{"id":386,"date":"2021-08-28T02:36:56","date_gmt":"2021-08-28T06:36:56","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/?post_type=chapter&#038;p=386"},"modified":"2024-03-22T11:50:19","modified_gmt":"2024-03-22T15:50:19","slug":"health-promotion-3","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/chapter\/health-promotion-3\/","title":{"raw":"Health Promotion and Disease Prevention: Considerations and Interventions","rendered":"Health Promotion and Disease Prevention: Considerations and Interventions"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Health promotion and disease prevention are important components of a healthy cardiovascular system. To determine appropriate interventions, you must carefully consider all available subjective and objective data. Part of your subjective data collection will include inquiring about risk factors, social determinants, and other considerations. <\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">The inquiry part is integrated throughout the assessment. Many of the probing questions may be asked when doing the subjective assessment. However, some of the questions will be formulated based on your critical reflection of data collected during the subjective and objective assessment. It is this data that will inform your clinical judgment and the health promotion needed for a specific patient.<\/span><\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Smoking<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>[pb_glossary id=\"1244\"]First-hand[\/pb_glossary], [pb_glossary id=\"1245\"]second-hand[\/pb_glossary], <\/strong>and<strong> [pb_glossary id=\"1246\"]third-hand smoke[\/pb_glossary]<\/strong> are major risk factors that negatively affect the cardiovascular system. The chemicals in smoke cause inflammation of the blood vessels and contribute to plaque buildup and narrowing of the blood vessels.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to smoking include:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you smoke cigarettes or any tobacco-related products? If the client\u2019s answer is affirmative, ask probing questions: How much do you smoke? How many packages of cigarettes do you smoke a day? How many years have you smoked? Can you tell me about the reasons that you started smoking?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If you do not currently smoke, have you ever smoked? If the client\u2019s answer is affirmative, ask similar probing questions as above, including the reason that they quit.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you ever tried quitting? If the client\u2019s answer is affirmative, ask probing questions: Tell me about what made you want to quit? How long did you quit? Did you use any strategies to help you quit?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you ever thought of quitting? If the client\u2019s answer is negative, make a non-judgemental comment like: \u201cIf you ever want to discuss quitting, let me know, there are many resources to help you.\u201d<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The effectiveness of <strong>health promotion<\/strong> is influenced by client interest and collaborative intervention because these factors are important in producing a successful outcome in smoking cessation. Each intervention must be tailored to the client, and could include counselling, cognitive-behavioural therapy, pharmacology treatments (e.g., nicotine replacement therapy), smart-phone applications, and short text message services. Sometimes a brief discussion about risks and a recommendation to quit smoking is sufficient. You might also choose to be involved in developing public health educational campaigns and resources about how smoking affects health as a population-based prevention strategy.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Contextualizing health promotion<\/strong> related to smoking from a <strong>sociocultural perspective<\/strong>\u00a0will help you understand who might be more vulnerable or at risk. For example, the prevalence of smoking is higher among individuals with lower socio-economic status and lower education attainment, and those experiencing racial and ethnic discrimination (Wang &amp; Wu, 2020). These populations are less likely to have access to resources pertaining to smoking cessation, so it is important to consider interventions as they relate to the social determinants of health, rather than using a one-size-fits all approach (Brady, 2020).<\/span><\/p>\r\n&nbsp;\r\n<div class=\"textbox shaded\">\r\n<h1 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity - Tobacco<\/strong><\/span><\/h1>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Tobacco plays an important part in traditional and spiritual practices in many Indigenous communities (CAN-ADAPTT, 2010). Many, but not all, Indigenous peoples use it for ceremonial and medicinal purposes (CAN-ADAPTT, 2010). Nurses should recognize and distinguish between tobacco use for traditional purposes and misuse, and questions to the client should be culturally sensitive and respectful of these differences (CAN-ADAPTT, 2010).<\/span><\/p>\r\n\r\n<\/div>\r\n<header class=\"textbox__header\"><\/header>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Diet<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">An unhealthy diet is a risk factor that contributes to cardiovascular disease, such as a diet high in saturated and trans fats, cholesterol, sodium, and alcohol. It is best for clients to choose water and reduce caffeine and alcohol intake. Clients with <strong>heart failure<\/strong> are sometimes recommended to limit all types of fluids.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to diet include:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about your usual diet?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">What have you eaten in the last 24 hours? Is that your usual diet?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any recent changes in your life that have affected your diet?