Stress: Enough Already
Perceptions, Implications, and
Adaptations
Presented by:
Heather Baker, BSN, RN
April 2014
What is Stress?
• By Definition, stress is any uncomfortable “emotional
experience accompanied by predictable biochemical,
physiological, and behavioral changes”
• In other words, it is not the demand or the event that
causes us stress, but rather our reaction or emotional
response that determines how we are going to handle
what we consider a perceived threat.
• unavoidable and in small doses it is beneficial
• motivates us to achieve our goals.
•
Baum, A (1990). “Stress, Intrusive Imagery, and Chronic Distress, “ Health Psychology, Vol.6.pp.
653-675.
What is stress? (cont)
• fight or flight response
• In moderation, it produces a boost
• provides us with energy and drive to get
through situations.
Types of stress
• Acute stress
– often situational
– Cause is known
– (examples include: looming deadlines, test taking, running late for an
appointment, getting into an argument with a loved one)
– Resolution occurs when perceived stress is gone
– No long term effects
** You have heard the saying “Everything in moderation” It is this
level of stress that helps us work efficiently, motivates us to
complete tasks, prepares us for new experiences, so what this means
is a little bit of stress keeps us on track and allows us to perform at
an optimal level.
Allostasis
• A regulatory process
• a stress mechanism that protects and promotes
short term adaptation to a perceived physical or
behavioral demand.
• maintains equilibrium during the exposure period
and allows for return to normal functioning once
the demand is gone.
• The ability of the body to have time to recover
from stress is crucial to maintaining one’s overall
health.
McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to
socioeconomic status, health, and disease,” Ann NY Acad Sci., February: 1186. pp. 190-222.
Ongoing Acute Stress
• Ongoing acute stress
– Situation that is causing you to feel the stress does not
end.
– examples: the pile of paperwork that sits on your
desk, always being in a hurry but not ever managing
to get anywhere on time, inability to say “no” to
people and then getting upset that you didn’t say “no”
• No resolution
• can have an effect on you physically and
emotionally.
• causes a shift in equilibrium.
Chronic Stress
• Chronic Stress
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ongoing acute stress
much larger scale and over a much longer period of time.
becomes part of your everyday life.
examples: poverty, an unhappy marriage, and chronic
illness
– “fight or flight “ response meant to be utilized in
emergency situations never fully shuts off causing your
body to stay in stress mode longer than it should.
• causes wear and tear on your body
• Potential for long term physical and emotional health
problems.
Allostatic Load
• “This wear and tear on the body and brain
promotes ill health, involving not only the
consequences of the stressful experiences
themselves, but also the alterations in lifestyle
that result from a state of chronic stress”
• Equilibrium cannot be maintained
• The body’s inability to shut off its physiological
responses and ineffective coping mechanisms can
invoke illness and chronic diseases.
McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to
socioeconomic status, health, and disease,” Ann NY Acad Sci., February: 1186. pp. 190-222.
See-Saw Effect
The lower image is an
image of Allostasismaintaining little stress
over the life course.
The upper image is one
of allostatic load- if you
put too much chronic
stress, the see saw will
inevitably break.
McEwen, B. and Lasley, E. The end
Of stress: As we know it. Washington
DC: John Henry Press. 2002.
Causes of perceived stress
• This can be broken down into 3 categories:
– Home
– Work
– Everything else
Sources of stress at home
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Death of a loved one
Divorce, separation, relationship problems
Chronic illness or major life altering injury
Money problems due to loss of job, high debt,
home foreclosure, just not having enough money
to meet your everyday needs or wants
• Marriage
• Pregnancy or birth of a new baby
• Your children
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Davis, M. (2000) The Relaxation and Stress Reduction Workbook, New Harbinger, Inc.
Sources of stress at work
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Losing your job, a demotion or change in work duties
A new job
Your relationship with your coworkers or boss
The workplace environment
The amount of pressure you are under
Number of hours you work (too many, not enough,
work schedule)
• Feeling unappreciated or not valued
• Being passed over for a promotion or pay raise
Davis, M (2000) The Relaxation and Stress Reduction Workbook. New Harbinger, Inc.
