3200 Exam 3 Topic 9-11

Topic 9

Physical Appearance

People look different. There is a great deal of diversity among human beings in terms of how they
appear. For instance, some people are shorter or taller than others.

The Tall and Short

Human height, or stature, varies little between people in various cultural and ethnic groups. There
are short, average, and tall people whose measurements fall along the famous bell-shaped curve in
statistics.

In general, U.S. males who are considered short measure an average of 5 ft 4.5 in. Tall men average
6 ft 1.6 in and average men about 5 ft 9.1 in. The shortest U.S. females, on average, measure 4 ft
11.9 in; tallest, 5 ft 8.1 in; and, the average is 5 ft 4 in. Of course, there are extreme differences. No
wonder it is difficult to shop for clothes in stores that try to accommodate various heights and
weights.

The tallest documented person, called a giant, was a man who was 8 ft 11.1 in tall. The tallest woman
was listed at 7 ft 8 in tall. The shortest man on record until his death in 1997 was 22.5 in tall and
weighed 37.5 pounds. There is an association for people of short stature that share a medical
condition called dwarfism. Little People of America http://www.lpaonline.org/ helps little people to
meet each other and to deal with the many problems of being very short.

Height is determined by the interaction of genes and environment and final adult height is typically
attained during one's early teens or early twenties. It is more common for females to reach this
height during the teens than for males. It has also been suggested that a person's height varies
during the course of a day, as the spine compresses during the daytime when people are moving
about and then stretches back out overnight while they are sleeping, perhaps as much as 0.75 in.

Adult men and women are roughly an inch taller now than they were in 1965. They are nearly 25
pounds heavier on average as well, according to a 2005 report from the Centers for Disease Control
and Prevention (CDC).

Height often plays a significant role in sports. Being tall is most valuable in sports like basketball and
volleyball, where "short players" are still well above the average when compared to the general
population. Small stature is more valuable in such sports as horse racing, auto racing, and
gymnastics. In these cases, a person's frame enables them to excel because of the demands and
particular tasks of the sport.

For men, being short is often considered a disadvantage because other men usually show more
respect to taller men and women tend to find shorter men less attractive. Surveys show that women
in most cultures prefer tall men as partners. For many young women, it is especially important that
the man be taller than the woman. Some men may not be attracted to tall women, although it is not
uncommon for tall (6 ft) supermodels to draw most men's special attention.

A few studies have suggested that being tall can be equated with more success. CEOs, for example,
and upper management in companies tend to be taller than average. Taller men seem to marry earlier
and earn higher wages. However, studies also suggest that it is not adult height alone that is the
critical factor. Adolescent experiences are even more influential because that period has such a
powerful impact on self-image.

There are instances of discrimination and bias in terms of a person's height. It works both ways, as
height can be intimidating or charming. It may or may not be an essential consideration in terms of
attractiveness.

Finding a Mate

We have all noticed how some people strike us as more attractive and desirable than others. We are
drawn to them. At the root of the attraction is the instinct and need for reproduction, influencing our
choices both consciously and unconsciously.

Humans are sexual creatures and their desires can be triggered by factors that create interest or
excitement. Deep down in the psyche, there is a desire for males and females to mate. The choice of
partners is what makes human diversity interesting and intriguing.

Humans are different from other species. First, humans think and are aware of their emotions, which
can take them beyond their physical desire to have sex. Men and women apply not only physical
criteria in seeking a partner, but they use social, cultural, and economic information in their
selections.

Second, women don't come into seasonal heat. They can mate and get pregnant at almost any time
throughout a year. This takes the dating and courtship process beyond a breeding season and
waiting for an alpha male to establish physical superiority over others. It is not just the survival of
the fittest, but that criterion is certainly within the mix.

Research shows that men think about sex more than women and apparently males have a drive to
mate with as many females as possible. Ehrlichman & Eichenstein (1992) linked this desire to the
basic instinct of wanting to create many offspring and to pass on genes to help the species survive.
The first criterion for men, in this case, is to find women who can be impregnated. Thus, they tend to
look for those old enough (past puberty) but young enough to care for children.

Admittedly, the logic may be an unconscious one and is based on evolutionary theories. Some men
want to be with women but not marry them. They fear the commitment level and tend to be more
self-centered.

Physical Attraction

Thus, males are initially attracted to a female's appearance. If a woman is young and healthy, men will
likely take notice of her. They will also consider her beauty, since being beautiful and desirable are
almost synonymous.

Perceptions of beauty and health have changed over the centuries and from culture to culture. For
example, at the turn of the 20th century, Lillian Russell was the leading sex symbol and she weighed
over 200 pounds. By today's standards, famous stars known for their sex appeal, such as Marilyn
Monroe, Jayne Mansfield, and Mae West would be considered overweight.

Down through the ages, cosmetics have been used to shape appearance, as have dress and
costumes that emphasize or de-emphasize parts of the anatomy. Barbers, hairdressers and
hairstylists provide personal services to enhance appearances. Likewise, so do manicurists,
pedicurists and skin care specialists. In addition, there are trainers and consultants who work in
fitness and health centers to help people feel and look better. There are thriving industries based
on helping people look their best, or as the latest fashion might be.

People are taught the way they are supposed to view the world, and characteristics that are
deemed beautiful and desirable are also learned. This includes particular traits that males and
females are conditioned to consider attractive and sexually desirable. Such attributes as intelligence,
wittiness, social skills, accomplishments and prospects for future success can influence how a
person is perceived. There is more to look for than anatomy.

Nevertheless, most men notice when a physically attractive woman walks by. One's thoughts could
be, "Don't look,"' but male eyes steal a glance and heads turn in an irresistible way. It's human nature,
although some men, because of their socialization, may feel guilty and deny or try to ignore the
attraction.

The human female, on the other hand, applies more criteria in selecting a mate. It is not the nearest
possibility, but the best possibility that she desires. According to sociologists, a woman's mind and
instincts allow her to examine, to a greater degree, other criteria besides sexual attraction. Women
are more likely to project the consequences of choices and consider the future. In addition to
strength and power for security, women might include intelligence, money, prestige, status,
attitudes, religious convictions, ability and willingness to share parenting roles, or any number and
combination of social factors.

Women's ability to think consciously about their sexual lives does not mean that their instinctive
sexual desires are less than men's. Rather, it suggests that women are likely to subordinate that
desire to other factors. A woman, for instance, may desire a physically attractive man, but she more
often will not have sexual relations with him until he has satisfied more than physical criteria.

Are we going out on a limb in this discussion and in danger of falling off because of such general
observations and stereotyping? Perhaps, but recent studies in England provided evidence that
catching the eye of someone "beautiful" triggers a flurry of activity deep in the male brain. The
research may shed some light on why first impressions last when we meet people and why some men
are immediately attracted to an other.

The study (Kampe, 2001) scanned the brains of men who examined photos of different people in
quick succession and rated how attractive they found faces. Unattractive faces did not activate the
subjects' brains; whereas, viewing photos of attractive persons- by the subject's own definition-
sparked more brain activity. Interestingly enough, the responses were not related to sex, as
responses were consistent regardless of whether the person in the photo was male or female

Yet, common knowledge and several studies also suggest that people eventually use another set of
personal criteria, going beyond initial sexual attraction and needs, when seeking a committed
relationship. Sexual gratification has a strong element of self-gratification but it takes love, caring
and sensitivity on the part of both partners to reach high levels of mutual satisfaction.

Common extremities - arms, legs, nose, eyes, torso, feet, hands and so forth, help us easily
recognize human beings. Yet, we still note physical differences among people. We know that all of
us, in some way, are different from each other and that people come in many sizes and shapes.

When you walk through a shopping mall, for instance, it's easy to see that no two people look
exactly alike, unless you encounter identical twins. In the United States, in the year 2000, there were
approximately 119,000 twin births, which was a 74% increase since 1980. This amounts to about 3%
of babies born as a twin, triplet or quad. Fraternal twins or multiples may have some physical
similarities, as many family members do, but they are not identical. The chance of having identical
twins with identical looks has remained steady at 0.4% or 1 in 250 births.

This means that despite millions of people, it would be most unusual to meet someone who in
appearance is your exact replica. At the same time, there are some general body types that are
used to differentiate people and help us understand human diversity.

Body types

Genetics determine our body types and the shape we develop from birth through adulthood. We
cannot change our body types but we can make the most of what our genetic heritage gave us.
Body appearance also depends upon lifestyle, diet and exercise, and perhaps little surgical nips and
tucks here and there.

William Sheldon (1898-1977) was an American psychologist who spent his life observing the diversity
of human bodies. As a child he was an avid observer of animals and birds. Over the years, this hobby
turned into an ability to observe the structure of the human body. He was an avid people watcher.
After years of study, he concluded that regardless of age, race, or gender, you will likely fit, more or
less, into one of three body types: ectomorph, mesomorph or endomorph.

Ectomorphs have a thin, linear appearance. They typically possess a narrow waist, hips and
shoulders. They also have a low percentage of body fat. They tend to have long fingers and toes
and the shape of the face is triangular, with a high forehead. They often have a narrow chest and
abdomen, thin legs and arms with little muscle or fat.

Some people consider the ectomorphs lucky because their lean appearance and ultra fast
metabolism enables them to stay slim even if they eat well. Slim has become the valued "look" in our
society, as portrayed by models through out fashion magazines and consumer catalogs.

The drawback is that ectomorphs lack a defined shape due to their low muscle weight. It takes them
longer to gain muscle, and lean muscle weight is what makes for a shapely figure. In addition, they
may suffer from extremes in temperatures. Due to the greater body area in relation to muscle mass,
the ectomorph may suffer from extreme heat. Similarly, due to low body fat, they may suffer from
great cold. Their hair is fine and grows quickly and they complain because sometimes it is difficult to
keep in place.

Ectomorphs were those skinny girls and guys who could eat as much as they like and still stay thin. in
the 1990's, especially, it was "trendy" to be an ectomorph. This was the preferred body type and
women models with that type were featured strutting the walkways in fashion shows. "They are all
anorexic!" grumbled one observer. A true ectomorph has trouble putting on weight and is not
suffering from anorexia nervosa.

Mesomorphs are characterized by broad shoulders, narrow waist, naturally large muscles and a fast
metabolism related to the amount of lean muscle. For men, a mesomorph has an athletic physique,
with heavy, naturally hard muscles. For women, there is a strong muscular and athletic look, with
narrow waists and broad hips. They tend to gather weight around their hips and thighs rather than
their abdomen. However, in general, they have the best body type for controlling weight.

Endomorphs have a body type that is characterized with big heavy bones, round face, and large
trunk and thighs. They carry more fat than muscle, which tends to center around the midsection.
Their stomachs and breasts may be larger in comparison to other types. They struggle to control
their weight and they must work much harder than mesomorphs to lose the same amount of weight.

Fat around the abdomen is much deeper than on the hips or thighs and this directly affects the
amount of fat stored around the body's heart. This can increase the incidence of heart disease and
high blood pressure. Being an endomorph requires a healthy regime to reduce the fat around
important organs.

Sheldon's three different body types are popular again because of modern weight training and
exercise programs. Trainers in health and fitness centers use the model to help set client goals. It
keeps people from being discouraged or having unrealistic objectives.

The general public is obsessed with talk about dieting and weight control. People read the labels on
packaged food goods looking especially for the amount of fat content. We all know that being
overweight, obese, or having excess body fat is bad for our health. But, it is not only total body fat
but also distribution that is significant.

Are you a pear or an apple? People who tend to gain weight mostly in their hips and buttocks have
roughly "pear-shaped" figures, while people who tend to gain weight mostly in the abdomen have
more of an "apple shape."

These analogies describe body types in terms of body fat and have made their way into the popular
literature. In many respects, they are related to Sheldon's work but they present a slightly different
picture.

The apple body is rounded in shape. It has a full bust or chest, waist, and upper back and sometimes
a prominent stomach. This body type appears top heavy, usually with a pronounced midriff and flat
rear end. The bust and/or midriff are larger than the hips, producing a natural wedge shape.

People with this body type tend to be short in the waist and may have a rounded hump in the back.
Their faces may be large in relation to their bodies and they have comparatively slim arms and legs.
Apple body types are at increased risk for the health problems associated with obesity, such as
diabetes, coronary heart disease, and high blood pressure.

The pear-shaped type has wider hips and thighs than shoulders and chest. The hips and rear are the
biggest parts of the body. The waist is smaller than the hips and the bust or chest and shoulders
may be relatively small. The legs are average to large, and the face and neck are slender in relation
to overall body size.

So what does this all mean? Clearly, people are diverse in terms of how they look. There are some
general classifications that identify differences in body types. There are some cautions when putting
people into categories.

First, Sheldon evaluated the extent to which a characteristic was present on a scale, ranging from
one (minimum) to seven (maximum). It's simply easier and more convenient to talk about body
typology in terms of three extreme types, although in actual life various combinations are more
common.

Second, Sheldon's initial work with body types was based mostly on men and there is a need to
develop a corresponding mesomorph type for women. In general fewer women than men have
mesomorph traits, with more women tending toward endomorph types Women are less mesomorphy
than men and more endomorphy. Women body builders, who are obviously muscled, try to develop
the same degree of sharp angularity, prominent bone structure, and highly accentuated muscles
found in their male counterparts. Some are able to accomplish that, often with the assistance of
drugs and medical supplements.

Many of today's observations about weight control and ways to shape the body through exercise
come from trainers and consultants at fitness and health centers. Their primary goal is to help
people have healthier lifestyles, regardless of type. They know from experience how certain
exercises, diets, and routines affect body types. Sheldon's types are simple and easy for clients to
understand.

In general, most of us have a combination of body types, with mesomorph and endomorph the most
common. A few people have bodies that are distinctly one type, but they are in the minority.

Identifying your body type(s) can help you understand what diet and exercise can and cannot
change. For example, you can't grow any taller in adulthood. The emphasis should be less on
attaining a certain shape and more on physical health and how your shape affects your self-image
and lifestyle.

Unfortunately the 1990's set an unhealthy standard for body types, especially for women - the
extreme ectomorph. Some women who appear to be ectomorphs have only achieved this through
starvation and over-exercise, which is not a healthy approach to life. Another unfortunate twist is
that men have always been given more leeway in terms of their physical appearance and they have
been held less accountable to society's standards.

Things are changing slowly in the 21st century. Mesomorph body types are becoming more popular.
Some beauty products are promoting the larger, more "normal" looking shapes for woman. The
clothing industry is also beginning to focus on what is realistic and common. There seems to be a
greater acceptance of people and their natural body types, particularly as the public increases its
awareness of body types, the extent of diversity in numbers, and are being less judgmental. There
is no such thing as the perfect figure. Ironically, while the modeling industry claims to be using larger
models, they are still ectomorphic and considerably thinner than most women..

Body Image

Body image is how you view your outer self. It is a picture in your mind's eye of how you look. It's
shaped by your experiences of living and moving around in your body. Your thoughts are influenced
a great deal by what you imagine others think of you and what you see and hear said about beauty
and being desirable.

We live in a culture that has unrealistic and unachievable standards of attractiveness. Advertising
agencies, fashion magazines, and media industries, present a narrow view of attractiveness and this
is perpetuated on society. Overtime, celebrated images become fixed in the public's mind and there
is a feeling that "only a look that nears perfection is acceptable." The mass media bombards us daily
with pictures of "perfect bodies."

Various sources indicate that body images presented through models, mannequins, and dolls are
strikingly deviant from actual male and female forms. In one fashion magazine (Marie Claire, 199B) it
was noted that the average American woman is 5'4" and a size 12. She has a 37-inch bust, a 29-inch
waist, and 40-inch hips. A store mannequin is 6 feet tall, a size 6, with measurements of 34-23-34. A
life-sized Barbie doll, at 1:6 scale. would be 5 ft 9 in tall with measurements of about 3-22-36. With
her neck nearly twice as long as the average woman's and perpetually high-heeled feet only about
half as long, Barbie's physical characteristics are anotomically improbable and ultimately unattainable.
First introduced by Mattel in 1959, it's not surprising that Barbie's status as an "icon" of beauty and
femininity has become a subject of controversy.

What are beautiful faces? Magazines and television screens are filled with attractive people and it's
obvious that both women and men are highly interested in good-looking people.

In youth, boys and girls have similar face shapes. Then, in the puberty stage of life, hormones act on
their faces to make them more masculine or feminine and produce more distinctive features of
mature men and women.

Testosterone provokes the growth of certain facial features, such as the jaw and cheekbones, so
boys' faces grow more than girls' faces. Female faces remain relatively childlike. High levels of
estrogen in growing girls prevent the growth of facial bone and leads to increased thickness of lips
and fat deposits in the cheek area.

Psychologists expect men to choose women with faces having a bone structure that reflects the
presence of high levels of estrogen, the female sex hormone, which, in turn, is associated with high
fertility and longevity. That's exactly what Perrett and associates (1998) found in their studies when
they allowed people to manipulate photographic images using computer technology.

Subjects could vary the facial structure of men and women to be slightly more masculine or more
feminine. To add masculinity, for example, the jawbone would be enlarged. To make a face more
feminine, the forehead would be altered and lips would be enlarged.

While the subjects did see the more masculine looking males as "dominant," they also found them
cold and intimidating. And when asked to select the most "attractive" faces, they chose faces that
were 15 to 20 percent more feminine than average.

Human faces can be so similar that it may be hard to distinguish one sex from another. Yet if women
were indeed selecting men with highly "masculine" faces, while men were selecting highly "feminine"
women, men's faces should differ dramatically from women's. Yet, Perret and his researchers from
Scotland and Japan were surprised to find that judges of both sexes preferred feminized faces for
both men and women. They speculated that women might perceive feminine-looking men as more
sensitive, honest and initially reliable fathers. Their work challenges the evolutionary psychologists
who theorize that women look for strong male features and characteristics to help the species
survive.

Some researchers have found that the more baby-faced a man looks, the more he views himself as
approachable and warm and the lower he ranks in terms of aggression. Researchers found that the
facial dominance of graduates from a military academy can be used to predict their final rank at the
end of their careers.

High levels of testosterone can produce some negative effects. Married men with high testosterone,
for example, were reported to have more troubled relationships with their spouses and to have
extramarital affairs.

Pretty people are appealing. They fascinate the general public, especially when they are made up to
draw attention to themselves.

Most people recognize that many of the people featured in popular publications are a fantasy
brought about by image editing. Editing is easy to do, given the advances in computer technology. It
has long been common practice for photographs used in advertising, publicity, and on cover pages
of magazines to be altered. Pictures are touched up and idealized images are presented to the
viewers.

The term "airbrushed" is used to describe glamour photos in which a model's imperfections have
been removed or certain attributes emphasized. Skin blemishes, shadows under the eyes and
excess bulges can be removed. Color, skin tones, breast size, or muscles can be added or
enhanced. The body in a picture can be changed to the point of having a new head or pair of hands.
Being naturally beautiful or even cosmetically advanced, is not quite good enough in the eyes of
fashion editors.

Professional models are often surprised, if not amused, to see themselves on magazine covers,
because in real life they don't really look like the picture. "I posed for it, but that's not me!" said one
famous fashion model.

Supermodel Cindy Crawford was well acquainted with the illusory nature of physical beauty. "Even 1,"
she once remarked, "don't wake up looking like Cindy Crawford!" At Dove Soap's Campaign for Real
Beauty site, you can see this process in action in a brief stop motion video called "evolution"
(http://www.campaignforrealbeauty.com/flat 4.asp?id=6909).

Some psychologists worry that editing and widely distributing idealized images creates a standard of
beauty real people cannot attain. This is especially true for teenagers who are very self-conscious
about their bodies. Many people believe that their idols actually look like their pictures and video
images, especially teenage females who spend a lot of money and effort trying to capture a certain
look or to become "more beautiful."

In 2005, several fashion and teen magazines began publishing pictures of women with
less-than-perfect figures. Editors said they intend to use more average women and fewer models to
reflect changing body types and to help insecure teens see that not everyone is perfect.

Mary Pipher (1994 ), author of a book about teen girls and body image, "Reviving Ophelia" says
anything that shows realistic women is a step in the right direction to help girls gain self-esteem. She
argues that teenage girls are defined and pressured by the need to be beautiful. The plain truth,
however, is that the search for physical attractiveness and beauty continues throughout most of life.
Sometimes, though, people see the beauty beneath the skin.

In October 2006, Marine Sgt Ty Ziegell and Renee Kline were married. She said, "I married my best
friend!" But, on that day he couldn't find his left hand. He looked around the house and finally came
up with the prosthesis and then with the remaining two fingers on his right hand he screwed it on.
Dressed in his Marine Corps uniform, he stood tall and proud next to his beautiful wife, as they
repeated their vows. Yet, if you didn't know the circumstances, you would say that beauty was
marrying the beast.

In December 2004, Ty became one of 20,000 troops wounded in Iraq when a suicide bomber struck
his truck. He took the brunt of the blast, which engulfed him flames. It left him blind in one eye,
shattered his skull, and riddled him with shrapnel. Doctors removed his left arm below the elbow. He
was disfigured beyond recognition, with his ears, lips, and most of his nose burned away. His story of
survival is a remarkable one (People, 2006).

