NS 1400 Exam 2 Flashcards
(129 cards)
1
Q
What is healthy people 2030?
A
a group/program that sets data-driven national objectives to improve health and well-being
2
Q
what is the major goal of Healthy People 2030?
A
reduce overweight and obesity by helping people eat health and get physical activity.
3
Q
what percentage is the target obesity proportion that Healthy People 2030 is aiming for?
A
36% down from 38.6%
4
Q
What is the social ecological model (SEM)?
A
a model that involves intervention at the intrapersonal and interpersonal level. It describes the interrelation between organisms and their levels
5
Q
What are the 5 levels of the SEM?
A
- public policy
- community
- organizational
- interpersonal
- individual
6
Q
What is one example of each of the 5 levels of the SEM?
A
- public policy: national, state, local law and regulations
- community: relationships between organizations
- organizational: organizations, social institutions
- interpersonal: families, friends, social networks
- individual: knowledge, skill, attitude
7
Q
What is the social ecological approach?
A
an approach grounded in the understanding that to achieve sustainable changes in behavior, prevention efforts must focus on the individuals within the population of focus at the different levels of influence surrounding them
8
Q
healthfulness of a situation and well-being of individuals are influence by multiple facets of _________________?
A
physical and social environments
9
Q
true or false, personal attributes DO NO play a role in the SEM?
A
false, personal attributes play a role
10
Q
human environments are ___________ and _________?
A
multidimensional and complex
11
Q
what are the 4 different levels that participants and their environments should be studied at?
A
- individual (microsystem)
- small groups (miso-system)
- organizational level (eco-system)
- population level (macrosystem)
12
Q
characterize the transactions between people and their environment?
A
cycles of mutual influence. You influence what’s around you and vice versa
13
Q
which of the 5 levels of SEM do these factors belong in?
- individuals personal attributes
- ones social identity
- knowledge, attitudes, experiences, and values
A
intrapersonal / individual
14
Q
which of the 5 levels of SEM do these factors belong in?
- cultural context (geographical, emotional, ideological)
- local state, and national laws and polices
A
societal/policy
15
Q
which of the 5 levels of SEM do these factors belong in?
- relationships among organizations, institutions, and interpersonal connections
- linkage
A
community
16
Q
which of the 5 levels of SEM do this describe?
- social institutions with organizational characteristics, such as schools, churches
- corporate culture: employees feel that there is management support in health programs
- institution must be supportive
A
institutional/organizational
17
Q
which of the 5 levels of SEM do this describe?
- formal and informal social network and social support systems, including family, workgroup, and friendship networks
- social support is conductive to health change
- psychosocial assets
A
interpersonal
18
Q
describe SEM examples of obesity prevention at each level?
A
Public policy/community level:
- Societal norms, marketing, media, political structures, and health care systems (practices, legislation)
Community/organizational level:
- Home, work/school, restaurants vs. supermarkets (access, availability, barriers)
Interpersonal level:
Family, friends, peers (role modeling, social support)
Individual level:
- Skills, behaviors, lifestyle, biological, demographics (expectations, motivations, behavioral capability)
19
Q
what are the 4 determinants/ influences affecting complex food decisions?
A
- biologically determined behaviors
- experience with food
- person-related determinants
- social and environmental determinants
20
Q
what are 4 biologically determined predispositions?
A
- taste/pleasure
- hunger/fullness mechanism
- tastes (sweet, sour, bitter, umami, savory)
- sensory specific satiety
21
Q
what are the 5 basic tastes?
A
sweet, salty, bitter, umami - also savory
22
Q
what parts of the tongue taste what?
A
front: salty/sweet
sides: sour
middle: not many taste buds
back: bitter
23
Q
what do biological determined predispositions lead to?
A
lead to preferences/dislikes: taste and affective factors which influence food choice and diet-related behaviors
24
Q
describe the physiological and environmental impacts on hunger and satiety?
A
physiological: ability to self-regulate, sensory-specific satiety
environmental: overabundance of inexpensive food
25
what are the two types of conditioning regrading experience with food?
physiological and social conditioning
26
describe physiological conditioning of food in early and middle childhood and adolescence
early childhood: food neophobia / picky eating - familiarity & learned safety
middle childhood: diminished self-regulation (fullness/satiety and hunger)
adolescence: more experiences with foods due to increased independence and autonomy
27
describe social conditioning of food choice
- role modeling
- parenting practices
- parenting styles
- mealtime practices
- labeling of foods (good vs bad)
- portion sizes
28
what are the three parenting practices related to food choice of children?
restriction, monitoring, and stimulation
29
what are the 4 parenting styles?
authoritarian, authoritative/ responsive, permissive/ indulgent, unresponsive
30
what are mealtime practices that socially condition children regarding food choice?
rewards, offering of foods (pressure and restriction)
31
how do person related determinants impact food choice and dietary behavior?
person related determinants include intra and interpersonal factors.
