
cells form
 Involves overproduction of one type of white blood cell
 Risk factors: smoking and chemical exposure (benzene); ionizing radiation; infection with
HTLV-1
 Signs and symptoms: fatigue, infection, weight loss, fevers, easy bleeding and bruising
 Screening and detection: blood test or biopsy
 Treatment: chemotherapy, blood transfusion
 Five-year survival rates range from 26% to 82%
o Oral Cancers
 Cancers that develop in the mouth or the pharynx
  Risk factors: tobacco, high alcohol consumption, HPV
 Signs and symptoms:
 Persistent sore in the mouth; lump or bump; patch of white or red along the gums or cheeks
 Late signs include pain or difficulty swallowing or chewing
 Screening and detection: doctor or dentist as part of routine care
 Treatment: surgery, chemotherapy, radiation
 Five-year survival rate for all stages is 64%
o Living with Cancer
 If you or a family member is diagnosed with cancer:
 Participate in decisions about treatment
 Be an informed consumer
 Consider how you will interact with others
 Consider school or work obligations
 Enlist support
 Know what physical changes are likely to occur
 Consider sperm or egg donation and freezing
 Spiritual beliefs and practices can be important
 Don’t think about cancer all the time
 Chapter 16: Injury and Violence
o Injury: Creating Safe Environments
 Unintentional injuries: those that are not purposefully inflicted
 Leading causes of unintentional injury death
 Vehicle crashes, poisoning, falls, choking, drowning
 Males are more likely to die from unintentional injury, from birth to age 80
 Injury death rates vary by race/ethnicity
 For example, poisoning is the second leading cause of death among Blacks and Hispanics,
yet for all other groups it is falls
o Motor Vehicle Safety
 Factors contributing to motor vehicle crashes
 Improper driving: speeding, failing to yield the right of way, disregarding signals and stop
signs, making improper turns, following too closely
 Accounts for 85% of motor vehicle crashes
 Defensive driving: anticipating potential hazards by keeping your eyes on other drivers and
monitoring conditions
 Other factors that contribute to crashes:
 Driver inattention
 Aggressive driving; alcohol-impaired driving
 Environmental hazards such as weather conditions
o Factors Contributing to Motor Vehicle Crashes
 Three main types of distraction:
 Visual (taking eyes off the road)
 Manual (hands off wheel)
 Cognitive (mind off what person is doing)
 Drivers under age 20 are the most likely to be involved in distraction-related crashes
 Electronic devices visually and cognitively, and sometimes manually, distract drivers
 Drowsiness reduces awareness of surroundings, impairs judgment, and slows reaction time
o Approaches to Motor Vehicle Safety
 NHTSA standards
 Effective restraint systems
 Seat belts reduce the risk of fatal injuries by 47%
 Airbags are a passive restraint that protects passengers from impact with the interior of the
vehicle in a crash
 Child seats and booster seats
 Pet restraints
 Only one in six people use animal restraints such as harnesses, pet vehicle seats, or pet
carriers
 Unrestrained pets can cause serious injury to the driver and passengers in the event of an
accident
 Motorcycle safety
 Motorcyclists are about five times more likely to die in a crash than passenger car occupants
 Factors include lack of proper training, distraction, alcohol, and environmental conditions
 Use of a helmet is important
o Bicycle Safety
 Cyclists should make sure their bike fits properly, that they wear a helmet, and that they
employ safe cycling practices
 Making cyclists visible to other vehicle operators is the biggest safety problem
 Bicycles are vehicles; cyclists must follow traffic laws
o Pedestrian Safety
 About 45% of deaths occur when pedestrians enter or cross streets, and 10% occur when
pedestrians are walking in the roadway
 Dangerous pedestrian practices
 Using a smartphone while walking, aka smartphone zombie
 Drunk walking
 At night, take steps to be visible
o Recreational Safety
 Injuries occur in a variety of recreational activities
 Alcohol is a factor in many injuries and deaths
 About ten people drown every day in the U.S.