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you add sugar and salt to your food?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">How much fluid do you typically drink in a day? What fluids (e.g., water, caffeinated beverages, alcohol)?<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">You may want to assess a client\u2019s familiarity with <strong>Health Canada\u2019s (2019) Food Guide<\/strong> and discuss with them how to use it:<\/span> <a href=\"https:\/\/food-guide.canada.ca\/en\/\" target=\"_blank\" rel=\"noopener\">https:\/\/food-guide.canada.ca\/en\/<\/a>. <span style=\"color: #000000\">This new food guide still has a Eurocentric bias, so you should collaborate with the client about its relevance in the context of their cultural food practices. It is now offered in dozens of languages that you can refer clients to:<\/span> <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-food-guide\/resources\/snapshot\/languages.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-food-guide\/resources\/snapshot\/languages.html<\/a> <span style=\"color: #000000\">and many resources are available about food safety for Indigenous People:<\/span> <a href=\"https:\/\/www.sac-isc.gc.ca\/eng\/1581522106156\/1581522147811\" target=\"_blank\" rel=\"noopener\">https:\/\/www.sac-isc.gc.ca\/eng\/1581522106156\/1581522147811<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Some <strong>key elements<\/strong> of Canada\u2019s Food Guide are:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Be mindful of eating patterns.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Choose water as the drink of choice.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">A dinner plate should be one-half vegetables\/fruit, one-quarter protein, and one-quarter whole grains.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Make time to enjoy eating meals with others.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Cook when possible, as opposed to eating processed meals and purchasing fast foods.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Reduce sodium, saturated and trans fats, and sugar, and monitor portion sizes.<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">Canada\u2019s guidelines now suggest that there are health risks associated with any level of alcohol consumption, although negligible with two drinks or less weekly (Paradis et al., 2022). Although some previous research had suggested some positive benefits to alcohol, this is now being disputed indicating that drinking alcohol of any kind does not decrease risks of heart disease, and high levels of consumption increase risk for coronary artery disease, myocardial infarction, heart failure, hypertension, and stroke (Paradis et al., 2022).<\/span>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Many types of diets can be heart healthy, but some research points especially to the benefits of the <strong>Mediterranean<\/strong> diet and <strong>DASH<\/strong> diet. The American Heart Association (2020) recommends the Mediterranean diet as heart healthy: it includes plenty of fruits and vegetables, grains, potatoes, legumes, nuts, and seeds, olive oil, along with small amounts of dairy, eggs, fish, and poultry. The Heart and Stroke Foundation of Canada (n.d.) recommends the DASH (Dietary Approaches to Stopping Hypertension) diet as heart healthy and helpful to lower blood pressure: it is rich in vegetables, fruit and low-fat dairy foods and lower in saturated fat, total fat and cholesterol. The two diets are very similar and may be used in combination; the Mediterranean diet typically emphasizes more fish and less dairy products than the DASH diet.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Healthy eating involves behavioural actions but also <strong>relational and structural actions<\/strong>. First, an individual needs access to healthy food and the financial capacity to purchase it; this is referred to as food security. The rising cost of food globally has made this a challenge, and in many remote regions of Canada\u2019s North, access to nutritious food is limited in terms of availability; even when available, the costs are excessive.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Socioeconomic status is known to affect food purchasing: individuals from socioeconomically disadvantaged communities \u2013 those with lower household income and lower levels of education \u2013 purchase fewer healthy foods like fruits and vegetables (Turrell et al., 2002). Therefore, health promotion efforts should focus on narrowing socioeconomic differences in food purchasing. Nurses can work in partnership with disadvantaged individuals and tailor a health promotion approach to their particular needs and attend to structural and economic barriers (Turrell et al., 2002). For example, you could direct clients to organizations that partner with vulnerable communities to support access to healthy foods, skill development, and capacity-building in terms of community-led initiatives (Turrell et al., 2002). You could also advocate on behalf of these communities for more effective social policy to address food insecurity (Turrell et al., 2002).<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">A sedentary lifestyle with limited activity\/exercise is another risk factor that contributes to cardiovascular disease. Guidelines vary based on age and health, but individuals should generally participate in about 30 to 60 minutes of aerobic activity five to seven times per week.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to activity are:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you have any concerns about your level of activity or exercise?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about your daily pattern of activity? What activity are you involved in?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">What exercise do you engage in? How long do you do this type of exercise? How many days a week do you exercise? If a client plays sports, ask about their use of protective equipment.