three easy pieces for maternal and child health policy: machs roundtable 2012

Three Easy Pieces for Maternal and Child Health Policy: MACHS Roundtable, Winnipeg, MB CANADA • December 11, 2012by Dennis D. Embry, PAXIS Institute

Mum & egg

Tuesday, December 11, 12

Maternal and Child Health Conference: Leadership to Action

• Name of Speaker: Dennis D. Embry, Ph.D.

• Title of Presentation: Three Easy Pieces for Maternal and Child Health Policy

• Date of Presentation: December 11, 2012

• Financial Disclosure

• Grants/Research Support: Yes, Co-Investigator, Towards Flourishing, PHAC

• Honoraria: I receive fees to speak at this conference and other Conference

• Consulting Fees: Yes, for multiple projects in Canada and the US

• Other: Training fees and royalties on multiple copyrights for publications

Disclosure of Poten/al for Conflict of Interest


Foretelling my talk todayA new concept today of evolutionary mismatch that honors wisdom and scienceSolving linked multi-problems or syndemics instead of one-at-a-timeUsing low-cost proven strategies for all as public-health policy for Maternal and Child Health (MACH)


My Three Easy Pieces for Today• Policy Goal 1: Reduce multiple sources of neuro-inflammation before pregnancy,

during pregnancy and during childhood—using low-cost, scientifically proven evidence-based kernels.

• Policy Goal 2: Recognize, reinforce and reward non-use of tobacco, alcohol & other drugs among women of childbearing age —using low-cost, scientifically proven evidence-based kernels.

• Policy Goal 3: Create public-private partnerships to promote specific nurturing environments actionable strategies for children and their caregivers.


The first low-cost, proven, evidence-based kernel for maternal and child health

The Epidemiological Observation



The Epidemiological Observation The Experimental Observation

ChlorineHandwash


Streptococcus pyogenesThe culprit of massive morbidity and mortality of mothers and children.

Image credit: CDC


Streptococcus pyogenesThe culprit of massive morbidity and mortality of mothers and children.

Image credit: CDC

But the discover caused an intellectual disease:

Semmelweis reflex


http://en.wikipedia.org/wiki/Semmelweis_reflex



A policy…A course or principle of action adopted or proposed by a government, party, business, or individual.

Also, archaic, prudent or expedient conduct or action: a course of policy and wisdom.

ORIGIN late Middle English: from Old French policy ‘civil administration,’ via Latin from Greek politeia ‘citizenship,’ from politēs ‘citizen,’ from polis ‘city.’policy 2 |ˈpäləsē|noun ( pl. policies )

ORIGIN mid 16th cent.: from French police ‘bill of lading, contract of insurance,’ from Provençal poliss(i)a, probably from medieval Latin apodissa, apodixa, based on Greek apodeixis ‘evidence, proof,’ from apodeiknunai ‘demonstrate, show.’


Let us begin with some wisdom and careful observations


Elder wisdom about child-rearing selected by evolutionary mechanisms

Humans are everyday scientists of their

successes


www.thisviewoflife.com “Look up Evolutionary Mismatch”Natural selection adapts organisms to their past environments and has no ability to foresee the future.

When the environment changes, adaptations to past environments can misfire in the current situation, producing a mismatch that can only be solved by evolving or by modifying the current environment.

Mismatches are an inevitable consequence of evolution in changing environments.


http://www.thisviewoflife.com

http://www.thisviewoflife.com

This creates an evolutionary mismatch in the womb


Early incubator experiences for premies


Early incubator experiences for premies What did we learn?


What did this nurse notice about this premie?


What are we noticing with babies and mums more today?


Some observable trends:• Increased postpartum depression

• More addictions

• More “inflammatory” diseases like asthma, diabetes and obesity

• More children with disabilities such as autism spectrum disorder

• Higher lifetime rates of mental, emotional, behavioral, and related physical disorders


Increases in Child Problems In Manitoba

Indicator Time Period Rates/Prevalence Change

ADHD

SP EducFunding

Children in Care

2000/01 to 2009/10 2.4% to 3.9% 66% increase

2000/01 to 2009/10 18.7/1,000 to 38.4/1,000 106% increase

2000/01-2002/03 to 2006/07-2008/09 3.7% to 4.0% 6% increase


2006 Statistics Canada report on the Participation and Activity Limitation Survey (PALS)

• According to Statistics Canada, more children in this country have a learning disability than all other types of disabilities combined.