What stands out in the account of their marriage is the positive attitude that each had and the
enduring love that was able to bridge standards of attractiveness. Of course, there are occasional
feelings of anguish over Ty's injuries and the couple must deal with gawking strangers. He wanted to
wear sunglasses, but he has no ears to hang them on. Ty and Renee are determined to make their
marriage work because as she said, "Everything is the exact same except he got blown up." Given
the nature of American society and its ephasis on physical attractiveness, they are admired but also
know that their bond will put to a test.

Reshaping the Body

Marvelous applications for beauty or health have been a common selling pitch for generations of
quack practitioners. They promise, among other things, the ability to bring back lost hair, get rid of
unwanted pounds, and regain a youthful appearance.

The word "quack" comes from the term "quacksalver," which combines "quack" for the noisy call of a
duck and "salver" meaning to heal. A quacksalver is someone who pretends to have medical
knowledge and skills and uses noise or fanfare promotes a false medical product. Quack medicines
and devices are promoted through advertising and frequently offer "miracle cures", "beauty aids" and
"quick fixes" to heal or enhance the body.

Quackery has persisted despite the passage of laws prohibiting it for the past 100 years.
Sometimes people perceive an improvement in their health or appearance even when the product
they used is, in fact, a useless fake. The power of this "placebo effect" is not lost on the makers and
sellers of such products. While the effect may be gratifying for some, there are potential dangers.
Let the buyer beware.

Advances in medical technology have made it possible for people to reshape their bodies through
cosmetic and plastic surgery. This involves the surgical alteration of one's features in order to
create a more aesthetically pleasing appearance. It can be performed on many areas of the body
such as the face, chest and stomach. Rather than reconstruction being performed because of an
accident or physical deformity, several surgical procedures are merely cosmetic and a personal
choice.

It is a matter of "'better abs, better butts, better breasts, better bodies and better looks." That is
what many Americans want and to satisfy their desires, plastic and cosmetic surgeons are providing
more and more services throughout the nation. Body contouring is big business. According to the
American Society for Aesthetic Plastic Surgery (2002), liposuction was the most popular surgical
procedure, with about 400,000 cases. Breast augmentations and reductions totaled almost 350,000
procedures that year. Cosmetic surgery is a $7 billion a year industry.

The organization also reported that Botox injections are the fastest-growing cosmetic procedure in
the industry. Botox is related to botulism, a form of food poisoning that can cause paralysis and
some cases be fatal. Botox consists of toxins that basically block the signals that normally tell your
body's muscles to contract. If an area of the body can't move then it can't wrinkle. Consequently,
Botox is used to smooth the skin and remove unwanted facial creases, neckbands, and "'crows-feet"
around the eyes. In 2001, more than 1.6 million people received injections, an increase of 46 percent
over the previous year.

Monster.com, a job search website, asked the question: "Do you think having plastic surgery or
cosmetic dental work would help advance your career?" More than half (53%) of the 22,000
respondents answered the "Yes." Less than a third (31%), said it would not.

Looks: Make a Difference or Not?

Does the way a person looks make a difference in life? It is definitely a factor to consider. (Sherrow, 2001 ).

Research suggests that babies as young as three months of age strongly prefer attractive mothers
who have pretty faces. In turn, attractive babies receive more affection and attention from their
parents and other adults. This helps them develop more positive attitudes about themselves and
others.

Children learn early in life that heroes are handsome and heroines are beautiful. Bad people are ugly
and scary looking. These stereotypes remain with us all of our lives and can cloud our impressions
and judgments.

Research shows that good looking students are more likely to be perceived as intelligent and tend
to get higher grades in school, perhaps because they receive more attention (Ackerman, 1990).
Teenagers are more concerned about their appearance than their relationships with parents,
siblings, or teachers.

Several studies in the 1970s suggested that unattractive people are more likely to become criminals
than those who are good looking. Ironically, criminals who have their appearance improved by facial
surgery were found less likely to return to prison (Lewison, 197 4 ). Unattractive people experience
more rejection than others and can become more anti-social for fear that they can never meet the
normative standards that the public admires.

A recently released study (Mocan and Tekin, 2006) tracked the life course of young people from
high school through adulthood reached the same conclusions. Unattractive young people commit
more crimes in comparison to average-looking students. They are also less likely to be hired, to earn
as much income, and they generally don't have the same polished social skills as good-looking
people.

Attractive people are likely to get better jobs, rise to higher positions in an organization or
company, and earn more money. A Federal Reserve study estimated that good-looking people make
about 5% more than their counterparts (CNN/Money, 2005). The common wisdom has been that
striking features -- high cheekbones, facial symmetry and a lack of disfigurement -- pay off more for
women. But, apparently, this is not the case.

In a study of lawyers, two economists found after controlling for a broad range of variables including
education, years of work experience, vocation, health, and marital status, incomes were similar for
both sexes. However, good-looking men were earning 12% more money than their less attractive
peers. Attractive women made 8% more. Look bias was across genders, race, and ethnicity.

Looks and Self-Image

Does beauty lie in the eye of the beholder? Maybe not. Research is showing that we all tend to put
peoples' appearance into approximately the same ranked order, regardless of race, color or
background. Mew (1993) concluded after close study that people generally agree about who is very
good looking and who is not.

All research to date on body image shows that women are much more critical of their appearance
than are men- much less likely to admire what they see in the mirror. Up to 8 out of 1 0 women are
dissatisfied with their reflection and more than half may see a distorted image.

Men looking in the mirror are more likely to be either pleased with what they see or indifferent.
Research shows that men generally have a much more positive body image than women. If anything,
they may tend to over-estimate their attractiveness. Some men looking in the mirror may deny or
literally not see flaws in their appearance.

Why are women so much more self-critical than men? Because women are judged on their
appearance more than men and standards of female beauty are considerably higher and more
inflexible. Whenever you are in a household with a shared bathroom and vanity top, check out the
number of items on the man's side and then on the woman's side.

Research confirms what most of us already know: that the main focus of dissatisfaction for most
women looking in the mirror is the size and shape of their bodies, particularly their hips, waists and
thighs. Among women over 18, research indicates that at least 80% are unhappy with what they see
in the mirror. Many will not even be seeing an accurate reflection.

Anorexics see themselves as larger than they really are, but some recent research indicates that
this kind of distorted body image is not just confined to people with eating disorders. In some
studies up to 80% of women over-estimated their physical size. (Note: This may not be true when
they initially try on clothes.) There are far too many normal, attractive women, with no weight
problems or clinical disorders who look at themselves in the mirror and see fat and ugliness.

Men, on the other hand, are often preoccupied with strength and muscle size. Most are more athletic
than they give themselves credit. But they, too, cannot escape the pressures of mass marketing,
which particularly targets ages 1 8-35. In a recent study (2004) of men, published in the Journal of
Clinical and Social Psychology, Results indicated that "male participants exposed to ideal image
advertisements became significantly more depressed and had higher levels of muscle dissatisfaction
than those exposed to neutral ads."

Keeping fit through exercise and good nutrition is the healthy way to perfect the body, but some
men use steroids to "bulk up" and improve their appearance. Athletes, in particular, are drawn to
them, hoping to boost strength and improve performance. They are a concern to athletic
organization because they affect the outcome of sports contests and there are some dangerous
side effects.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone. They
promote growth of skeletal muscle, reduce body fat, and increase lean body mass. More than 1 00
different anabolic steroids have been developed, but they require a doctor's prescription to be
used in the United States. Most steroids that are used illegally are smuggled in from other countries
or synthesized in illegal laboratories.

Anabolic steroids, whether taken orally or injected, have been reported to cause behavioral
problems. For instance, in high doses they increase irritability and aggression, such as physical
fighting or using force to obtain something. They have also been linked to property damage, stealing
from stores, and breaking into houses or buildings. After initial feelings of euphoria, increased
energy and perhaps sexual arousal, the end results may be mood swings, forgetfulness, confusion
and depression.

The extent to which steroid use contributes to anti-social behavior is unknown and evidence has
primarily been obtained through interviews and case reports. The prevalence of extreme cases of
violence and behavioral disorders seems to be low, but it may be under reported or not recognized.
For instance, as part of a 2002 NIDA-funded study, teens were asked if they ever tried
steroids-even once. Only 2.5% of 8th graders ever tried steroids; only 3.5% of 10th graders; and
4% of 12th graders.

The side effects of using steroids make the practice questionable. Health risks are high. Men, for
example, may like the bulging biceps, rippling abs and large quads when they flex in the mirror, but
steroid can cause livers to grow tumors and hearts to clog up. Men might also experience shrunken
testicles and reduced sperm count. Women who use steroids can become more masculine, with
deeper voices, decreased breast size and more body hair.

Why do people take steroids? Even men who are large and muscular often think they look small and
weak. In one series of interviews with weightlifters, 25% who used steroids reported memories of
childhood physical or sexual abuse compared to those who did not use the drug.

In a study of women weightlifters, more than twice as many who had been raped reported using
muscle-building drugs in comparison to those had not been assaulted. Being an elite athlete is not
good enough for some who want a "winning edge" or who fear that their competition is using drugs,
believing they can only win or set records if they use them.

Beauty: More than Skin Deep

Beauty and being physically attractive are highly prized in our society and we are constantly
reminded of their advantages. Those who are jealous treat good-looking people according to
stereotypes and with a halo effect.

In reality, according to one study (Feingold, 1992), no matter how high we put them on a pedestal,
they are not categorically more confident, intelligent, or social than the norm or ordinary people. In
various pageants, judges consistently scored beauties better than the women scored themselves.

What represents beauty has become more diversified, with a greater acceptance for unique and
ethnic features. Past studies highlighted features that people find initially attractive and appealing,
but they overlooked many of the non-physical traits that can influence a person's perception of
beauty. In other words, over time people may see physical attractiveness differently, especially
when they see a person's other qualities that are invisible to strangers (Kniffin, 2004 ).

People Magazine releases its annual spring issue that pictures the 50 most beautiful people in the
world. It's a sales gimmick, but it's popular because people are curious and enjoy looking at pictures
of attractive people. It's not an official comparison but simply the opinions of an editorial staff. In
addition, staff members touches up the pictures so that only best qualities are shown. What are
those qualities?

German scientists (Gruendl, 2002) have recently tackled the question of what is beauty and what
people look for when they say that someone is beautiful. In a series of studies
(www.beautycheck.de) they used digital cameras and computers to create ideal pictures of people's
faces. Only European white faces were used, but the concepts could easily be applied to various
racial or ethnic groups to identify preferred characteristics.

The technique used to generate compound images is referred to as "morphing." In one study two
faces were morphed or merged together to obtain a pretty face. The morphed pictures were
consistently selected by subjects as the most attractive. But, the person in the picture was not real.

In another study, the researchers - again, using white faces -- examined "sexy faces." Blending
together four of the most attractive faces created the most "sexy face."

The characteristics featured for the woman were:

- Suntanned skin
- Narrower facial shape
- Less fat
- Fuller lips
- Slightly greater distance of eyes
- Darker, narrow eye brows
- More, longer and darker lashes
- Higher cheek bones
- Narrower nose
- No eye rings
- Thinner eye lids

Characteristics of the male "Sexy face" in the comparison to the "unsexy face":

- Browner skin
- Narrower facial shape
- Less fat
- Fuller and more symmetrical lips
- Darker eye brows
- More and darker lashes
- Upper half of the face broader in relation to the lower
- Higher cheek bones
- Prominent lower jaw
- More prominent chin
- No receding brows
- Thinner eye lids
- No wrinkles between nose and corner of the mouth

One interesting comparison used the morphing technique and the pictures of Miss Germany (2001).
The researchers found that the real beauty queen was unable to compete against a virtual face,
which was composed by blending together all the contestants of the final round of competition. No
contest among judges.

In a similar way, advertisers morph pictures of models in order to develop faces that they think will
help sell products. We often look at computer-created faces that we would never find in everyday
live. These virtual faces show characteristics that are unreachable for average human beings.

People living in modern post-industrial societies are exposed to these kinds of artificially created and
manipulated, 'perfect' faces every day, via TV advertising or fashion magazines. The result may be
that we may become victims of our self-created, completely unrealistic ideal of beauty.

Certainly, friendly and successful personalities can develop independent of physical appearances,
look around and you can see the diversity of people who are attracted to one another and who
become partners in life. First impressions, beauty and initial attractions may be only skin deep, and
truly beautiful people are more than their outer selves.

Growing Pains

A lot of changes happen as a person grows up. In addition to the role that genes and environments
play in a person's life, the fundamental stages of life also play an important part. One of the most
dramatic stages for boys and girls occurs when they reach puberty. There are some similar
experiences that they all go through; yet, there is considerable diversity among young people and
this can cause them some confusion and frustration.

Puberty starts when extra amounts of chemicals called hormones start to be produced in the body.
These hormones guide body development and cause emotional changes to occur. Generally, changes
start earlier for girls than for boys, but there are exceptions and everyone has his or her own
timetable.

When a girl reaches puberty, she sometimes isn't aware of what is happening to her body. The
changes are normal but she doesn't have much control over them. For example, about age 11 a
growth spurt begins and the body takes more shape and becomes curvier. Her weight increases and
that's normal. It's unhealthy for girls to go on a diet in an effort to stop this gain.

Girls' figures change and their menstrual cycle begin during puberty. To many young girls, everything
seems to be happening at once. However, it doesn't happen at the same age for every girl. Some
girls begin puberty as early as the third grade, or age 9, while others begin years later in middle or
high school. When the body is rapidly changing girls can feel uncomfortable, awkward and different,
especially as they compare their experiences with others.

For a boy, there isn't just one event or sign that he is growing up. The body is growing bigger, the
voice is beginning to change and may crack once in awhile, and hair seems to be sprouting
everywhere. Most boys begin puberty between the ages of 1 0 and 15. But again, puberty starts
when a body is ready and everyone grows at his own pace.

Some boys are embarrassed when they observe that some of the girls are taller than they are. They
notice that most men are taller than women and they may wonder and worry about what is happening
to them. Part of the answer to their concern is that girls start their puberty changes earlier than
boys and it takes time before family and gender genetics are evident.

There's no need to rush boys into lifting weights at an early age. It will help tone muscles but not
build them until puberty is reached. In the meantime, they can stay fit and healthy through various
sports and exercises.

Hormones trigger acne (pimples), which is the curse of the teenager who is eager to be seen as
beautiful or handsome. It usually disappears by the end of the adolescent years, but some individuals
need medical help to regain hormonal balance.

The American Academy of Pediatrics http://www.aap.org/family/puberty.htm provides puberty
information for boys and girls. It emphasizes that the body has a natural rhythm and an unfolding
schedule that is within a normal range for those of the same sex. Yet, each body has its own peculiar
clock to determine height, weight appearance that make each person unique. This can be a sensitive
topic for girls and boys and it is reassuring for them to know that they are "normal" and "on their
own special course."

Weighty Issues

A person's weight or the number of pounds that a person carries is, by itself, not an issue. Some
body types lend themselves to carrying more weight while the person is still fit and healthy. Doctors
have charts that project the average and recommended weight of males and females given their
stature and height.

Athletes and body builders try to build muscle tissue, which is dense and heavier than regular tissue.
Working out in the weight room will put on pounds rather than take them off, but the goal is to see
the extra weight in the form of lean muscle.

There is a tendency in American society, with its abundance of food resources, to indulge and
overeat. Food may be comforting and given the high fat and sugar content of most American food
products, food can be tasty and spark the brain in an "Hmmm, good" reaction. Of course, a lot of
eating preferences are a result of what people experienced and were conditioned to eat when they
were growing up. Eating habits are often based on what is prevalent and offered in one's
environment.

In addition, the food industry is intent on getting people to eat as much as they can. It's their
business to earn money based on the public's eating habits. They know that dietary patterns begin
in childhood and shape the health of Americans. Comprehensive studies have found that advertising
affects food choices and dietary habits. Therefore, the industry spends millions of dollars on
advertising and marketing to encourage consumption of food products.

Each day, children receive about 58 commercial messages from television alone, about half of which
are for food. According to The Center for Science in the Public Interest (2005), much of that
advertising is for high-calorie or low-nutrition foods and undermines parents' efforts to provide
healthful diets for their kids. While a number of factors affect children's food choices, studies show
that food marketing attracts kids' attention and affects their food preferences and choices. The
amount of marketing aimed at kids has doubled in the last 10 years from $7 billion to $15 billion a
year.

In the past few years, the marketing of food products has received special attention from the
medical profession, especially in regards to children. Foods most heavily targeted at children include
energy-dense fast foods, carbonated soft drinks, sugary breakfast cereals, salty snacks and baked
goods high in fats, and nutrient poor foods. Parents try to get their children to eat bananas, broccoli
and whole what bread, but those messages get drowned out by marketing for French fries, cookies,
hamburgers and candy.

It's been suggested that marketing such foods contributes to the recent increases and concerns
about obesity. In addition, eating habits are learned early in life and appealing marketing strategies
make it more difficult for people to make healthy food choices.

If a person overeats and fails to burn up the calories that were taken in, then fat deposits find a
place somewhere on the body. One of the reasons that health and fitness centers appeal to many
people is the thinking that if they work out regularly, then they can eat and drink more rich foods
and beverages.

Without a managed diet and exercise plan, most people are going to put on extra pounds. People
with high metabolism rates are the envy of those who love to eat rich foods. Rigorous exercise
increases the metabolism rate needed to burn calories, but it is an unappealing activity for some
people. So, they put on weight.

A little extra weight may detract from someone's appearance, but it's not likely to be harmful. A lot
of extra weight, on the other hand, can be unhealthy and ruin a person's lifestyle. The number of
pounds that a person can carry and still be healthy will differ among people.

Doctors advocate stable weight, sensible diet, and exercise for fitness rather than equating good
health with thinness. Stereotyping people by weight is a usually an act of ignorance or insensitivity,
and can be cruel. Yet, given the popular notion of what people should look like and how much they
should weigh, there are many people who are stigmatized because of their weight.

Some people make immediate judgments when the see a heavy person, assuming that the person is
an undisciplined eater who gorges him or herself on unhealthy foods that contain a lot of fat.
However, many of the problems that people have with their weight might be rooted in heredity. Not
only body type is inherited. There is a "'fat gene"' that genetically predisposes a person to be
overweight.

Everyone has this gene but those with two copies of one version of the gene are 70% more likely to
be obese, according to scientists in London (2003) who studied families from across the world. They
found the same genetic mutation in individuals affected by obesity-caused heart disease, cancer and
type 2 diabetes. In other research, scientists at UCLA (2005) identified a gene, called lipin, that
regulates how the body produces and uses fat.

There is still a lot of research to be done in the area of weight control and reduction. But, these
discoveries are expected to lead to new therpies for controlling obesity, diabetes and other
weight-related disorders

Probably, you first saw it happen on the playground and around school. Popular people who are also
chosen as leaders tend to choose other people who are like them as friends. The same bias is
prevalent in workplaces. Employees who don't fit societal norms are singled out and experience
rejection, discrimination, or isolation. People who are overweight are prime targets for this kind of
prejudice.

Dying to Fit In: Eating Disorders

Body image dissatisfaction is so epidemic in our society that it is considered normal. People talk
about it a lot. Mass media, again, is an omnipotent force, but so are parents and friends.

Little children hear that certain types of food will make them "fat." As early as the third grade, they
are concerned about their weight, but the most vulnerable time occurs when they are teenagers.
This is a most impressionable time in life and self-perceptions are critical in growth and development.

About half of teenager girls think that are too fat and almost half are dieting in some way. There is a
lot of pressure to look good and fit in. One way is to have the perfect body. Trying to obtain it,
however, has led many young people, and adults, to form obsessive eating disorders that are
unhealthy and sometimes life threatening.

Obesity: A SuperSized World

The American Obesity Association http://www.obesity.org/ provides facts and information about the
nature of obesity. Obesity is not a simple condition of eating too much. It is now recognized that
obesity is a serious, chronic disease. The association claims, "No human condition - not race, religion,
gender, ethnicity or disease state- compares to obesity in prevalence and prejudice, mortality and
morbidity, sickness and stigma."

Obesity is frequently determined by using Body Mass Index (BMI). It is a formula that produces a
number based on a person's weight and height, although it does not measure body fat directly. In
the year 2002, approximately:

- 127 million adults in the U.S. were overweight.
- 60 million adults were obese.
- 9 million were severely obese.

The simple fact is that Americans are getting bigger. Super-sizing meals, snacking on fat saturated
foods and slouching on couches have led to a serious health crisis. More specifically, in 1980 about
45% of U.S. adults were overweight or obese. That rose to 55% in 1990 and in 2003 it reached 65%
and, of these, more that half weighed 30 or more pounds above a healthy weight for their height.

In addition, more children are overweight, with about 15% between ages 6-19 being obese. The
percentage of children and adolescents who are overweight and obese is now higher than ever
before. Poor dietary habits and inactivity contribute to the increase of obesity among youth. They
are considered the most inactive generation in history caused in part by reductions in school
physical education and sports programs and unavailable or unsafe community recreational facilities.

Reports show that there is a difference among US racial groups in terms of overweight. For instance,
African American, Hispanic American and Native American children and adolescents have particularly
high obesity prevalence.

Obesity is not good news in terms of health costs and loss productivity in the workplace. According
to estimates by the US Surgeon General's Office (2003), the cost of obesity related illness to the
U.S. was $75 billion, up from $52 billion in 1995. Costs are likely to go higher as people age and the
long-term effects are likely to increase rates of diabetes, sleep disorders, arthritis, heart disease
and strokes.

