Microsoft powerpoint - lect04slides.ppt

• No response with low perceived threat • Acceptance when perceived threat and efficacy are high • Rejection when perceived threat is high, but efficacy is low Witte, et al. Effective Health Risk Messages. (2001) • Health Belief Model• Theory of Reasoned Action • Perceived barriers to performing the recommended • Perceived benefits of performing the recommended • Perceived susceptibility to a health threat• Cues to action (media, family, etc.) Witte, et al. Effective Health Risk Messages. (2001) • One’s own beliefs about performing a • Peoples beliefs that they can exert control over their motivation and behavior and over their social environment (people doubt this) • Beliefs about what other people think about the behavior and the motivation to comply with those other people (referents).
• Explain how variables work together to This takes work. Results in long lasting • Variables are threat, efficacy and barriers (Detail is beyond the scope of this class) • Describe different steps to increase the • Not a linear progression, rather a spiral DiClemente, Crosby, Kegler, Emerging Theories in Health Promotion Practice and Research (2002) • No association of problem with behavior • Unable to confront problem or behavior • Remember behavior related illness are • Aimed at those who have not started a risk behavior • Aimed at those who do not exhibit chronic behavior McKenzie, Piner, Kotecki, An Introduction to Community Health. (2002) • Limit demand by providing information • Removal physical & environmental conditions that contribute to behavior (AA, NA) • Addictive Behavior (physical & psychological) • Tobacco use (Nicotine)• Drug abuse (Heroine, crack, cocaine) • High Risk Behavior (psychological hook) “The Techniques of Skilled Interviewing” (NO THREATS) • Active listening• Adaptive questioning• Nonverbal communication• Facilitation • Echoing• Empathetic responses• Validation• Reassurance• Summarization• Highlighting Transitions Bickley, L., Bate's Guide to Physical Examination and History (2003) • How the patient experiences the symptoms • The explanation the clinician brings to the Tobacco kills more people than all of these • AIDS• Suicide• Homicide• Illicit Drug use• Alcohol American Cancer Society, Living Well Tobacco Free (2001) American Cancer Society. Cancer Facts & Figures (2001) • Cigarette smoke contains 4,000 chemicals • Examples of poisons: carbon monoxide, Presented by the American Cancer Society Refer to the book for Stages of Change Page • Staying Quit and Enjoying it Forever (Maintenance) • 1964 Surgeon general established advisory committee • 1992 Synar Amendment passed: federal law that requires all states on Tobacco which suggested relationship to cancer in to adopt legislation that prohibits the sale and distribution of tobacco • 1994 attorney generals of 4 states sued big tobacco. Settlement in 1965 Federal Cigarette Labeling and Advertising Act Mississippi, Florida, Texas. Recouped millions for smokers medical requiring surgeon general’s warning on all packs.
linton announced FDA plans to regulate tobacco, • 1971 all broadcast advertising was banned.
• 1998 6.5 billion dollar settlement in Minnesota. Public knowledge of 1990 smoking banned on all interstate buses and domestic airline flights lasting six hours or less.
• Set back in 1998- Senate rejected MCain bill to raise taxes and www.cnn.com/us/9705/tobacco/history (June 2004) • Smoking prevalence rates among adults • Adolescent smoking increased 28.3% from • 1.6 million deaths were postponed, saving • Second hand smoke is still a big problem • Only 15% of smokers who saw a provider in the • Effective treatments exist (psychiatric hook) past year were offered assistance with quitting • Every patient who uses tobacco should be offered treatment • Only 3% were given a follow up appointment to • Strong dose-response relationship, effectiveness increases with • Only 9% of managed care organizations have fully implemented the guidelines for coverage • Clinically effective and cost effective American Cancer Society, Living Well Tobacco Free (2001) Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services • Providers• Legislators• Consumers • “Practical Clinical Behavioral Treatment of • Problem consciousness (contemplation) Obesity,” by Ingela Melin & Stephan Rossner (2003) refer to the article for Prochaska reference #15 “The Therapeutic challenge: behavioral changes for long-term weight • Behavioral stabilization (Maintenance) Westehoefer, "The therapeutic challenge: behavioral changes for long-term weight maintenance, " (date) • “Isolated changes of single behaviors will not suffice for long-term success, but more complex changes of many behaviors and perhaps life-style as a whole are necessary for long-term weight maintenance.” • Meal rhythm and frequency, quality of food, meal • Melin & Rosner don’t have patient data.
• But they do feel that they changed the attitudes of the health care personnel. “850 nurses, dietitians and other health care personnel have been educated –overall these participants find their education and supervisions meaningful and valuable.” • Fast food healthy choices• Public schools • Schools: California (has ban in place) & New York• 17 states (NY) have “sin taxes” on soda & junk food• What if things were different? Will Doritos get sued? Dissemination (1977) Fairweather & Tornatzky • Behavior Change Model Variant for Societal implications carried out traditionally by scientists (Because people have sex with somebody else) • “HIV, Sex, and Social Change: Applying ESID Principles to HIV Prevention Research,” By Fernandez, et al. (2003) • In 1989 68% of all adult/adolescent AIDS • Include representative of the affected • Not because they are homosexual, but because of their high risk behavior.
Fernandez et al., "HIV, Sex, and Social Change: Applying ESID Principles to HIV Prevention Research," (date) • Adoption of an idea with verification of • 30% decrease in unprotected receptive • 18% decrease in proportion of men with • Ownership of the problem• Group support• Program longevity you can’t use a condom in stages • Facilitators• Harm reduction • No vaccines, limited pharmacology Tx• Fatality when not adhered to • Increases ownership of a societal behavior • Nicotine gum, patch, nasal spray, Zyban, clonidine • Shares the burden of the problem behavior • “Stomach stapling” Gastric Bypass Surgery

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