Reading Doc - Health Hazards PDF

Two More Health Hazards As you read in Chapter 11, three habits influence health lifelong, specifically sleep, exercise, and nutrition. All three are discussed again in Chapter 14. Here we discuss two other hazards to adult health: drug use and obesity. Like sleep, exercise, and nutrition, these two...

Two More Health Hazards As you read in Chapter 11, three habits influence health lifelong, specifically sleep, exercise, and nutrition. All three are discussed again in Chapter 14. Here we discuss two other hazards to adult health: drug use and obesity. Like sleep, exercise, and nutrition, these two could be discussed in every chapter. However, they are here because notable effects on the body, for good or ill, occur especially between age 25 and 65. Drug Use As apparent in many topics in this text, every substance, every experience, every social context affects not just an isolated aspect of development at one time, but the entire person over the years. That truism was stressed in the discussion of ecological systems in Chapter 1 and echoes throughout. This is obvious in drug use. Every drug, whether prescribed by a doctor, bought at a nearby store, or obtained from a clandestine drug dealer, is chosen because it might benefit the body or mind. And every drug has effects beyond the ones that led to that choice. ON DOCTOR’S ORDERS Let us begin with the benefits. Medication has improved health for many people, especially in midlife. In fact, the rate of heart disease (the leading cause of adult death) before late adulthood has been reduced by two-thirds, primarily because of drugs that reduce hypertension and cholesterol (see Figure 12.2). Cancer deaths are also reduced in adulthood, with chemotherapy (a combination of drugs) the primary reason. Surgery and radiation also stop cancer, but those measures are usually in addition to drugs not instead of them. Psychological health is also often improved with drugs. One in every eleven adults younger than 45 take antidepressants daily, as does one in five older adults (National Center for Health Statistics, 2019a). Antianxiety and antipsychotic drugs are also common. Thanks to research on insulin, people with diabetes can reach the highest levels of success. U.S. Supreme Court Justice Sonia Sotomayor was diagnosed with childhood diabetes and began injecting insulin when she was 7; now her drugs are precisely calibrated to keep her healthy lifelong (Sotomayor, 2014). AVOIDING OR SEEKING MEDICINE Although many adults take at least one prescription drug every day, others do not. This is age-related. According to surveys completed between 2013 and 2014, in the past month, 64 percent of 18- to 44-year-olds and 31 percent of 45- to 64-year-olds took no prescription drugs. Some of them are unusually healthy, and some of them are suspicious of every drug that a doctor recommends. Virtually every adult, however, uses over-the-counter drugs such as vitamins, analgesics, laxatives, antihistamines, herbal supplements, or some other medication. Obviously they think they benefit, although opinions and practices differ. Many scientists warn of misuse of drugs that can be bought at any grocery or drug store (Chiappini & Schifano, 2020). Use and concern about readily available drugs vary dramatically from one nation to another: Many drugs that require prescription in the United States are readily available elsewhere. Is the United States too cautious, or are the other nations too careless? OPIOIDS The harm from one category of prescription drugs has become starkly evident. Doctors prescribe opioids (mostly codeine, Oxycotin, or Vicodin) to reduce pain. These drugs are addictive, and withdrawal is painful. If doctors stop the prescription, some patients turn to heroin or synthetic opioids such as fentanyl. The risk of overdose and suicide increases (Oliva et al., 2020). To some extent this is economic and cultural. Poor people have less access to prescription drugs, and therefore less addiction to opioids (Wilkerson, 2020). A study comparing what doctors prescribed for patients on discharge from hospitals after appendectomy or hernia repair found that 91 percent of the patients in the United States, and only 5 percent of those in other nations, were prescribed opioids (Kaafarani et al., 2020). Opioid deaths in the United States increased every year from 2000 to 2017, before decreasing slightly in 2018 (see Figure 12.3). Nationwide data reveal fewer overdose deaths in 2018 from prescribed pain medicine, but an increase in deaths from synthetic opioids (Wilson et al., 2020). Deaths from opioid overdose are highest among 26- to 44-year-olds (Wilson et al., 2020). This is one source of “deaths of despair” (deaths caused by suicide, drug overdose, alcoholism, and obesity), which are particularly likely in middle-aged adults in the United States. (Case & Deaton, 