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">You can collaborate with clients to create an activity\/exercise care plan that is specific to their needs and goals. Start at a realistic and attainable level, depending on physical capability and energy level, then slowly increase the timing and level of activity. Many interventions are also available to support clients to achieve their activity goals: community walking groups, fitness apps, local gyms, and group activities. The participACTION website is a helpful resource for activity guidelines:<\/span> <a href=\"https:\/\/www.participaction.com\/en-ca\" target=\"_blank\" rel=\"noopener\">https:\/\/www.participaction.com\/en-ca<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Nurses should use a <strong>relational health promotion<\/strong> approach when addressing activity. A community of support can promote activity, so you should assess the client\u2019s access to support (e.g., friends, family, acquaintances) who may have similar activity interests or goals. A <strong>structural approach to health promotion<\/strong> can also help address and eliminate inequities. For example, some clients may not be able to afford gym memberships or sports registration fees. Additionally, those in urban areas may have more access to specific activities or rehabilitation programs than those living in rural or remote regions, including in the North. You will need to consider these factors and tailor activity programming to each client. You could also advocate for policies to address these inequities.<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Sleep<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Adequate sleep is important for restoration of the body and mind: 6\u20138 hours is usually considered adequate sleep. Pulse and blood pressure lower during deep sleep, known as non-rapid eye movement, which is important for cardiovascular health. Lack of sleep quality and quantity has been linked to cardiovascular-related illnesses such as hypertension, obesity, myocardial infarction, and stroke.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to sleep include:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">How much sleep do you get each day\/night? How many hours? Do you rest during the day?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you have any concerns about your sleep?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about your sleep routine? What do you do before you go to bed? Do you take any medications to help you sleep?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you wake up during the night? If so, why? Are you able to fall back to sleep?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you feel rested when you wake up?<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">One behavioural intervention is a sleep journal. Ask the client to record how much sleep they get. If less than recommended, address potential triggers that may be disrupting the client\u2019s sleep, such as stress or pain. Limiting screen time two hours prior to bedtime can also be helpful. Additionally, you may want to discuss with the client the potential for naps.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The physical and social environment affects sleep. Siengsukon (2020) describes that sleep may be affected by the following:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Living in an unsafe or noisy neighbourhood.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Not having access to private transportation and needing to get up early to commute via public transportation.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Living in congregate or multigenerational housing might mean that clients share bedrooms or beds.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Being a caregiver for a spouse or parent can also interfere with sleep, as does living with someone who works long hours or shift work.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">It is important to note that many of these physical and social factors influencing sleep are associated with race, ethnicity, and socioeconomic status (Siengsukon, 2020).<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Stress<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Stress is subjective and can have emotional, physical, mental, social, and financial effects; it is a risk factor for cardiovascular-related illnesses. Stress is usually caused by a combination of multiple stressors. How a person may talk about themselves, their life and their situation can indicate potential concerns and areas that need further assessment.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Probing questions related to stress could include:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about the stress in your life?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you experienced stress recently? Physically? Emotionally?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any recent changes in your life? (tell me more).<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">How does stress affect you?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">How do you handle this stress?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about the coping strategies you use?<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Stress management and coping strategies may include:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Regular physical activity.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Getting adequate sleep.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Spending time with family and friends.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Taking time for personal interests and hobbies.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Practicing relaxation techniques such as meditation, deep breathing exercises, and tai chi.