reduce:

-infant deaths by 35% by preventing low birth weight and birth defects

-deaths in children by 20% through growth and development screening and injury prevention

-deaths in young adults by 20% through prevention of motor vehicle injuries and decrease use of drugs/alcohol

-adult deaths by 25% through screening for and prevention of heart attacks, stroke,and cancer

-sick days in older adults by 30% by maintaining functional independence and preventing flu and pneumonia

careless habits/lifestyle

pollution of environment

harmful social conditions

increase the span of healthy life

reduce health disparities among Americans

achieve access to preventive services for all Americans

-physical activity

-overweight and obesity

-tobacco use

-substance abuse

-responsible sexual behavior

-mental health behavior

-injury and violence

-environmental quality

-immunization

-access to health care

-rapid changes in lifestyles

-population growth and demographic changes

-increasing urbanization and types of work

-development and proliferation of communication channels

-global trade and marketing

International Union for Health Promotion and Education

advocate for health

build knowledge of effective health promotion and health education

improve effectiveness of policy and practice

-build capacity for health promotion and health education

World Health Organization

promoting development

fostering health security

strengthening health systems

harnessing research, information, and evidence

enhancing partnerships

improving performance

11 countries with > 100 million people

Bangladesh

Brazil

China

India

Indonesia

Japan

Mexico

Nigeria

Pakistan

Russian Federation

USA

-Genetic and gestational endowment 30%

-social circumstances 15%

-environmental conditions 5%

-behavior 40%

-medical care 10%

aging population

primary growth through immigration

4 major minority groups: African American, Hispanic, Asian American and Pacific Islanders, Native Americans and Alaska Natives

fastest growing are hispanic and asian american/pacific islanders

accidents

cardiovascular disease

stroke

cancer

Pneumonia, TB, diarrhea, and enteristis

40% deaths among children < 5 yrs

1918 influenza epidemic = 20 million deaths

sanitation and hygiene, vaccination, antibiotics and other antimicrobials

29.2 year increase in lifespan

heart disease, cancer, stroke

AIDS in 33 million and 13.9 million deaths

new challenges: bioterrorism, new infectious diseases, re-emergence of old diseases, large foodborne outbreaks

downstream interventions more effective than midstream or upstream ones

outcomes have been primarily short-term and limited in reach

most successful in tobacco, alcohol, and drug use and in risky sex

adaptive

role-performance

clinical model

eudamonistic

absence of signs/symptoms of disease/disability

mechanistic view of man

derived from medicine

disease is a malfunction

3 main reasons for disease:

-failure of homeostasis

-heredity

-intrusion of foreign substance

deviation from normal

normal considered ideal/optimal

health is viewed as normative

ability to fulfill one's central role

role refers to the pattern of organized behaviors people assume in society

illness is the inability to perform at expected levels in one's roles

condition of the whole person interacting with the phsyical and social environment

person is continually adjusting to changign environment

disease is a failure to adjust

types of adaptation

biological

social

passive

active

biological adaptation

-health is general well-being and self-realization

-living up to maximum of functional and social ability no matter what limitations are

-illness is a condition that impedes or prevents self-actualization

-views health from entire nature of individual: phsyical, social, aesthetic, and moral

-state of complete physical, mental, and social well-being and not merely the absence of disease

-stability and balance among systems

-state and process of successful adaptation that promotes being/becoming an integrated person

-disease prevention, risk reduction, health protection, health promotion

specific

stabilizing

avoidance motivated

thwart negative assaults

keep from occuring

general

actualizing

approach motivated

expansion of potential

encourage to flourish

-Primary: health promotion, protection

-Secondary: early diagnosis and treatment, limit disability

-Tertiary: restoration and rehabilitation

metaparadigm: person, environment, health, nursing, transitions, human care

conceptual models: adaptation, self-care, systems, health promotion

theories: nursing and other disciplines

-social cognitive theory

-theory of reasoned/action theory of planned behavior

-transtheoretical model

-health belief model

-ecological models

-Pender's health promotion model

Health Belief Model, Health Promotion Model, Theory of Reasoned Action and Planned Behavior

determine the performance of the behaviors

focus on identification of variables that predict behavior

stimulus response theory

value-expectancy theory

perceived susceptibility, perceived severity, perceived barriers, cues to actions, self-efficacy

intentions are determinants of behaviors

intention is determined by:

-attitudes towards the behavior

-subjective norms regarding it

-perceived barrier control over it (TPB only)

prior related behavior

personal factors

perceived benefits

perceived barriers to action

perceived slef-efficacy

activity-related affect

interpersonal and situational influences

commitment to a plan of action

immediate coping demands and preferences

stages related to behavior change:

precontemplation

contemplation

preparation

action

maintenance

no intention to change behavior, safety zone, may be defensive and resistant, may be demoralized from past failure

intervention: non-threatening information, assess thoughts and feelings, listen and acknowledge their perspective, generate pros and cons and demonstrate that pros outweigh the cons

thinking about the action 

more aware of benefits of changing but remain keenly aware of costs

often seen as procrastinators

interventions: can handle more information, translate thinking into doing, help them see how changes can be made, become aware of alternate choices

transition stage 

convinced of pros

want to change

may lack skills

interventions: focus on preparing to meet temptation, self-efficacy, a single change, on interventions rather than motivations

individual makes lifestyle modifications

barriers: time, success, temptation

relapse is common

interventions: help to get on target, boost confidence, identify small steps, identify high temptation situations

working to prevent relapse

temptation low, confidence high

behavior is routine

interventions: plan to avoid temptation, encourage to talk about change as a lifelong habit, talk about relapse prevention, assess for boredom, build upon successes

-consciousness raising

-self-reevaluation

-cognitive restructuring

-reinforcement/reinforcement management

-Florence Nightengale

-Social Policy Statement

-Research and Practice

-Policy and Legislative Agenda

UM SON: educational threads, research, practice

-growing research in health promotion and risk reduction

-reponsive to the need for a lifespan perspective

-growing recognition of multilevel interventions, inclusion of technology, and tailoring

multilevel of analysis

lifespan perspective

interventions across spectrum

knowledge from genetics

contextual competence