- Individual perceptions, attitudes, beliefs, values, emotions and personal meaning.
- personal meanings we give to food
- attitudes towards certain practices
- environmental stimuli
- tradeoffs
- knowledge and skills
-social and cultural context
32
how do social and environmental determinants influence food behavior?
- physical and built environment
- food availabiltiy
- social relations
- cultural environment
- social structures and policy
33
what is consumption of unhealthy foods and beverages best predicted by?
home availability
34
how do economics play a role in food choice/behavior?
- food prices
- income and food insecurity
- time availability
- education
- shopping patterns
35
how does behavior relate to medicine?
behaviors, patterns of behavior, or practices are actions individuals take related to their health behaviors (diet physical activity, sleep)
36
what is framing behaviors?
frame and address behaviors within their personal, social, and environmental contexts
37
what is the COM-B model?
Capability and opportunity affect motivation and all three of these affect behaviors
38
what is capability?
refers to whether we have the knowledge, skills, and abilities required to engage in a particular behavior
39
what are the two types of capability?
psychological capability: our knowledge, psychological strength, skills, and/or stamina
physical capability: our physical strength, skill or stamina
40
what is motivation?
refers to the internal process which influence our decision making and behaviors
41
what are the two types of motivation?
reflective motivation,
automatic motivation
42
what is reflective motivation?
reflective processes such as making plans and evaluating things that have already happened
43
what is automatic motivation?
automatic processes, such as our desires, impulses, and inhibitions
44
What is opportunity?
refers to the external factors which make the execution of a particular behavior possible
45
what are the two types of opportunity?
physical opportunity: opportunities provided by the environment, such as time, location and resource
social opportunity: opportunities as a result of social factors, such as cultural norms and social cues
46
which levels of the SEM do capability, motivation, and opportunities fall under?
capability and opportunities fall under interpersonal
motivation under individual
47
what is the difference between information that is motivating vs. information that facilitates change?
information that is motivating: motivation knowledge or why-to knowledge
information that facilitates change: functional or facilitating knowledge or how-to knowledge
- capability and competency
- includes skill
- necessary but unlikely to improve behaviors in those not already motivated
48
what does focusing on why to and how to often lead to?
leads to knowledge based programs and counseling
49
what are the 5 stages of change?
1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance
50
true or false, willpower and self-control is the driving force behind sustained behavior change
false, developing good habits and eliminating temptations is more important
51
what are GLP1s?
Glucagon-like petite 1. Intended to regulate blood sugar and insulin in diabetes 2 patients. Side affect is weight loss. Can lose up to 15% of body weight a y ear.
52
how do GLP1s worK?
mimic naturally-occurring hormone that our bodies release after we have a meal. Make you feel fuller, faster for longer
53
true or false, GLP medications keep working after stopping.
false, stop working
54
How does behavior become the easy choice?
- optimal defaults
- virtue bundling
- cues to action
- conscious thought
- environmental stimuli/conditions
55
what is an example of optimal defaults?
stairs
56
what is an example of virtue bundling?
cooking shows while exercising
57
what is an example of cues to action?
workout clothes
58
what is an example of conscious thought?
popcorn with non-dominate hand
59
what is an example of environmental stimuli/conditions?
stairs/ cakes in fridge
60
trend in the prevalence of obesity?
rise in both obesity and severe obesity since 2000
61
what is the prevalence of obesity based on location in the US?
midwestern and southern states tend to be more obese according to self reports
62
what is the trend in obesity by sex and education?
for both females and males, less education shows a trend with higher levels of obesity
63
what are the 4 ways energy expenditure arises from?
1. metabolic processes
2. growth during infancy, childhood and youth
3. pregnancy and lactation
4. physical activity
64
what is the only modifiable form of energy expenditure?
physical activity
65
energy expenditure trend based on occupation?
service jobs have increased the most and these jobs tend to be some of the least physically active
active jobs like agriculture and goof producing jobs have gone down
66
true or false, caloric intake for men and women has not change much regarding race?
true
67
true or false, women still eat less then men?
true
68
trend regarding food costs?
more money is being spent on food, particularly away from home. Away from home is now 60% of total household budets
69
trend in quick serve restaurants?
growth in quick service restaurants
70
is there substantial evidence that the growth in quick service restaurants is correlated with obesity?
simple associational studies can find correlations but once we control for other factors correlated with access (income levels, education) these correlations tend to disappear
71
how has relative price changed?