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">From a relational and structural health promotion perspective, it is important to be aware that stress does not exist in a vacuum: how it is experienced, perceived, and managed is affected by relationships with others. All clients experience stress sometimes, but structural factors influence whether a client is more at risk for stress or able to manage stress. For example, racism is a major determinant that can lead to highly stressful experiences. You can use an anti-racist approach to stress and stress management to understand how the client is being influenced by racism and how best to support them. Socioeconomic status can also influence a person\u2019s access to resources to cope with stress. When collaborating with clients to develop stress management techniques, you must be aware of these larger structural influences.<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Weight and blood pressure\u00a0<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Obesity and high blood pressure are linked to cardiovascular-related illnesses, so clients should monitor their weight and blood pressure.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Probing questions may include:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Are there any recent changes in your life that may have affected your weight or blood pressure?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any recent changes in your weight?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you have any concerns about your weight?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">When was the last time you had your blood pressure taken?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you know what your blood pressure normally is?<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">In collaboration with the client, discuss any disruptions in daily patterns and explore possible ways to address these \u2013 and facilitate weight loss and lowering of blood pressure if relevant. Many interventions related to diet, activity\/exercise, and stress will help with weight and blood pressure. Nurses can also advocate on behalf of clients and take actions to develop and advance equitable healthy public policies.<\/span><\/p>\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">American Heart Association (2020). What is the Mediterranean diet?<\/span> <a href=\"https:\/\/www.heart.org\/en\/healthy-living\/healthy-eating\/eat-smart\/nutrition-basics\/mediterranean-diet\" target=\"_blank\" rel=\"noopener\">https:\/\/www.heart.org\/en\/healthy-living\/healthy-eating\/eat-smart\/nutrition-basics\/mediterranean-diet<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Brady, K. T. (2020). Social determinants of health and smoking cessation: A challenge. The American Journal of Psychiatry, 177(11), 1029-1030.<\/span> <a href=\"https:\/\/doi.org\/10.1176\/appi.ajp.2020.20091374\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1176\/appi.ajp.2020.20091374<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">CAN-ADAPTT. (2011). Canadian Smoking Cessation Clinical Practice Guideline. Canadian\u00a0Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health.<\/span> <a href=\"https:\/\/www.nicotinedependenceclinic.com\/en\/canadaptt\/PublishingImages\/Pages\/CAN-ADAPTT-Guidelines\/CAN-ADAPTT%20Canadian%20Smoking%20Cessation%20Guideline_website.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nicotinedependenceclinic.com\/en\/canadaptt\/PublishingImages\/Pages\/CAN-ADAPTT-Guidelines\/CAN-ADAPTT%20Canadian%20Smoking%20Cessation%20Guideline_website.pdf<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Health Canada (2109). Canada\u2019s Dietary Guidelines for health professionals and policymakers.\u00a0<\/span><a href=\"https:\/\/food-guide.canada.ca\/en\/guidelines\/\" target=\"_blank\" rel=\"noopener\">https:\/\/food-guide.canada.ca\/en\/guidelines\/<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Heart &amp; Stroke Foundation of Canada (n.d.). The DASH diet to lower high blood pressure. <\/span><a href=\"https:\/\/www.heartandstroke.ca\/healthy-living\/healthy-eating\/dash-diet\" target=\"_blank\" rel=\"noopener\">https:\/\/www.heartandstroke.ca\/healthy-living\/healthy-eating\/dash-diet<\/a><\/p>\r\n<span style=\"color: #000000\">Paradis, C., Butt, P., Shield, K., Poole, N., Wells, S., Naimi, T., Sherk, A., &amp; the Low-Risk Alcohol Drinking Guidelines Scientific Expert Panels. (2022). Update of Canada\u2019s Low-Risk Alcohol Drinking Guidelines: Final Report for Public Consultation. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.<\/span>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Siengsukon, C. F. (2020). The link between social determinants of health, sleep, and cardiovascular disease. Cardiopulmonary Physical Therapy Journal, 31(1), 5-10.<\/span> <a href=\"https:\/\/doi.org\/10.1097\/CPT.0000000000000130\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1097\/CPT.0000000000000130<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Turrell, G., Hewitt, B., Patterson, C., Oldenburg, B., &amp; Gould, T. (2002). Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. Journal of Human Nutrition and Dietetics, 15(5), 355-364.<\/span> <a href=\"https:\/\/doi.org\/10.1046\/j.1365-277X.2002.00384.x\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1046\/j.1365-277X.2002.00384.x<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Wang, G., &amp; Wu, L. (2020). Healthy people 2020: Social determinants of cigarette smoking and electronic cigarette smoking among youth in the United States 2010-2018. International Journal of Environmental Research and Public Health, 17(20), 7503.<\/span> <a href=\"https:\/\/doi.org\/10.3390\/ijerph17207503\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3390\/ijerph17207503<\/a><\/p>\r\n<p style=\"text-align: left\"><\/p>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Health promotion and disease prevention are important components of a healthy cardiovascular system. To determine appropriate interventions, you must carefully consider all available subjective and objective data. Part of your subjective data collection will include inquiring about risk factors, social determinants, and other considerations. <\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">The inquiry part is integrated throughout the assessment. Many of the probing questions may be asked when doing the subjective assessment. However, some of the questions will be formulated based on your critical reflection of data collected during the subjective and objective assessment. It is this data that will inform your clinical judgment and the health promotion needed for a specific patient.