Discrimination against overweight people has been documented in three areas: education, health
care and employment. There appears to be very strong anti-fat attitudes that result in prejudice. For
example, 28% of teachers in one study said that becoming obese is the worst thing that can happen
to a person; 24% of nurses said they are "repulsed" by obese persons; and, controlling for income
and grades, parents provide less college support for their overweight children than for their thin
children.

Several studies indicate that obesity may influence health care professionals' judgments and
practices. For instance, mental health workers evaluating a case histories frequently assigned more
negative symptoms to obese patients than to overweight or average-weight clients. Obese patients
were viewed more severely in terms of psychological functioning.

The stigma of obesity is somewhat unique from that of other groups, in that obese people internalize
societal anti-fat and pro-thin biases. Obese people tend to agree with society's assessment that an
imperfect body represents an imperfect person.

Bariatric surgical procedures are major gastrointestinal operations that seal off most of the stomach
in order to reduce the amount of food one can eat. It also rearranges the small intestine to reduce
the calories a body can absorb.

Self-report studies show substantial changes in perceived discrimination after bariatric surgery. In
one study, 87% of pre-surgical patients reported that their weight prevented them from being hired
for a job, 90% reported being stigmatized by coworkers, 84% avoided being in public places
because of their weight, and 77% reported daily depression.

Fourteen months after surgery, every patient reported reduced discrimination; most reported rarely
or never perceiving prejudice after surgery, and 90% reported substantially increased cheerfulness
and confidence. Studies are limited by self-reports, but social perceptions motivate the decisions to
undergo surgery or managed health care.

Those who were successful with restricted diets and rigorous routine exercise programs have also
reported this phenomenon of reduced bias. Their changing self-perceptions and images contributed
to a greater self-confidence.

The negative reactions that many people have toward heavy weight people spurred one woman to
tell about her experiences on an Internet Slog. She wrote,
"I am a BBPW (Big Beautiful PROUD Woman). Proud because I have accomplished a lot of things in my
life that, at one time, I never thought possible.

Ever since I can remember, I've been on the receiving end of taunts and unsolicited advice of
so-called "well meaning"- and obviously not so well meaning- classmates, family, "friends",
co-workers and even complete strangers on the street. In the past, my basic instinct was to retreat
into myself, wrap myself in my own comfortable world, becoming shy around unfamiliar people, fearful
of rejection that had been so much a part of my life.

Then, in March of 1996, I bought a computer, started surfing the Net and found that there were lots
of BBWs out there and that I wasn't alone in what I had experienced in life concerning my
appearance. The feeling was very enabling. It opened up new doors for me and allowed me to be
myself with people who didn't pass negative judgments about me based on my size. I had found
personal acceptance in myself a long time ago, but it was a terrific feeling to find so many people
who had that same acceptance of me and my body."

Size is just one aspect of a person. People of any size deserve to be treated with respect as a
human being. People are wrong to judge anyone's worth on whether they find- or do not find-
someone physically attractive or what they determine a person's health status to be.

In American society, thin people, especially women, are afforded a lot in their lives based on their
appearance. If they are found to fit the current criteria for "attractive", they are automatically judged
to be "good" and worthy of happiness, good jobs, loving mates- almost everything in life, no matter
their character or personality.

Anorexia Nervosa: Dying to be Thin

Many entertainers go to great lengths to display their slim bodies and add to the desire to be thin.
A great number of people, especially young people, are obsessed with trying to look like slender
stars and they fear the stigma of being overweight. Such obsessions can drive some people to
develop an eating disorder.

Anorexia nervosa is an illness that usually occurs in teenage girls, but it can also affect boys and
adult women and men. People with anorexia are obsessed with being thin. They lose a lot of weight
and are terrified of gaining weight. They see themselves as fat even though they are very thin.

Anorexia is more than a problem with food or weight. It is an attempt to starve oneself to deal with
emotional problems. It makes the anorectic feel more in control of life and n a strange way eases
tension, anger and anxiety. Therefore, it is classified as a mental disorder 3nd treated as such by
doctors, psychiatrists and mental health counselors.

It may start with how the girl sees herself. She hates the way she looks. Her unrealistic expectations
make her strive for perfection, which is perceived as being thin not fat. She feels worthless, despite
any academic or athletic achievements, and she keeps driving herself to lose more weight. On
occasion, genetics and related hormones may contribute to the onset of the disorder and stressful
events or life changes can be triggers. In addition, those with a mother or sister who is anorexic
have an increased chance to develop the disorder.

Someone with anorexia will often go to extreme lengths to avoid consuming food. One of the most
typical behaviors is lying, which can quickly become second nature. For example, telling a parent you
have already eaten dinner when you haven't. Anorectics will also make excuses so they can eat less
or even avoid meals altogether. To them, this isn't necessarily the same as lying because they may
decide to become vegetarian or vegan, have to fast for religious reasons, or they may simply claim
they are on a "diet".

The number of people affected by eating disorders is growing rapidly. According to the U.S. National
Institute of Mental Health, an estimated 1% of adolescent girls and women are anorexic but this
figure is much lower for males. Men account for less than 10% of reported cases of anorexia and
bulimia, although this figure is on the increase.

Studies demonstrate that certain athletic activities appear to put males at risk for developing eating
disorders. Body builders, wrestlers, dancers, swimmers, runners, rowers, gymnasts and jockeys are
prone to eating disorders due to the weigh restrictions necessitated by their sports (Andersen,
Bartlett, Morgan & Rowena, 1995).

Males with anorexia do not tend conform to the cultural expectations for masculinity such as:
competitiveness, physical strength, aggressiveness, independence and competence in athletics
(Kearney-Cooke & Steichen-Asch, 1990). Research also indicates that eating disorders in males are
clinically similar to eating disorders in females.

Anorexia is the relentless pursuit of thinness. Some telling signs of the problem include:

- Refuses to maintain normal body weight for age and height.
- Self-starvation by refusing to eat and denying hunger.
- Weighs B5% or less than what is developmentally expected for age and height.
- Puberty delayed for both sexes and girls do not menstruate at an appropriate age.
- Denies dangers of low weight.
- Is terrified of becoming fat.
- Is terrified of gaining any weight, although alarmingly underweight.
- Talks of feeling fat even when emaciated.
- Constant exercising may be a part of a routine.
- Loss of scalp hair.
- Menstruation periods stop for women and sex hormones level falls for men.

In addition, anorexia nervosa often includes fits of depression, irritability, withdrawal, and peculiar
behaviors such as compulsive rituals and strange eating habits. Food might be divided in a
compulsive manner into good/safe and bad/dangerous categories. There may be a strong fear of
growing up and accepting adult responsibilities or engaging in an adult lifestyle. There is often an
increased dependency on parents or family.

More than 1 ,000 women die from anorexia each year in the U.S. alone. None of them thought it would
end like that and none of them started out intending to die.

Bulimia: Throwing out the Trash

Bulimia nervosa is another eating disorder. Someone with bulimia eats a lot of food in a brief amount
of time (called bingeing) and then tries to prevent weight gain by purging.

Typically, bulimics make themselves throw up. Taking laxatives that increase how fast food moves
through the body and causes a bowel movement is another way of purging. Sometimes a person with
bulimia will prevent weight gain by exercising excessively or overdose themselves on diet pills.

Bulimics may be underweight, overweight, or have normal weight. This makes it harder to know if
someone has this disorder. However, someone with bulimia may show some of these common signs:

- Diets, becomes hungry, and then binge cots in response to powerful craving for food.
- Feels out of control while eating, and appears to be.
- Fears gaining weight.
- Believes self-worth is dependent on not being fat and fears gaining weight.
- May engage in risk-taking or impulsive behaviors, giving little thought to consequences.
- Goes to bathroom all the time after eating (to throw up).
- Exercises a lot, yet feels a loss of strength and is frequently tired.

Like anorexia, bulimia can kill. People with these eating disorders may put up a brave front but they
are often depressed, lonely, ashamed, and feel empty inside. They often try to hide their feelings of
guilt, anger and self-doubt. They are secretive and have difficulty in talking about themselves or
sharing their feelings.

Compulsive Exercise: Buildi1g Up and Tearing Down

Exercising is a socially acceptable behavior in our society that is advocated by doctors and health
care specialists. The desire to look good and feel better by "working out" has spawned a fitness and
health center industry. The centers not only provide exercise equipment and trainers, but they have
also become social centers where people meet and chat with friends and take health-related classes
and seminars.

Cardiovascular health requires that 2,000 to 3,500 calories be burned each week in aerobic
exercise: running, jogging, dancing, brisk walking, and so forth. That can be accomplished by thirty
minutes of exercise each c day, six days a week, or through less strenuous efforts (gardening,
walking on the job) for an hour a day five days a week. After 3,500 hundred calories per week are
burned, health benefits decrease, and the risk of injury increases.

Compulsive exercising, like other addictions, is intense and there is a feeling of being obligated to
perform certain rituals. It may be the need to jog outside or run on the treadmill. It might involve
pursuing a strenuous routine in spite of injuries or the time that it takes away from work, service or
personal relationships,

At some point, compulsive exercisers have much in common with drug addicts. They might report
that the activity is no longer an enjoyable part of life but it has taken over their life. It is the top
priority under which everything else is subordinate. Exercising is no longer a free choice; it is now
necessary and compulsory.

Exercise can provide temporary feelings of well-being and even euphoria. -he compulsive exerciser
feels the need to do an activity over and over, more and more, and never seems to get enough.
Failing to exercise as routi1ely scheduled can cause anxiety and guilt and a person may become
irritable, short-tempered, and easily annoyed with others. It is as if the person were experiencing a
drug withdrawal.

Eventually the obligatory exercisers become obsessive in thought and compulsive in deed. They
might keep detailed records, scrupulously observe a rigid diet, and constantly focus on improving his
or her personal best. Many times this carries over into personal relationships or the workplace.

Researchers say that prolonged, strenuous exercise stimulates the body to produce substances
similar to the opiate morphine. This is what marathon runners experience in long strenuous runs when
their energy resources are depleted. Debate continues whether or not compulsive exercisers
become physiologically addicted to these body-produced substances. If they do, then obligatory
exercise is a vicious circle where the biochemical products of activity lead to a self-induced high,
which in turn demands more activity to generate more biochemical products.

Sociologists say we live in an age of narcissism and self-absorption. We are preoccupied with our
bodies and ourselves. Both men and women are expected to achieve perfect or near-perfect
bodies: slim, toned, strong, agile, and aesthetically appealing. The closer people get to the cultural
ideal, the more they notice the flaws that remain.

A preoccupation with appearance may grow out of a preoccupation with health and unrealistic
expectations. We want to live to a hundred, never be sick, keep all our hair, have unlined faces and
flat bellies, be attractive forever to romantic partners, and be strong, quick, and admirably
competent.

Paradoxically, in the United States, increasing affluence and improving health care enable more
people to be better nourished and healthier than the world has ever known before. Ironically,
satisfaction with our health and appearance has decreased.

We know that people who are unhappy often take out their ill feelings on others. They suspect
others of talking about them or being judgmental. This can make it difficult to form positive
relationships, which then seems to reinforce negative thoughts of being "'unworthy."

We also know that some people who want to change their lives and to pursue healthier live styles
may have their attempts sabotaged by friends and family members. Change is threatening to them.
Perhaps unconsciously, they feel superior and enjoy that feeling or perhaps they worry that any
positive changes might affect their relationship with a person in a negative way.

One husband, for example, continued to encourage his wife's desire to eat sweets by buying her
candy and ice cream as surprise gifts to express his love. She was trying to diet and to lose weight.
The sweet gesture was net helpful. Later, through counseling, he came to realize that he was
threatened by the idea of his wife becoming slimmer. It not only made him look at his own health and
physique, but he associated her desire to lose weight with wanting to be attractive to other men.

Physical appearance is an important factor in the development of personality and social relations. For
some reason, humans are acutely sensitive to variations in physical appearance. How we appear to
others is one script within each of us that is played over and over, with modifications.

"How does this look?" It's a common question that girlfriends, boyfriends, partners and spouses ask
of one another from time to time. People wear clothing for social as well for functional or protective
reasons. Most people believe that the right clothes make them more attractive.

In addition, people decorate their bodies with makeup or cosmetics. They cut, dye and arrange their
hair and mark their skin with tattoos and piercings. They were ornaments, such as perfumes,
eyeglasses and jewelry.

We all want to be seen a certain way and hope that our bodies, posture, and choice of clothing tell
something positive about us. We want to be interesting and attractive to others. Because humans
have shown an extreme inventiveness for doing things that affect their appearance, and because
everyone has his or her own references points for what is desirable and attractive, the world is full
of diversity. Enjoy the show.

Topic 10

Physical Health

Health Indicators

All of us are constantly exposed to germs, millions of them. Most of the time our natural immune
system is strong enough to fight infections and allow us to move along in our daily tasks and
routines. When the immune system is run down from stress or disease, then we might become sick
enough to need medical attention and maybe even hospitalization.

In addition, there are traumas from such things as physical injuries, assaults, and accidents. You can
be injured riding a bike, falling off a ladder, or cutting open a package. You can receive serious
injuries from an automobile or perhaps a boating accident. Injuries must be treated or you run the
risk of developing life-threatening consequences.

Although some illnesses, at the present time, have no cure and some injuries may result in lifetime
disabilities, treatments and support from others can improve the quality of life. Diversity is reflected
in society's health issues and concerns.

Health Goals and Indicators

We all want to enjoy good health and live a long life. We wish the same for our family and friends.
Good health requires awareness and personal attention.

Healthy people are informed. They know how to take care of their minds and bodies through physical
and mental activities and they know how to choose doctors and treatments when they need help.
They plan and work at building positive lifestyles.

Some health problems are normal and common among people. Others are more unusual and of special
concern because they also affect a nation's well-being. It is not easy to assess healthy lifestyles, but
there are indicators that suggest how well life is going for us personally and for the nation. They
alert us to public health issues that threaten productivity and progress.

According to the U.S. Center for Disease Control and Prevention (CDC), the leading health indicators
are:
- Physical activity
- Overweight and obesity
- Mental health
- Chronic illnesses and diseases
- Alcohol, drug and substance abuse
- Responsible sexual behavior
- Injuries and violent behavior
- Quality of environment
- Access to health care

The U.S. Department of Health and Human Services (HHS) is a government agency that provides
reports and programs designed to improve health conditions in our nation. It launched Healthy People
201 0, which is a comprehensive, nationwide effort at health promotion and disease prevention.

One of the primary goals of this program is to eliminate health disparities among different segments
of the population. To do this, the initiative will also address increasing access to quality health
services.

There is need for community-based programs that are culturally and linguistically responsive and a
need to increase the number of minority professional graduates in medicine. Another objective is to
improve data gathering in order to better understand health disparities and service needs.

Dr. Donna Shalala, former Secretary for HHS said, "Americans are living longer and are in better health
than ever before. But not all Americans are sharing equally in this improvement." Surgeon General
David Satcher spoke to the issue of minorities, "In spite of all the medical breakthroughs in the later
part of 20th century, we still see significant health disparities for minorities."

Diversity and Health Care

The growing diversity of the United States population is reflected in the racial and ethnic distribution
of women across age groups. White women, for example, account for 82 percent of women aged 65
years and older, but only 60 percent of those under 15 years of age. Their health needs and care
are different from Blacks and Hispanics.

In 2003, 63 percent of White females reported themselves to be in excellent or very good health,
compared to only 53 percent of Hispanic women and 51 percent of Black women. Minority women are
disproportionately affected by a number of diseases and health conditions, including AIDS, diabetes,
hypertension, and overweight and obesity.

For instance, in 2003 Black and Hispanic women accounted for more than three-fourths of women
with AIDS. In 1999, AIDS was the fifth leading cause of death among all women aged 25 to 44 years,
but was the third leading cause of death among African American women of the same age.

Diabetes is a chronic condition and a leading cause of death and disability in the United States. It is
especially prevalent among Black women, where it occurs at a rate of 91 per 1,000 women,
compared to 61 per 1 ,000 White women. Hispanic women are also affected at a rate of 61 per 1,000
women, and the lowest rate (47 per 1 ,000 women) occurs among Asian women.

Hypertension, or high blood pressure, is more prevalent among Black women than women of other
races. Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and
arterial aneurysm.

Being a healthy person means making healthy choices. There are many opportunities to improve your
health and to help others improve their health. In addition, since the U.S. is seen as a trusted and
effective resource for heath around the world, there are many opportunities to improve global health
by sharing knowledge, tools and resources. Differences in the health of people can affect us
personally, our nation and other countries.

Overall, the nation continues to improve in health. It is a pattern that has been established for the
past century, during which many diseases have been controlled or reduced.
For instance, such infectious diseases as typhoid and cholera have been controlled through
decontamination of water. Polio, diphtheria and measles have been eradicated or contained through
the widespread use of vaccines. Fluoridation of water has reduced dental cavities. New medications
and public education programs have led to a decline in deaths from cardiovascular disease.

Yet, even as progress is being made in improving the quality of life and increasing longevity, there is
an increase in chronic conditions associated with pain and disability. At a time when consumers are
expressing an unprecedented interest in making decisions related to their health, more public
involvement in health planning seems appropriate.

Common Illnesses and Diseases

The immune system is an amazing protection network that exists in our bodies. It defends us against
millions of invading and debilitating bacteria, microbes, viruses, toxins, and parasites. This can be
seen quite dramatically when death occurs and the immune system shuts down. It takes only a few
weeks for organisms to dismantle a body until all that is left is a skeleton. Clearly, your immune
system is busy and doing amazing things to keep you alive.

Vaccinations and antibiotics can help the immune system in its response to some powerful infectious
agents. The body's response is then accelerated. For example, when you get a small cut, all sorts of
bacteria and viruses enter your blood stream through the break in the skin. The system immediately
helps the skin heal and seal the puncture. If your system fails to respond or misses something, the
cut gets infected. It fills with pus and becomes inflamed, which is also a sign that the system is doing
its job and making repairs.

When a mosquito bites you, you get a red, itchy bump. It's a visible sign th3t your immune system is
at work. Each day you inhale millions of germs floating in the air and your immune system deals with
them without much of a problem. On occasion a germ gets past the system and you catch a cold, get
the flu, experience a sore throat, or worse. All of the symptoms are results of the system's
response. In short time, you get over the cold or flu if the immune system is working correctly.

There are situations when the immune system works in unexpected or incorrect ways and this
causes problems. For example, if you have allergies, your immune system is just overreacting to
certain stimuli that don't bother other people at all. If you are diabetic, then your system is
inappropriately attacking cells in the pancreas and destroying them. Some people have rheumatoid
arthritis, which is caused when the system acts inappropriately in the joints. There are many
different medical problems related to an immune system error.

Organ transplants provide an example of how diverse and unique our systems are. A person's
system will most often reject a transplanted organ. When foreign tissue is placed inside your body
its cells do not have the correct identification. Your system then attacks the tissue. The problem
cannot be prevented, only diminished by carefully matching the donor with the recipient and using
immunosuppressant drugs to prevent an immune system reaction.

It took years for this medical breakthrough, but today most organ transplants are relatively safe and
routine procedures. Transplantation is considered the best treatment option for thousands of
patients each year. However, it took time to learn 1ow to use medicines to prevent the natural
tendency for immune systems to reject a foreign object.

Some common illnesses that challenge our immune systems are found in Figure 10.1. Have you
experienced any of these ills in your lifetime? Do you know people who are repeatedly burdened
with such illnesses?

Chronic Illnesses and Diseases

Most of the health indicators cited earlier are related to illnesses that draw special attention. First,
they are a major threat to society because they affect so many people's lives, including those who
must work or live with an ill person. Second, the diversity in both an individual's response to illness
and in obtaining assistance is of national interest. Third, we are concerned about the amount of
personal and national resources, including both mo1ey and time, that are devoted to managing and
coping with these indicators.

The problems associated with the leading indicators are so prevalent that it's very likely that one or
more of them have affected you, your family or your friends. Increasing your awareness can help you
understand and communicate with those who are struggling with health problems. It can also alert
you to ways to improve your own psychological and physical well-being.

Diversity is clearly a theme among the indicators. Not everyone experiences life the same way,
handles their problems in the same manner, seeks the same solutions or has access to the same
resources.

Most of us want to develop and build healthy and productive lives. This involves challenges and
creating new experiences and perspectives. Life also brings anxiety, stress, difficult work situations,
family worries and unsettling personal issues. Some people don't cope well and their dysfunction can
lead to chronic illnesses.

More specifically, the first few health indicators deal with illnesses related to ineffective coping
mechanisms and poor habits: alcohol, drug and substance abuse; overweight and obesity,
irresponsible sexual behavior, and smoking.

It is not our intent to review the nature and all of the issues related to each indicator. There are
many books and other courses devoted entirely to examining them in detail. Rather, it is important
here to recognize the matters of diversity and effects on behavior and relationships.
Alcohol and drug use have many of the same physical and psychological issues that lead to
dependency. Let's begin with alcohol.

Alcohol and Health Risks

Alcohol has been used medicinally throughout recorded history. Current research suggests that
moderate alcohol consumption actually may have some health benefits, including the potential for
reducing diabetes, heart attacks and strokes. However, whether any advantages outweigh the risks
is debatable and excess drinking of alcohol almost always negates any benefits.

