Lifestyle and Risk Factors
Lifestyle factors are patterns of living that we choose to follow, such as the amount and type of exercise performed by an individual. Nutrition, smoking, substance abuse, stress, and violence are also lifestyle factors an individual can control. These factors may also include risk factors. Risk factors may or may not be preventable. Smoking is a risk factor that is preventable. Our genetic makeup contains risk factors that we cannot control. Certain risk factors are related to our occupation, environment, or age.
NCLEX Alert Lifestyles, inherited risk factors, preventive measures, and educational topics are frequently components of NCLEX clinical scenarios and options. These issues identify specific, individual healthcare priorities for a client.
Physical Activity
Physical activity is recommended for all people. Moderate physical activity enhances energy, reduces stress, and provides relaxation. Physical activity is essential in the management of chronic conditions such as diabetes and arthritis. It helps in weight control and decreases the percentage of body fat. Exercise increases the activity and health of the cardiovascular system. It improves flexibility, muscle tone, strength, and stamina. It helps to increase the levels of good cholesterol in the blood. Exercise helps to prevent life-threatening conditions such as coronary heart disease (CHD), obesity, and cancer. Sleep and rest are also important to maintain health.
Today’s recommendations are acceptable and are generally not difficult to accomplish. Every American adult should perform 30 minutes or more of moderate-intensity physical activity most days of the week. This activity does not have to be in the form of traditional exercises. It also does not have to be 30 minutes at one time but can accumulate throughout the day (e.g., three 10-minute walking sessions each day). Note that this level of exercise is for maintenance and prevention. Individuals who are striving to lose weight or to build strength will need more intense levels of activity. Taking the stairs instead of the elevator, parking at the far end of the parking lot, walking during lunch breaks, riding a bike, swimming, skiing, or playing tennis are examples of exercise.
An expansive problem in the United States is inadequate exercise for children. Reasons include excessive television viewing and video-game playing and reduced physical activity programs in schools. Family caregivers need to encourage exercise because it helps children to reach their best physical, mental, and spiritual potential.
Key Concept Exercise helps to prevent osteoporosis and hypertension. It reduces stress, promotes weight loss, and improves heart health. Walking is exercise that almost anyone can do. It helps to prevent many disorders. A 30-minute walk each day reduces the risk of death from heart disease by 35%.
Nutrition
In recent years, a great deal of attention has been given to nutrition. The U.S. Surgeon General states that 70% of illnesses are related to nutrition. Poor nutrition contributes to congestive heart failure, cancer, obesity, and growth retardation in children. High sugar intake, pesticide use, fertilizer overuse, and food additives also contribute to disease. The major components of a healthy diet include reduced fat and sodium intake, adequate calcium intake, and increased intake of fiber and natural carbohydrates. Unit 5 covers nutrition and diet therapy.
Some programs to improve the American diet include nutrition education in schools, improved quality and choices in school lunches, worksite nutritional programs, and home-delivered meals for older adults. Primary care providers who educate and counsel clients on healthcare topics can provide additional help on nutritional issues, if needed. Laws now require basic informational labeling of food products, so consumers can be better informed. More reduced-fat foods are now available.
Key Concept Some situations in combination dramatically increase risks. For example, the combination of high cholesterol and hypertension increases the risk of coronary heart disease up to six times. Add smoking to that combination and the risk increases up to 20 times.
Abstinence From Tobacco Products
Cigarette smoking is the single leading cause of preventable death in the United States, yet about 25% of the population smokes. More than 4,000 substances, including highly addictive nicotine, are found in cigarette smoke. Many of these chemicals are known to cause cancer. Chemicals that cause cancer are called carcinogenic. Cancers caused or aggravated by smoking are those of the lung, mouth, throat, esophagus, bladder, kidney, pancreas, and cervix.
Other medical conditions that result from smoking include heart disease and chronic respiratory diseases. Respiratory disorders include asthma, emphysema, bronchitis, pneumonia, and other acute and chronic respiratory disorders.
Tobacco-related heart attack and stroke deaths surpass lung cancer deaths each year. More than 40% of all fatal heart attacks and strokes in people under age 65 are a result of smoking. Smoking one to four cigarettes per day doubles a person’s chance of having a heart attack.
Secondhand smoke also causes cardiovascular diseases, heart attacks, and numerous respiratory problems. The chemicals found in smoke that a nonsmoker breathes are more dangerous than the smoke that is inhaled by the smoker. Secondhand smoke is especially damaging to the young, developing lung tissues of infants and children. Acute and chronic pulmonary problems occur early in the lives of children of smokers.