<\/span><\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Smoking<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong><button class=\"glossary-term\" aria-describedby=\"386-1244\">First-hand<\/button>, <button class=\"glossary-term\" aria-describedby=\"386-1245\">second-hand<\/button>, <\/strong>and<strong> <button class=\"glossary-term\" aria-describedby=\"386-1246\">third-hand smoke<\/button><\/strong> are major risk factors that negatively affect the cardiovascular system. The chemicals in smoke cause inflammation of the blood vessels and contribute to plaque buildup and narrowing of the blood vessels.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to smoking include:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you smoke cigarettes or any tobacco-related products? If the client\u2019s answer is affirmative, ask probing questions: How much do you smoke? How many packages of cigarettes do you smoke a day? How many years have you smoked? Can you tell me about the reasons that you started smoking?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If you do not currently smoke, have you ever smoked? If the client\u2019s answer is affirmative, ask similar probing questions as above, including the reason that they quit.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you ever tried quitting? If the client\u2019s answer is affirmative, ask probing questions: Tell me about what made you want to quit? How long did you quit? Did you use any strategies to help you quit?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you ever thought of quitting? If the client\u2019s answer is negative, make a non-judgemental comment like: \u201cIf you ever want to discuss quitting, let me know, there are many resources to help you.\u201d<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The effectiveness of <strong>health promotion<\/strong> is influenced by client interest and collaborative intervention because these factors are important in producing a successful outcome in smoking cessation. Each intervention must be tailored to the client, and could include counselling, cognitive-behavioural therapy, pharmacology treatments (e.g., nicotine replacement therapy), smart-phone applications, and short text message services. Sometimes a brief discussion about risks and a recommendation to quit smoking is sufficient. You might also choose to be involved in developing public health educational campaigns and resources about how smoking affects health as a population-based prevention strategy.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Contextualizing health promotion<\/strong> related to smoking from a <strong>sociocultural perspective<\/strong>\u00a0will help you understand who might be more vulnerable or at risk. For example, the prevalence of smoking is higher among individuals with lower socio-economic status and lower education attainment, and those experiencing racial and ethnic discrimination (Wang &amp; Wu, 2020). These populations are less likely to have access to resources pertaining to smoking cessation, so it is important to consider interventions as they relate to the social determinants of health, rather than using a one-size-fits all approach (Brady, 2020).<\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox shaded\">\n<h1 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity &#8211; Tobacco<\/strong><\/span><\/h1>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Tobacco plays an important part in traditional and spiritual practices in many Indigenous communities (CAN-ADAPTT, 2010). Many, but not all, Indigenous peoples use it for ceremonial and medicinal purposes (CAN-ADAPTT, 2010). Nurses should recognize and distinguish between tobacco use for traditional purposes and misuse, and questions to the client should be culturally sensitive and respectful of these differences (CAN-ADAPTT, 2010).<\/span><\/p>\n<\/div>\n<header class=\"textbox__header\"><\/header>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Diet<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">An unhealthy diet is a risk factor that contributes to cardiovascular disease, such as a diet high in saturated and trans fats, cholesterol, sodium, and alcohol. It is best for clients to choose water and reduce caffeine and alcohol intake. Clients with <strong>heart failure<\/strong> are sometimes recommended to limit all types of fluids.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to diet include:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about your usual diet?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">What have you eaten in the last 24 hours? Is that your usual diet?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any recent changes in your life that have affected your diet?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you add sugar and salt to your food?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">How much fluid do you typically drink in a day? What fluids (e.g., water, caffeinated beverages, alcohol)?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">You may want to assess a client\u2019s familiarity with <strong>Health Canada\u2019s (2019) Food Guide<\/strong> and discuss with them how to use it:<\/span> <a href=\"https:\/\/food-guide.canada.ca\/en\/\" target=\"_blank\" rel=\"noopener\">https:\/\/food-guide.canada.ca\/en\/<\/a>. <span style=\"color: #000000\">This new food guide still has a Eurocentric bias, so you should collaborate with the client about its relevance in the context of their cultural food practices. It is now offered in dozens of languages that you can refer clients to:<\/span> <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-food-guide\/resources\/snapshot\/languages.