• According to Statistics Canada, of all the children with disabilities in this country, more than half (59.8%) have a learning disability.

• According to Statistics Canada, more than half a million adults in this country live with a learning disability, making it more challenging for them to learn in universities and colleges, and on the job.

• According to Statistics Canada, learning disabilities increased considerably between 2001 and 2006 among Canadians aged 15 and over by almost 40 per cent to 631,000 people, making it one of the fastest growing types of disabilities in Canada that isn’t related to aging.


With various early childhood disabilities increasing, how does that parents and families?


With various early childhood disabilities increasing, how does that parents and families?

Impact of child's condition on parental employment for parents of children with disabilities aged 0 to 14, Canada, 2006


Physiologicalinfluences triggeradverse biological

mechanisms

Reinforcementmore for anti-social

than prosocialbehaviors

Antecedentscue anti-social

acts and threats

Verbal Relationsoccasion perceivedthreats and related

reactions

Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses

Multi-Inflammatory Brain & Body Response

The Same Mismatches Predict Multiple MACH DisordersTuesday, December 11, 12

MoodInstability Inattention Lo Reward

DelayLo ExecutiveFunction

Lo BehavioralCompetencies

PoorMotorSkills

Immune-Healing

Dysfunction


mechanisms




acts and threats


reactions


Multi-Inflammatory Brain & Body Response


MoodInstability Inattention Lo Reward

DelayLo ExecutiveFunction

Lo BehavioralCompetencies

PoorMotorSkills

Immune-Healing

Dysfunction


mechanisms




acts and threats


reactions


Mental Illness SubstanceAbuse Violence Work

ProblemsObesity,

etc CancerEarlySex

School Failure

STD’s SpecialEdMulti-Inflammatory Brain & Body Response


Physiologicalinfluences trigger

protective biologicalmechanisms

Reinforcementmore for prosocial

behaviors

Antecedentscue prosocial

behaviors

Verbal Relationsoccasion perceived

safety andaffiliation

Multiple Behavioral Vaccines Protect the Futures of ALL Children, Youth and Adults

Multi Anti-Inflammatory Brain & Body Response

Changing Conditions Protect and Prevent MACHTuesday, December 11, 12

MoodStability

AttentionHi Reward

DelayHi Executive

FunctionHi BehavioralCompetencies

GoodMotorSkills

Immune-Healing

Efficiency




behaviors


behaviors




Multi Anti-Inflammatory Brain & Body Response


MoodStability

AttentionHi Reward

DelayHi Executive

FunctionHi BehavioralCompetencies

GoodMotorSkills

Immune-Healing

Efficiency




behaviors


behaviors




Mental health LowAddictions Prosociality Work

SuccessHeart Health

etc

LowCancerDelayed

SexHi Sch.Grad

LowInjuries

HigherEdMulti Anti-Inflammatory Brain & Body Response


Solving some current mismatches affecting MACH


Richly Reinforce Pro-social Behaviors Reduce Toxic In!uences

Limit Problematic Behaviors Increase Psychological FlexibilityBiglan, A., B. R. Flay, et al. (2012). "The critical role of nurturing environments for promoting human well-being." American Psychologist.


Mothers and children in Canada do not eat foods sufficient in Vitamin D

Mothers and children in Canada do not get sufficient Vitamin D via sunlight

This evolutionary mismatch harms MACH


Mismatch, Latitude & Schizophrenia

both latitude and low temperature are highly significant(P< .001 in each case), the correlationwith infantmortalityis not significant at the .05 level. Moreover, the direction(sign) of the respective correlations of prevalence withlatitude and cold are consistent across all continents

and subgroups. In contrast, the direction of the correla-tion of prevalence with infant mortality is inconsistentacross different continents.The best-fit regression lines in figure 1 also suggest that

the increase in prevalence with increasing latitude occurs

Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality.Note: SouthAsia siteswere from Indiaand Indonesia; those sites hadhigher infantmortality rates than all but one of theEastAsian sites. For theregressionlinesinNorthAmerica,thosewithinfantmortalityratesabove30per1000weregroupedashavingahigherrate, thosebelow30ashavinga lower rate.Theslopesof linear regression lineswere0.15 for theEastAsiansites, 0.22 for theAfricansites, 0.086 for theSouthAsiansites,0.14 fortheNorthAmericansiteswithlowerinfantmortality,0.51fortheNorthAmericansiteswithhigherinfantmortality,and0.48fortheEuropeansites.