The highly addictive substance nicotine found in cigarettes makes platelets more sticky, which can injure heart arteries or form clots and cause a heart attack. Smoking contributes to heart disease because nicotine increases plaque buildup in arteries; it causes the insides of arteries to form rough, chapped places. Sticky cholesterol can attach there more easily and build up plaque, which can increase the chances of a heart attack.
Low-tar, filtered, and menthol cigarettes are just as dangerous as plain ones. Smokeless tobacco is also dangerous. Studies show it can cause cancers of the mouth, larynx, and esophagus and may contribute to stomach cancer.
Benefits of Smoking Cessation
Smoking cessation has an immediate effect on the improvement of health. Twenty minutes after a last cigarette, a person’s blood pressure and pulse return to normal levels. In 8 hours, oxygen and carbon dioxide levels normalize. In 1 year, the excess risk of heart disease drops by half. In 15 years, a former smoker’s risk of heart disease is the same as that of a nonsmoker. Even people who have already had a heart attack can help prevent another by not smoking. The health benefits of quitting smoking are much greater than the risks of weight gain that may occur.
Key Concept Smoking not only increases an individual’s risk of having a heart attack but also increases that individual’s risk of having a fatal heart attack.
Tobacco Use and Pregnancy
Concerns abound for the child of the pregnant woman who smokes. Studies have shown that pregnant women who smoke less than one pack of cigarettes per day increase their chances of having a low birth weight baby by 53%. Women who smoke more than one pack per day increase these chances by up to 130%. Pregnant women who smoke also increase the chances of preterm births (born early, before the expected due date) and stillborn babies. The risk of sudden infant death syndrome (SIDS) doubles for children of mothers who smoked during pregnancy.
Substance Abuse
Three of every five Americans drink alcoholic beverages. Everyone who drinks alcohol is influenced to some extent. Therefore, each person has the potential of abusing alcohol. It is a mistake to think that only the stereotypical “alcoholic” abuses alcohol.
The abuse of alcohol and other drugs contributes in many ways to decreased public health. Accidents and homicides are major causes of death. Alcohol and drugs often contribute to these events. In addition to accidents, alcohol abuse contributes to such disorders as cirrhosis of the liver, diverticulitis, and mental health conditions, such as depression and suicide.
Substance abuse also contributes to family strife, domestic violence, work absenteeism, and unemployment. Increased use of marijuana, cocaine, crack, heroin, and similar “street” drugs has become a major factor in the rising crime rate in the United States. Substance abuse also directly affects the health of the individual as well as the health of society.
Laws regulating substance use have become more stringent, but the appeal and habit-forming nature of many illegal drugs offset the effects of the laws in many cases. In addition, the huge amount of money to be made on drugs has rendered laws difficult to enforce.
Stress
Stress is normal. It is the physical and mental wear-and-tear of life. Stress is a mental or physical tension exerted on an individual’s homeostasis. It is often associated with change. Some stress is beneficial because it offers people a challenge that keeps them moving toward goals. Stress can also alert people to danger, helping them deal with emergencies. Sometimes stress is harmful and can interfere with homeostasis.
Physical causative factors of stress include injury, diseases and disorders, and invasion of pathogens. Psychological factors include fear, anxiety, crisis, happiness, and change. Often the stress is not the actual physical or emotional event, but the stress is our reaction to the event. For example, getting married is a highly emotional event. The preparations for marriage cause stress. This type of stress can be energizing or damaging to the individual.
Cumulative stress leads to health problems. The individual may be able to adapt to a major change, such as moving to a new state or starting a nursing program. However, stress can be much greater, and can lead to physical and emotional dysfunction if additional change is added, such as a sudden loss of transportation. Individuals need to recognize that stress is insidious (sneaky) and often we do not recognize the symptoms until a crisis emerges.
Unmanaged stress causes or aggravates disorders such as overeating, mood swings, chronic diseases, chemical dependency, and use of tobacco. Stress manifests in many forms, such as physical symptoms (pain, frequent infections, fatigue) and emotional symptoms (the use of negative defense mechanisms). Defense mechanisms are internal stress reducers, even though they may not be truthful or effective ways of adapting to a stressful situation. Examples of such defense mechanisms include projection (blaming someone else) and denial. Lack of motivation and activity can also be stressful. This may occur when an individual retires.