2020). Several other drugs may relieve pain. Some are chosen illegally by patients; others are bought at drugstores; still others are prescribed by doctors. For example, marijuana may relieve pain, which may reduce opioid use (Meng et al., 2020). Many psychologists advocate nondrug pain relief. Meditation, hypnosis, and cognitive-behavior therapy all reduce the need for prolonged or intense drug use, and that reduces the risk of overdose (Garland et al., 2019). Deaths of despair are reduced when people are part of well-functioning families and have jobs with good health care (Case & Deaton, 2020). DRUGS FOR THE MIND, NOT THE BODY Most adults consume psychoactive drugs, or drugs that affect the emotions more than physical functioning. Almost everyone drinks caffeinated soda, tea, or coffee, more than half drink alcohol, about a fourth use tobacco, and a few take illegal drugs. Look at Table 12.1. Each of these drugs has varied effects, with some much worse than others. TABLE 12.1 Psychoactive Drugs Commonly Used in Adulthood Caffeine For most of the 85 percent of the world’s population who drink it, coffee reduces the risk of depression, type 2 diabetes, and death (Loftfield et al., 2018; Palatini, 2015). For some, however, coffee disrupts nighttime sleep and increases anxiety. Marijuana Cannabis is at least partially legal in 44 U.S. states, Canada, and several other nations, which means that research on legal use is now accumulating with mixed findings (Finn, 2020; Graves et al., 2020). Some medical uses seem proven, among them that marijuana improves appetite and reduces nausea in chemotherapy and may be a better pain reliever than opioids. Nonetheless, addiction and withdrawal symptoms — depression, anxiety, aggression, sleep disturbances — occur in about half the regular users (Bahji et al., 2020). Tobacco The World Health Organization calls tobacco “the single largest preventable cause of death and chronic disease in the world today,” with one billion smoking-related deaths projected between 2010 and 2050. The harm from cigarettes is dose-related: Each puff, each day, each breath of smoke makes cancer, heart disease, strokes, and emphysema more likely. Smoking is an example of the need for an intersectional perspective. How strongly the social context encourages or discourages cigarette smoking depends on gender and age and nationality and income. Each of these affects whether or not a person smokes, but sometimes the influence of one factor depends on another. For example, in 2018, U.S. smoking rates were three times higher for people below the poverty line than for people far above it (23 and 7 percent), a disparity as evident for women as for men. However, the opposite was true a century ago in the United States and still is true internationally, because smoking was a sign of wealth and independence. Currently in the poorest nations, rates of smoking increase with income, because people with the lowest income cannot afford cigarettes. This is glaringly evident in Asia, where smoking rates have plateaued in wealthier nations (e.g., Japan, Singapore) but are continuing to increase in China and India (Yang & Dong, 2019). Alcohol Unlike for cigarettes, the harm from alcohol does not increase steadily with each increment. In fact, some alcohol may be beneficial: Adults who drink wine, beer, or spirits in moderation — never more than two drinks a day — live longer than abstainers (Goel et al., 2018). However, with too much alcohol, harm is widespread. Alcohol destroys brain cells (especially in the cerebellum, which regulates balance), causes liver damage (alcohol use disorder is the main cause of cirrhosis), and contributes to many other diseases, including osteoporosis, infertility, and many cancers. It also increases the rates of suicide, homicide, and accidents — all while wreaking havoc in families. Again, gender, income, and nationality make a difference. In general, low-income nations have more abstainers, more abusers, and fewer moderate drinkers than more affluent nations. One protective factor is Islam: devout Muslims do not drink alcohol, which limits the problem in many nations of the Middle East. However, in other developing nations, prevention and treatment strategies for alcohol use disorder have not been established, regulation is rare, and laws are lax (Bollyky, 2012; Myadze & Rwomire, 2014). Obesity When food is ample, most adults eat as much as they want, so weight increases with age. Metabolism decreases by one-third between ages 20 and 60, and digestion becomes less efficient. To avoid gaining weight, adults must eat less, add more vegetables, and increase physical activity. That does not usually happen. PREVALENCE OF OBESITY From ages 25 to 60, adults in the United States steadily gain an average of about 20 pounds, much more than prior generations did. The definitions of overweight and obesity