Table 3. Correlations of Schizophrenia Prevalence with Predictor Variables

Geographic Group ofSamples N Absolute Latitudea Temperatureb Infant Mortalityc Fish Intaked

All study samples 49 .46** !.60*** !.26! !.10

Europe 18 .58* !.81*** !.22 !.21

North AmericaAll samples 10 .75* !.74* .92*** !.64!

High infant mortality 3 .94 !.99* .97 n/aLow infant mortality 7 .68! !.62 .58 !.85*

AsiaAll samples 15 .58* !.56* .05 !.05South Asia 9 .51! !.51! .49 !.49East Asia 6 .78* !.69 .46 !.20

Africa 4 .53 !.67 .25 !.81

Othere 2 n/a n/a n/a n/a

n/a = data available on only 2 samples.aAbsolute latitude in degrees north or south of the equator.bMean low temperature for the coldest month of the year in degrees Fahrenheit.cInfant mortality rate is the number of cases per 1000 adult population.dFish intake (in kg/person/year); n = 48 because data were not available for Oxford Bay.68eIncludes Christchurch, New Zealand, and Buenos Aires, Argentina.!0.05 < P " .10; *P < 0.05; **P < 0.001; ***P < 0.0005; all P values are two tailed, for Pearson product-moment correlations.

588

D. K. Kinney et al.

Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, InfantMortality, and Skin Color: A Role for Prenatal Vitamin DDeficiency and Infections?

Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, SienaC. Napoleon2,4, David J. Crowley2, Andrea Miller2,William Hyman2, and Emerald Huang2

2Genetics Laboratory, McLean Hospital, Belmont, MA; 3De-partment of Psychiatry, Harvard Medical School, Boston, MA;4Wellesley College, Wellesley, MA

Previous surveys found a large (>10-fold) variation inschizophrenia prevalence at different geographic sitesand a tendency for prevalence to increase with latitude.We conducted meta-analyses of prevalence studies to inves-tigate whether these findings pointed to underlying etiologicfactors in schizophrenia or were the result of methodolog-ical artifacts or the confounding of sites’ latitude with levelof healthcare at those sites. We found that these patternswere still present after controlling for an index of health-care—infant mortality—and focusing on 49 studies thatused similar diagnostic and ascertainment methods. Thetendencies for schizophrenia prevalence to increase withboth latitude and colder climate were still large and signif-icant and present on several continents. The increase inprevalence with latitude was greater for groups with lowfish consumption, darker skin, and higher infant mortali-ty—consistent with a role of prenatal vitamin D deficiencyin schizophrenia. Previous research indicates that poor pre-natal healthcare and nutrition increase risk for schizophre-nia within the same region. These adverse conditions aremore prevalent in developing countries concentrated nearthe equator, but schizophrenia prevalence is lowest atsites near the equator. This suggests that schizophrenia-producing environmental factors associated with higher lat-itude may be so powerful they overwhelm protective effectsof better healthcare in industrialized countries. The ob-served patterns of correlations of risk factors with preva-lence are consistent with an etiologic role for prenatalvitamin D deficiency and exposure to certain infectious dis-eases. Research to elucidate environmental factors that un-

derlie variations in schizophrenia prevalence deserves highpriority.