Violence and Abuse
Domestic violence and abuse are probably among the fastest-growing public health problems in the United States today. This is violence that occurs in the home. Abuse by a male partner is the single largest cause of injury to women in the
United States. Nearly 15 million cases of spousal abuse are reported every year. However, unreported cases could greatly increase the total numbers.
Domestic abuse occurs at all racial, ethnic, and socioeconomic levels, although persons with higher levels of education and income may be better equipped to hide it. Some cultures permit violence to women as a prerogative of the male members.
Violence is a community and a nationwide concern. Violence in the workplace is becoming more common as stress levels increase. Violence in schools can start at elementary levels and continue through the educational system. Increasing numbers of gang members and the use of drugs (e.g., crack cocaine and “crank”) contribute greatly to rising violence—especially in young adults.
Rape and other sexual crimes are more frequently reported today than in the past. Many people suffer from the after effects of childhood sexual abuse several years later.
Homicide, usually weapon related, is a growing cause of death for young adults. Also growing is the reported incidence of child homicide, abuse, and neglect.
Elder abuse and neglect are problems that promise to increase in the 21st century. This form of abuse occurs to the dependent and often frail elderly. Many times the abused or neglected senior is dependent on the care of one or more family members. Physical abuse, poor nutrition, lack of medical care, and emotional abuse, such as threats, are examples of elder abuse.
People are living longer and many do not have the resources to care for the side effects of aging. These seniors will be using the healthcare system in the early 21st century in large numbers, perhaps more than can be adequately cared for with current resources (see Fig. 6-1).
Abuse commonly occurs in families in which personal and financial resources have been exhausted. In many cases, older adults may not be receiving the care they need. This is a form of neglect. The isolation of living alone or with relatives sometimes allows abuse to continue without detection or reporting.
Conflict resolution and anger management programs attempt to reduce rates of violence. Your legal nursing responsibility is to report any cases of suspected abuse or violence. Victims of domestic violence can receive assistance at shelters, by using a telephone hotline, or through individual counseling. Local law enforcement and social service agencies are other available resources.
Key Concept Physical activity; having a well- balanced, low-fat diet; maintaining a healthy body weight; and not smoking can reduce the incidence of many disorders.
EDUCATION AND HEALTH PROMOTION
One way to combat society’s health problems is through extensive education. Education can be the leading source of prevention of disease and disabilities. Numerous sources of information are available, for example:
• Formal courses in school (e.g., mine safety)
• Informal courses (e.g., prenatal and birth courses)
• Public service announcements and advertisements
• Informational flyers, brochures, and books
• Nonprofit organizations (e.g., American Cancer Society, American Lung Association)
• Healthcare providers
• Internet Websites
Nursing Alert Websites offer wonderful and easy access to hundreds of health-related information sites. However, use caution when gathering information. Not all sites use information based on truth and documented fact. Double check your resources and use sites that have reliable, professional, and current information. See Web Resources on Point1-, for Website addresses of several healthcare resource sites.
Individuals need to be aware of their risk and lifestyle factors. If a person’s parents had high blood pressure (hypertension), then that person may be at risk for this condition. Awareness of the potential problem will help individuals initiate measures to prevent the complications of hypertension. Education includes frequent monitoring of blood pressure, maintenance of an ideal weight, exercise, and compliance with a medication regimen.
Many schools and healthcare facilities offer classes that emphasize child development and effective parenting. All levels of schooling offer age-appropriate health education courses. Special programs are set up in worksites to educate employees on topics from the safe operation of equipment to the hazards of lifting heavy objects. Many of these educational resources are free. The courses are effective ways of educating individuals and preventing illness and injury. Thus, the employer or facility requires that all employees attend these courses. Acute and long-term healthcare facilities have voluntary and mandatory educational in-service programs for hospital staff.
Many insurance and pharmaceutical companies publish materials aimed at assisting people to live more healthy lives. Information is provided with all prescribed drugs. These companies also publish materials regarding selected disorders and their management, laboratory and other diagnostic tests, and surgical procedures. Such materials are often published in languages in addition to English to better serve target populations. They are also available on audiotape and videotape for persons who cannot read. Students should use caution with some materials because they may be promotional, used to advertise the product.
Television programs and public service announcements emphasize healthier lifestyles. Many programs are targeted at selected populations, such as teenagers, maternal-neonatal issues, older adults, those living in poverty, and members of minority groups.