 About half of drownings occur in natural water settings
 Life jackets or personal flotation devices (PFDs) are essential protection
 Rock-climbing is relatively safe; attention to equipment and instruction can lower the risks
 Drones, or unmanned aerial vehicles (UAVs), can cause serious injury if used unsafely
o Home Safety
 Nearly 40% of all disabling injuries occur in the home
 Fires
 Poisons, gas, and carbon monoxide
 Choking
 Heimlich maneuver: used to help when choking occurs
 Temperature-related injuries
 Excessive noise
 Noise-induced hearing loss (NIHL) occurs over a period of years
 Concussions
o Providing Emergency Aid
 You can help others who have been injured or are in life-threatening situations with training in
first aid and emergency rescue techniques
 Cardiopulmonary resuscitation (CPR) is used when someone is not breathing and a pulse
cannot be found
 Many organizations offer classes: American Heart Association; American Red Cross;
community or campus resource centers
 Automatic external defibrillators (AEDs) are increasingly available
o Computer Use
 Extensive computer use can cause strain on the back, neck, arms, hands, and eyes
 Injuries from improper body position and over use
 Repetitive strain injuries
 Carpel tunnel syndrome (CTS)
 How to prevent these injuries
 Correct ergonomic problems in the workstation
 Taking frequent breaks from repetitive tasks
 Perform exercises that stretch and flex the wrists and hands
o Carpal tunnel syndrome


 Certain repetitive uses of the hands can cause the compression of the median nerve, located
inside a “tunnel” created by the carpals (wrist bones) and tendons in the hand. When the
tendons become inflamed through overuse or incorrect use, they compress the median nerve,
leading to tingling, pain, and weakness in the hand, especially in the thumb and first three
fingers.
o Natural Disasters
  Natural disasters are sudden events, caused by natural forces, that result in loss of life, severe
injury, or property damage
 Tornadoes, hurricanes, floods, wildfires, earthquakes
 Individuals can help themselves by preparing as much as they can for the types of disasters
likely to occur where they live
o Violence: Working Toward Prevention
 Violence: use of force or threat of force to inflict intentional injury, physical or psychological,
on oneself or to another person
 Murder, robbery, assault
 Assault: attack by one person on another using force or threat of force to intentionally inflict
injury
 Aggravated assault: attack that causes bodily injury, usually with a weapon or otherwise
capable of producing bodily harm or death
 Simple assault: attack without a weapon that causes less serious physical harm
 Also occurs in association with child abuse, sexual harassment, suicide, and other kinds of
conduct
o What Accounts for Violence?
 Risk factors:
 Age and sex: young and male
 Being a member of a minority group
 At the societal and cultural levels: factors such as poverty, poor schools, disorganized
neighborhoods, alcohol, drugs, guns, and lack of opportunity
 At the family level: factors such as child abuse, substance abuse, criminal activity, lack of
positive role models, and chaotic family organization
 At the individual level: factors such as genetics, brain chemistry, low intelligence,
aggressiveness and poor impulse control, and antisocial behavior
o Violence on the College Campus
 Campuses confront the same violence issues that occur in almost any city
 Since the Virginia Tech shooting, campuses have expanded emergency communication
measures
 Clery Act: institutions must disclose information about crimes on or near campus
o Hazing and Hate Speech
 Hazing: actions taken to cause mental or physical discomfort, embarrassment, or ridicule in
individuals seeking to join an organization
 Deaths have occurred as a result of hazing, most often fraternity hazing; it is illegal in many
states
 Hate speech: acts that convey a grossly negative view of persons or groups based on gender,
ethnicity, religion, sexual orientation, or disability