Sources of stress everywhere else
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Poverty
Environment (where you work, play, live)
Racism
Gender
Emotional Health (how you feel about yourself, relationships, your
purpose)
Fears about Safety
Education
Lack of a support system
Negative feelings about oneself
Drug and Alcohol abuse
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Davis, M (2000) The Relaxation and Stress Reduction Workbook. New Harbinger, Inc.
Socioeconomic Status and Stress
• “There is evidence to support that disparities in
income, education, occupation, health care
accessibility, housing, and many other variables
account for appreciable variance in cause and
disease specific morbidity and mortality rates as
well as the prevalence of risk factors for chronic
medical conditions, psychopathologies of mood
and substance abuse.
McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to
socioeconomic status, health, and disease,” Ann NY Acad Sci., February: 1186. pp. 190-222.
Environment and Racism
• Chronic stressors of neighborhood environment and racial
discrimination have shown to be associated with preterm birth
especially among the African American population which may
contribute to the disparity in preterm births and infant mortality
rates.
• The feelings of physical isolation, living in unsafe and violent
neighborhoods, lack of social support, and racism contribute to the
stress that is felt among these women.
• “Racism is seen as a significant health risk because of the
psychosocial or affective responses it produces (stress, anxiety,
anger, depression, etc), this leads to a physiological response that is
associated with chronic illness.”
Giurgescu, C., Banks, A., Dancy, B., Norr, K ( July/August2013). “African American Women’s Views of Factors Impacting Preterm Birth,” MCN,
Volume 38. Number 4. pp. 229-234.
Jackson, F., Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality,” Joint Center for Political and Economic Studies
Health Policy Institute.
Delaware Stats
• Black infants experienced significantly higher mortality rates than
white infants for the time period of 2006-2010
• For this time period, black IMRs were anywhere from 2.2 to 2.8
times that of white IMRs.
• Significant disparities existed between black non-Hispanics and
each of the two other groups, white non-Hispanics and Hispanics.
• Black non-Hispanics had the highest IMRs of 14.1 in 2006-2010 was
more than double the white non-Hispanic rate of 5.4 and nearly
twice the Hispanic rate of 7.4 infant deaths per 1,000 live births.
Delaware Vital Statistics Report 2010
Gender Stress
• just being a woman invokes a level of stress
due to role of expectations placed upon a
woman
– Sandwich Generation
– Balancing multiple roles
– the decision makers and organizers
–
Jackson, F. “Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality,” Joint Center for Political and
Economic Studies Health Policy Institute.
Socioeconomic Status and Stress
(Individual Level)
• low socioeconomic status can invoke feelings
of:
– insecurity, low self worth, low self esteem, social
exclusion and an overall feeling of just not being
good enough.
• has a direct impact on emotional and
physiological reactivity and recovery from life
stressors thus impacting the risk of ill health.
McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links
tosocioeconomic status, health, and disease,” Ann NY Acad Sci., February: 1186. pp. 190222.
Snowball Effect
How does it happen?
• A person who develops, matures, and ages in a low
socioeconomic position is more vulnerable to impairments
in the function of the regulatory process that is meant to
maintain equilibrium which puts them at greater risk for
disease and maladaptive coping behaviors.
• Take that a step farther, now their children are being raised
in a low socioeconomic environment in which they are
being exposed to toxic substances, excessive noise,
unfavorable housing conditions, the possibility of unhealthy
family dynamics, as well as other forms of early life stress
which very likely will alter their abilities to lead a healthy
life.
McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to
socioeconomic status, health, and disease,” Ann NY Acad Sci., February: 1186. pp. 190-222.
What does stress look like?
What does it feel like?
• the initial feeling is the “fight or flight
response”:
– Your heart beats faster
– Your breathing increases
– You feel an adrenaline rush
– Your muscles tighten up
– Your pupils dilate
– Blood moves from the center of your body to your
limbs
Physical Symptoms
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Chest pain or tightness
Weight gain or weight loss
Muscle tension, aches and pains
Skin breakouts
Excessive sweating
Increase in blood pressure
Loss of interest in sex
Hair loss
Headaches
Stomach upset/nausea
Shortness of breath
Sleep issues- too much or too little
Gritting or grinding teeth
Hives
Trembling of lips and hands
Karren KJ, et al. Mind-Body Health: The Effects of Attitudes, Emotions and Relationships. 4th ed. San Francisco, Calif.: Pearson Education; 2010:28.
Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014.
Charlesworth EA, et al. Stress Management: A Comprehensive Guide to Wellness. New York, N.Y.: Ballantine Books; 2004:24.
Stress: Coping with everyday problems. National Mental Health Association. http://www.nmha.org/go/information/get-info/stress/stress-copingwith-everyday-problems. Accessed April 5, 2013.
Emotional Symptoms
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Mood swings
Anxiety
Depression
Frustration
Nervousness
Feelings of guilt, shame, helplessness, loss of control
Poor self esteem and lack of confidence
Feelings of failure
– ***Long term effects have been linked to eating disorders, depression
and anxiety disorders, panic attacks and suicide***
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•
Karren KJ, et al. Mind-Body Health: The Effects of Attitudes, Emotions and Relationships. 4th ed. San Francisco, Calif.:
Pearson Education; 2010:28.
Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014.
Charlesworth EA, et al. Stress Management: A Comprehensive Guide to Wellness. New York, N.Y.: Ballantine Books;
2004:24.
Stress: Coping with everyday problems. National Mental Health Association. http://www.nmha.org/go/information/getinfo/stress/stress-coping-with-everyday-problems. Accessed April 5, 2013.
Behavioral Symptoms
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Irritability or anger outbursts
Maladaptive behaviors such as drinking too much, smoking, poor eating habits
Inability to concentrate
Memory lapses, forgetfulness or short term memory loss
Relationship problems
Poor work performance
Poor time management
Overreacting to minor irritants
Karren KJ, et al. Mind-Body Health: The Effects of Attitudes, Emotions and Relationships. 4th ed. San Francisco,
Calif.: Pearson Education; 2010:28.
Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014.
Charlesworth EA, et al. Stress Management: A Comprehensive Guide to Wellness. New York, N.Y.: Ballantine Books;
2004:24.
Stress: Coping with everyday problems. National Mental Health Association.
http://www.nmha.org/go/information/get-info/stress/stress-coping-with-everyday-problems. Accessed April 5,
2013.
Signs of Stress Overload
• Frequent anxiety or panic attacks
• An overwhelming sense of impending doom
• Constant feelings of sadness, hopelessness, not feeling like you are ever
good enough
• Feeling of being constantly pressured and hurried
• Development of health problems: Hypertension, Diabetes, Depression,
Obesity, Eating disorders, Substance Abuse, Irritable Bowel, Memory Loss,
Autoimmune Disease, Insomnia, Thyroid Problems, increased risk of poor
birth outcome, and Infertility (result of allostatic load)
• “Weathering effect”- prolonged stress is thought to create this effect
which prematurely ages the body thus leading to the development of
chronic diseases and may contribute to results of poor birth outcomes.
The body is prematurely aging as a result of chronic, longitudinal stress.
•
Jackson,F. “Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality,” Joint Center for Political and Economic
Studies Health Policy Institute.
The Effects of Stress
Hair: high levels of stress may lead to
Excessive hair loss or some form of baldness
Stress triggers mental and emotional problems such as insomnia, headaches,
Personality changes, irritability, anxiety, and depression.
Mouth ulcers and excessive dryness may be symptoms of stress
Muscles: stress has been associated with pain in
The neck and shoulders, tension, twitches, and
Nervous tics.
Cardiovascular disease and hypertension are linked to accumulated
Stress.
High levels of emotional stress have can adversely affect asthmatics
Digestive tract: stress has been associated
With stomachaches, irritable bowel and weight gain/loss
Some individuals react to stress with
Skin outbreaks such as eczema and psoriasis
Stress can affect the reproductive system causing menstrual disorders
And recurrent vaginal infections, infertility and has been linked to prematurity
In men, it has been linked to impotence and premature ejaculation.
Psychological Resilience
•
How stressed out are you?
Take the test
How many of the following statements or feelings apply to you?
Little things make me angry.
I don’t laugh as much as I used to.
I feel sad and anxious most of the time.
I am eating or drinking too much.
I am engaging in risky behaviors.
I can’t seem to remember things as well.