Key Concept If you understand the concepts of healthy living, you will be better able to teach your clients.
AGE-RELATED HEALTH CONCERNS
Health is a family concern. You are aware that if one person in the family has the common cold, then the rest of the family is more apt to get it as well. Healthy habits are also contagious. Simple examples, such as frequent handwashing and responsible eating habits, educate others in the ways to enhance health and to help prevent illness.
BOX 6-4.
CDC Life Stages and Specific Populations
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The CDC has extensive resource information that is useful, practical, and free for the nursing student, clients, and the general population. Throughout your nursing program, by going to the Life Stages Website of the CDC, you can access continually updated information for the following groups. Example topics found in each of the sections are listed. |
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Life Stages |
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♦ Infants and Toddlers: Birth defects, healthy youth, immunizations, SIDS ♦ Children: ADHD, autism, child development, growth charts, healthy youth, injury ♦ Adolescents and Teens: Adolescent health, alcohol and drug use, nutrition, risk behavior school health ♦ Young Adults: College health and safety, folic acid healthy living, HIV and AIDS: Are You at Risk ♦ Pregnancy: Folic acid, nutrition, pregnancy tips, vaccination, violence ♦ Women: Bone health, breast cancer heart disease, mammograms, reproductive heath ♦ Men: Alcohol use, HIV/AIDS, oral health, prostate cancer reproductive health ♦ Older Adults and Seniors: Arthritis, cancer falls, heart disease, stroke (CVAs), older adult drivers |
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Specific Populations ♦ On the Job: Workplace hazards and illnesses, stress, injuries and health disorders, safety and prevention ♦ Correctional Health: Criminal justice and public health, HIV/AIDS, MRSA, TB, viral hepatitis, STIs ♦ Lesbian, Gay, Bisexual, and Transgender: Health resources for gay and bisexual men, lesbian and bisexual women, transgender persons ♦ Disabilities: Accessibility, autism, disability and health, hearing loss, mental retardation ♦ Minority Health: African American, health disparities, Hispanic, racial and ethnic populations |
Avoidance of risk behaviors can be part of a family’s healthy lifestyle. Children who see smoking in their home are more likely to develop the habit. Good eating habits become generational.
Specific concerns are related to each age group. Some of these concerns relate to avoidable risk and lifestyle factors. The CDC has summarized much information on age-related concerns that nursing students will find helpful. As you progress through the subjects of your curriculum, refer to Box 6-4.
Infants
According to the CDC and NCHS, the United States has lowered its infant mortality rate to 0.7% (7 of 1,000 newborns or infants die). This number is still high, compared with other industrialized countries. In Native American, Hispanic, and African American populations, the infant mortality rate is higher than in the white population. The rate of infant mortality for ethnic minorities is greater than that for white Americans, however, these differences have improved in some areas since the 20th century.
Low birth weight, congenital anomalies, sudden unexpected infant death, and respiratory distress syndrome are known to contribute to the majority of all infant deaths.
Two major factors, the education level and the financial resources of the mother, influence mortality rates. Many women do not obtain prenatal care. The reasons include lack of available finances (even though prenatal care can be free or income adjusted), lack of transportation to the facility, and lack of interest in obtaining prenatal care. Infants and mothers who have prenatal care have a significantly decreased morbidity and mortality rate. If prenatal care is neglected, the infant often has an unhealthy beginning. A healthy infant has a much better chance of growing and developing into a fulfilled adult.
Children
The number one cause of death in young children in America is accidental injury. Asthma is the leading cause of illness in children and can be life threatening. Asthma is twice as prevalent in homes where smoking occurs. Asthma also is influenced by environmental conditions such as air pollution.
The misuse of firearms has led to an increase in mortality and morbidity of children and young adults. If a weapon is kept in the home, statistics show that a child is five times more likely to be injured or killed by a firearm. Death by firearm is the second leading cause of death for ages 10 to 24 and it is the third leading cause of death for ages 25 to 34.
Lack of exercise and physical play activities is a growing concern for the young. Obesity is present in at least one third of the young. Children who are overweight are much more likely to develop health risk factors (e.g., coronary artery disease) in their youth, which will stay with them throughout their lifetime.