Excess drinking can lead to such things as high blood pressure, cancers, pancreatitis, and congenital
disorders. Impaired eye-hand coordination and loss of motor control can cause accidents and
injuries. While it might help some people to relax and "loosen up," alcohol makes others aggressive
or hostile. It also results in depression.

Alcohol affects people differently, depending on their size, sex, body build, and metabolism. General
effects are a feeling of warmth, flushed skin, impaired judgment, decreased inhibitions, awkward
muscular movements, slurred speech, and loss of memory and comprehension. In states of extreme
intoxication, vomiting is likely to occur, possibly accompanied by incontinence, poor respiration and a
fall in blood pressure. Severe alcohol poisoning can cause a "blackout," coma and even death.

One sad case took place on a university campus in Florida not long ago when a young man was
participating in some fraternity activities. Heavy drinking was part of some drinking games. The man
continued to drink to excess and eventually passed out. He had a toxic re3ction and died.

Men and women are not equal when it comes to alcohol. Because female bodies have a higher
proportion of fat than males, drinking alcohol affects women faster. Since fat does not absorb
alcohol, alcohol is concentrated at higher levels in the bloodstream. Women also have less of a
gastric or stomach enzyme that metabolizes or breaks down alcohol before it enters the
bloodstream.

Consequently, women can absorb up to nearly 30% more alcohol into their bloodstream than men of
the same height and weight who drink the same amount. Women are usually shorter and lighter than
men, further concentrating alcohol in their blood. Therefore, when women of average size consume
one drink, it will have almost the same effect as two drinks for the average size man. If women eat
little or skip food entirely, that compounds the effects of drinking alcohol.

The estimates are from 1 C-23% of alcohol-consuming individuals are considered alcoholics. Twice as
many men have alcoholism, which suggests that more men imbibe than do women and drink to
excess. Actual statistics are difficult to obtain because so many cases go unreported.

For both men and women, drinking heavily over a short period of time usually results in a "hangover" –
headache, nausea, shakiness, and sometimes vomiting. A hangover is due partly to poisoning by
alcohol and other components of the drink and partly to the body's reaction to withdrawal from
alcohol. The immune system is working very hard to rid the toxins and get things back in balance.

People who drink on a regular basis become somewhat tolerant of alcohol's unpleasant effects.
Subsequently, they are able to drink more before suffering ill effects. In addition, those who have a
high level of alcohol tolerance often don't appear to be intoxicated. They continue to work and
socialize reasonably well. Their deteriorating physical condition may go unrecognized by others until
something dramatic happens in a social situation, or they have an accident or suddenly exhibit
withdrawal symptoms.

Alcoholism starts with an individual taking an occasional drink. This gradually becomes a habit and
leads to a state where the person cannot do without alcohol. Some people drink alcohol to enliven
social gatherings or they feel under social pressure and the alcohol makes them giddy. For others,
the stupor is an escape from the responsibilities or stresses of life.
Alcoholics feel a strong craving to drink. They cannot stop drinking because of their physical
dependence and the need to avoid the ill effects of withdrawal symptoms. These may range from
nausea, physical agitation, insomnia, profuse sweating, vomiting, poor appetite, tremors (the
"shakes"), convulsion, hallucinations, and sometimes death.

Psychological dependence on alcohol may occur with regular use, relatively moderate daily amounts,
or under certain condition such as before and during social occasions. There is also a craving for
alcohol's psychological effects, although not necessarily in amounts that produce serious
intoxication. For psychologically dependent drinkers, the lack of alcohol tends to make them anxious
and, in some cases, panicky. "'I just need one drink to help calm my nerves."'

Drinking is considered by many to be a harmless social activity. Yet, some alcoholics felt addicted
from the time of their first drink. Sometimes, young people feel pressured to demonstrate that they
can "hold their liquor" and "getting wasted" is a faddish thing to do in college. Binge drinking might be
considered a funny and raucous thing to do at a college party, but it may also be the first step to
being entrapped in an addiction.

Life's day-to-day activities lose their appeal as the alcoholic opts for the numbing or euphoric effects
of drink. Alcoholics, and their loved ones, suffer physically and emotionally. Alcohol dependency
destroys relationships, promotes violence and sends the alcoholic and his family into a seemingly
endless cycle of drunkenness, anger and despair. Alcoholic behavior can interfere with school and
career goals and can lead to unemployment.

Many addicts minimize the impact of their drinking and insist that their life---and their habit---is under
control. This complicates treatment. Detoxification is difficult and withdrawal is painful for the
addicted to experience and for loved ones to witness. Rehabilitation centers almost always isolate
their patients during the initial part of treatment. After that, social support is considered essential
for recovering alcoholics to gain control of their lives.

Alcoholics Anonymous (AA) and similar organizations provide the valuable social support that an
alcoholic needs to break away from a debilitating habit and disease. There is a common bond that
members share: "I'm an alcoholic."'

Research has shown that individuals who were encouraged to cut down on their drinking by fellow
AA members were three times more likely to be abstinent a year after their first treatment for
alcoholism, compared to individuals who received no support.

Drug Abuse and Health Risks

A comprehensive course and a set of extensive references are needed to thoroughly study drug
abuse and to recognize the diversity of drugs and their use. That is not our purpose in this course.
However, it can be helpful to examine the quick reference guide to commonly abused drugs provided
by NIDA. See Figure 10.2.

http://www.nida.nih.gov/DrugPages/DrugsofAbuse.html

The NIDA table organizes common drugs or substances by categories and gives some examples.
There are cannabinoids (e.g., hashish and marijuana), depressants (e.g., barbiturates and
methaqualone), dissociative anesthetics (e.g., ketamine and PCP), hallucinogens (e.g., LSD and
mescaline), opiates (e.g., codeine and heroin), stimulants (amphetamines and cocaine), and other
compounds (e.g., steroids and inhalants).

Figure 10.2 also provides some examples of commercial and street names for the drugs and how
they are typically administered. Do you recognize any of the names? In another column, you can see
the DEA drug classification level (schedule I-V) for each substance as well as how it is administered.
Finally, there are some examples of the intoxication effects and potential health consequences.

There are numerous drugs that people use to "get high" and produce exaggerated feelings of
pleasure. In 1987, there was an anti-narcotics public service announcement that ran on television. It
showed a man holding an egg and he says, "This is your brain." He holds up a hot frying pan and
says, "This is drugs." He cracks the egg into the pan and the egg sizzles and fries. He then says,

"This is your brain on drugs." He looks up at the camera and says, "Any Questions?"
Another public service announcement in 1998 featured an actress who also holding an egg and
saying, "This is your brain." She then lifts up a frying pan and says, "And this is heroin." Next, placing
the egg on the counter, she goes on, "And this is what happens to your brain after using heroin," as
she smashes the egg with the frying pan. "This is what your body goes through," she adds, pointing
to the remnants of the egg dripping from the bottom of the pan. She then proceeds to destroy
everything in the kitchen. With each item she smashes with the frying pan, she continues, "... and this
is what your family goes through..." and "... and your friends...."

"This is your brain on..." became a catchy and popular phrase among teenagers and young adults
during the time of the broadcasts. Of course, many parodies, jokes, spoofs, and ridicules followed.

One assumption is that drug abuse is a matter of choice and anyone who wants to stop using drugs
can do so. It may be a matter of choice in the beginning, but casual and recreational drug use is a
dangerous game to play. There is great diversity among people in terms of their constitutions,
genes, attitudes and backgrounds, making it almost impossible to predict who will become sensible
users and who will become addicts.

No one knows how many times a specific individual can use a drug without it changing his or her brain
and leading to addiction. However, research has shown in convincing ways that the brain is the
centerpiece for drug reactions and that it is damaged by drug abuse.

A person's genetic makeup probably plays a role, but after enough doses an addict's limbic system
craves the drug as it once craved food and water. The craving is exaggerated and made worse
when a person is deprived of the drug.

Dopamine is a chemical naturally produced in the body and it serves many functions. It plays a role in
body movements. In the brain, dopamine functions as a neurotransmitter, activating dopamine
receptors. Without a dose of the drug, dopamine levels in the drug abuser's brain are low. The
abuser feels flat, lifeless, depressed. Without drugs, an abuser's life seems joyless.

The abuser needs drugs just to bring the dopamine levels up to normal levels. In time, larger
amounts of the drug are needed to create a dopamine flood or high, an effect known as drug
tolerance. The addict, in abusing drugs, changes the way his or her brain works. Subsequently, the
changes in reactions and tolerance levels lead to long-term transformations in which users lose the
ability to control their drug use and brain cells are affected. This is the reason that drug addiction
has been labeled a chronic disease.

Like those dependent on alcohol, drug addicts fear the effects of withdrawal symptoms and will
deny, lie, cheat, steal, sneak and exhaust their personal and financial resources in order to support
their habit. It is a dreadful and vicious cycle that affects those whose live and work with addicts, as
well as the abusers.

Drug abusers are often portrayed on television and in films as people who hang out in dark alleys in
dangerous neighborhoods. However, drug abuse also takes place in schools, universities, suburban
neighborhoods, and in places of business. Some people you may never suspect are abusing drugs.

It is important to note that drug abuse is not exclusively related to illegal drugs. Rather, it can occur
by taking more than the recommended dosages of prescribed medications. Prescribed painkillers, for
instance, make up a large proportion of drug abuse and, prescription or not, the long-term effects of
dependency can be the same.

The National Transportation Safety Board claims that prescribed medications are a serious threat to
driving safely. Some common medication for colds, allergies or anxiety can impair driving ability,
perhaps as much as alcohol does, but in subtle ways so that people may not know that they are
drugged or sedated. Reaction time can be affected and a person may feel sleepy and weave across
the road or make poor judgments.

Regulation and control of prescription medicine belongs to the Food and Drug Administration (FDA).
The FDA must grant approval for all new medications to be marketed based on specific information
that includes case studies, research and trials. Warning labels are a result of FDA's monitoring and
regulating procedures, but there are many drugs whose long-term effects are still unknown.

It hasn't been until very recently that prescription medicine accounted for any portion of the
advertising industry's profits. Manufacturers now spend millions of dollars advertising their
prescription medicines to patients and doctors alike. It is a consumer's market and they want people
to take an interest in and choose their products.

From television ads to full-page magazine spreads, prescription medicine is being pushed as a
remedy for almost any ailment a person can imagine. In fact, prescription medicine has gone from
merely identifying and harvesting specific plants and herbs during early civilization to one of the
largest industries in the world.

"Ask your doctor abou..." How many times have you heard or read this comment in various
promotions? Unfortunately, a case could be made that the drug industry is a "drug pusher"' and it
fosters the idea that drug use is not only okay or desirable but a key element to good health and
feeling better.

Nicotine and Health Risks

Taken through cigarettes, cigars and chewing tobacco, nicotine is one of the most heavily used
addictive drugs in the United States. In 2004, 29.2 percent of the U.S. population 12 and older---70.3
million people---used tobacco at least once in the month.

This figure includes 3.6 million young people ages 12 to 17. Young adults ages 18 to 25 reported
the highest rate of current use of tobacco products (44.6 percent). There is some good news in
that teenage use of cigarettes has declined since 1996. The bad news is that before they leave
high school, more than a third will be active smokers.

Cigarettes and other tobacco products contain nicotine that spikes an increase in dopamine. When
smoked, nicotine goes straight to the brain and provides feelings of pleasure in about 8-1 0 seconds.
Within a few minutes, the pleasure is gone and the craving for another cigarette begins a new cycle.
Nicotine is absorbed readily from tobacco smoke in the lungs, and it does not matter whether the
smoke is from cigarettes, cigars or pipes. Nicotine also is absorbed readily when tobacco is chewed.
With regular use of tobacco, levels of nicotine accumulate in the body during the day and persist
overnight. Thus, daily smokers or chewers are exposed to the effects of nicotine for 24 hours each
day.

Addiction to nicotine results in withdrawal symptoms when a person tries to stop smoking. For
example, a study found that when chronic smokers were deprived of cigarettes for 24 hours, they
had increased anger, hostility, and aggression, and were less cooperative. Persons suffering from
withdrawal also take longer to regain emotional equilibrium following stress.

During periods of abstinence and/or craving, addicted smokers have shown impairment across a
wide range of psychomotor and cognitive functions, such as language comprehension. They become
agitated and inattentive to their social surroundings until they have had a smoke.

Women who smoke cigarettes typically experience menopause earlier. Pregnant women who smoke
are more at risk of having stillborn or premature infants or infants with low birth weight. Children of
women who smoked while pregnant have an increased risk for developing behavior disorders.

National studies of mothers and daughters have also found that maternal smoking during pregnancy
increased the probability that female children would smoke and would persist in smoking. Apparently,
the craving for nicotine can be passed down through the bloodstream.

In addition to nicotine, cigarette smoke is composed of a dozen gases (mainly carbon monoxide) and
tar. The tar in a cigarette exposes the user to an increased risk of lung cancer, emphysema, and
bronchial disorders. The carbon monoxide in tobacco smoke increases the chance of cardiovascular
diseases.

Despite strong public awareness programs, many young people ignore the health hazards. It's
difficult to think of negative consequences when people are young. So, many teens will experiment
with cigarettes and drugs, often trying to imitate adults. Smoking cigarettes makes them feel mature
or grown up. However, with repeated dosages, nicotine becomes a habit and then an addiction,
which is described as a disease.

Before the Surgeon General's office became involved, older generations viewed smoking cigarettes
as fashionable. Film stars, athletes and celebrities were often shown with cigarettes in their hands.
Colorful packages and names were designed to attract users. The industry gave away free
cigarettes to men and women in the military service, knowing that they were planting the seeds for a
profitable business. Once addicted, the smoker was considered a lifetime customer.

Statistics from the Centers for Disease Control and Prevention indicate that tobacco use remains the
leading preventable cause of death in the United States, causing approximately 440,000 premature
deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs
attributable to smoking. (See www.cdc.gov/tobacco/issue.htm).

Over the past four decades, cigarette smoking has caused an estimated 12 million deaths. This
included 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million
deaths from respiratory diseases, and 94,000 infant deaths related to mothers smoking during
pregnancy. (See www.cdc.gov/nccdphp/publications/aag/osh.htm).

By the year 2020, tobacco--a major risk factor for chronic obstructive pulmonary diseases like
emphysema and cancers of the lung, bronchus and trachea--is expected to kill more people than any
single disease. It will surpass even the HIV epidemic.

Data from the Department of Health and Human Services 2002-2004 National Surveys on Drug Use &
Health were pooled to examine rates of cigarette smoking among various racial and ethnic groups.
Rates of cigarette smoking among persons aged 12 or older were highest among American Indians
or Alaska Natives (34.B%) and persons of two or more races (34.6%).

Cigarette smoking was lowest among Asian-Americans (13.4%). Among Asians, the highest rate was
among Koreans (24.9%) and lowest among Chinese (7.5%). Among Hispanic smokers, Puerto Ricans
and Cubans were more likely to report daily cigarette smoking than Central or South Americans or
Mexicans.

One woman exclaimed, "I'm so glad that I don't smoke. I wish my husband didn't." She complained
about the smell and the cigarette butts and ashes, but tolerated her partner’s habit because he was
addicted. She worried about the long-term effects on his health. She seldom acknowledged that she
also was at risk.

Secondhand tobacco smoke is a mixture of the smoke given off by sidestream smoke, which is the
burning end of tobacco products, and the mainstream smoke exhaled by smokers. It is a complex
mixture containing many chemicals (including formaldehyde, cyanide, carbon monoxide, ammonia, and
nicotine), many of which are known carcinogens.

Nonsmokers exposed to secondhand smoke increase their risk of developing heart disease by 25 to
30 percent and lung cancer by 20 to 30 percent. In addition, secondhand smoke causes respiratory
problems in nonsmokers such as coughing, phlegm and reduced lung function. Children exposed to
secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory
infections, ear problems, a1d severe asthma.

Since 1964, all of the Surgeon General's reports on smoking and health have concluded that tobacco
use is the single most avoidable cause of disease, disability and death in the United States. This
caught the eye of health insurance companies who increased their rates for those who smoke.
Smokers always pay more for life insurance.

Tobacco companies, recognizing the diversity that exists in the market, develop products and
advertising campaigns to t3rget specific populations, including women and different ethnic groups.
They are particularly interested in teenagers.

For example, Reynolds Tobacco is marketing flavored cigarettes to attract young people. The sweet
smell and taste mask the harshness of natural tobacco, which can deter some first-time smokers.
These new cigarettes are packaged in shiny tins with cool new names, flashy advertising, and candy
flavors ranging from watermelon ("Beach Breezer"') to berry ("Bayou Blast") to pineapple and coconut
("Kaui Kolada").

Tobacco companies have known for decades that 90 percent of adult smokers became addicted as
kids and the younger a person begins to smoke the more likely that he or she will become a regular
smoker. The age at which young people are first trying cigarettes has been declining and is now
about 12 years of age. Getting people hooked on an unhealthy product, despite all the warnings, is
still the goal of tobacco companies.

Overweight and Health Risks

Weight control and obesity are among the top health indicators. Obesity is an eating disorder that
was discussed in the previous topic (Topic 9) of this course. We know that during the past 20
years, obesity among adults has risen significantly in the United States. In addition, the percentage
of young people who are overweight has more than tripled since 1980. Among children and teens
aged 6-19 years, 16% (over 9 million young people) are considered overweight.

These increasing rates raise concern. Being overweight or obese increases the risk of many
diseases and health conditions because excess body fat leads to a higher risk for:

- Premature death
- Hypertension
- Type 2 diabetes
- Hypertension
- Dyslipidemia (high levels of cholesterol or triglycerides)
- Cardiovascular disease
- Stroke
- Gall bladder disease
- Respiratory dysfunction
- Gout
- Sleep apnea and respiratory problems
- Osteoarthritis
- Certain kinds of cancers

This a very intimidating list of extended problems related to obesity. Although one of the national
health objectives for the year 201 0 is to reduce the prevalence of obesity among adults to less
than 15%, current data (2006) indicate that the situation is worsening rather than improving.

The Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) have
published dietary Guidelines for Americans jointly every 5 years since 1980. The latest Guidelines
(2005) www.healthierus.gov/dietaryguidelines

provide sound advice about how good dietary habits promote health and reduce the risk for chronic
diseases. This report (DGAC) serves as the basis for food and nutrition education programs.

Ideally, the goal for adults is to achieve and maintain a body weight that optimizes their health.
However, for obese adults, even modest weight loss (e.g., 10 pounds) has health benefits.

For overweight children and adolescents, the goal is to slow the rate of weight gain while achieving
normal growth and development. Maintaining a healthy weight throughout childhood may reduce the
risk of becoming an overweight or obese adult. Eating fewer calories while increasing physical
activity are the keys to controlling body weight.

A Healthier You is an HHS and Dept of Agriculture publication that is based on the dietary guidelines.
It is an easy-to-use resource that includes how to read food labels, prepare healthy meals and plan
physical activities. It provides helpful websites and links. See it at
http://www.health.gov/dietarygqidelines/dga2005/healthieryou/contents.htm

While overweight and obesity are currently significant public health issues, not all Americans need to
lose weight. People at a healthy weight should strive to maintain their weight, and underweight
individuals may need to increase their weight. In addition, as we know, fear of gaining weight can lead
to other eating disorders such as anorexia nervosoa and bulimia (See Topic 9).

Unfortunately, individuals who are following typical American eating and physical activity patterns are
likely to be consuming food in excess. But, caloric intake is only one side of the energy balance
equation. Caloric expenditure needs to be in balance with caloric intake to maintain body weight and
must exceed caloric intake to achieve weight loss.

Body mass index (BMI) is a measure of body fat based on height and weight that applies to both
adult men and women. An adult BMI chart can be seen in Figure 10.3.

Can you find your score? How do you match up? Begin by locating your height in the left-most column
and read across the row for your weight. Follow the column of the weight up to the top row that
lists the BMI. BMI categories are:

- Underweight = Less than 18.5
- Normal weight = 18.5-24.9
- Overweight = 25-29.9
- Obesity = 30 or more

To reverse the trend toward obesity, most Americans need to eat fewer calories, be more active
and make wiser food choices. This is not easy, given the push by businesses for customers to
consume foods filled with fats and sugars. "Would you like us to Supersize that order?". Apparently
the fast food industry assumes that everyone is going to the gym to work out everyday, or running
a marathon, or riding a bicycle for miles and miles. That doesn't seem to be the case.

Americans tend to be relatively inactive. About 25 percent of adult Americans did not participate in
any leisure time physical activities (2002) and 3B percent of students in grades 9 to 12 joined the
"couch potatoes" and viewed television 3 or more hours per day (2003). An example of how physical
activities burn calories can be seen in Figure 10.4.

There are many different kinds of physical activities that can help you from becoming overweight.
Look at the suggestions in Figure 10.5. How many of these fit your lifestyle? How many of them are
part of your regular routine or personal habits?

The most important part of being a normal weight isn't looking a certain way. Rather, it's feeling good
and staying healthy. For most of us, it's not too late to make changes in eating and exercise habits
to control weight, and those changes don't have to be as big as one might think.

Responsible Sexual Behavior

Sexuality is an integral part of being human. Love, affection and sexual intimacy contribute to healthy
relationships and individual well-being. But along with the positive aspects of our human sexuality,
there also are illnesses that can affect sexual health. In addition, irresponsible sexual behaviors can
result in undesirable consequences, including unwanted pregnancies and sexually transmitted
diseases.