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-food-guide\/resources\/snapshot\/languages.html<\/a> <span style=\"color: #000000\">and many resources are available about food safety for Indigenous People:<\/span> <a href=\"https:\/\/www.sac-isc.gc.ca\/eng\/1581522106156\/1581522147811\" target=\"_blank\" rel=\"noopener\">https:\/\/www.sac-isc.gc.ca\/eng\/1581522106156\/1581522147811<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Some <strong>key elements<\/strong> of Canada\u2019s Food Guide are:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Be mindful of eating patterns.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Choose water as the drink of choice.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">A dinner plate should be one-half vegetables\/fruit, one-quarter protein, and one-quarter whole grains.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Make time to enjoy eating meals with others.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Cook when possible, as opposed to eating processed meals and purchasing fast foods.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Reduce sodium, saturated and trans fats, and sugar, and monitor portion sizes.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">Canada\u2019s guidelines now suggest that there are health risks associated with any level of alcohol consumption, although negligible with two drinks or less weekly (Paradis et al., 2022). Although some previous research had suggested some positive benefits to alcohol, this is now being disputed indicating that drinking alcohol of any kind does not decrease risks of heart disease, and high levels of consumption increase risk for coronary artery disease, myocardial infarction, heart failure, hypertension, and stroke (Paradis et al., 2022).<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Many types of diets can be heart healthy, but some research points especially to the benefits of the <strong>Mediterranean<\/strong> diet and <strong>DASH<\/strong> diet. The American Heart Association (2020) recommends the Mediterranean diet as heart healthy: it includes plenty of fruits and vegetables, grains, potatoes, legumes, nuts, and seeds, olive oil, along with small amounts of dairy, eggs, fish, and poultry. The Heart and Stroke Foundation of Canada (n.d.) recommends the DASH (Dietary Approaches to Stopping Hypertension) diet as heart healthy and helpful to lower blood pressure: it is rich in vegetables, fruit and low-fat dairy foods and lower in saturated fat, total fat and cholesterol. The two diets are very similar and may be used in combination; the Mediterranean diet typically emphasizes more fish and less dairy products than the DASH diet.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Healthy eating involves behavioural actions but also <strong>relational and structural actions<\/strong>. First, an individual needs access to healthy food and the financial capacity to purchase it; this is referred to as food security. The rising cost of food globally has made this a challenge, and in many remote regions of Canada\u2019s North, access to nutritious food is limited in terms of availability; even when available, the costs are excessive.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Socioeconomic status is known to affect food purchasing: individuals from socioeconomically disadvantaged communities \u2013 those with lower household income and lower levels of education \u2013 purchase fewer healthy foods like fruits and vegetables (Turrell et al., 2002). Therefore, health promotion efforts should focus on narrowing socioeconomic differences in food purchasing. Nurses can work in partnership with disadvantaged individuals and tailor a health promotion approach to their particular needs and attend to structural and economic barriers (Turrell et al., 2002). For example, you could direct clients to organizations that partner with vulnerable communities to support access to healthy foods, skill development, and capacity-building in terms of community-led initiatives (Turrell et al., 2002). You could also advocate on behalf of these communities for more effective social policy to address food insecurity (Turrell et al., 2002).<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">A sedentary lifestyle with limited activity\/exercise is another risk factor that contributes to cardiovascular disease. Guidelines vary based on age and health, but individuals should generally participate in about 30 to 60 minutes of aerobic activity five to seven times per week.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to activity are:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you have any concerns about your level of activity or exercise?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about your daily pattern of activity? What activity are you involved in?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">What exercise do you engage in? How long do you do this type of exercise? How many days a week do you exercise? If a client plays sports, ask about their use of protective equipment.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">You can collaborate with clients to create an activity\/exercise care plan that is specific to their needs and goals. Start at a realistic and attainable level, depending on physical capability and energy level, then slowly increase the timing and level of activity. Many interventions are also available to support clients to achieve their activity goals: community walking groups, fitness apps, local gyms, and group activities. The participACTION website is a helpful resource for activity guidelines:<\/span> <a href=\"https:\/\/www.participaction.com\/en-ca\" target=\"_blank\" rel=\"noopener\">https:\/\/www.participaction.com\/en-ca<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Nurses should use a <strong>relational health promotion<\/strong> approach when addressing activity. A community of support can promote activity, so you should assess the client\u2019s access to support (e.g., friends, family, acquaintances) who may have similar activity interests or goals. A <strong>structural approach to health promotion<\/strong> can also help address and eliminate inequities. For example, some clients may not be able to afford gym memberships or sports registration fees. Additionally, those in urban areas may have more access to specific activities or rehabilitation programs than those living in rural or remote regions, including in the North. You will need to consider these factors and tailor activity programming to each client. You could also advocate for policies to address these inequities.