- more unhealthy foods being produced and healthier foods becoming more expensive
- real price of 100kcal fell for Coca-Cola and pizza
71
what are three underlying causes that influence time allocation and energy intake?
1. relative prices
2. technological changes in food production, processing and preparation
3. women's time allocation
72
is there a correlation between fast food prices and obesity?
very small if any
73
how have technological changes impacted time allocation and energy intake?
- increased yields of some crops but not others
- improved extracting oils from plants
- better automated preparation of food
- foods prepared in one place, cooked and sold somewhere else (temperature and moisture control)
- better packaging
- reduce labor and time needed to cook food (microwave, fryers, pizza ovens)
74
what is the trend in women's time allocation and how does it impact food intake?
women are working more than in the past. Who has the time to cook?
75
What are the 4 classifications of processed foods?
1. unprocessed or minimally processed
2. processed culinary ingredients
3. processed food products
4. ultra-processed food products
76
what describes unprocessed or minimally processed foods?
- no processing or minimal processing that involves subtraction so as to preserve shelf life (cleaning, drying, freezing)
- fresh fruits and vegetables
77
what describes processed culinary ingredients?
- foods that are milled, pressed, or pulverized
- vegetable oils, salts, pepper, spices, butter, cream, flour, pasta and noodles
78
what describes processed food products?
- processing of foods by adding substances such as sugar, oil, or fats so as to increase attractiveness, durability of palatability
- canning, salting, pickling, or curing
- fruits and vegetables that have been canned or bottles in brine or syrup; slated nuts; cheese; ham, bacon
79
what describes ultra-processed foods?
- processing of foods by baking, frying, extruding, reshaping
- chicken nuggests; cookies, cakes, and pastries; ready to eat microwaveable meals; burgers, hot dogs, pizza; sugar-sweetend beverages
80
overall trends in the consumption of ultra-processed foods?
- consumption as a share of all energy intake has been rising (1205 kcal out of mean daily average intake of 2042)
81
how does race and income affect the consumption trend of ultra-processed foods?
consumption higher in:
- household with lower education levels
- lower income households
- non-hispanic black households
lower in:
- asian households
82
where do soft drinks rank in contributors to calories from ultra-processed foods?
7th
83
what is higher BMI associated with?
- cardiovascular diseases
- diabetes
- musculoskeletal disorders such as osteroarthritis
- some cancers
84
what are the economic costs of obesity?
1. direct medical costs
2. economic productivity costs
3. externalities relating to medical costs or economic productivity costs
85
how can researchers obtain estimates of medical costs?
1) obtaining cost data from private insurers, Medicaid and Medicare
2) analyzing data on self-reported medical expenditures
86
Some studies begin estimating costs by considering chronic diseases which are linked to obesity, what are the three parts that they consider?
1. prevention
2. diagnostic
3. treatment
87
what was the primary finding of Finkelstein et al.?
excess weight (BMI >25) accounted for 9.1% of all US health expenditure in 1999
88
general trends for medical costs of obesity?
- obese adults have medical costs that are 20% higher than the average for healthy adults
89
why might these studies be slightly overstated?
obese people tend to have shorter lifespans, so in the lifetime of everyone, health people would spend as much money on healthcare as obese people
90
What are the two channels in which economic costs are measured?
wages and employment
91
Obesity can lead to lower wages due to what two factors?
1. absenteeism
2. presenteeism
92
what is absenteeism?
obese individuals are more likely to miss work because they are ill more often and have more medical appointments
93
what is presenteeism?
even if obese people are present at work, they are less productive because they are more likely to fatigue quicker
94
how many days does being obese raise absenteeism per year?
3.0 days per year, leading to $13.4 billion to $26.8 billion in losses per year
95
how does associations between wage and obesity vary by gender and race?
- for white males, estimates tend to be small and not statistically significant
- for women, impacts are much larger and more precisely measured. 10lb increase in weight is associated with a 2.8% reduction in white womens wages
96
how does obesity affect hiring?
- obesity can lead to people being hired less, especially in more foward facing jobs
- Study done by Cawley (2015) which sent in pairs of resumes to employers that were identical in all aspects excepts one person looked obese.
- Called back to less interviews
- Both men and women are affected by this but women more so
97
what is an externality?
a cost or benefit from an activity that is borne by an entity not directly involved in that activity
98
what are the external costs of obesity?