Sexual behavior is one of the leading health indicators for the nation. In many cases, the underlying
causes of sexual disorders continue to be poorly understood, and sometimes few treatment options
are available. The unwillingness of individuals to discuss their sexual problems may be the greatest
barrier to achieving sexual health and responsible sexual behavior.

Common sexual health problems suggest that there is a great deal of diversity among the population.
These include:

- Reproductive system disorders, including cancer invasions.
- Infertility.
- Gynecologic problems, including endometriosis, pelvic inflammatory disease and premenstrual
syndrome.
- Urinary system problems, including incontinence and urinary tract infections.
- Sexually transmitted diseases.
- Sexual dysfunction, including erectile dysfunction, painful intercourse and loss of sexual
desire.

Other sexual health issues include what is normal or socially acceptable sexual behavior and
lifestyles? What kind of birth control is most effective and what prevents birth control methods from
being used? How should teenage sexual issues be addressed? What roles do morality, laws and
social customs play in creating happy and healthy sexual relationships? Do they allow freedom to
express individuality?

We value the sexual part of our being for the pleasures and benefits it gives us. Yet, when
exercised irresponsibly it can have negative aspects that threaten health and well-being, such as
sexually transmitted diseases, unwanted pregnancies, and unhappy people who have relationship
problems.

Sexual health is not limited to the absence of disease or dysfunction, nor is its importance confined
to just the reproductive years. It includes the ability to understand and weigh the risks,
responsibilities, outcomes and impacts of sexual actions and to practice abstinence when
appropriate. It involves individual and community responsibility.

Individual responsibility includes: understanding and awareness of one's sexuality and sexual
development; respect for oneself and one's partner; avoidance of physical or emotional harm to
either oneself or one's partner; ensuring that pregnancy occurs only when welcomed; and,
recognition and tolerance of the diversity of sexual values within any community.

Community responsibility includes assurance that its members have: access to developmentally and
culturally appropriate sexuality education, as well as sexual and reproductive health care and
counseling; the freedom to make appropriate sexual and reproductive choices; respect for diversity;
and, freedom from stigmatization and violence on the basis of gender, race, ethnicity, religion, or
sexual orientation.

Unintended pregnancies and sexually transmitted diseases (STDs) can result from unprotected
sexual behaviors. Abstinence is the only method of complete protection. Condoms, if used correctly
and consistently, can help prevent both an unintended pregnancy and STDs but they are not
guaranteed protection.

It is estimated that more than half of all pregnancies in the United States are unintended; that is, at
the time of conception the pregnancy was neither planned nor wanted. Unintended pregnancy rates
in the United States have been declining. The rates remain highest among teenagers, women aged
40 years or older, and low-income African American women.

Approximately 1 million teenage girls each year in the United States have unintended pregnancies.
Nearly half of all these pregnancies end in abortion. The cost to U.S. taxpayers for adolescent
pregnancy is estimated at between $7 billion and S15 billion a year.

STDs are infections that can be transferred from one person to another through sexual contact.
According to the Centers for Disease Control and Prevention, STDs are common in the United States,
with an estimated 15 million new cases reported each year. Almost 4 million of the new cases occur
in adolescents.

Women generally suffer more serious STD complications than men, including pelvic inflammatory
disease, ectopic pregnancy, infertility, chronic pelvic pain, and cervical cancer from the human
papilloma virus. African Americans and Hispanics have higher rates of STDs than Whites. The total
cost of the most common STDs and their complications is conservatively estimated at $17 billion
annually.

One STD that many people worry about is the human immunodeficiency virus (HIV). It was once
thought to only affect a select group of people. Now, it is recognized that HIV affects people from
every walk of life and regardless of sexual orientation. HIV can eventually progress to AIDS and,
ultimately, to death.

More than 40 million people worldwide are infected with the HIV virus. More than 700,000 cases have
been reported in the United States and of these about one-half occurs among people under 25
years of age.

These figures are considered conservative estimates since many people may not realize that they
are infected. The virus is often asymptomatic and many people do not show any signs for the first
few years. Medical tests are the only sure way to know if one is infected.

Some common STDs that are prevalent in the United States and that need medical attention are:

- Syphilis, which without treatment can affect the nervous system and cause brain damage that
leads to dementia or death.
- Trichomoniasis, a most common and curable disease whose symptoms might be mistaken for a
yeast infection.
- Chlamydia and gonorrhea, common infections that may strike a person at the same time and
can damage the reproductive system.
- Pubic lice, similar to head lice, these pests produce itchy symptoms.

More people are beginning to believe in the slogan, "Safe sex or no sex."' What then are the
concerns and issues related to responsible sexual behavior?

Is irresponsibility lax morality and promiscuity? Is it the change in attitudes toward sexual
relationships brought about by the sexual revolution decades ago? Is it the unwillingness of people,
especially teenagers, to delay sexual activity and, consequently, increase the risk of unwanted
pregnancies or the chance of venereal diseases? Or is it the lack of a public health system and
services that makes contraception available at little or no expense? All of these factors contribute.

Teenage birth, abortion, and STDs rates in the US are higher than in most other industrialized
countries. The U.S. is a large and more diverse country than many of the other nations around the
world. Diversity has given rise to varied perspectives and opinions based on beliefs and values.

One segment of our population believes, for example, that young people will have intimate sexual
relationships without being married and that these relationships are natural. They do not see sexual
expression in a negative light or as deviant behavior. They are not afraid to talk openly about the
nature of sex and advocate responsibility. They also realize that there are too many myths and
taboos about sex and sexual behavior that create health problems for too many people.

Another segment of the population believes that sexual intimacy should be reserved for a married
man and woman who live together as a family. Anything to the contrary can be seen as immoral
and/or illegal. "Just say no, until you're married." is the message.

Despite the general discomfort that many U.S. adults have with the subject of sexuality, particularly
teenage sexuality, the majority of people do not agree that the best policy is to dismiss the issue
and ignore it. Instead, they want young people and adults alike to have the information and services
that they need to lead healthy lives.

Diversity makes it difficult to know where our nation stands in terms of being sexually responsible. In
general, the public places a greater value on abstinence and self-restraint rather than indulgence
and immediate gratification. Yet, at a time when about 70% of 18-year-olds in the U.S. have had
sexual intercourse, the needs of sexually active youth should not be ignored. In addition, recent
surveys (2006) suggest that 90% of adults have had premarital sex.

The entertainment media frequently portray young, single people engaging in casual sex and with no
contraception and no consequences. The media often presents uncommitted sex, such as "one night
stands" as desirable and the characters rarely suffer any ill effects.

A television prime time analysis revealed that the average adolescent in the U.S. views and/or hears
14,000 sexual references, jokes and innuendos each year. However, only one in 85 of these will
mention abstinence, contraception or commitment.

In the US, sex education is controlled by the individual states, which in turn leave decisions to local
governments. They set the guidelines for curricula and subject matter. Most of the mandates for
abstinence education come from state legislatures rather than departments of education. It is easy
to see why instruction about sexuality in the U.S. is so diverse. However, some general themes seem
to be present:

- Sexual activity outside marriage is likely to have harmful psychological and physical effects.
- Having children out-of-wedlock may have harmful consequences for the child, the child's
parents, and society.
- It is important to attain self-sufficiency before engaging in sexual activity.

Those programs that embrace the abstinence-until marriage philosophy do not address teen sexual
behavior, use of contraceptives and condoms, or teach how young people can protect themselves
and others. There is a belief that to do so would be acknowledging the behavior and in essence
giving permission. The consequences of STDs, guilt and shame are often used in an attempt to
frighten youth into abstinence. Despite these limitations, most states have applied for and accepted
the "abstinence-until-marriage" education funds that were made available by the U.S. Congress.

Another approach, defined by proponents as an accurate and balanced sex education, takes a
broader perspective. Students are encouraged to postpone sex until they are older and then to
lower their risk of negative consequences by using safer sex practices. These programs utilize
principles of social learning theory and emphasize communication, negotiation and problem-solving
skills.

The World Health Organization and UNAIDS each reviewed the research on abstinence-only and
balanced sex education programs. The reviews found that no abstinence-only (or
abstinence-until-marriage) programs were proven effective while some balanced programs were
effective, in delaying first intercourse and in increasing the use of protection by sexually active
youth. Additionally, there was no evidence that balanced programs caused earlier sexual activity or
increased the number of sexual partners among sexually active youth.

Mental Illness and Health

Mental health could be viewed as the absence of mental illness, but it should be seen as a broader
concept. It is the state of successful mental functioning that results in productive activities, fulfilling
relationships, positive attitudes about life, and the ability to adapt and cope with adversity.

A mental illness is a disease that causes mild to severe disturbances in thi1king, perception and
behavior. If these disturba1ces significantly impair a person's ability to cope with life's ordinary
demands and routines, tre3tment with a mental health professional is needed. Approximately 20
percent of the U.S. population is affected by some kind of mental illness every year.

Many mental illnesses are believed to have biological causes, just like cancer, diabetes and heart
disease. Some mental disorders are caused by a person's environment and experiences. The
Diagnostic Statistical Manu31 is the official publication used by counselors, therapists and doctors
that lists and identifies the symptoms of different kinds of illnesses.

This overview of mental illness focuses on the most common disorders that occur across the life
span. The purpose here is to provide a framework for the diversity and societal burden of mental
disorders.

Anxiety Disorders. Most people experience feelings of anxiety before an important event such as an
important exam, business presentation or first date. Anxiety disorders, however, are illnesses that
fill people's lives with overwhelming stress and fear that are chronic and can grow progressively
worse. Tormented by an a1xiety, some people even become housebound.

Anxiety disorders, as a group, comprise the most common mental illness. More than 19 million
American adults are affected by these incapacitating illnesses each year. Children and adolescents
can also develop anxiety disorders.

Here are a few of the most common anxiety disorders:

- Panic Disorder---Repeated episodes of intense fear that strike ofte1 and without warning.
Physical symptoms include chest pain, heart palpitations, shortness o' breath, dizziness,
abdominal distress, feelings of unreality, and fear of dying.
- Obsessive-Compulsive Disorder---Repeated, unwanted thoughts or compulsive behaviors that
seem impossible to stop or control, such as washing one's hands or putting things in place.
- Post-Traumatic Stress Disorder---Persistent symptoms that occur after experiencing or
witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or
human-caused disasters. Nightmares, flashbacks, numbing of emotions, feeling sad and angry,
irritable or distracted and being easily startled are common.
- Phobias---Two major types of phobias are social phobia and specific phobia. People with social
phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in
social situations, which leads to avoidance of many potentially pleasurable and meaningful
activities. People with specific phobia experience extreme, disabling, and irrational fear of
something that poses little or no actual danger; the fear leads to avoidance of objects or
situations and can cause people to limit their lives unnecessarily.
- Dysthymia---feeling mildly depressed on most days over a period of at least two years.
Symptoms resembling major depression, but with less severity.
- Generalized Anxiety Disorder---Constant, exaggerated worrisome thoughts and tension about
everyday routine life events and activities, lasting at least six months. Almost always
anticipating the worst even though there is little reason to expect it. These thoughts are
accompanied by such physical symptoms as fatigue, trembling, muscle tension, headache, or
nausea.

Mood Disorders. Most of us know what it means to feel happy and joyful. We also know that moods
can be altered and sometimes there is a sustained feeling of sadness or feeling down. Disturbances
of mood may occur in a variety of patterns associated with different mental disorders.

The disorder most closely associated with persistent sadness is major depression. When one mood
disorder is coupled with sustained elevation or fluctuation of mood the condition is called a bipolar
disorder. Along with the prevailing feelings of sadness or elation, disorders of mood are associated
with a host of related symptoms that include disturbances in appetite, sleep patterns, energy level,
concentration, and memory.

Depression. Depression is the most common mental disorder, with more than 19 million adults
suffering from it. The illness comes in different forms, has many different causes, and affects people
differently.

About 20% of adults in the U.S. will have at least one major depressive episode in their lifetime.
Depression, often called the "common cold" of mental disorders, is the most widespread and most
easily treated mood disorder, yet it is usually misdiagnosed or under-diagnosed. Unfortunately, if
ignored, a single episode of depression can lead to a life-long struggle with recurring bouts.

Although everyone feels "down" once in a while, a Major Depressive Episode dominates the life of
the sufferer and often interferes with day to day living. Usually, people with depression experience a
sense of feeling "'blue"' or very sad. They may feel like keeping to themselves and not really wanting
to be around other people. They may be more irritable and short-tempered than usual; little things
may annoy them. Decisions may be more difficult to make and even avoided altogether.

During depression, sleeping patterns are often affected. A person may want to sleep around the
clock or they may lie awake in bed, tossing and turning, unable to get a night's rest. Changes in
appetite are frequently experienced, with either increased or decreased food intake. One's sexual
urges decline substantially.

Individuals suffering from depression typically lose much of their normal energy and motivation and
may not feel like doing the normal things usually found enjoyable. As the depression deepens, there
is a feeling of hopelessness. Major depression is closely linked to suicides.

Depression is known to have many possible causes, including hereditary factors, significant personal
losses, and even lack of exposure to sunlight. Most often, though, it results from life circumstances
that overwhelm a person's ability to effectively cope with normal, day-to-day events, such as
decision-making.

The loss of a loved one, losing a job, a severe illness, the breakup of an important relationship,
financial loss or debt, even loneliness, can each, or in combination, contribute to the development of
depression. Certain physical conditions, such as thyroid problems can also cause symptoms that are
very similar to depression, as can deficiencies of certain nutritional substances. Depression has
numerous causes and can be hard to cure, but it is treatable.

The brain is a giant messaging system that controls everything from your heartbeat, to walking, to
your emotions. It is made up of billions of nerve cells called neurons. These neurons send and
receive messages from the rest of your body, using brain chemicals called neurotransmitters. In
mental illness, these neurotransmitters do not function properly.

Your brain's chemicals, in varying amounts, are responsible for your emotional state. Depression
happens when these chemical messages aren't delivered correctly between brain cells, disrupting
communication. Think of a telephone. If your phone has a weak signal or breaks up, you may not hear
the person on the other e1d. Their communication is muted or unclear.

Major depression has a combination of symptoms that interfere with the ability to work, study, sleep,
eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only
once but more commonly occurs several times in a lifetime.

Dysthymia, a less severe type of depression, involves long-term, chronic symptoms that do not
totally disable, but keep one from functioning well or from feeling good. Many people with dysthymia
also experience major depressive episodes at some time in their lives. This kind of depression allows
people to muddle their way through life, without much enthusiasm and energy.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as
prevalent as other forms of depressive disorders, it is characterized by cycling mood changes:
severe highs (mania) and lows (depression). The mood switches can be dramatic and rapid, but most
often they are gradual. When in the depressed cycle, an individual can have any or all of the
symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive,
over-talkative, and have a great deal of energy.

Mania in the bipolar disorder often affects thinking, judgment and social behavior in ways that cause
serious problems and embarrassment. For example, the individual in a manic phase may feel elated,
full of grand schemes that might range from unwise business decisions to romantic sprees. They are
impulsive. Left untreated, mania may worsen to a psychotic state.

Some types of depression run in families, suggesting that a biological vulnerability can be inherited.
This seems to be the case with bipolar disorder. Studies of families in which members of each
generation develop bipolar disorder found that those with the illness have a somewhat different
genetic makeup than those who do not get ill.

However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability
to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home,
work, or school are involved in its onset.

In some families, major depression also seems to occur generation after generation. It can also occur
in people who have no family history of depression. Whether inherited or not, major depressive
disorder is connected with changes in brain structures and brain functions.

People who have low self-esteem, who consistently view themselves and the world with pessimism or
who are readily overwhelmed by stress, are prone to depression. Whether this represents a
psychological predisposition or an early form of the illness is not clear.

Adults and older adults have the highest rates of depression. Major depression affects
approximately twice as many women as men. Women who are on welfare, less educated, unemployed,
and from certain racial or ethnic populations are more likely to experience depression.

Women experience depression about twice as often as men. Hormonal factors may contribute to the
increased rate of depress on in women, particularly menstrual cycle changes, pregnancy, miscarriage,
postpartum period, pre-menopause, and menopause. Many women also face additional stresses such
as responsibilities both at work and home, single parenthood, and caring for children and for aging
parents.

Postpartum Depression is 3 type of depression that can occur in women who have recently given
birth. It typically occurs in the first few months after delivery, but can happen anytime within the first
year after giving birth. The symptoms are those seen with any major depressive episode. Often,
postpartum depression interferes with the mother's ability to bond with her newborn. Postpartum
depression is different fro11 the "Baby Blues," which tend to occur the first few days after delivery
and resolve spontaneously.

Although men are less likely to suffer from depression than women, 6 million men in the United States
are affected by the illness. Men are less likely to admit to depression and doctors are less likely to
suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In
fact, after age 70, the rate of men's suicide rises, reaching a peak after age B5.

Men's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working
excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless,
but as being irritable, angry, and discouraged. Even if a man realizes that he is depressed, he may
be less willing than a woman to seek help.

Depression rates are higher among the elderly. For example, 12 percent of older persons
hospitalized for problems such as hip fracture or heart disease are diagnosed with depression.
Rates of depression for older persons in nursing homes range from 15 to 25 percent.

Finally, one of the most severe mental disorders is schizophrenia, which is associated with psychosis
and hallucinations. Although the disease affects men and women with equal frequency, the disorder
often appears earlier in men---usually in the late teens or early twenties---than in women, who are
generally affected in the twenties to early thirties. People with schizophrenia often suffer terrifying
symptoms such as hearing internal voices not heard by others, or believing that other people are
reading their minds, controlling their thoughts, or plotting to harm them.

These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so
disorganized that they may be incomprehensible or frightening to others. Most people with
schizophrenia suffer some of the symptoms throughout their lives.

The treatments for mental illness are quite diverse. Medications prescribed by doctors are available
to help with symptoms. Psychotherapy and counseling are also common approaches, since talking
with an expert about the condition can help provide relief and intellectual insights that might resolve
matters.

Because so many people develop symptoms of mental illness between the ages of 15 and 25, they
are in danger of missing substantial portions of traditional education and career training
opportunities. With effective treatment and a supportive environment, many of these opportunities
can still be pursued. Mental health is a subject that we will revisit in Topic 14 of this course.

Injuries and Health Risks

In the course of living, most of us have suffered minor physical injuries. We all have had cuts, bruises,
bites and burns that may or may not have required special medical attention. Most the time, our
immune system will combat the bacteria associated with these accidents, unless they are unattended
and serious infections develop.

On occasion some more catastrophic events take place causing serious injury to the body. For
example, some people are critically injured or killed in car crashes, or by flying debris from a
hurricane, or in other weather related events. The risk of injury is so great that most persons
involved sustain a significant injury at some time during their lives.

Motor vehicle crashes are the most common cause of serious injuries. Death rates associated with
motor vehicle-traffic accidents are highest in the age group 15 to 24 years. In 1996, teenagers
accounted for only 10 percent of the U.S. population but 15 percent of the deaths from motor
vehicle crashes. Those aged 75 years and older had the second highest rate of motor
vehicle-related deaths. Nearly 40 percent of traffic fatalities are alcohol related.

In 2003, males accounted for 80% of fatal drownings in the United States. Alcohol use is involved in
about 25% to 50% of adolescent and adult deaths associated with water recreation. In 2004, among
those who drowned, 90% were not wearing life jackets.

Being victims of a crime can leave people, and those around them, in a state where they are not
thinking as clearly as they usually do and they may feel overwhelmed. There is often financial loss
and physical injury connected with victimization, but the most devastating part for many victims is the
emotional pain caused by crime. It is difficult to understand that someone else wanted to hurt them.
The experience of becoming a crime victim can shatter a person's life in a variety of ways.

Environmental Risks and Health

When people hear about environmental risks they most often think of global warming and air
pollution. For example, we know that higher temperatures threaten dangerous consequences around
the world: droughts, diseases, floods, and lost ecosystems. Global warming and its effects are in the
news, but not everyone pays attention or takes them seriously.

Air pollution has been a major problem for many years, although in the past three decades
environmental measures have cleared up a lot of the visible pollution that once hovered over urban
areas. Smog, soot and haze still persist in many cities and even cloud the views in wilderness and
park areas. In addition, city dwellers especially must cope with dirty air and water, dwindling open
space, garbage, carbon monoxide from cars and buses, and the air pollutants from industry.

In the United States, air pollution alone is estimated to be associated with 50,000 premature deaths
and an estimated $40-$50 billion in health-related costs annually. Two indicators of air quality are
ozone (outdoor) and environmental tobacco smoke (indoor).

Indoor environment has received increasing attention by those who investigate hazards to health.
The obvious one, secondary cigarette smoke, is being attacked with vigor and it is no longer legal or
encouraged to smoke in offices and restaurants in many states. Toxic molds that grow in buildings,
offices and homes can cause respiratory illnesses, such as allergies and asthma, and they are health
hazards that are commonly ignored, as they seem almost invisible to the eye.

Less obvious environmental indicators that affect health are the pet peeves that office workers
have regarding their work or home environments For example, unwanted and annoying telephone
calls from telemarketers can be disruptive and increase stress. Given computer technology,
marketing companies have target populations to call that match lifestyles and spending habits with
neighborhoods and households.