The great news is that major childhood infectious diseases are preventable. The six childhood scourges of the past have highly effective immunizations. Immunizations are available against measles, mumps, rubella, diphtheria, pertussis, and tetanus. Newer vaccines against hepatitis A and B, chickenpox, and other viruses are also eliminating illness in children. Because of the effectiveness of modern immunization programs, infectious diseases are no longer the problem they were in the past in countries with well-developed healthcare systems. The public must remain alert to these potential killers because these diseases have not been eliminated. They can only be prevented with proper and complete immunizations. Measles and tetanus, which are vaccine-preventable diseases, are still responsible for hundreds of thousands of childhood deaths worldwide.
Adolescents and Young Adults
Risk behaviors are more prevalent in adolescents and young adults. For example, one third of high school students smoke, compared with 25% of the general population. Substance abuse is another risk behavior common in adolescents and young adults.
Specific lifestyle factors influence this age group. Peer pressure is stronger in this age group than in others. Additionally, this population has the lowest rate of utilization of healthcare, possibly because of the costs of healthcare; a high unemployment rate; and lack of healthcare insurance.
Motor Vehicle Accidents
Motor vehicle accidents (MVAs) are the leading causes of morbidity and mortality for ages 10 to 24. MVAs are associated with alcohol and/or other abused drugs. Worldwide, two thirds of the individuals killed in MVAs are under 45 years of age. Individuals injured in MVAs are numbered to be in the millions. These numbers are projected to increase significantly; therefore, prevention is the main worldwide objective that would result in a vast decrease in healthcare costs.
Firearms
Firearms and other weapons, such as knives, are the second leading cause of death for young adults. At least 10 young people a day die from firearms.
Homicide is the second leading cause of death in adolescents and young adults. It is the number one cause of death among African American youth; this is six times higher than the rate for whites. Low socioeconomic status is the greatest risk factor for death by homicide.
Binge Drinking
Binge drinking is defined as having five or more alcoholic drinks in one day at least once per month. Weekend binge drinking is not uncommon in high school students and is very common in college students. Alcohol is not metabolized in young adults as efficiently as in older adults. Thus, the effects of alcohol consumption are often tragic. MVAs, violent acts, and suicides are often associated with alcohol consumption.
Suicide
Suicide is also a leading cause of death in this age group. It is the second-leading cause of death in whites. The African American suicide rate is half that of the white population. Households with firearms have five times the number of suicides compared with households without firearms. Young women attempt suicide three times as often as men, but the rate of suicide completion in young women is much lower than that in young men.
Eating Disorders
Young women who begin dysfunctional eating habits often develop eating disorders between the ages of 12 and 25. Eating disorders include self-starvation, binging, purging, excessive exercise, and overuse of diuretics, laxatives, and diet pills.
Sexual Health and Safe Sex
Sexual health and safe-sex concerns are a result of the peer pressure that exists for early sexual activity. Sexual activity involves consequences such as sexually transmitted infections (STIs formerly known as sexually transmitted diseases, STDs), pregnancy, and emotional distress. HIV/AIDS is the fifth leading cause of death between the ages of 25 and 44. This rate has increased significantly in teens and women, especially women of color. Of HIV cases in this age group, 90% are transmitted by only two methods: heterosexual intercourse and sharing of contaminated needles and syringes.
The use of condoms is recommended for sexually active individuals, whether or not they use other fertility control measures. Condom use does not prevent all disease transmission. Therefore, the use of condoms is considered “safer” but not totally “safe” sex. The use of a dental dam is recommended for those who engage in oral sexual contact.
Abstinence is the only 100% effective way of preventing pregnancy, exposure to herpes, gonorrhea, syphilis, and other STIs. Teen pregnancy decreased somewhat in the last decade of the 20th century, but has increased in this century.
Some schools have peer support groups for students who have chosen to abstain from sex before marriage.
Pregnancy
Pregnancy occurs most often to women in their 20s. The maternal and infant morbidity risks are significantly higher in teenage mothers and mothers over the age of 35. Prenatal care is imperative, especially with the higher risk pregnancies (see Box 6-3). Unit 10 discusses pregnancy in detail.
Pregnant women who smoke or use cocaine, crack, heroin, marijuana, alcohol, or a number of other drugs also put their babies at high risk. Use of crack or cocaine, even one time, can cause learning disabilities, preterm birth, low birth weight, fetal stroke, miscarriage, and stillbirth. Cocaine use increases the chance of preterm birth by 25%.
Pregnant women should maintain a healthy weight, eat a balanced diet (with special modifications), continue physical activity, and avoid smoking, alcohol, and all medications (including over-the-counter drugs) without a physician’s prescription.