Key words: epidemiology/etiology/immune function/prenatal/geography/risk factor

Introduction

Schizophrenia is an unusually burdensome disorder be-cause of the great economic costs of extensive care andloss of economic productivity, as well as the personal suf-fering and stigma, which often affect a patient and his orher family for most of the patient’s life. Moreover, formost patients there is still no cure or even an effectiveway of treating many of the most disabling, ‘‘negative’’symptoms of the disorder. Therefore, a key goal of schizo-phrenia research is elucidation of etiologic factors, partic-ularly environmental ones that could be readily avoidedand used in effective, inexpensive, and ethically sound pri-mary prevention programs.In a comprehensive survey of schizophrenia prevalence

studies around the world that were published in Englishover a period of 4 decades, Torrey1 noted 2 importantpatterns. First, prevalence rates varied widely at differentgeographic sites, with the highest rate being more than 10times greater than the lowest. Second, there was a strongtendency for schizophrenia prevalence to increase withincreasing latitude; ie, prevalence rates tended to bevery low near the equator and to increase as one movedtoward the poles. Both of Torrey’s conclusions were alsoreached in a survey and meta-analysis by Saha et al,2

which included more recent studies as well as ones pub-lished in languages other than English. Several other sur-veys have also concluded that schizophrenia rates vary atleast 10-fold around the world, including studies usingmeasures of point prevalence, lifetime prevalence, andincidence.1,3–10

A number of explanations have been proposed for thisvariability inprevalence.Severalcomplementary linesofre-search suggest that the tendency for schizophrenia preva-lence to increase with latitude and cold climate may bedue, at least inpart, to someunderlyingpre-orperinatal en-vironmental influences. For example, several studies have

1To whom correspondence should be addressed; Genetics Lab-oratory, McLean Hospital, NB-G-28 115 Mill Street, Belmont,MA 02478; tel: 617-855-3439, fax: 617-855-2348, e-mail:[email protected].

Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009doi:10.1093/schbul/sbp023Advance Access publication on April 8, 2009

! The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.For permissions, please email: [email protected].

582


Mismatch, Latitude & Schizophrenia

both latitude and low temperature are highly significant(P< .001 in each case), the correlationwith infantmortalityis not significant at the .05 level. Moreover, the direction(sign) of the respective correlations of prevalence withlatitude and cold are consistent across all continents

and subgroups. In contrast, the direction of the correla-tion of prevalence with infant mortality is inconsistentacross different continents.The best-fit regression lines in figure 1 also suggest that

the increase in prevalence with increasing latitude occurs

Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality.Note: SouthAsia siteswere from Indiaand Indonesia; those sites hadhigher infantmortality rates than all but one of theEastAsian sites. For theregressionlinesinNorthAmerica,thosewithinfantmortalityratesabove30per1000weregroupedashavingahigherrate, thosebelow30ashavinga lower rate.Theslopesof linear regression lineswere0.15 for theEastAsiansites, 0.22 for theAfricansites, 0.086 for theSouthAsiansites,0.14 fortheNorthAmericansiteswithlowerinfantmortality,0.51fortheNorthAmericansiteswithhigherinfantmortality,and0.48fortheEuropeansites.

Table 3. Correlations of Schizophrenia Prevalence with Predictor Variables

Geographic Group ofSamples N Absolute Latitudea Temperatureb Infant Mortalityc Fish Intaked

All study samples 49 .46** !.60*** !.26! !.10

Europe 18 .58* !.81*** !.22 !.21

North AmericaAll samples 10 .75* !.74* .92*** !.64!

High infant mortality 3 .94 !.99* .97 n/aLow infant mortality 7 .68! !.62 .58 !.85*

AsiaAll samples 15 .58* !.56* .05 !.05South Asia 9 .51! !.51! .49 !.49East Asia 6 .78* !.69 .46 !.20

Africa 4 .53 !.67 .25 !.81

Othere 2 n/a n/a n/a n/a

n/a = data available on only 2 samples.aAbsolute latitude in degrees north or south of the equator.bMean low temperature for the coldest month of the year in degrees Fahrenheit.cInfant mortality rate is the number of cases per 1000 adult population.dFish intake (in kg/person/year); n = 48 because data were not available for Oxford Bay.68eIncludes Christchurch, New Zealand, and Buenos Aires, Argentina.!0.05 < P " .10; *P < 0.05; **P < 0.001; ***P < 0.0005; all P values are two tailed, for Pearson product-moment correlations.

588

D. K. Kinney et al.

Semmelweis Reflex







Introduction








582


Mismatch, Fish Intake & Schizophrenia

different sites around the world1,2 were not simply arti-facts of differences in diagnostic and ascertainment meth-ods used by different studies. Even though our analysesrestricted prevalence studies to those that used more sim-ilar research methods for diagnosis and ascertainment ofschizophrenia cases, our analyses also found (a) thatprevalence rates varied more than 10-fold across geo-graphic sites and (b) that prevalence increased markedlywith increasing latitude.