The cell phone can be a practical tool to use and to keep in touch with people. It's a marvelous
networking device. But, incessant chatter in public places and annoying rings in the workplace and
home environments can put people on edge. When not used in a sensitive way, they can be intrusive
and affect personal and social relationships. In addition, the increased use of cell phones has also
introduced an increased number of technical problems in a new and changing industry that in turn
create high levels frustration and stress.

More and more, we are turning to new household items that can promote safety and health. Some
might reduce the chance of injury, such as guards on saws, lawnmowers and kitchen utensils. Others
might help people reduce tension and get more rest, such as improved bedding and ergonomic
chairs. More furniture is being designed to accommodate differences in size and height in an attempt
to help people relax and feel comfortable.

The risk indicators related to environmental concerns are so wide ranging that it seems impossible
for any of us to avoid being affected in some way. There is so much diversity in our environments
that we can't fully control. We are increasingly aware of how our outdoor and indoor environments
affect our health, for better and for worse.

Access to Health Care

One of the leading indicators of health in the nation is access to health care, such as having health
insurance and a regular primary care provider. Two generations ago few people had these and only
the very wealthy had any protection against ruinous medical expenses. Today, you may not be able
to access a doctor's services or even be admitted to a hospital unless you can show proof of health
insurance.

In 2003 national health care expenditures totaled $1.7 trillion dollars, an increase of 7.7% in one
year. Since 1 995 the average annual rate of increase for prescription drug expenditures was higher
than for any other type of health expenditure, indicating a growing importance and reliance on
prescription drugs.

The source of payment for personal health varies according to the type of care provided.
Government sources are the primary payers of hospital and nursing home care. They pay for about
60% of the services, while private health insurance pays most of the rest.

More than 44 million persons in the United States do not have health insurance. Over the past
decade, the proportion of persons under age 65 with health insurance remained steady at about 85
percent. About one-third of adults under 65 years of age and below the poverty level were
uninsured. People aged 18 to 24 years were the most likely to lack a usual source of ongoing
primary care.

For persons of Hispanic origin, approximately one in three was without health insurance coverage in
1997. Mexican Americans had one of the highest uninsured rates at 40 percent.

More than 40 million Americans do not have a particular doctor's office, clinic, health center, or other
place where they usually go to seek health care or health-related advice. Even among privately
insured persons, a significant number lack a usual source of care or they report difficulty in
accessing needed care due to financial constraints or insurance problems.

There are 9 million children without health insurance in this country---that's one out of every eight
children. Millions more have skimpy, inadequate coverage. Uninsured children fail to get medical,
mental health and dental services. They go without prescriptions and skip doctor visits, all of which
leads to poor health.

Our nation is growing older and is becoming more racially and ethnically diverse. In 2005, there were
major disparities in health and health care by socioeconomic status, race, ethnicity, and insurance
status. Persons living in poverty are much more likely to be in fair or poor health and to have
disabling conditions. They are less likely to have used many types of health care. In 2003, they were
twice as likely to report eyesight problems and to have asthma attacks.

Healthy People 201 0 is a federal program that seeks to eliminate disparity. It calls for: an increase in
access to quality health services; an increase in community-based programs that are culturally and
linguistically appropriate; an increase in minority health professional graduates; and improved data
gathering to better understand health disparities and service needs.
As health care has become more technological, it has become more effective and is getting better
outcomes. It has also become more expensive. One critic claimed, "The practice of medicine has
shifted from a vocation, a calling, and a profession, to a business. What was gained in effectiveness
and efficiency has been accompanied by a loss in humanity and caring." The concept of the "country
doctor providing house calls and providing a nurturing bedside manner" is no longer viable.

America's growing diversity underscores the importance of examining and addressing racial and
ethnic disparities in health status and the use of health care services. The new millennium also brings
new health and safety challenges, such as emerging infectious diseases (e.g. SARS, monkey pox, bird
flu, pandemic influenza), environmental threats and lifestyle choices.

Despite criticisms, inequities, inability to access care and increasing costs, the health care system
has improved in two generations. It is increasingly more effective and efficient. It provides coverage
for the vast majority of Americans, rich and poor alike.

At a time when consumers are expressing an unprecedented interest in decisions related to their
health, more public involvement in health planning seems appropriate.

Topic 11

Physical Disabilities

The History of Disabilities

In ancient times, people were considered useless if they could not contribute to food gathering or
the wealth of the tribe. Those with disabilities were left to die when the tribe moved on. Infants with
impairments were generally killed at birth, especially in ancient Greek and Roman societies. This
"'return on investment"' philosophy was to be a recurrent theme in the history of disabilities.

It was thousands of years before a gentler approach focused more on sympathy and pity, which also
produced a condescending and paternal attitude. In the middle ages, supernaturalism emerged and
people became fearful of people with disabilities who appeared to be possessed by evil spirits. They
were also ridiculed and the targets of laughter. This general attitude lasted for hundreds of years
before charitable organizations began to help and speak up against abuse. Public education was the
best caring and helping model of all.

World War I created a great number of veterans with disabilities. Rehabilitation services and federally
funded programs began. There was an outpouring of sympathy. Still, people with disabilities were
often cast as freaks.

In early movies, the film industry tended to portray people with disabilities as "savages" or "criminally
insane." One of the greatest actors of all time, Lon Chaney built a career by playing villains with
disabilities---The Hunchback of Norte Dame and the Phantom of the Opera. Physical abnormalities and
disfigurement continue to characterize villains in modern day horror films-Halloween, Nightmare on Elm
Street, Friday the 13th, and The Texas Chainsaw Massacre.

During the 1930s, the eugenics movement, devoted to improving the human race by artificial
selection, called for euthanasia of "defectives," which was a throwback to the thinking of ancient
times. In addition, it was the custom of the time to separate people with disabilities from the
community at large and house them in institutions. Some evaded this isolation and abuse by living
with their families in rural areas.

It took World War II and the wars that followed, plus the great social change movements of the
1960s, before the public started thinking about people with disabilities beyond birth defects, charity
and welfare. Rehabilitation programs and medical advancements allowed more people to live longer
and make contributions to society.

For example, two decades ago, children born with spina bifida might not have expected to survive
childhood. Now they have normal life expectancies. A few decades ago, amputees were expected to
just sit around or do menial jobs. Now, many participate in challenging athletic events, which most
people without disabilities cannot perform or would find extremely difficult, and provide leadership in
responsible jobs.

Perception and Impairments

Imagine that you and some friends or family members have just witnessed an extraordinary
event-perhaps a group of stunt skydivers or the chase and arrest of a purse-snatcher. In talking
about it afterwards, practically everyone has a different take on what took place. And, while you may
be surprised by what some people say, you're not surprised this is happening, because it happens a
lot.

Different people experience things differently. Why? Because we perceive and interpret the same
stimuli according to our different perspectives.

Our perception of the external world begins with our senses, which leads us to generate concepts
about the world around us, relating our new ideas to preexisting ones. Because our perceptions
lead to our unique impressions of the world and our experiences, they play an important role in how
we relate with our world and with other people.

Now imagine how your perceptions of that shared event with your family or friends would be
impacted by a visual or hearing impairment, or by a condition that changes how you can physically
experience the event. By adding these variables to the great diversity of perceptions among
people, our disabilities and impairments influence our relationships.

Perceptions come into play here in another way as well. History shows that disabilities and the
people who have them have been perceived and interpreted in so many ways. These perceptions
have lead to treatment that has been condescending, punitive, frightful, inhibiting, and to a lesser
extent, enlightened.

Major Disabilities

Disability is a contested term that covers a number of physical and mental impairments. Relatively few
people are born with disabilities and the majority of impairments are acquired through disease,
accidents or late-emerging genetic effects.

Anyone who lives long enough finds that their abilities to see, hear and move around diminish. In that
sense, disability is expected to affect everyone. Some disability rights activists use the acronym TAB
for Temporarily Able-Bodied, as a reminder that many people will develop disabilities at some point in
their lives. Yet, people with long-term disabilities face prejudice and problems accessing basic
facilities and services.

About one in five Americans has a disability, making people with disabilities the nation's largest
minority group. It is also the most inclusive and diverse, taking its members from every other
diversity category. Furthermore, it is the only minority group that anyone can join at any time,
whenever disability happens. Some say that, in the end, the only thing members of this large diverse
group have in common is being on the receiving end of a great deal of societal misunderstanding and
its consequences.

There is a greater proportion of Americans today living with significant disabilities than ever before.
Current studies suggest more than 49 million Americans have disabilities that have some significant
impact on their lives and major life activities. In Figure 11.1, based on data from Census 2000, the
number of people with disabilities is shown in four major age groupings.

In some cases, a person's disability is a minor inconvenience, something that is controlled through
medication or that requires simple adaptations. In other cases, a person's disability plays a major
role in his or her life, impacting the ability to earn a living, to participate in social activities, and to do
many of things that other people take for granted in their daily lives.

For our purposes, we can become more aware of this population by taking a closer look in this topic
at some specific physical disabilities: vision, hearing and orthopedic. Mental disabilities will be
considered in Topic 12 of this course, but even then our discussion is not inclusive. As we increase
our understanding and ability to relate with people who have disabilities, there is greater comfort
and more opportunities to build productive and satisfying communities.

People with Vision Impairments

We know that our eyes are different from others. There are different shapes and different colors.
Some are less effective, perhaps because of genetics, environment or events that have taken place,
such as diseases and accidents. Yet, we are all so accustomed to seeing people wear glasses or
contact lenses that we do not think of poor vision as a disability. Scientists and inventors have
developed corrective lenses to compensate for the deformities in the shape of our eyes, affording
us the possibility of seeing with perfect, though somewhat artificial, vision.

Many of us have natural vision so flawed that there is no question we would have a disability were it
not for our glasses. Bad eyesight is common but it is so easy to correct that we often forget how
different our lives would be without this incredible sense.

Others of us have visual disabilities that are not so easily corrected, nor so easily forgotten. Some
of us have no vision at all. Total lack of vision represents the extreme end of the scale of a condition
that we call blindness. As it turns out, however, most people who are considered "legally blind" do
have some, though very limited, vision.

Another category of visual disability, low vision, is a common condition among the elderly. Younger
individuals may also have this disability, whether due to genetics, traumatic injuries or illnesses. The
visual acuity of people with low vision varies widely, but, in general, low vision is defined as a
condition in which a person's vision cannot be fully corrected by glasses, thus interfering with daily
activities such as reading and driving.

A third category of visual disability is color-blindness, defined as the inability to be able to reliably
distinguish colors. However, it is probably an overstatement to call color-blindness a disability, since
the conditions under which color-blindness is a true limitation are few.

The most common category of color-blindness is often called red-green color-blindness, which makes
it hard to differentiate between the two. Oranges, yellows and beiges may also be confused, with
the blues being the least affected.

It is extremely rare for someone to be totally colorblind. Rather, there are many different types and
degrees of color deficiencies. In fact, many forms of so-called colorblindness are really just natural
variations in the proteins in the cells.

The Amazing Human Eye

The human eye is a remarkable organ that gives us the sense of sight. It allows us to learn more
about the surrounding world than any of our other four senses. We use our eyes in almost every
activity we perform, whether we are reading, working, watching television or driving a car.

The eye is extremely complicated, functioning as a perfect and interrelated system of about 40
special subsystems, including the retina, pupil, iris, cornea, lens and optic nerve. For instance, the
retina has about 137 million cells that respond to light and send messages to the brain.

Approximately 130 million of these cells look like rods and handle black and white vision. The other 7
million are cone shaped and allow us to see in color. The retina cells receive light impressions, which
are translated to electric pulses and sent to the brain via the optic nerve. A special section of the
brain, called the visual cortex, interprets the pulses to color, contrast, depth, etc., which allows us
to see images and pictures of the world.

Surprisingly, the eye, optic nerve and visual cortex are totally separate and distinct subsystems.
Yet, working together they capture, deliver and interpret up to 1.5 million pulse messages a
millisecond. It would take dozens of supercomputers programmed perfectly and operating together
flawlessly to even come close to performing this task. If all the separate subsystems aren't present
and performing perfectly at the same instant, the eye won't work well. Vision can be distorted or
lost.

There is evidence that each eye is unique in its cellular structure. In this sense, the eyes are more
than a window to the soul, as poets and lovers claim. They provide a clue to people's identities, a
kind of super-fingerprint. So, less romantically, scientists continue to research how the eye's iris, for
example, can be used in security devices.

The human iris has more individuating characteristics than a fingerprint. Mathematically, the
probability of two people having exactly the same iris pattern is much smaller than with fingerprints.
In addition, your left and right irises have distinct patterns and even identical twins are different from
each other.

Facial biometrics involves the use of facial properties to identify individuals. They often fail as
security checks due to the changes in features caused by expressions, cosmetics, hairstyles and
the growth of facial hair, as well as problems related to lighting and shadowing. Iris features, on the
other hand, remain relatively consistent over time and are easy to extract.

The difficulty with acquiring an image of an iris at the necessary resolution from a distance is still
limiting the technology.

It appears that eventually iris scans will be used in almost all security checks. You will simply walk by
such a scanner, look at it quickly, and instantly confirm your identity. In the future, iris scanners will
likely be seen more in banks, airports and places of business. The scanners will also replace
passwords on desktop computers.

Genetics have a powerful influence on the development of our eyes. One obvious difference can be
seen in eye color. Babies are usually born with blue colored eyes, regardless of the eye color of
their parents. Babies' eye color changes as they get older and the production of a dark brown
pigment called melanin rises.

Similar to skin tone, the darker the eye color, the more melanin is present. Furthermore, iris color
falls along a spectrum from blue to dark brown or even black. Gray, green, hazel and lighter colored
eyes fall in between these ranges. Eye color is a physical trait that is determined by the pairing of
genes and chromosomes-15 of them---from both parents. It becomes even more complex when we
consider that everyone has two copies of each chromosome.

Most members of the human species have brown hair and brown eyes because most people have
pigment genes that produce that color. In addition, brown is a dominant trait, while traits like red hair
and green eyes are recessive. The genes for red hair and green eyes seem to have arisen in
ancient Celtic populations of the British Isles. Some human populations, such as those with origins in
northern Europe, have a tendency for blonde hair.

Many things can affect normal vision temporarily. Fatigue, for instance, can decrease visual acuity.
Drugs have potential side effects of blurred vision, halos, or spots. Poor working conditions that lack
sufficient light or where the light is too intense can affect our eyes and what we see. Finally, there
are body changes, such as high blood pressure or drooping eyelids (ptosis) that have an impact on
vision.

Some say that early humans were born with hunter's eyes, needed for spotting game or danger at a
distance. But in the last 50 years especially, nearly all our work had shifted the focus of our vision to
arms length. This is also true for many recreational activities as well (think video games). A high
number of near visual tasks in our daily routines may contribute to such changes as nearsightedness,
suppressed vision in one eye, poor eye teaming and reduced efficiency at work and at play.

With this increase in near visual tasks, having a daily routine of eye exercises makes sense. Eye
exercises help maintain healthy vision, reduce or eliminate the effects of eyestrain and ultimately
help to preserve eyesight. There are even yoga exercises designed to strengthen the eyes and
increase the flexibility of the eye muscles. Nutrition, eye hygiene and common sense eye care can
help us make the most of the vision we have.

Common Visual Impairments

There are many diseases, disorders and age-related changes that affect the eyes. Changes occur
as the eyes age_ Most of these follow a gradual decline and are related to the reduction of pupil
size and ability to focus. The quality of vision slowly worsens.

Older adults jokingly tell young people to make an appointment with an optometrist for the day after
their 40th birthday because they won't be able to read as well as they used to. Eye disorders are
part of the normal aging process as the lens of an eye becomes more rigid and does not flex as
easily.

Perhaps the most common visual impairments are those related to refractive errors. They are
disorders, not diseases. It means that the shape of the eye does not bend light correctly, resulting
in a blurred image. Light has to be refracted or bent by the cornea and the lens to the retina in
order for us to see.

Refractive errors are extremely common all over the world. About 150 million Americans, or 50% of
the population, wear glasses or contact lenses to correct refractive errors. Many are now using
laser surgery to correct their disorders.

One of the most common refractive disorders is myopia, also known as nearsightedness and often
discovered in childhood. Distant objects are blurry. The opposite is hyperopia, known as
farsightedness, in which close objects seem blurry. As children get older, this disorder tends to
lessen.

Myopia is more common than hyperopia. Among Americans over the age of 40, about 30 million have
myopia and at least 12 million have hyperopia. While myopia tends to stabilize in people in early
adulthood, the prevalence of hyperopia increases with age as our eyes gradually lose their ability to
adjust. The prevalence of myopia is greater in women than men up to the age of about 60 years.

Astigmatism usually occurs when the front surface of the eye, the cornea, is no longer round. It
begins to look more like a football than a basketball and the result is that a person has blurred vision
at all distances. This disorder is present in approximately 30-40% of individuals who wear
eyeglasses.

While glasses and contact lenses are the most common means of correcting refractory disorders,
refractive surgery with a laser can also be used to correct some refractive disorders. Laser eye
surgery is a fast growing industry in the U.S. Within four years of its approval in 1995, more than one
million patients had undergone the surgery and it appear that this surgery will be the predominant
means of correction in the future.

It basically involves going into a licensed doctor's office and having a laser shot through your pupil to
change the shape of your lens or cornea so that your eye can focus better. It is relatively painless
and takes only about 15 minutes. Typically there is no need to wear glasses or contacts anymore
and it's possible to gain 20/20 vision.

Laser surgery is a particular attractive approach to younger people, who are self-conscious about
wearing glasses or find contact lenses too bothersome. It is becoming more attractive to older
adults, although typically they are hesitant about such medical advancements or may not be able to
afford the optional procedure.

A cataract develops when the lens becomes cloudy or opaque (less transparent or see-through)
and blurs the image to the eye. This clouding is caused by a variety of age-related changes in the
lens. For example, a yellow-brown pigment caused by protein builds up in the lens over time.

Most cataracts are treated by surgical removal. A local anesthesia is applied directly to the eye and
the surgery can take less than 15 minutes to perform. Approximately 1.5 million cataract surgeries
are performed each year in the United States, with 90% of patients having improved vision of 20/40
or better. Follow-up studies show that cataract surgery also improves mental outlook, ability to
function and quality of life.

Severe Loss of Vision

Visual loss is medically defined as visual acuity (visual sharpness) less than 20/40. This 20/40 vision
means that a person sees things at 20 feet away that other people without vision loss can see at
40 feet away. Visual loss increases rapidly with age, with 20%-30% of people affected after age 74.
Blindness is legally defined as visual acuity of 20/200 or less. Legal blindness is a level of visual
impairment that has been defined by law to determine eligibility for benefits. Age-related eye
changes, cataracts, macular degeneration, eye disease caused by diabetes, and glaucoma are the
most common causes of blindness.

Every year 50,000 Americans become blind. Those aged 65 and older make up 12% of the total U.S.
population, but over 50% of the blind population. About 20% of the population 75 years old and
older is legally blind.

Younger individuals may also experience severe vision loss or blindness due to genetics, traumatic
injuries or illnesses. Of the approximately 10 million people in the U.S. who are blind or visually
impaired, about 4.5 million are under the age of 65.

Macular degeneration is the leading cause of permanent loss of central vision in older adults. Central
vision (as opposed to peripheral or side vision) is needed to read, watch television, recognize faces,
drive a car, etc. Unfortunately, no specific medical treatment is widely accepted. For some people
with macular degeneration, lasers are used to burn the new vessels that are developing and blurring
vision. However, laser treatment usually only postpones visual loss, rather than preventing it.

Glaucoma is the second most common cause of blindness worldwide and the most common cause of
blindness among African-Americans. Each year, glaucoma affects more than 3 million Americans aged
40 years or older. Glaucoma is caused by increased fluid pressure within the eye, which damages the
optic nerve. Untreated, it can lead to total blindness.

Blindness is the lack of vis on or a loss of vision that cannot be corrected with glasses, contact
lenses or surgery. People with vision worse than 20/200, or a field of vision of less than 20 degrees
in the better eye, are considered legally blind in most states in the US.

Blindness may be partial, with very limited vision, to complete, with no perception of light.
Approximately, 1 0 percent of those deemed legally blind, by any measure, are fully sightless. The
rest have some vision, from light perception alone to relatively good acuity.

Blindness has many causes. Around the world, the leading cause is the lack of Vitamin A. In the
United States, the leading causes are diabetes, glaucoma, macular degeneration and accidents.
Beyond vehicle accidents, eye injuries may be caused by chemical burns, power tools, bungee cords,
fishing hooks, fireworks, racquets and balls, and similar objects.

Treatments and Aids for Vision Loss

Despite the advancements in treatment of vision problems, there are many individuals with severe
vision loss or blindness for whom there is no surgery or prescription to help improve their sight.
However, there are some aids and strategies that may help.

Adequate lighting is key to improving vision. Glare can be avoided by using sunglasses, visors and
the like. People with low vision can often adapt with proper training. For example, people with
macular degeneration can earn to use their peripheral vision more effectively.

Visual aids are commonly used for reading. More and more reading materials are available in bold,
large type. Many people can use high-plus reading glasses and hand-held or stand magnifiers.
Magnifying glasses usually allow a broad field of vision, but looking at objects close up requires that
they be held fairly near the eye. Closed-circuit television and TV programs with captions are also
helpful.

Talking aids can eliminate some of the problems caused by visual loss. These include talking books
and computers.