<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Sleep<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Adequate sleep is important for restoration of the body and mind: 6\u20138 hours is usually considered adequate sleep. Pulse and blood pressure lower during deep sleep, known as non-rapid eye movement, which is important for cardiovascular health. Lack of sleep quality and quantity has been linked to cardiovascular-related illnesses such as hypertension, obesity, myocardial infarction, and stroke.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Probing questions<\/strong> related to sleep include:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">How much sleep do you get each day\/night? How many hours? Do you rest during the day?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you have any concerns about your sleep?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about your sleep routine? What do you do before you go to bed? Do you take any medications to help you sleep?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you wake up during the night? If so, why? Are you able to fall back to sleep?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you feel rested when you wake up?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">One behavioural intervention is a sleep journal. Ask the client to record how much sleep they get. If less than recommended, address potential triggers that may be disrupting the client\u2019s sleep, such as stress or pain. Limiting screen time two hours prior to bedtime can also be helpful. Additionally, you may want to discuss with the client the potential for naps.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The physical and social environment affects sleep. Siengsukon (2020) describes that sleep may be affected by the following:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Living in an unsafe or noisy neighbourhood.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Not having access to private transportation and needing to get up early to commute via public transportation.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Living in congregate or multigenerational housing might mean that clients share bedrooms or beds.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Being a caregiver for a spouse or parent can also interfere with sleep, as does living with someone who works long hours or shift work.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">It is important to note that many of these physical and social factors influencing sleep are associated with race, ethnicity, and socioeconomic status (Siengsukon, 2020).<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Stress<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Stress is subjective and can have emotional, physical, mental, social, and financial effects; it is a risk factor for cardiovascular-related illnesses. Stress is usually caused by a combination of multiple stressors. How a person may talk about themselves, their life and their situation can indicate potential concerns and areas that need further assessment.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Probing questions related to stress could include:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about the stress in your life?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you experienced stress recently? Physically? Emotionally?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any recent changes in your life? (tell me more).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">How does stress affect you?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">How do you handle this stress?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Tell me about the coping strategies you use?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Stress management and coping strategies may include:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Regular physical activity.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Getting adequate sleep.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Spending time with family and friends.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Taking time for personal interests and hobbies.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Practicing relaxation techniques such as meditation, deep breathing exercises, and tai chi.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">From a relational and structural health promotion perspective, it is important to be aware that stress does not exist in a vacuum: how it is experienced, perceived, and managed is affected by relationships with others. All clients experience stress sometimes, but structural factors influence whether a client is more at risk for stress or able to manage stress. For example, racism is a major determinant that can lead to highly stressful experiences. You can use an anti-racist approach to stress and stress management to understand how the client is being influenced by racism and how best to support them. Socioeconomic status can also influence a person\u2019s access to resources to cope with stress. When collaborating with clients to develop stress management techniques, you must be aware of these larger structural influences.<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Weight and blood pressure\u00a0<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Obesity and high blood pressure are linked to cardiovascular-related illnesses, so clients should monitor their weight and blood pressure.