I am having recurring headaches, stomachaches, tension in jaw, shoulders, back or chest.
I recently got married, divorced, or separated.
I was recently injured or have been sick.
I am having major financial problems.
I work more than 10 hours a day.
I was recently fired, laid off from my job.
I hate my job or some of the people I work with.
I have not had a vacation in 3 years.
I sleep less than 6 hours a night.
I hardly have anytime for myself.
I am always in a hurry and cannot manage to get anywhere on time.
I don’t have an emotional support network.
A close friend or relative is sick or recently died.
Brott, Armin. Your Head: An Owner’s Manual. Understanding and Overcoming Depression, Anxiety, and Stress.
How did you answer and what does
this mean?
• Chances are, at least 5-6 of the above statements are true for you.
This should not come as a surprise. Stress is so widespread that
The American Institute for Stress estimates that 75-90 % of all visits
to PCPs are for stress related issues.
• According to The American Psychological Association, American
Institute of Stress, NY, the top causes of stress are:
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Job pressure
Money
Health
Relationships
Poor nutrition
Media overload
Sleep deprivation
Statistics
• According to American Psychological Association, American Institute of
Stress, NY,
– 77% of people in the U.S. regularly experience physical symptoms caused by
stress
– 73% of people in the U.S experience psychological symptoms caused by stress
– 33% of people in the U.S. feel that they are living with extreme stress.
– 48% of people in the U.S. feel their stress has increased over the past 5 years
– 48% of people in the U.S. said that stress has had a negative impact on their
personal and professional life.
– $300 billion dollars is being spent annually by employers on stress related
health care and missed work.
– 51% of people in U.S. reported fatigue as the number 1 physical symptom
– 50% of people in U.S. reported irritability and anger as the number 1
psychological symptom
Good and Bad News
• The good news is that we are not alone, the
bad news is, is that it is costing us billions of
dollars and making us sick!!
So…what do we do about it???
How do you handle stress?
• Positive vs. Negative
Maladaptive Coping Strategies
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Alcohol abuse
Smoking
Drug Abuse
Over eating
Escapism
Spending sprees
Blaming others
Physical or verbal abuse
Overworking
Denial
Magnification
Drinking too much caffeine
Negative self talk
Dealing with Stress
• Stress Reduction Kit
Bang
Head
Here
Directions:
1. Place Kit on FIRM surface
2. Follow directions in circle of kit
3. Repeat step 2 as necessary, or until
unconscious
4. If unconscious, cease stress reduction
activity immediately!!!
OR………………….
Dealing with Stress: The 4 A’s
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Avoid
Alter
Adapt
Accept
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Miller LH, et al. The Stress Solution: An Action Plan to Manage the Stress in Your Life. New York, N.Y.: Pocket Books; 1993:86.
Patel C. The Complete Guide to Stress Management. New York, N.Y.: Plenum Press; 1991:233.
Wheeler CM. 10 Simple Solutions to Stress. Oakland, Calif.: New Harbinger Publications, Inc., 2007:39.
Seaward BL. Essentials of Managing Stress. 3rd ed. Sudbury, Mass.: Jones & Bartlett Publishers; 2014:109.
How can I manage stress? American Heart Association.
http://www.heart.org/HEARTORG/GettingHealthy/StressManagement/StressManagement_UCM_001082_SubHomePage.jsp. Accessed May 23, 2013.
Avoid
• 1. Avoid unnecessary stress
– Not all stress can be avoided, nor is it healthy to avoid
situations that need to be addressed but you may be
surprised at the number of undo stressors you place on
yourself
• Learn to say “NO”- know your limits and stick with it both in your
personal and professional life, refuse to accept any added
responsibilities that you do not have time for. Taking on more than
you can handle is a recipe for unnecessary stress!
• Avoid people who cause you stress, or at least limit your time with
them. Set limits. Understand that you cannot control someone
else’s behavior but you do have control of your own.
• Take control of your environment.