- obesity leads to higher costs of programs like Medicare and Medicaid
- everyone has to pay more because some individuals require more medical costs
- VERY difficult to quantify externalities related to obesity
99
what is an obesogenic environment?
an environment that enables weight gain and/or is not conductive to weight loss
100
what are the two overarching causes of obesity?
1. individual behavior
2. food system that has created an obesogenic environment
101
What are wellness progams?
employer-provided efforts to enhance awareness, change behavior, and create environments that support good health practice
102
what do wellness programs usually involve?
- biometric health screenings (height, weight, BMI, blood pressure, blood glucose, etc.)
- health risk assessments regarding lifestyle, medical history, and attitude towards changing behavior
- wellness activities
103
why is it hard to say whether or not wellness program work?
because the group that participates in these programs are not an accurate representation of the workplace. The people signing up want to improve their health
104
what are randomized control trials used?
a way of overcoming selection bias (systemic error due to a non-random sampling of a population)
105
What was the design of the Illinois Workplace Wellness Study?
Study treatments:
- onsite biometric screening at no cost
- completion of online health assessment
- conditional on undertaking these activities
- wellness program series with monetary incentives upon completion
Study design: RCT
- all eligible employees invited to participate
- participants randomized into either the control or treatment group
- had access to employment status
- pre-intervention information on health claims
- athletic facilities
- implemented three treatments: biometrics; health survey; wellness activity
106
What were the findings and results of the Illinois Workplace Wellness Study?
no impact on:
- physical activity measured by gym visits
- employee medical spending
-productivity
positive effects:
- employees perceived that management cared about their health
- increased the likelihood that employees were screened for health conditions at some point
107
Why did we find these results in the Illinois Study?
- not representative because individuals that filled out the form did not represent the whole office
- more women and young people filled out the form
- those already going to the gym and running filled out form
- lower incomes and lower pre-intervention medical costs filled out form
108
what happened to employee participation after a year in the Illinois study?
fell sharply after screenings and fell much farther in the second year
109
We focus on taxes on sugar sweetened beverages (SSBs). Why?
1. Americans consume a LOT of SSBs. 50% of Americans consume at least one per day. SSB consumption account for about 7% of total caloric intake
2. SSBs contribute to:
- weight gain
-likelihood of type 2 diabetes
- cardiovascular disease
3. number of US cities already do tax
110
What are some examples of health interventions at the environmental level in the food industry?
- having labels that provide informative nutrition information
- changing the locations of foods in grocery stores, cafeterias, etc
- addressing food deserts
111
What are two reasons we should tax SSBs?
1. externalities: SSBs adversely affects everyone, not just consumers. Through higher health costs
2. individuals would be better off if they consumed fewer SSBs but find it difficult to do this. Taxes play two roles:
- signaling that such foods are unhealthy
- increasing the current cost of consuming them
112
What 5 factors affect how consumption will change from a tax?
1. How large is the tax?
2. Is the tax passed onto consumers?
3. by how much does the demand change when the price is increased?
4. What precisely is taxed? All SSBs? SSBs purchased in stores only? What about restaurants? Bars?
5. will consumers shift to other foods with added sugar
113
How large is the tax?
SSB taxes in the US seem to be on the order of 5-10%
114
is the tax passed onto consumers?
in Berkely CA, only half the tax passed onto consumers
115
by how much does demand change when price is increased?
-0.8 and -1.2 (8-12% decrease)
116
what was a key feature of the UK soda tax?
tiered depending on the amount of sugar per volume
117
what were the two reasons behind the UK soda tax?
- added sugars have no nutritional value
- increased caloric intake is due in part to consumption of SSBs
118
how did researchers collect data?
supermarket scanner data pre- and post tax implementation
118
What was the results of the UK SSBs tax?
- there was no change in the amount of consumption of sodas
- reduction of sugar from SSBs approximate to 12.5g per person per week (average 420grams a week). so insignificant
- there were no changes in confectionary sweets consumption or alcohol so people did not but switch to other sweets or alcohol
- The predicted impact on obesity is approximately 0.25 percentage points
119
What is Ozemic approved for?
treatment of type 2 diabetes
120
what is Wegovy approved for?
- obesity (BMI>30)
121
how are Ozempic and Wegovy taken?
weekly, injectable form
122
123
true or false, both drugs have been shown to substantially reduce body weight (15-20%)?
true
124
true or false, Wegovy also reduces the likelihood of stroke and heart attacks?
true
125
how much are these medicines per month?
900-1400 dollars
126
are these two drugs covered by most health insurance plans or Medicare?
no
127