That the correlation of schizophrenia prevalence withlatitude is both robust and large, and is not due simply tobetween-site differences in diagnostic and ascertainmentmethods, is further suggested by analysis of data collectedby Lehtinen et al.42 Their study is particularly informa-tive because it is the study that best controlled for possi-ble methodological sources of differences in prevalence atdifferent geographic sites; the same investigative person-nel, as well as the same methods, were used to obtainprevalence rates at several different sites within thesame country. Those investigators studied schizophreniaprevalence at 5 different Finnish sites in the same timeperiod, using a consistent set of diagnostic criteria andascertainment methods, and their data showed a veryhigh correlation of prevalence with both latitude(r = .97, P < .01) and mean low temperature (r =!.99, P < .001).

Athigher latitudes, there isanespeciallywidevariation inprevalence rates. By contrast, near the equator, prevalencefor all sites tends to be quite low. That is, for all groups andcontinental regions for which there are data frommultiplesites, thebest-fit (least squares) regression lines all havepos-

itiveslopes,andtheslopes tendtobesteeper forsitesathigh-er latitudes.This is evident by inspecting table 1, but ismostreadily visualized in figure 1.The results suggest that etiologic factors closely asso-

ciated with latitude and cold climate may be much morepowerful contributors to risk for schizophrenia than isgenerally recognized. The general level of a population’seconomic status and healthcare, as indexed in our anal-ysis by the infant mortality rate, appears to be a muchweaker predictor of risk for schizophrenia than are lati-tude and winter temperature. A high infant mortality rate

Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake.Note:Errorbars represent95%confidence limits.Theslopesof linear regression lineswere0.03 for siteswithhighfish intake, 0.21 for siteswithmoderate fish intake, and 0.17 for siteswith low fish intake. For the subset of Scandinavian sites, the slope of linear regression forwas 0.03 forsites with high fish intake and 1.57 for sites with moderate fish intake.

Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.Note: Error bars represent 95% confidence limits. The slopes of thelinear regression lines were 0.24 for those with lightest skin, 0.43 forthosewithintermediateskincolor,and0.31forthosewithdarkestskin.

590

D. K. Kinney et al.







Introduction








582


Mismatch, Fish Intake & SchizophreniaSemmelweis

Reflex








590

D. K. Kinney et al.







Introduction








582


Mismatch, Skin Color & Schizophrenia








590

D. K. Kinney et al.







Introduction








582


Mismatch, Skin Color & SchizophreniaSemmelweis

Reflex








590

D. K. Kinney et al.







Introduction








582


Latitude and Infantile Autism

Grant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.


Latitude and Infantile AutismSemmelweis

ReflexGrant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.


Estimated deaths per year would fallby 37,000 people, or about 16%-22% of annual mortality

in Canada.

And, $14 billion


Semmelweis Reflex

Estimated deaths per year would fallby 37,000 people, or about 16%-22% of annual mortality

in Canada.

And, $14 billion


Among pregnant women, lower Vitamin D is associated with:• Adverse fertility

parameters (n = 2),

• Preeclampsia (n = 5),

• Gestational diabetes or higher blood glucose (n = 6),

• Bacterial vaginosis (n = 4),

• Primary cesarean section (n = 1),

• Few days' (n = 2) shorter gestation,

• And, postpartum depression (n = 1)

Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/aogs.12000. Epub 2012 Oct 17.The impact of vitamin D on pregnancy: a systematic review.Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.


http://www.ncbi.nlm.nih.gov/pubmed?term=Christesen%20HT%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


http://www.ncbi.nlm.nih.gov/pubmed?term=Lamont%20RF%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


http://www.ncbi.nlm.nih.gov/pubmed?term=J%C3%B8rgensen%20JS%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


Among pregnant women, lower Vitamin D is associated with:• Adverse fertility

parameters (n = 2),

• Preeclampsia (n = 5),

• Gestational diabetes or higher blood glucose (n = 6),

• Bacterial vaginosis (n = 4),

• Primary cesarean section (n = 1),

• Few days' (n = 2) shorter gestation,

• And, postpartum depression (n = 1)

Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/aogs.12000. Epub 2012 Oct 17.The impact of vitamin D on pregnancy: a systematic review.Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.