 So as not to infringe on freedom of speech, hate speech must be proven to inflict
o Sexual Violence
 Sexual assault is any sexual behavior that is forced on someone without his or her consent
 Forced sexual intercourse (rape)
 Forced sodomy (oral or anal sexual acts)
 Child molestation
 Incest
 Fondling
  Sexual coercion is the imposition of sexual activity on someone through the threat of
nonphysical punishment, promise of reward, or verbal pressure
o Rape
 Statutory rape: sexual intercourse with someone under the age of consent, whether consent was
given or not
 Stranger rape: committed by someone unknown to the victim
 Acquaintance rape: committed by someone known to the victim
 Date rape: committed by someone with whom the victim has a dating relationship
 Use of date rape drugs
 Red zone: period of time when female students are
at greatest risk for sexual assault
 First year: first few days or weeks of initial fall semester
 Second year: entire first semester
 College students sometimes refer to assaults as “unwanted sex,” likely due to victims being
acquainted with their assailants
 These safety tips are especially important for the red zone times:
 If you feel unsafe, trust your instincts
 Avoid being isolated with someone you don’t know
 Know your surroundings
 Don’t post your location online or on voicemail
 Use a buddy system when you go out
 If you suspect a friend has been drugged, call 911
 Always lock your door, and don’t let a stranger in
 Practice safe drinking
 Don’t go out alone at night
 In about 1 to 2% of completed and attempted rapes in the U.S., the victim is male
 Male rape victims require the same level of medical treatment, counseling, and support as
female victims
 For many victims, the effects of rape can be profoundly traumatic and long lasting
 Fear, anxiety, phobias, guilt, nightmares, depression, substance abuse, sleep disorders, sexual
dysfunctions, social withdrawal
 Between 4% and 30% contract an STI
o What to Do If You Are Raped
 Do whatever you need to do and can do to survive
 Remember rape is not your fault; your attacker is violating your rights and committing a crime
 Seek help as soon as possible by contacting law enforcement
 Contact your local Rape Victim Advocacy Program (RVAP) or the Rape, Abuse, and Incest
National Network (RAINN)
 Rape counseling is critical to recovery
o Campus Responses to Sexual Assault Complaints
 Investigative reports suggest many colleges and universities are underreporting sexual assaults
 Campus Sexual Assault Victims’ Bill of Rights: requires college administrators to provide
justice, medical treatment, and psychological counseling for crime victims and survivors
 Campus Sexual Violence Elimination Act: protection for victims and whistleblowers against
retaliation
 In response, many colleges have enacted more favorable grievance procedures
o Affirmative Consent
 More than 1,400 colleges have implemented an affirmative consent standard: “yes means yes”
 Victims must no longer prove they physically or verbally resisted
 Some states, such as California and New York, have also implemented affirmative consent
laws
 Are affirmative consent laws/rules actually legal?
 State laws for affirmative consent are new, and there are not yet any judicial decisions that
frame their legality
 Higher education institutions have also not yet faced extensive legal challenges to their
affirmative consent standards
o Preventing Sexual Violence
 Rape prevention involves creating a culture and a community in which sexual violence is not
tolerated
 Green Dot Violence Prevention Strategy focuses on engaging bystanders to act against sexual
violence
 Overcoming shyness and lack of assertiveness, peer pressure, the “bystander effect,” and
cultural norms
o Sexual Harassment
 Sexual harassment includes two broad types of behavior or situations:
 Person of authority who offers benefits for sexual favors or threatens retaliation for
withholding sex
 Suggestive language or intimidating conduct that creates a hostile atmosphere that interferes
with a person’s work or academic performance
 Is it harassment or flirting?
