Health Promotion Intervention Program
Imagine that you are an English teacher in a high school in a very diverse community in an American city. The community residents have emigrated from many different countries and have come to the United States to achieve a better life. Many
of the residents have limited incomes and work in low-level jobs. In addition, they often have difficulty with the English language. Yet, many firmly believe that their children should advance and thus make certain that the children attend school.
One thing that you, the teacher, have noticed is that knowledge of health promotion and disease prevention is limited. You have decided that you may be able to help them, and possibly their families, by providing some health education opportunities both in the classroom and in special after- school meetings.
You decide to develop a health education plan that can be tested initially with a small group of students and then expanded as you see what works. Since you are a female teacher you decide that you will focus initially on female students in the ninth and tenth grades. Having discussed the project with some of the students, you decide, based on their recommendations, to focus on cardiovascular and cancer risk factors: smoking, overweight, and exercise in an after-school program.
If you were the teacher, think about how you would proceed by answering questions 1-5.
How would you design the after-school program? Would you include lectures, discussions, presentations by local advocates? Why or why not?
How would you market the program to the ninth and tenth-grade girls?
What materials would you design to engage them in learning about the health risks? What is your rationale behind selecting the materials to design and engage your group of students?
Would you serve snacks/refreshments? Why or Why not?
Please develop an action plan for a 3-month period of time. Make certain to state your goal and objectives, the plan for implementing the action, and how you will evaluate the results of the plan.
Course Materials• Required Text or E-Book: Alexander, L., LaRosa, J., Bader, H., & Garfield, S., Alexander,W. (2007). New Dimensions in Women’s Health, 7th ed. Sudbury, MA: Jones and Bartlett.ISBN# 978-1284088434
Chapter 10 Cardiovascular
Disease and Cancer
Cigarette Smoking and CVD
• Smoking is a major risk factor for CVD (as well as lung and other cancers).
• Carbon monoxide, nicotine, and other substances in cigarette smoke constrict and injure arteries.
• Secondhand smoke is a CVD (and cancer) risk factor.
• Health risks for smoking decline the earlier a woman quits.
Cancer • Cancer: disease caused by uncontrolled
cellular growth or reproduction • Tumor: any abnormal cell growth
– Benign (contained) – Malignant (growing/spreading)
• Metastasis: the process of cancer spreading throughout the body
• Carcinogen: a substance that can cause cancer
Cancer and Women • Cancer is the second-leading cause of death in
the United States. • 75% of cancers are diagnosed in people aged 55
and older. • Breast cancer is the most common cancer in
women. • Second most common = lung cancer, but causes
the most deaths (lower survival rate) • Third most common cancer = colorectal • Fourth most common cancer = endometrial
Breast Conditions • Most women will find a lump in their breast at
some point in their lives. In 9 of 10 cases, this is not cancer.
• Benign breast diseases – Fibrocystic breast disease (cystic mastitis) – Hyperplasia – Fibroadenoma
Breast Conditions Breast cancer is a frightening, misunderstood issue in women’s health. It can usually be successfully treated if detected early. •Five levels
– In situ: Too small to be felt; nearly 100% 5-year survival rate
– Stage I: < 2 cm in size, localized – Stage II: 2–5 cm in size, localized – Stage III: > 5 cm in size, grown into chest wall, skin,
or lymph nodes – Stage IV: Growth spread to other parts of body
Risk Factors for Breast Cancer • Gender • Age • Family history • Never had children or first child after 30 • Early menarche (before 12) or late menopause
(after 55) • Consumption of high-fat diet or alcohol • Environmental factors • Obesity • Oral contraceptive use?
Breast Cancer Screening • Breast self-exam • Clinical breast exam • Mammography
Treatment • Lumpectomy • Partial or segmental mastectomy • Simple mastectomy • Radical mastectomy • Modified radical mastectomy • Chemotherapy, radiation therapy, and
hormone therapy may be used alongside surgery to improve chances of recovery.
Lung Cancer • Cigarette smoking is responsible for almost
every case of lung cancer, the deadliest form of cancer for men and women.
• Lung cancer often spreads to other parts of the body before it can be detected.
• Common symptoms are persistent cough, weight loss, bloody sputum, recurring bronchitis, pneumonia, and chest pain.
• Treatment is very difficult but can include surgery, radiotherapy, and chemotherapy.
Cervical Cancer • Caused by “high risk” strains of HPV • Modern medicine has the potential to prevent
almost all cases of cervical cancer. • Screening: Pap smear, HPV test (for women 30
and over) • Vaccination can prevent most, but not all, cases
of cervical cancer (screening still needed). • Treatment: cyrosurgery, cone biopsy, laser cone
Gynecological Conditions Benign uterine conditions •Fibroids •Endometriosis—when it grows into wall of uterus, called adenomyosis •Endometrial hyperplasia •Treatments include: hormone therapy or surgery (myomectomy, laparoscopy, hysterectomy)
Malignant Uterine Tumors • Risk factors
– Age (over 50) – Obesity, diabetes, high blood pressure, smoking – Early menarche or late menopause – History of infertility – Family or personal history of other cancers – Long-term high-dose ERT – Use of Tamoxifen for breast cancer
• Difficult to detect—too high up to be found on a pelvic examination
• Treatment may involve surgery and/or radiotherapy.