Braille is especially helpful for those who have complete vision loss and computers hold much
promise. Most legally blind people (70% across all ages) do not use computers, according to the
Lighthouse for the Blind. However, this is changing as advanced technology makes computers voice
responsive and more user-friendly for people with vision impairments.

However, as the internet continues to rapidly expand, so does the complexity of websites. This
makes access to internet websites and resources more difficult for users with vision impairments.

Another obstacle is the widely varying needs of low-vision and blind users. For example, Google's
release of a new accessible search was well received by the blind community, but many low-vision
users were disappointed. Why? It turns out that the sites that are now accessible to blind users are
still not accessible to low-vision users, who require a variety of different methods to access content.

A single fix for making websites accessible to all blind and low-vision users is unlikely. Thus,
developers studying the varied nature of access will be looking for a variety of solutions.

Computer technology has provided other aids. Legally blind people are beginning to use such
devices as enlarged dials for clocks and ovens, and talking devices such as watches, thermometers,
calculators and scales.

People With Hearing Impairments

Stop and listen for a moment. What do you hear? Perhaps you hear the whirring of the computer, the
air conditioning fan, traffic outside the window, or some music being played. How would you describe
the sounds? The noises? How many of them were in the background and out of your awareness until
you stopped and tuned in to your environment?

Your ears are busy collecting sounds, processing them, and sending signals to your brain. In addition,
your ears play a part in helping you keep your balance, so when you bend over to pick up a pencil
on the floor, you won't fall over and down.

The Incredible Human Ear

The human ear is made up of three different sections: the outer ear, the middle ear, and the inner
ear. These parts work together so you can hear and process sounds. See Figure 11.2.

The outer ear is the part of the ear that people can see. It catches sound waves and is shaped like
a cup to funnel sound. Otherwise we wouldn't hear as well and every sound would seem more faint.
The lobe of the outer ear is what people pierce to wear earrings.

The outer ear also includes the ear canal, where ear wax is produced. That's the sticky stuff that
protects the canal and has chemicals that help fight off germs. It also traps dirt to help keep the
canal clean.
The middle ear's main job is to take the sound waves that come through the canal and turn them into
vibrations that are delivered to the inner ear. To do this, it needs the eardrum, which is a thin piece
of skin stretched tight like a drum.

A healthy middle ear contains air at the same atmospheric pressure as outside the ear, allowing free
vibration. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to
your middle ear to equalize the air pressure.

The eardrum vibrates when sounds reach it and that moves the ossicles, which are tiny delicate
bones that act like a hammer (malleus), anvil (incus) and stirrup-like attachment (stapes). These
bones move the sound waves along their journey to the bony labyrinth of the inner ear.

When vibrations strike the inner ear, they enter the cochlea, a small, curled tube filled with liquid that
moves like a wave when the ossicles vibrate.

The cochlea is lined with miniscule cells covered with the smallest of hairs that can only be seen with
a microscope. They are small but important because when the hairs move they create nerve signals
that the brain understands. It may be the sound of your best friend's voice or perhaps your favorite
song on the radio.

Besides enabling you to hear, the inner ear also has three small loops called semicircular canals that
affect your balance. When you move your head, the liquid in the canals also moves, which moves the
tiny hairs, sending a nerve message to the brain about the position of your head. In a millisecond,
your brain sends messages to the muscles in your body that helps you keep your balance.

If the liquid keeps moving after you've stopped moving, then you might feel dizzy and may even
stagger. It's somewhat like filling a cup halfway with water and then moving it around in a circle in
front of you. When you stop moving the cup, you will notice that the water keeps swishing around.
This process is what you experience when you spin in circles or go on a tilt wheel at an amusement
park.

When you stop spinning or step off the ride, the fluid in your semicircular canals is still moving. You
might feel woozy or dizzy until the fluid in the canals stop moving and your brain gets the right
message so you can regain a sense of balance.

The Loss of Hearing

The terms hearing loss or hearing impairment are used to describe what happens when there is a
problem with one or more parts of the ear or ears. The person is able to hear only some sounds or
nothing at all.

Sometimes people use the words deaf or hard of hearing when they are talking about hearing loss. In
general, people who strongly identify with the Deaf community do not prefer People First Language.
(e.g. people who are deaf, people with hearing loss,)

It is useful to know that sound is measured by its loudness or intensity (in units called decibels, dB)
and its frequency or pitch (in units called hertz, Hz). Impairments in hearing can occur in either or
both areas and may exist in only one ear or in both ears. Hearing loss is generally described as
slight, mild, moderate, severe or profound, depending upon how well a person can hear the
intensities or frequencies most associated with speech.

Signs and symptoms of hearing loss may include:

- Muffled quality of speech and other sounds
- Difficulty understanding words, especially against background noise or in a crowd of people
- Needing to turn up the volume of the television or radio
- Asking others to speak more slowly, clearly and loudly
- Withdrawal from conversations
- Avoidance of social settings

Infants and children, as well as adults, have hearing impairments. Hearing loss is a common birth
defect. Hearing loss that is present at birth is called congenital hearing loss. About 4 in 1,000
newborns have a significant hearing impairment. In about 50% of the cases, the hearing impairment is
inherited. An inherited hearing impairment can also develop later in childhood.

At the other end of the age continuum, hearing loss is the third most prevalent but treatable
disabling condition, behind arthritis and hypertension. One in three people over 60 years of age and
about half of those over 75 have hearing loss. Presbycusis is the name given to the loss of hearing
that gradually occurs as adults grow older. It most commonly arises from changes in the inner ear as
a person ages, and it most often occurs in both ears affecting them equally.

It is estimated that currently more than 29 million Americans, or one out of every ten, have a hearing
loss. Baby Boomers are nearing their retirement age of 65, starting in 2010. As they age, the
number of people with hearing loss is going to climb rapidly and nearly double by the year 2030.

Causes of Hearing Loss

People can lose all or some of their ability to hear because of infections, injuries or brain damage.
Various health conditions and side effects of some medicines (aspirin and certain antibiotics) may
also play a role.

A loss of hearing can also result when the ears are unprotected and intrusive objects damage the
ear. For example, poking straws, cotton swabs or other objects in the ear can push earwax into the
outer ear's canal or perhaps puncture the eardrum.

Doctors believe that heredity and chronic exposure to loud noises are the primary factors that
contribute to hearing loss. In addition, our genetic makeup may make us more susceptible to ear
damage later in life.

Over time, the cumulative effects of repeated exposure to daily traffic sounds or construction work,
noisy offices, equipment that produces noise and loud music take their toll. The cochlea, a vital part
of your inner ear, breaks down. This is often referred to as Noise Induced Hearing Loss (NIHL).

How Much is Too Much?

The threshold of hearing is generally reported as the sound pressure level. The absolute threshold
Is the minimum amplitude (level or strength) of a pure tone that the average ear with normal hearing
can hear in a noiseless environment. Some people report hearing noises when none are present in
the environment and this is known as tinnitus. The threshold of pain is the point at which sound
becomes unbearable to the listener. These sounds, if prolonged, are especially damaging to the ear.

How do you know if sounds are too loud? Some warning flags might be:

- You have to shout to be heard above the noise.
- You can't understand someone who is speaking to you from less than 2 feet away.
- A person standing near you can hear the sounds from your stereo 1eadset while it is on your head.

It's difficult to generalize because tolerance or sensitivity to various stimuli and pain differs among
individuals. Therefore, perceived loudness is a subjective measure and should not be confused with
objective measures of sound intensity as reported in decibels. See Figure 11.3 for some
representative events and sample decibels. The measure is designed to reflect sounds from soft
and innocuous to those that are deafening.

Too much noise and too long of exposure to loud noise can harm the soft tissue of the inner ear. If
enough cells and nerves are destroyed, then hearing is permanently damaged.

Attending rock concerts, which are notorious for loud music, can lead to a noise induced hearing
loss. Entertaining music or not, when the threshold for receiving sound is exceeded, the inner ear's
sensory hair cells can be damaged by the pure force of the sound. This would also be true if you
were exposed to jet engines or perhaps the deafening roar of a stadium crowd attending a football
game.

Cranking up the volume on your car stereo to see if your new speakers can crack your back window,
sure that's a lot of fun, but at what cost to hearing?

And, those people who wear ear buds connected to an IPod or MP3 player every day, playing their
music full blast, are risking damage even more. People tend to listen at higher volumes in the privacy
of their headphones. Even at comparable volumes, the headphones pose c higher risk due to the
nearness of the transducers to the ears.

You can protect your hearing by reducing your exposure to noises above 90 decibels in loudness,
which can cause damage. People are exposed to damaging noise levels almost every day. It is
estimated that more than 10 million Americans have permanently damaged their hearing due to loud
noise. In fact, more Baby Boomers are experiencing hearing loss, and sooner in life, than their
parents and grandparents did. For anyone who is exposed to loud sounds on a regular basis, it's
never too late to invest in a good pair of earplugs.

Damage to the Ear

The outer ear, or auricle, is just skin-covered cartilage with only a thin padding of tissue and it can
be easily damaged. Rough handling can cause the ear to swell or tear. The blood supply is then
jeopardized and portions of the cartilage can starve and die. The ear never heals back to its normal
shape, but instead become lumpy and distorted.

Wrestler's ear is an old but familiar term that describes the result of harsh handling. The reference is
because the injury often occurs in the sport of wrestling. Cauliflower ear from boxing is another
name for the same condition because the thickened auricle can resemble that vegetable.

When the earlobe (lobule) is torn, generally it can be repaired with good results. There is no
cartilage and, thus, there is no risk of deformity from a blood clot. Sometimes blast injuries from
firecrackers or other explosives, beyond the damaging sound, can put hurtful debris in the ear.
Perhaps our greatest concern is injury to the inner ear, which can be caused by loud noise. The
elevated noise traumatizes the hair cells. This injury is a hazard in some occupations, such as
working in certain construction areas or factories. Damage to the inner ear can also be a
consequence of drugs and other substances. For instance, ringing in the ear (tinnitus) or hearing
loss can occur as a result taking very high doses of aspirin over time. Physical illnesses that result in
a high fever, such as meningitis, can also damage the cochlea.

The Impact of Hearing Loss

Hearing loss can have a major impact on the life of a child and his or her family. Because language
and communication develop so rapidly during the first 3 years of life, an undetected hearing loss is
likely to interfere with a child's speech, language and communication patterns. Hearing loss also can
result in learning problems that affect a child's performance at school. The goal of early hearing
screening, diagnosis and treatment is to help children develop language and academic skills.

Ideally, acoustically appropriate classrooms where noise levels can be controlled would be available
in all schools. However, most rooms are filled with noise from activities. Even children with hearing in
the normal ranges can miss as much as one-third of a teacher's message because of competing and
disturbing noises. Furthermore, voice volumes are often noticeably louder when a teachers or aide
works with one or more students who have hearing impairments. This can set a louder general level
for an entire classroom, thus generating louder sounds and more noise.

Hearing problems can make it hard for adults to understand and follow a doctor's advice, to respond
to warnings and to hear doorbells and alarms. They can also make it hard to enjoy talking with friends
and family. A person may neglect to do something important because he or she did not hear the
instructions or all of the conversation.

All of this can be frustrating, embarrassing and even dangerous. In addition, it's hard for people with
hearing lost to pay attention and stay focused when they tend to miss a lot of the discussion. After
a while, some adults with hearing loss simply prefer to avoid situations where they must listen and
converse with people in groups. Hearing loss can make a person more irritable, defensive,
argumentative, and depressed.

There is nothing wrong in asking people to speak slower, enunciate and, on occasion, repeat what
they said. However, it can annoy others when they must frequently repeat themselves. If they
comply, the natural and free flow of a discussion is affected. Therefore, many people with hearing
loss, both children and adults, often choose silence and isolation over putting themselves in
situations where they have to regularly acknowledge their disability.

Treatments and Aids for Hearing Loss

A person doesn't have to live in a world of garbled words and indistinct sounds. While hearing loss is
generally irreversible, it is highly treatable. A doctor or hearing specialist (audiologist) can take
steps to improve what is heard. Sometimes a referral is made to an otolaryngologist, who is a doctor
and surgeon with special training in problems of the ear, nose, throat, head, and neck.

A hearing aid, fitted in or behind the ear, can make sounds stronger and easier for a person to hear.
Hearing aids come in many shapes and sizes. Although they can't help everyone with a hearing loss,
they can improve hearing for most. Hearing aids work to control amplification, boosting voices and
decreasing background noises, and getting used to them may take some time.

Health insurance coverage for expenses related to hearing loss is limited, so out-of-pocket
expenses for hearing aids and equipment can be quite high. Even Medicare and Medicaid benefits
can be limited, especially for adults. The National Institute on Deafness and Other Communication
Disorders (NIDCD) has information about organizations that offer financial assistance for hearing aids
and equipment. See the website at http://www.nidcd.nih.gov/health/hearing/.

According to research, while 95% of Americans with hearing loss could be successfully treated with
hearing aids, only 22% use them. Vanity may be a likely reason for some people not using hearing
aids and cost may be another, but perhaps the biggest reason is that many people fail to recognize
the signs of hearing loss or acknowledge it.

For the more severe cases of hearing loss, cochlear implants may be an option. Cochlear implants
are electronic devices placed in the inner ear that compensate for damaged or nonworking parts.

Personal listening systems can be used to amplify sounds or lower noises. For example, headsets
might be used to listen to favorite television or radio shows, so that others without a hearing loss
may listen in comfort at the same time. In addition, captioning is already available for much of today's
television programming and in the near future captioned telephone service will be an option.

Lip reading or speech reading is another option. This involves paying close attention to others when
they are talking, particularly to mouth and body movements. Reading nonverbal cues is an essential
communication skill and those with a hearing loss often learn to master this skill quite well.

There are schools specifically designed for deaf student education in the United States. The Laurent
Clerc National Deaf Education Center at Gallaudet University provides a list of elementary, middle and
high schools for deaf students that have websites.
http·//clerccenter.gallaudet.edu/jnfotogo/schools-usa.html

One example is the Florida School for the Deaf and the Blind, grades pre-school through 12th grade,
which is the state's public residential school for eligible students with hearing or visual impairments
or both. There is no cost to families for tuition. Founded in 1885, the School awards standard and
special diplomas and prepares its graduates for a wide range of professional careers and trades.
Each year, over 70% of the students in a graduating class continue their education at colleges,
universities, and technical training centers.

Most institutions of higher learning are designed, built and operated for students without
impairments, so students with hearing loss will likely encounter barriers in accessing information and
services in the same way students with other disabilities do. Federal laws mandate certain kinds of
accommodations, but even with these, there are challenges. Managing the environment is often more
difficult than man aging the curriculum.

Gallaudet University, located in Washington, D.C., is the world's only university in which all programs
and services are specifically designed to accommodate deaf and hard of hearing students.
Undergraduate and graduate degree programs as well as continuing education courses are available.
It is a federally chartered, private university and was the first U.S. school for the advanced education
of deaf and hard-of-hearing students. Gallaudet students are required to have abilities in both English
and American Sign Language.

The National Technical Institute for the Deaf (NTID) is the first and largest technological college in
the world for students who are deaf or hard of hearing. It was founded in 1965 in Rochester, New
York, and provides academic programs that use sign language. It is one of eight colleges of
Rochester Institute of Technology, a privately endowed, coeducational university. Currently, there
are about 1,100 deaf and hard-of-hearing students within the larger school enrollment of 14,000
hearing students.

Sign language

Just as there is no universal spoken language, there is no universal sign language. Instead, sign
languages develop specific to their communities. For example, ASL is totally different from British
Sign Language even though both countries speak English.

Some people have described sign languages as gestural languages. This is not truly accurate
because the hand gestures used in sign language comprise only one component. In sign language,
facial expressions, including the raising or lowering of the eyebrows while signing, and body language
are integral parts of communicating. These actions help give meaning to what is being signed, much
like vocal tones and inflections give meaning to spoken words.

American Sign Language (ASL) is the dominant sign language used by the deaf community in the U.S.
It is a language in its own right, with its own syntax and grammar, supporting its own culture. In fact,
linguistic research begun in the 1960s has shown that ASL is a true, complete and rich language that
is unrelated to English.

ALS is considered the fourth most commonly used language in the U.S. and the argument could be
made that it is historically a more truly American language than English. ASL classes are offered in
many secondary and postsecondary schools throughout the nation and many hearing students enjoy
learning the language. Interestingly, an increasing number of schools and colleges now accept ASL as
meeting part or all of their foreign-language credit requirements.

There are several websites that have information about sign language. These sites contain pictures,
videos, cartoons and general information. Among them are:

ASL Browser: This site has videos of an adult signing.
http://commtecblab.msuedu/Sites/aslweb/browser.htm

Basic Dictionary of ASL Terms: This site has words with video clips.
http://www.masterstech-home com/ASLDict.html

ASL Pro: This site has a video dictionary, with conversational phrases and baby sign dictionary.
http://www.aslpro.com/

ASL University: This site has groups of words, photos and cartoons. http://www.lifeprrint.com/

The Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act
(P.L. 94-142), includes hearing impairment and deafness as two of the categories under which
children with disabilities may be eligible for special education and related services. While the term
hearing impairment is often used generically to describe a wide range of hearing losses including
deafness, the regulations for IDEA define hearing loss and deafness separately.

Examples of ways to provide accessibility for people with hearing loss include: assistive listening
devices (FM, Infrared, Audioloop ), captioning, CART (computer assisted real-time transcription), visual
and tactile alarms, oral interpreters, volume control phones and telecommunications relay services,
particularly captioned telephones.

Perspectives on Hearing Impairments

There are two major perspectives regarding people with impairments including hearing impairments.
The first is the pathological point of view. This has also been called the medical model. The second
viewpoint is called the cultural, or social, model. This approach offers a new perspective on the
identity of deaf people. It assumes that people who are deaf and hard of hearing form a definite
grouping of people with their own sub-cultural mores and affiliations.

The medical model accepts the behaviors and values of people who can hear as the standard or the
norm by which people should be evaluated and judged. This perspective is a tradition one, and you
only need look at some of the negative language used to describe people with hearing impairments
to confirm that it is an outsider's view. It implies that something is wrong with deaf people. If not
fixed, then they are doomed to live less than full lives.

It's fairly easy to see that this perspective can result in paternalistic and maternalistic behaviors and
attitudes toward the Deaf and hard of hearing. Critics fear that this view also shares many of the
same attitudes and approaches that are common to racism, sexism, and anti-Semitism.

On the other hand, the cultural view, or social model, recognizes that deafness has a number of
complex factors that must be considered. This includes defining the deaf community as a group of
persons who share a common means of communication (sign language) that provides the basis for
group cohesion and identity. A common culture is shared, based on visual cues as the primary means
of relating to the world. Those who adopt the cultural perspective embrace deafness as a unique
difference and do not focus on the disability aspect. This, in turn, allows them to give attention to
the environmental and attitudinal barriers that truly limit them.

Which of these best characterizes your own perspective? Is it based on people with disabilities and
impairments or on unique and positive differences?

People with Orthopedic Impairments

The term orthopedic impairment refers to the loss or lack of ability of an individual to move oneself
and/or objects from one place to another. Orthopedic impairments are related to acute, chronic,
traumatic and recurrent injuries and other disorders of the locomotor system, its musculature and
bone parts. In reading about the topic you may come across various other word combinations
referring to the same topic. These include the words orthopedic, physical, locomotor and mobility as
adjectives, with disability or impairment as the nouns.

Orthopedic medicine focuses on the evaluation and treatment of the moving parts of the body. It
specializes in musculoskeletal problems, including ligaments, muscles and joints. Related disabilities
and topics can be found at Orthopedic Topics http://www.orthoseek.com/topics.html

People can be born with or acquire orthopedic problems, which affect their bones, joints and/or
muscles. The problems may result from deformities, diseases, injuries or surgeries. Some may come
simply from degeneration and the process of aging. When they reach the point of chronic difficulty
and/or pain with mobility, then they are considered orthopedic impairments.

Arthritis is a term that refers to a group of disorders that affect joints and muscles. Arthritis
symptoms include joint pain, inflammation and limited movement of joints. When a joint is inflamed it
may be swollen, tender, warm to the touch or red.

Arthritis is one of the most pervasive diseases in the United States and is the leading cause of
disability. According to the Centers for Disease Control and Prevention one out of every three
Americans (more than 95 million people) is affected by one of the more than 100 types of arthritis.

There's a saying that if you live long enough, you can pretty much count on developing arthritis.
Generally speaking it's true; arthritis pain and inflammation cannot be avoided as the body ages. In
fact, by the age of 50, most people show some signs of arthritis. Recent figures show that fifty-six
percent of adults 75 years and over have bad an arthritis diagnosis.

Despite the strong correlation with age, arthritis can affect people of all ages. For example, right
now there are nearly 300,000 children in the U.S. with some form of arthritis s or rheumatic disease.
There are 8.4 million young adults between the ages of 18-44 who have arthritis and millions of
others at risk for developi1g it. Research indicates that it is an autoimmune disease, but the medical
community doesn't yet knew exactly what causes it in children.

Arthritis can be managed to a degree, usually with a combination of medication, exercise, rest,
weight-management, nutrition, and, in some cases, surgery. The impact of having arthritis on school,
social life, family relationships, dating, sports and almost every other aspect of an active, growing
young person's life raises special concerns. For everyone with arthritis, it is a chronic disease that
will likely be with them forever.