depend on the ratio of height and weight, with a body mass index (BMI) above 25 considered overweight, above 30 considered obese, and above 40 considered severely obese (see Table 12.2). Obesity is a serious health risk. TABLE 12.2 Body Mass Index (BMI) Categories Underweight Normal weight 18.5–24.9 Overweight 25–29.9 Obesity 30 or greater Whether or not being overweight is a health problem is disputed, with some research finding longer lives in adults who are slightly above 25 BMI, especially if they have strong muscles (Flegal et al., 2013). Muscle weighs more than fat, so people with a BMI of 26 or 27 may be fit, not fat. The cutoff at 25 was based on White American adults. In the United States, Black adults tend to be heavier and Asian adults lighter than White adults, so the BMI cutoffs may need adjustment. However, for everyone, excess body fat increases the rate of almost every chronic disease. Many people put on weight during the recent pandemic’s shelter-in-place (Flanagan et al., 2021). COVID-19 increased poor health in many ways — less exercise, more alcohol, more stress, less preventive care. The result was twice as many non-COVID deaths (called “excess deaths”) among adults aged 25–65 in 2020 as in 2019 (Woolf et al., 2021). COVID-19 targeted people who were obese: Deaths rose among obese adults under age 65 (the oldest adults had higher death rates at every weight) (Anderson et al., 2020). The consequences are psychological as well. Obese adults experience scorn and prejudice, making them less likely to have partners, employers, friends. Stigma leads them to avoid doctors, eat more, and exercise less — harming health more than weight alone (Puhl et al., 2020). WHAT AND WHEN TO EAT What can a person do to prevent obesity? The Mediterranean diet seems best. Death rates are lower, diabetes less common, and heart health improved (Migliaccio et al., 2020; Romagnolo & Selmin, 2016; Sánchez-Sánchez et al., 2020; Willis et al., 2019). That diet is high in fruits, vegetables, nuts, legumes, fish, whole-grain cereals, and extra virgin olive oil, and low in meat and dairy. Those who follow this diet are less likely to become obese. But what if people are already overweight? Does changing to this diet help them lose fat? The answer is yes, sometimes. Thirteen of the 18 studies of weight loss on this diet found significant reduction of obesity, especially in the “central fatness” part of the body, where it is most crucial (Bendall et al., 2018). Another strategy seems more effective, although not as easy: intermittent fasting. There are three common versions of this diet: no food for two of the seven days per week, fasting every other day, or fasting for 14 to 20 hours each day. This lowers blood pressure and improves metabolism, as well as reduces weight, because the digestive system is less active, and other physiological responses protect against temporary starvation (Mani et al., 2018). One study enrolled about 140 overweight women (Schübel et al., 2018). One group reduced daily calories by 20 percent (the classic calorie reduction), one reduced weekly calories by 20 percent but were allowed more on some days than others, one group fasted two days a week and then ate without restriction on the other five days, and one group ate as usual. The result: Weight loss was about the same for all three dieting groups. However, the participants of the two-day fasting version were happiest. This is important, because people find it hard to stick to any diet. Of course, you should never start a diet without first consulting a physician. A Deliberate Choice A healthy diet is often contrary to advertising. To increase sales, grocery stores display candy at check out, end-of-aisle displays are never fresh vegetables, cartoon characters help to sell sugary cereals, snack foods are fried and salty. Eating out is particularly hazardous, because people are tempted by foods high in fat, sugar, and salt. But it need not be so: Here, convention attendees in Calgary, Alberta, Canada, fill their plates with vegetables and other nutritious foods. Does this resemble your choices at the most recent event you attended? Finally, some people in extreme cases opt for surgery. Each year, about 200,000 U.S. residents undergo bariatric surgery, which restructures their digestive system. “Complications are not uncommon” (Schulman & Thompson, 2017, p. 1640), but every year this surgery becomes safer. Less than 1 in a thousand die from the operation, and about 2 in a thousand need additional surgery (Campos et al., 2020). Such surgery saves lives because it reduces heart diseases, diabetes, and strokes. However, in the decade after bariatric surgery, rates of depression, suicide, and alcohol abuse increase (Maciejewski et al., 2020). This reminds us that the health of our bodies influences the health of our minds, the next topic in this chapter.