Semmelweis Reflex










Vitamin D with Omega-3 (fish)

• Reduced postpartum depression

• Reduced lifetime depression, including bipolar disorder

• Increased child IQ

• Better academic success

• Reduced childhood mental, emotional, and behavioural disorders

Hibbeln, J., J. M. Davis, et al. (2007). "Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study." The Lancet 369(9561): 578-585.

Hibbeln, J. R., L. R. Nieminen, et al. (2006). "Healthy intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity." American Journal of Clinical Nutrition 83(6 Suppl): 1483S-1493S.


Vitamin D with Omega-3 (fish)

• Reduced postpartum depression

• Reduced lifetime depression, including bipolar disorder

• Increased child IQ

• Better academic success

• Reduced childhood mental, emotional, and behavioural disorders

Hibbeln, J., J. M. Davis, et al. (2007). "Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study." The Lancet 369(9561): 578-585.

Hibbeln, J. R., L. R. Nieminen, et al. (2006). "Healthy intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity." American Journal of Clinical Nutrition 83(6 Suppl): 1483S-1493S.

Semmelweis Reflex


Semmelweis Reflex


Richly Reinforce Pro-social Behaviors Reduce Toxic In!uences

Limit Problematic Behaviors Increase Psychological FlexibilityBiglan, A., B. R. Flay, et al. (2012). "The critical role of nurturing environments for promoting human well-being." American Psychologist.


How might we reduce alcohol, tobacco, and other drugs among women of child bearing age


Which warning labels might work?


Trendline for humorous warnings on binge drinking by women of child-rearing

No Warnings Humorous Warnings


Trendline for humorous warnings on binge drinking by women of child-rearing

1995 1997 1999 2001 2002 2003 2004 2005 2006 20070

4

8

12

16

20Pe

rcen

tage

No Warnings Humorous Warnings


Rewarding Clerks & Stores for Not Welling to MinorsYouth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1995 1997 1999 2001 2003 2005 2007

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Baseline Reward and Reminder

Source: YRBS, US Centers for Disease Control

Wyoming

Wisconsin

United States

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States

Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder


= Trend = Wyoming = Wisconsin =United States

Youth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1995 1997 1999 2001 2003 2005 2007

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Baseline Reward and Reminder


Wyoming

Wisconsin

United States

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States

Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder


= Trend = Wyoming = Wisconsin =United States

Source: Youth Risk Behavior Survey

(YRBS), Centers for Disease Control


Happens BEFORE the

behavior

Wait for the Timer for tobacco addictions with SMI/CMI

AntecedentKernel


Writ

e a

thou

ght a

nd a

feelin

g on the leaf and put it on the thoughts and feelings “stream”

I am

hav

ing

the

thou

ght t

hat…

I am having a feeling of …

Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.com

I am having a sensation of …

Teaching Psychological flexibility by cognitive defusion


ReinforcementKernel

Lifespan example of one kernel for prevention, intervention and

treatment

Happens AFTER the behavior

Available from Amazon.com for $45


Mobilizing for MACH


Implementation & Logic Models

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See:


EpigenesisEpigenetics are heritable changes in gene expression caused by mechanisms other than changes in the underlying DNA sequence.

These changes can pass through multiple generations.

Genesis

Social Biological Environmental Inputs

Nurturing or Toxic Environments,

Disease, orThreats

Signali

ng

Morphogensis

PhosphorlyationAcetylation

Methylation

Histone RemodelingChromatin Stucture Changes

Development Immunity Stem Cell Changes Imprinting

ThreeGenerationE!ects

Parent, 1st Generation

Baby, 2nd Generation

Reproductive Cells,3rd Generation

These polygenes

can be “added”,

“subtracted”, “divided”, or “multiplied.”


http://en.wikipedia.org/wiki/Gene_expression

http://en.wikipedia.org/wiki/Gene_expression

http://en.wikipedia.org/wiki/DNA

http://en.wikipedia.org/wiki/DNA

Dennis D. [email protected]

Thank you


mailto:[email protected]

mailto:[email protected]

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