• Scale down your To-Do list- distinguish between your “shoulds”
and the “musts”
Alter
• 2. Alter the situation: if you can’t avoid it, figure out a way
to change how you respond to the situation
– Express your feelings instead of bottling them up. People are
not mind readers, you cannot expect people to look at your face
or observe your body language and know how you are feeling
• Communicate your feelings openly and respectfully otherwise feelings
of resentment will fester and the situation will likely remain the same
• Compromise, if you are asking another person to make changes, then
you should be willing to bend yourself
• Be more assertive- don’t take a backseat in your own life. Look out
for your own well being and deal with problems that arise head on.
• Manage your time- don’t overextend yourself. Don’t make promises
you cannot keep, you will only feel badly about yourself.
Adapt
• 3. Adapt to the stressor: if you can’t change the stressor, change
how you react to it.
– Reframe the problem: try to see the positive in every situation (ex:
stuck in traffic jam, take a moment to listen to your favorite music)
– Look at the big picture: “Don’t sweat the small stuff” Ask yourself
will this really matter in a few days, a month, a year, if the answer is
no, then it is time to put your focus and energy somewhere else.
– Adjust your standards: stop comparing yourself to others, stop setting
yourself up for failure by demanding perfection. Set reasonable goals
for yourself. You are not a Super Hero, so don’t try to act like one.
• (Sojourner Syndrome and Superwoman Complex)
– Focus on the positive: learn to be grateful and appreciative of what
you do have in your life instead of focusing on what you don’t have.
Be sure to take note of all of your own positive qualities and gifts that
you have to share.
Accept
• 4. Accept the things that you cannot change
– “it is what it is”, there are just some things and situations we cannot control,
instead of stressing about these things, learn to focus on the things that you
do have control over.
– Look for the upside: when faced with challenging circumstances, take a
moment to look at how this is a chance for you to grow as a person. If you
make a mistake, don’t see it as a failure but as a way to learn from it and move
forward, look at it as if there are no mistakes just life lessons to learn along the
journey
– Share your feelings: opening up about how you feel if nothing else makes you
feel better even if you cannot change it
– Learn to forgive- accept that we live in an imperfect world and that people
make mistakes, let it go. Freeing yourself from all of that negative energy and
resentment leaves room for more positive experiences. It frees you up from
time and energy spent on things you cannot change.
– Eliminate the words: “always, never, should, and must”. These are self
defeating words that will only set you up for failure.
Achieving Inner Health through Stress
Reduction Techniques
• Learn To:
– Appreciate Yourself- value who you are and what
you do
• Problem: Questioning your ability?
• Solution: Do a self inventory of your skills, strengths
Ask for Help, seek out resources that are available
• Problem: Feeling Pessimistic?
• Solution: Keep a gratitude journal, do a self inventory, rent a funny,
uplifting movie, surround yourself with positive people
• Problem: Worn out, Burned out?
• Solution: Take care of you!! Eat Healthy, sleep, exercise, engage in
activities that make you happy
Achieving Inner Health through Stress
Reduction Techniques
• Learn To:
– Find Balance and Purpose
• Problem: Frequently Late?
• Solution: Prioritize, map out your day: segment by segment
Get to the bottom of why you are really late!!
• Problem: Angry and Irritated?
• Solution: Pause, Breathe, Reflect, Regroup, and Choose
Don’t magnify or leap to conclusions
• Problem: Overextended?
• Solution: Decide what is important to you
Delegate
Achieving Inner Health through Stress
Reduction Techniques
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Learn To:
• Connect with Others
Problem: Feeling Lonely?
Solution: Volunteer, Strike up a conversation, connect on social media,
phone a friend, avoid judging others, identify with your own
racial, ethnic, or cultural background, learn about other cultures
surround yourself with people who respect and value you
Problem: Upset by conflict/Poor Communication
Solution: Try Being more assertive, let your needs be known in a respectful
way.
Avoid words like “you always” or “you never” instead try saying
I feel _____ when you____.”
Other Solutions to Stress
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Create a worry box- great for children
Meditation- clears your mind of all the clutter, helps to find an inner calmness and inner peace
(www.how-to-meditate.org)
Deep Breathing: Less than a minute
Count down slowly from 10-0: takes 2 minutes
Self Massage: 5 minutes or less
Find your happy place: 10 minutes or less
Yoga
Engage your senses
Drive in the slow lane
Pray
Before work, sit in the car for a minute and plan out your day, leaving behind any negativity that
happened before coming to work
After work, sit in car and reflect on your day, let go of the negativity that happened during your
work day
Take a break from technology, unplug
Ask for help, Dial 2-1-1
(adapted from www.dbsalliance.org) Healthy Lifestyles: Improving and Maintaining the Quality of your Life.