Ovarian Growths Benign ovarian growths •Cysts—follicular, hemorrhagic, epithelial, dermoid •Polycystic ovarian syndrome Ovarian cancer •A deadly, stealthy, and largely misunderstood form of cancer. •Risk factors: no children, early menstruation, late menopause, pregnancy after age 30, previous cancer, long- term use of some fertility drugs •Early symptoms: pelvic pressure, abdominal swelling, gas pains, indigestion, vague abdominal discomfort •Treatment: surgery, radiotherapy, chemotherapy
Cervical Cancer • Caused by human papilloma virus (HPV), a
common sexually transmitted virus • Only high-risk strains of HPV can cause cervical
cancer • Most women with high-risk HPV will not develop
cervical cancer • Easily treated if found early (Pap smear, HPV test) • A vaccine can protect against some high-risk
strains of HPV
Colorectal Cancer • Risk factors: Increasing age and familial
adenomatous polyposis (FAP) are major risk factors; high-fat, low-fiber diet is also a risk factor.
• Warning signs: blood in stool, cramping in lower abdomen
• Screening: digital rectal exam, sigmoidoscopy, fecal occult blood testing, colonoscopy
• Treatment: surgery, radiotherapy, chemotherapy
Skin Cancer • Melanomas vs. nonmelanomas (basal cell and squamous
cell carcinomas) • Risk factors: UV from sunlight, moles, family history, race • Screening and diagnosis: skin exam looking for ABCD
– Asymmetry – Border irregularities – Color irregularities – Diameter
• Treatment: surgery, radiation therapy, electrodessication, cryosurgery, laser therapy
o f N
na l C
r I ns
Reducing Your Risk of CVD and Cancer
• Importance of preventive lifestyle habits • Knowledge of family history, genetic risks • Importance of screening for early detection
What are you doing to reduce your risk of CVD and cancer?
Chapter 10 Cardiovascular
Disease and Cancer
Cardiovascular Disease and Cancer
The greatest causes of death in the United States • Cardiovascular disease
– Heart disease – Cerebrovascular disease (stroke)
• Cancer – Can affect any area – In women, most likely to affect breasts, lung,
reproductive system and skin
Cardiovascular Disease Figures: 2013
• 289,758 U.S. women died of heart disease—the leading cause of death in women.
• 75,287 U.S. women died of stroke—the third leading cause of death in women.
• More women than men die of stroke each year.
Economic Dimensions • Direct costs: health expenditures, hospital and
nursing home services, medications, home health care
• Indirect costs: lost productivity (both to people with CVD and their caretakers)
Coronary Heart Disease (CHD) • Occurs when the
coronary arteries become blocked or narrowed with plaque
• Clots forming in an artery can also lead to blockages.
• Can lead to a heart attack (death of part of the heart)
If Plaque Causes CHD, What Causes Plaque?
• CHD begins with plaque buildup inside the lining of the coronary arteries.
• Plaque begins with LDL cholesterol moving inside the arteries; white blood cells can also get stuck inside the lining and die.
• Plaque can grow until it takes up 95% of the space in an artery.
Other Forms of Heart Disease Congestive heart failure (CHF) • Weak heart muscles that cannot perform the
pumping function with proper vigor • Often a disease of older women who have
suffered heart damage from other causes Arrhythmias • Problems with the heartbeat (fast, slow, or
Other Forms of Heart Disease Rheumatic heart disease • Results from bacterial infection with
Streptococcus, which can cause damage to heart valves; can usually be cured with antibiotics
Angina pectoris • Chest pain resulting from insufficient supply of
blood (oxygen) to heart muscle • Disease of the extremities (arms/legs) in which
blood supply is diminished, resulting in lack of nutrients and oxygen
Metabolic Syndrome • Group of diseases that occur together and
cause CVD • Risk factors
– Elevated waist circumference – High blood lipid levels – Low HDL levels – High blood cholesterol levels – Elevated fasting blood glucose level
• Metabolic syndrome is a greater risk for women than it is for men.
Cerebrovascular Disease (Stroke)
• Blood vessels either within or leading to the brain becomes damaged, blocked, or burst.
• This leads to portions of the brain being unable to receive oxygen, and thus dying.
• Often survivors have a long, difficult recovery process—many thought processes and physical actions may have to be relearned.
Stroke Types of stroke
– Ischemic stroke: the most common type, caused by a cerebral thrombus or embolism
– Hemorrhagic stroke: caused by ruptured blood vessels such as an aneurysm
• Possible warning signs: transient ischemic attacks (TIAs)—brief memory loss, garbled speech, or other symptoms
Figure 10-6: Cerebrovascular
Recovery from a Stroke Recovery statistics • 50 to 70% of survivors regain functional
independence. • 15 to 30% are permanently disabled. • 20% require institutional care within 3 months of onset. • 25% die within a year (risk of death and future strokes
increases with age). Rehabilitation • Depends on area affected—may require physicians,
nurses, physical therapy, speech therapy, mental health professionals, or others
Risk Factors for CVD
• Age • Genetics • Race • Obesity • Smoking
• Hypertension • Elevated cholesterol • Sedentary lifestyle • Diabetes • Menopause
CVD Gender Differences • Before menopause, women’s hormones, in
general, protect them from CVD; with menopause, the risk increases more sharply.
• Symptoms and signs of a heart attack vary among genders; women tend to have somewhat different symptoms. – Fewer sharp, intense pains – Less shortness of breath – More cold sweats, nausea, dizziness
• Women more likely to die from heart attack
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