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Probing questions may include:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Are there any recent changes in your life that may have affected your weight or blood pressure?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any recent changes in your weight?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you have any concerns about your weight?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">When was the last time you had your blood pressure taken?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Do you know what your blood pressure normally is?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">In collaboration with the client, discuss any disruptions in daily patterns and explore possible ways to address these \u2013 and facilitate weight loss and lowering of blood pressure if relevant. Many interventions related to diet, activity\/exercise, and stress will help with weight and blood pressure. Nurses can also advocate on behalf of clients and take actions to develop and advance equitable healthy public policies.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">American Heart Association (2020). What is the Mediterranean diet?<\/span> <a href=\"https:\/\/www.heart.org\/en\/healthy-living\/healthy-eating\/eat-smart\/nutrition-basics\/mediterranean-diet\" target=\"_blank\" rel=\"noopener\">https:\/\/www.heart.org\/en\/healthy-living\/healthy-eating\/eat-smart\/nutrition-basics\/mediterranean-diet<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Brady, K. T. (2020). Social determinants of health and smoking cessation: A challenge. The American Journal of Psychiatry, 177(11), 1029-1030.<\/span> <a href=\"https:\/\/doi.org\/10.1176\/appi.ajp.2020.20091374\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1176\/appi.ajp.2020.20091374<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">CAN-ADAPTT. (2011). Canadian Smoking Cessation Clinical Practice Guideline. Canadian\u00a0Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health.<\/span> <a href=\"https:\/\/www.nicotinedependenceclinic.com\/en\/canadaptt\/PublishingImages\/Pages\/CAN-ADAPTT-Guidelines\/CAN-ADAPTT%20Canadian%20Smoking%20Cessation%20Guideline_website.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nicotinedependenceclinic.com\/en\/canadaptt\/PublishingImages\/Pages\/CAN-ADAPTT-Guidelines\/CAN-ADAPTT%20Canadian%20Smoking%20Cessation%20Guideline_website.pdf<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Health Canada (2109). Canada\u2019s Dietary Guidelines for health professionals and policymakers.\u00a0<\/span><a href=\"https:\/\/food-guide.canada.ca\/en\/guidelines\/\" target=\"_blank\" rel=\"noopener\">https:\/\/food-guide.canada.ca\/en\/guidelines\/<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Heart &amp; Stroke Foundation of Canada (n.d.). The DASH diet to lower high blood pressure. <\/span><a href=\"https:\/\/www.heartandstroke.ca\/healthy-living\/healthy-eating\/dash-diet\" target=\"_blank\" rel=\"noopener\">https:\/\/www.heartandstroke.ca\/healthy-living\/healthy-eating\/dash-diet<\/a><\/p>\n<p><span style=\"color: #000000\">Paradis, C., Butt, P., Shield, K., Poole, N., Wells, S., Naimi, T., Sherk, A., &amp; the Low-Risk Alcohol Drinking Guidelines Scientific Expert Panels. (2022). Update of Canada\u2019s Low-Risk Alcohol Drinking Guidelines: Final Report for Public Consultation. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Siengsukon, C. F. (2020). The link between social determinants of health, sleep, and cardiovascular disease. Cardiopulmonary Physical Therapy Journal, 31(1), 5-10.<\/span> <a href=\"https:\/\/doi.org\/10.1097\/CPT.0000000000000130\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1097\/CPT.0000000000000130<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Turrell, G., Hewitt, B., Patterson, C., Oldenburg, B., &amp; Gould, T. (2002). Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. Journal of Human Nutrition and Dietetics, 15(5), 355-364.<\/span> <a href=\"https:\/\/doi.org\/10.1046\/j.1365-277X.2002.00384.x\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1046\/j.1365-277X.2002.00384.x<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Wang, G., &amp; Wu, L. (2020). Healthy people 2020: Social determinants of cigarette smoking and electronic cigarette smoking among youth in the United States 2010-2018. International Journal of Environmental Research and Public Health, 17(20), 7503.<\/span> <a href=\"https:\/\/doi.org\/10.3390\/ijerph17207503\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3390\/ijerph17207503<\/a><\/p>\n<p style=\"text-align: left\">\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"386-1244\" hidden><p>is the direct inhalation of smoke by the person smoking.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"386-1245\" hidden><p>is the inhalation of exhaled smoke from another person or smoke from a burning cigarette.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"386-1246\" hidden><p>is exposure to the residue left on surfaces (e.g., furniture, walls) from smoke.<\/p>\n<\/div><\/div>","protected":false},"author":177,"menu_order":13,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-386","chapter","type-chapter","status-publish","hentry"],"part":27,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/users\/177"}],"version-history":[{"count":30,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/386\/revisions"}],"predecessor-version":[{"id":2230,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/386\/revisions\/2230"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/parts\/27"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/386\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/media?parent=386"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapter-type?post=386"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/contributor?post=386"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/license?post=386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}