Orthopedic impairments prevent many people from using their upper or lower body parts --- hips and
legs, feet and ankles, knees, hips, arms, bands and wrist, and elbows. The shoulders, back, neck and
joints might also be restricted. These impairments are the most easily recognized disabilities.

For our purposes, orthopedic impairments can be viewed as congenital or acquired. One impairment
can affect another and some impairments work in combination. For instance, although orthopedic and
neurological impairments are considered two distinct and separate kinds of disabilities, they may
cause similar limitations in movement, and having one may cause a person to be more vulnerable to
the other.

Congenital anomalies or impairments (e.g., club foot, absence or deformity of an appendage, cerebral
palsy) are present at birth. They result from genetics or may be part of an inherited developmental
process.

Acquired impairments happen as a result of interactions within the environment. Diseases (e.g. polio,
cancer, diabetes) attack external body parts from the inside. From the outside, accidents can cause
physical injuries that damage extremities and often result in limited mobility and movement. In some
cases impairment is associated with the loss of a limb through amputation.

A look at the skeletal system of the human body will show how dependent and how vulnerable are
the body's extremities. A review of medical records indicated that the typical types injuries are:

- Fractures (broken bones)
- Dislocations (bone out of joint)
- Sprains (stretches and tears to ligaments)
- Strains (stretches and tears of muscles)
- Muscle fatigue (overuse from sports or exercises)
- Muscle bruise (hard blow to body, such as to thigh muscle)
- Bone bruise (hip or elbow)

Many times, such injuries heal by themselves. If not, they may need only minor medical attention,
perhaps some minor surgery. These slight injuries, while serious if untreated, are debilitating for a
given time, but they are temporary. At other times, the extremities are so damaged that they cannot
be repaired and the result is a permanent impairment.

The following are common orthopedic impairments. They are rated from mild to severe, as
determined by the number of limbs affected.

Cerebral Palsy (CP) is a disorder occurring before or after birth that causes poor posture, lack of
coordination and involuntary muscle movements. It is not a disease and is neither progressive nor
communicable. It is not cur3ble, however therapy and technology can help persons with cerebral
palsy lead productive lives.

Cerebral Palsy may result from illness during pregnancy, premature delivery, or lack of oxygen supply
to the baby. It can also occur early in life as a result of an accident, lead poisoning, viral infection,
head injuries from child abuse or some other factors. Apparently, the chief cause is insufficient
oxygen or poor blood flow to the brain.

Depending upon which part of the brain is damaged, one or more of the following may occur: spasms,
involuntary movements, seizures, tonal problems, disturbance in the way o1e walks, and deficits in
perception and speech. Persons with cerebral palsy can usually attain a substantial degree of
independence, but in some cases they may need considerable assistance.

Spina Bifida (SB) is a congenital disorder of the spine. It is manifested in muscle weakness or
paralysis. Actually, about 40% of Americans have a mild form (occulta) but experience little or no
symptoms. Few ever know that they have it. Other types of the disorder, however, are more evident
and severe. They cause muscle weakness or paralysis, a loss of sensation, loss of bowel and
bladder control and an accumulation of fluid in the brain.

Spina Bifida is the most common permanently disabling birth defect. Quite often children who suffer
severely from this disorder must have a series of operations throughout their childhood. They often
have learning problems because it is hard for them to pay attention, express themselves or grasp
reading and math.

Muscular Dystrophy (MD) refers to a genetic disease marked by progressive weakness and
degeneration of the skeletal or voluntary muscles that control movement. There are different forms
of this disorder but they are all generally inherited. However, research shows that it may appear in
some cases when there is no evidence that the disease existed in a family’s history.

MD affects people of all ages. Some forms appear in childhood and others may not appear until
middle age or later. There is no specific treatment for any of the forms of muscular dystrophy.
Physical therapy might reduce some contractures and shortening of the muscles, but muscle
deterioration when severe enough will require use of a wheelchair. In addition, respiratory infections,
frequent fractures or injuries from falls, and spinal curvature often follow. Medical advances and care,
particularly with problems affecting the heart and lungs, have enabled children with MD to live longer.

Multiple Sclerosis (MS) is a disorder of the central nervous system. It causes deterioration of the
nerve tissue and is usually associated with paralysis, spasms, speech disorders and hand tremors.
MS is not yet well understood, although it is thought to be an autoimmune disease in which the
body's immune system mistakenly attacks the brain and the spinal cord, the two primary components
the central nervous system.

Having MS is not an automatic sentence to a wheelchair. Only 25% of people who have MS use a
wheelchair or stay in bed because they are unable to walk. Many can walk without help, but the
likelihood of needing a mobility device increases the longer someone has MS. Although symptoms
such as fatigue can cause problems on a job, approximately 30% of people with MS are working
full-time after twenty years.

MS is twice as likely to occur in whites as in any other group. Women are twice as likely as men to be
affected early in life. Most women with MS find their symptoms lessen during pregnancy. Then, the
risk of an attack increases somewhat in the first six months after delivery. Overall, pregnancy and
childbirth have no long-term effects on MS. Those who fear passing on the disease to their children
should know that the risk is very small: somewhere between 1% and 5%. A bigger issue is obtaining
help in caring for the children in the event that MS interferes with a parents' ability to do so.

Parkinson's Disease (PD) is another degenerative disorder of the central nervous system that
affects the control of muscles and, subsequently, movement, speech and posture. While the
condition usually develops after the age of 65, 15% of those diagnosed are under 50.

It is often characterized by muscle rigidity, tremors, slowing and eventual loss of physical movement.
Other symptoms include non-motor disorders of changes in mood, behavior, thinking, and sensation.
Individual patients' symptoms may be quite dissimilar and progression is also distinctly individual.
Diagnosis is difficult, requiring careful examination and ruling out disorders with similar symptoms.

In 1991, Michael J. Fox, the actor famous for his roles in the Back to the Future movies and several
television shows, was diagnosed with young-onset PO, but he didn't go public until 1998. Since then
he has been a strong advocate of stem cell research. His efforts and the attention given to other
famous sufferers with PO, such as Pope John Paul I, artist Salvador Dali, evangelist Billy Graham,
former U.S. Attorney General Janet Reno, and boxer Mohammad Ali, have increased awareness of the
disorder.

PO is not by itself a fatal disease, but it does get worse with time. The average life expectancy of a
person with Parkinson's Disease is generally the same as for most people. However, in the late
stages of the disease, complications such as choking, pneumonia and falls can lead to death.

Amoyotropic Lateral Sclerosis (AI S)

Amyotropic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive ailment
caused by the degeneration of nerve cells. This leads to muscle weakness and waste away
(atrophy) throughout the body. Ironically, despite the lack of muscle control and body contortions, it
does not necessarily debilitate a person's mental function in the same manner as Alzheimer's disease
or other neurological conditions. Despite being only able to move eyes, eyebrows and lips, some
individuals with ALS still manage to communicate and demonstrate that their brains are fully
functioning.

Stephen Hawking (1942- ) is viewed as the greatest mind in physics since Albert Einstein. An
academic scholar at Cambridge University, he used quantum theory and that of general relativity to
help the world understand the scientific nature of the universe. At an early age he was diagnosed
with ALS. At the time, he was not expected to life long.

Hawking's scientific career now spans over 40 years. He has a computer that enables him write,
speak with an electronic voice and make public appearances. Despite the limitations caused by ALS
he has written a number of books, including the popular, A Brief History of Time (1988).

Spinal Cord Injuries (SCI) can be especially devastating. The number of people with SCIs in the U.S. in
2004 was estimated to be about 285,000. Of these, more than 78% were males. In the past 20
years, there has been a decrease of SCIs among white men and an increase in African-American and
Hispanic men.

Motor vehicle accidents have been the leading cause for SCIs. The next most common cause is falls,
followed by acts of violence and recreational sporting activities. Some people develop non-traumatic
spinal cord injuries due to infection or chronic conditions.

Considering the youthful age, 16-30, of most persons with SCI, it is not surprising that most (53%)
are single when injured. Among those who were married at the time of the injury, as well as those
who married after the injury, the likelihood of their marriages remaining intact is less than it was for
the uninjured population. The likelihood of getting marry after the injury is also reduced.

Paraplegia results from a spinal cord injury and refers to paralysis of the lower extremities and part
or all of the trunk muscles. Usually there is a loss of sensation in paralyzed limbs and other effects
such as muscle spasms, pain and loss of bowel and bladder control.

Quadriplegia occurs when there is damage to the spinal cord in the cervical region, causing paralysis
below the neck. This will cause impairment to the hands and arms in addition to the effects of
paraplegia.

Jesse Billauer is surfer from Malibu, California, who is well known in the sport. At age 17, he hit his
head on a shallow sandbar after being knocked off his board by a wave. The force of the fall broke
his neck, damaging his spinal cord, and immediately rendered him a quadriplegic.

Doctors told Billauer that he would never surf again. However, not willing to give up on his favorite
sport, he was convinced that he could prove the doctors wrong. After months of rigorous training,
he adapted his surfing technique and eventually returned to surfing. He became an inspirational
speaker and is involved with a non-profit foundation called Life Rolls On. He intends to join others in
continuing the work of Christopher Reeve.

Some other famous people who have or had quadriplegia:

- Curtis Mayfield (Singer/songwriter) Stage accident
- Teddy Pendergrass (Soul singer) Auto accident;
- Christopher Reeve (Actor, Superman) Horseback riding accident

In these and other cases, the will of the person to continue living and making contributions to life
have provided inspirational stories.

Amputation was the most common surgery performed during the Civil War. Of all operations, 75%
were amputations. About 1 out of 4 died, if the operation was done in the first 24 hours. After that,
the mortality rate doubled. Still, amputation saved more lives than it took and was remarkably
effective considering the medical knowledge of the time.

Today it is estimated that there are 350,000 amputees living in the United States, with approximately
135,000 new amputations occurring each year. The most common causes of amputation are disease,
such as diabetes (70%), trauma (22%), congenital or birth defects (4%) and malignant tumors (4%).

Trauma injuries may result from penetrating blows such as gunshot or knife wounds. But not all such
injuries are violent in nature. Many of them are from industrial or motor vehicle accidents. Four of
every five victims are male and most of them are between the ages of 15-30.

Farm and factory workers have greater-than-average risks of suffering injuries that result in
amputation. The use of mowers, saws and power tools are common causes of injuries. Accidents in
recreational areas comprise another major cause of trauma injuries that lead to amputation.

Most amputees experience problems with body image and difficulty in coping with lifestyle changes
to some extent. People with amputations frequently go through a grieving period similar to someone
dealing with the death of c close relation. These feelings are normal but if they persist they can
affect recovery. Talking with a trained mental health professional with experience treating people
with disabilities can be very helpful.

People with amputations have managed to get along and some have accomplished extraordinary
feats. Over the last one hundred years, amputees have been able to take more active and
productive roles in their communities as a result of developments in prostheses.

Treatment and Aids for Orthopedic Impairments

A prosthesis is an artificial device designed to replace a missing part of the body or to make a body
part work better. Diseased or missing eyes, arms, hands and legs are commonly replaced by
prostheses. False teeth are known as dental prostheses. Artificial replacements might also include
heart valves, implants, pacemakers and other substitutes for body parts. Making a prosthetic nose is
one of the oldest operations in plastic surgery.

The simplest body movement requires the brain to choose which combination of motor neurons will
stimulate which of thousands of muscle fibers with just the right amount of force and at the proper
time. No existing computer, at this point in time, can analyze the superabundance of variables
involved in the movements of a multi-jointed limb, such as an arm picking up a coffee cup. However,
scientists report (Delude, 2005) that brain research is providing new hope for better prostheses.
Many are convinced that in the future, it will be possible to implant computer chips to help
coordinate movements.

For example, in one clinical trial, a new $50,000 computerized leg uses a microprocessor that
calculates every move its wearer makes 50 times a second. In another, a sensor implanted in a
paralyzed man's brain enabled him use his thoughts to operate a prosthetic hand and open email,
play a computer game and pinch the fingers together.

Sometimes crutches, canes or wheeled walkers are helpful to people with orthopedic impairments. At
other times, because movement and mobility are more restricted, such aids as wheelchairs,
scooters, power chairs (that tilt forward) and various lifts are needed.

People with limited personal mobility also need accessible vans and accommodations that allow them
to shop in malls, eat in restaurants, attend athletic events, go to school, and visit public parks and
offices. They want access so that they can participate in life rather than being a passive spectator
or, worse, being "warehoused" somewhere, dependent on caretakers. Clearly, the environmental and
attitudinal limitations imposed on people with disabilities are, in many ways, the most handicapping
factors they confront.

Pushing the Limits of Physical Disabilities

The mass media frequently report stories about individuals with disabilities who have done some
remarkable things. For example, there are some inspirational stories and reports about amputees
who participate in sports and athletic events
http://www.amputee-online.com/amputee/welcome.html, including mountain climbing, scuba diving,
golf, rappelling, volleyball, basketball, and cycling.

The Paralympic Games is an elite sporting event for athletes from six different disability groups.
Traditionally, athletes are grouped for competition in classes defined by the degree of function
presented by the disability. The games emphasize the participants' athletic achievements rather than
their disabilities. The movement has grown dramatically since its first days. The number of athletes
participating in the Summer Paralympic Games has increased from 400 athletes from 23 countries in
Rome in 1960 to 3,806 athletes from 136 countries in Athens in 2004.

The 2005 movie, MURDERBALL, is a film about tough, highly competitive rugby players, who happen to
have quadriplegia. It is about the extreme sport of wheelchair rugby, played in reinforced and
armored chairs by players with various degrees of disability. It is also the story of overcoming
injuries and despair and learning not only to function in the everyday world, but also to become
Olympians.

Jean-Dominique Bauby, journalist and editor, became disabled in 1995, unable to breathe on his own
and able to move only his left eyelid. Despite this, he dictated his 130-page memoir, "The Diving Bell
and the Butterfly," by blinking his left eyelid in code more than 200,000 times.

But, whether we have a physical disability or not, we aren't all going to be larger-than-life heroes. For
the most part, we just want to live our lives as fully as we can and to be treated with human dignity.

One person with a severe orthopedic disability said, "Living with my injury is more of an enormous
inconvenience than it is a tragedy. I don't need people to feel sorry for me or tell me how
courageous I am. I just want them to see and talk with me not as handicapped, but just a person who
happens to have a disability---which may or may not prevent me from doing the things that they do."

The Language of Disabilities

It was Mark Twain who said, "The difference between the right word and the almost right word is the
difference between lightning and the lightning bug."

The way we speak and write about people with a disability is more than a superficial issue. Language
is continually evolving, including language related to people with disabilities. For example, consider
the terms disability, impairment and handicap. Although these words have been used interchangeably
for years, even in government publications, there is a new distinction.

Disability and impairment are still use to refer to the loss or limitation of a physical, mental or sensory
function. Handicap, however, is more often used to refer to barriers imposed by society, the
environment or attitudes that limit or interfere with the full functioning of people with disabilities.
Thus, disability (or impairment) refers to a personal condition, while the term handicap signifies an
external barrier or problem.

Staying current is important, not merely to show that you are "politically correct" but to communicate
effectively and with respect. Chosen well, your language can communicate respect for the dignity of
people with disabilities. Otherwise, your language may reflect stereotypes and negative attitudes,
consciously or not.

There is a tendency to associate disability with disease even when the condition is congenital or
accidental. Most people with disabilities are as healthy as most people without disabilities, even
though others often assume otherwise when someone uses a wheelchair or other aid.

People First Language, as described by its foremost spokesperson, Kathie Snow, puts the person
before the disability. In doing so, it describes what a person has rather than who a person is. It is
better to say "people with physical disabilities" than" the crippled" or "quadriplegics."

This preference may be different within some communities. In particular, many individuals identify
themselves as a deaf person or a blind person because they choose to present that part of their
identity up-front.

People First Language also encourages accuracy. The word handicapped is archaic and derogatory
in its origin. Besides, Accessible Parking is more accurately descriptive than Handicapped Parking.
You can learn more about People First Language at
http://www.disabilityisnatural.com/peoplefirstlanguage.htm

It is best to avoid using the term "the disabled" because it generalizes and implies that a person with
disabilities is not a capable or able person. Likewise, labeling other people as normal or healthy,
thereby suggesting that people with disabilities are not normal, is insensitive. Also, mention a
person's disability only when it is relevant to the discussion.

People who use wheelchairs as their primary or exclusive means of mobility are neither confined
(locked up) nor bound (tied up) to their chairs. A more appropriate phrase might be wheelchair user
or person who uses a wheelchair. Furthermore, just because one uses a wheelchair for mobility, that
does not necessarily mean the person has a spinal cord injury, and assuming so is inappropriate.

The intention here is not to deny the reality of disabilities. People with disabilities don't need or want
to be pitied, nor should they be deemed "courageous" or "special" as they accomplish daily activities
or work. Euphemisms like physically challenged" and "differently able" are generally inappropriate as
well. On the other hand, it is quite appropriate to continue using words such as see, look, walk and
listen when talking to people with various disabilities.

There are words that perpetuate the myths surrounding various disabilities that should not be used.
For example, it is inappropriate to use any of these terms: crippled, deaf and dumb, victim, invalid,
afflicted, retard, crazy, or tragic. These and other words, along with their more appropriate
counterparts, are shown in Figure 11.4.

It is important to note that there are different versions of such guidelines and, most certainly,
differing opinions about how to best communicate with and about people with disabilities. Even some
terms that many now cons der inappropriate are still prominently used. For example, the term birth
defects still appears in the names and literature of organizations dedicated to advancing the cause
of congenital and developmental disorders.

APA style has long been the gold standard for clear and consistent technical writing in colleges and
professional publications. -he APA Guidelines for Non-Handicapping Language is a valuable resource
and can be found on its website http://www.apastyle.org/disabilities.html.

Accommodations

No doubt there are certain accommodations that make life easier for people with disabilities. In a
school setting, for example, accessible classrooms and a place to meet with a faculty member make
common sense. Students with disabilities often need a little extra time to get from one classroom to
another. They may need devices that help them take notes, such as tape recorders or laptop
computers. They may also need extended time for tests, a computer station or a separate and quiet
place.

Public schools, including public colleges and universities, provide information and services for
students with disabilities. For example, Florida Atlantic University, Boca Raton, FL, has an Office for
Students with Disabilities (OSD). Its website http://www.osd.fau.edu/ provides useful information
about how to access OSD services, guidelines for faculty members, and the documentation required
for other services and accommodations.

Similar accommodations apply for workplaces, where adjustments in the height of a desk, keyboard
modifications, or extended time to complete projects may be appropriate. Otherwise, capable
people, who just happen to have disabilities, will have a more difficult time making their valuable
contributions.

Fitting In and Relationships

People with disabilities view themselves as a minority group and they are interested in their civil
rights. It is not a matter of a benevolent person allowing them to participate and giving them the
benefit of the doubt. Rather, they have a right to participate, to be treated with respect and dignity,
and to be a contributing member of society.

A physical disability affects everyone in a family, not just the person who has it. Disabilities can
change everyday tasks and activities for the whole family. Depending on their severity, each day's
pain and mobility is different. Some days will be better than others. Basic tasks, such as household
chores, may become difficult for the person with a disability. Certain tasks may have to be delegated
to different family members.

You might think that a close marriage, with its give-and-take of physical and emotional support, would
protect against the extra stress that comes when coping with a disability. Typically, the opposite
occurs. Even without physical impairments, most families are living busy, stressful lives, trying to work
and take part in family activities. When a physical disability comes into the picture, there is added
strain on everyone and all relationships.

It is important that partners are open and honest with each other. They need to share their pleasant
and unpleasant feelings. A physical disability has an impact on moods and behaviors. People can try
to be considerate and restrain their anger, confusion, and disappointment, but eventually the
frustration will pour out.

For example, one person in a family may begin to resent the person with the disability because they
feel constrained or no longer feel comfortable participating in some of their favorite activities.
Depending upon the severity of the disability, adjustments can be made and most activities
continued, but perhaps to a lesser degree.

New activities can and should be pursued, but most psychologists believe that people should find
time, without feeling guilty, to pursue separate activities to meet their own needs and interests. A
physical disability need not create a psychological disability as well. Of course, finding new activities
that everyone can do together is also essential to a healthy relationships.

Support groups for couples and families can help them in coping with and learning to manage the
stress related to a disability. The groups not only help the person with the disability, but they also
provide an opportunity for partners, spouses and family members to meet and make friends with
others who are struggling with similar issues.

Relationships with young children are affected by disabilities. Knowing that a parent has a physical
disability can cause children to feel fear and anxiety. They may not be able to verbalize their
feelings. Open communication with children is just as important as it is with a spouse.

Children want to know if it is a fatal disease and if they are going to be abandoned. Children can also
be helpful. Once they understand the limitations that are a part of the disability, children can take an
active part in any changes around the home that need to be made. Sometimes, children's less
cynical or jaded perceptions may even bring a refreshing perspective to the situation.
If you are a caregiver or a partner of someone with a physical disability, it is important to find a
balance between being supportive and over-protective. The first step is to educate yourself about
the physical disability. Learn to listen and be watchful and you will find the right balance.

Although a physical disability will bring additional stress to a marriage or family, it can be overcome
with interpersonal skills and sustained effort. Patience and a willingness to communicate fears,
concerns and hopes help relationships grow even stronger. Communication and support do not
travel on a one-way avenue. Supporting each other is what tends to draw people together.