 One person’s power over the other
 Behavior that puts pressure on a person
 Desire to end the interaction
o Stalking, Cyberstalking, and Cyberharassment
 Stalking: malicious following, harassing, or threatening of one person by another
 Cyberstalking: use of electronic media to pursue, harass, or contact another person who has not
solicited the contact
 Threatening, harassing, sexually provocative e-mails; and online attacks or impersonation
 Cyberharassment: tormenting e-mails, instant messages, blog entries, and website entries
 Cyberbullying: among children and among college students
o Intimate Partner Violence
 Violence in families can be directed at any family member, but women, children, and older
adults are the most vulnerable
 Intimate partner violence or domestic violence is abuse against one’s partner in an intimate
relationship
 Physical
 Sexual
 Threats
 Emotional abuse
 Domestic violence is usually characterized by a cycle of abuse
 Tension builds up
 Violent outburst occurs
  “Honeymoon” period follows, where often the abuser promises change
 Violence does recur, and the cycle repeats
 Sometimes referred to as battered woman syndrome,
but can occur in any relationship
 Dating violence is widespread: 43% of college women experience violent or abusive dating
behaviors; 22% report actual physical abuse, sexual abuse, or threats of violence
 If concerned that someone you know may be in an abusive relationship, encourage her or him
to get support to leave the relationship and begin a new life
 Help is available from social services, educational programs, hotlines, shelters, advocacy
organizations, and more
 Sexual assaults, stalking, and intimate partner violence are a form of abuse known as coercive
control
 Dominating another through isolation, manipulation, degradation, micromanagement, sexual
coercion, and/or possibly physical violence
 Victims include all genders and sexual orientations, although it is usually men who exert it
over women
 Many colleges and universities now provide education on coercive control and have revised
campus conduct codes to address coercive control
o Hate Crimes and Terrorism
 Hate crimes: crimes motivated by bias against the victim’s ethnicity, race, religion, sexual
orientation,
or disability
 Terrorism: violence directed against persons or property, including civilian populations, for the
purpose of instilling fear and engendering a sense of helplessness
o The Role of Guns: Facilitating Violence
 Guns contribute to the lethality of any violence
 “Keep and bear arms” may not be as important today as in colonial times
 Proponents of gun control support bans on the sale of assault guns, waiting periods for gun
purchases, licensing of guns, restrictions on access by young people, and safer guns
 Advocates for the right to bear arms include Students for Concealed Carry on Campus
(SCCC); they often argue students need handguns for self-defense
o The Role of Media and Entertainment: Glorifying Violence
 Violent acts occur more frequently in movies and TV than in real life
 Repeated exposure may lead to habituation and desensitization
 Prominent medical groups have concluded there is a connection between violence in mass
media and aggressive behavior in children
 Entertainment industry maintains these studies demonstrate only possible associations, and
attempts at regulation would border on censorship
o Self-Defense Devices
 Products that are wearable, lightweight, and concealable include pepper spray lipstick/perfume
cases, defense keychains, rings that can activate a siren, and bracelets that detect a head injury
 Smartphones and data connections can serve as
a “guardian angel” with certain apps such as
Life Button 24
 Self-defense technology is not a replacement for being actively aware of your surroundings
o Background Checks
  New strategy for protection against violence is checking the background of family friends,
neighbors, and actual or potential intimate partners
 Use Internet search engines to find publicly available data points from criminal, traffic, and
arrest records
 Many states now have public sex offender registries
 There are also subscription-based people-search web sites
o The Role of Communities and Campuses: Promoting Safety
 Communities can help provide safe physical environments that are less conducive to criminal
activity
 Neighborhoods where people look out for each other are less inviting
 College campuses need to continue and adapt prevention efforts and to promote gender
equality, healthy relationships, healthy sexuality, and civility
o Campus Parties
 About 58% percent of fraternity and sorority members prefer to maintain a double standard
that prohibits sororities from hosting parties with alcohol but permits alcohol in fraternities
 Some argue sororities should be allowed to have alcohol at their parties, and that the risk of
sexual assault would be lower while drinking “on their own turf”
o Campus Security Drones
 Drone development is shifting from predominantly military uses to safety and security services
 Using drones to improve campus safety
 Monitoring walking trails, secluded areas, and parking lots
 Uber-like drone escort service
 Balancing safety and privacy