Tips for Health Care Providers
• When dealing with a difficult or stressed patient, remember
to:
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Observe- voice, words, attitude
Connect- Ask open ended questions
Be an active listener
Validate their feelings: (examples: “What I hear you saying is..”)
Show Respect: make eye contact
Slow down
Address their basic human needs
Focus on feelings
Be safe, know when to de-escalate and know when to terminate
Benefits of Effectively Managing Your
Own Level of Stress
• Improved physical and emotional health
• Improved memory and cognitive functioning
• Increase in energy during the day and more restful sleep at
night
• Increase in emotional connectedness, feeling of
contentment and satisfaction with life
• Decrease in impatience, irritability, depression and sadness.
• Increase in positive attitude and in joy of everyday
activities, finding humor in situations
• The acknowledgement that managing stress is a lifestyle,
not just a single event.
•
(adapted from www.dbsalliance.org) Healthy Lifestyles: Improving and Maintaining the Quality of your Life.
The Role of Public Policy in Stress
Reduction
• Investments in Women’s Health
– push for better access, affordability, and quality of
health care across the lifespan (loss of Medicaid
coverage at 60 days postpartum even if poor
pregnancy outcome)
– a multidisciplinary approach in treatment, so that
there is follow through and follow up services, a
continuity of care is needed.
– push to educate women before their reproductive
years( preconception education) (Healthy women
beget healthy children)
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Lu, M and Halfon, N (2003). “Racial and Ethnic Disparities in Birth Outcomes: A Life –Course Perspective,”
Maternal and Child Health Journal, Vol. 7, No. 1, March. pp. 13-30.
The Role of Public Policy in Stress
Reduction
• Investments in Community Health
– Create a comprehensive health care system that takes preventative steps to
illness and injury, that maintains the well being of those who are already sick
– Offer full services (medical ,dental ,vision, screening and diagnostic services
and disease management) all within the communities where people live
(Prevention institute)
– push for what influences our health outside of this, which is where we live,
work, play, socialize, and learn(location, location, location)
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Creating affordable and decent housing
Safe neighborhoods that allow for parks and recreation
Provide clean air and water
Provide access to healthier foods (farmers markets that accept food stamps), there is a
problem when there are more liquor stores and fast food restaurants than there are
grocery stores.
• Make bus routes more accessible and safer
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Lu, M and Halfon, N (2003). “Racial and Ethnic Disparities in Birth Outcomes: A Life –Course Perspective,”
Maternal and Child Health Journal, Vol. 7, No. 1, March. pp. 13-30.
The Role of Public Policy in Stress
Reduction
• Investments in improving social conditions:
– Create programs that address drug and alcohol issues without
prejudice or punitive charges
– Decrease domestic violence
– Engage fathers and encourage them to be active, positive role models
in their children’s lives by including them in preconception education,
the pregnancy and the parenting. Giving them value and place in the
future of their children.
– Create better working conditions for women by decreasing work load,
creating flexibility in work schedules, offering daycare options so that
women can work. Create neighborhoods that foster a sense of
connectedness that create opportunities that foster positive
community relationships ( it takes a village)
McEwen, B and Gianaros, P (2010). “Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease,”
Ann NY Acad Sci., February: 1186. pp. 190-222.
Lu, M and Halfon, N (2003). “Racial and Ethnic Disparities in Birth Outcomes: A Life –Course Perspective,” Maternal and Child Health Journal,
Vol. 7, No. 1, March. pp. 13-30.
Visualization/Guided Imagery
Conclusion
• Your Heart is Free…. Have the courage to follow it!!
• “Your time is limited, so don’t waste it living someone
else’s life. Don’t be trapped by dogma-which is living
with the results of other people’s thinking. Don’t let
the noise of other’s opinions drown out your inner
voice. And most important have the courage to follow
your heart and intuition. They somehow know what
you truly want to become. Everything else is
secondary.”
by Steve Jobs
Thank You!!!
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Stress: Enough Already