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Health Psychology Quiz 1 Chapters 1, 2, 3 With Complete Solutions 100% Verified Latest Update
Typology: Exams
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Lesson 1/Chapter 1 - ANSWER "Intro to HP"
illness/wellness continuum - ANSWER a model describing health and sickness as intersecting states that differ in degree rather than discrete conditions
health - ANSWER The absence of disease or infirmity, coupled with complete physical, mental and social well-being; health psychologists recognize health as a condition that is actively attained, rather than simply the absence of illness.
biopsychosocial model - ANSWER The perspective that biological, psychological, and social factors are all implicated in every state of health or illness.
health psychology - ANSWER The area within psychology concerned with understanding psychological contributions to health, illness, and healthcare responses, and the psychological processes underlying health policy and health service delivery.
infectious diseases - ANSWER What people mainly died from prior to the 20th century. Prevention and treatment advances greatly reduced the death rate from infectious diseases.
chronic diseases - ANSWER Illnesses that are long lasting and usually irreversible. Often the cause of death in modernity.
etiology - ANSWER The origins and causes of illness.
mind/body problem (AKA mind-body relationship) - ANSWER The philosophical position regarding whether the mind and body operate indistinguishably as a single system or
whether they act as two separate systems; the view guiding health psychology is that the mind and body are indistinguishable.
biomedical model - ANSWER The perspective that illness can be explained on the basis of aberrant somatic processes and that psychological and social processes are largely independent of the disease process; the dominant model in medical practice until recently.
mortality - ANSWER The number of deaths due to particular causes.
psychosomatic medicine - ANSWER A field within psychiatry, related to health psychology, that developed in the early 1900s to study and treat particular diseases believed to be caused by emotional conflicts, such as ulcers, hypertension, and asthma. The term is now used more broadly to mean an approach to health-related problems and diseases that examines psychological as well as somatic origins.
correlational research - ANSWER Measuring two variables and determining whether they are associated with each other.
retrospective research - ANSWER A research strategy whereby people are studied for the relationship of past variables or conditions to current ones. Interviewing people with a particular disease and asking them about their childhood health behaviors or exposure to risks can ID conditions leading to an adult disease, e.g.
morbidity - ANSWER The number of cases of a disease that exist at a particular given point in time; it may be expressed as the number of new cases (incidence) or as the total number of existing cases (prevalence).
experiment - ANSWER A type of research in which a researcher randomly assigns people to two or more conditions, varies the treatments that people in each condition are given, and then measures the effect on some response.
longitudinal research - ANSWER The repeated observation and measurement of the same individuals over a period of time.
prospective research - ANSWER A research strategy in which people are followed forward in time to examine the relationship btn one set of variables and later occurrences. E.g., prospective research can enable researchers to ID risk factors for diseases that develop at a later time.
wellness - ANSWER An optimum state of health achieved through balance among physical, mental, and social well-being.
Why does contemporary thinking suggest the need to revise our focus from health as the absence of signs and symptoms to thinking of health in terms of the illness/wellness continuum? - ANSWER 1) You may be ill and not yet show symptoms.
What's the difference between major diseases of the past and major diseases of the present? - ANSWER People used to die from infectious diseases--now that we have better treatments and prevention, mostly we die from chronic illnesses.
What social and cultural changes led to the development of the biomedical model? - ANSWER p. 4-
What are some potential liabilities of this model? - ANSWER 1) It's reductionist--doesn't recognize overall picture.
Its unifactorial. Sickness can only be biological malfunction.
It implies a mind-body dualism
It orients to sickness rather than wellness.
What are some limitations of this model? - ANSWER 1) It cannot explain why a specific collection of somatic circumstances need not necessarily result in disease
It denies psychological and social causes.
It is left to other factors whether a treatment will cure.
What is the biopsychosocial approach to health and illness? - ANSWER Biopsychosocial approach: biological, psychological and social factors are all involved in any given state of health or illness
Both macrolevel and microlevel interact for health or illness.
The mind and body cannot be distinguished in health/illness.
What is the difference between the retrospective and the prospective approach in research studies? -ANSWER Time. Prospective approaches (e.g. longitudinal research) focus on changes in individuals or variables into the future. In contrast, a retrospective research looks back and attempts to establish how something came to be.
How can you identify whether a research study used experimental versus non experimental methods? - ANSWER A variable must be manipulated in an experiment; it's not necessary in other types.
Lesson 2/Chapter 2 - ANSWER "Systems of the Body"
adrenal glands - ANSWER Two small glands, located on top of the kidneys, that are part of the endocrine system and secrete several hormones, including cortisol, epinephrine, and norepinephrine, that are involved in responses to stress. p.
autonomic nervous system - ANSWER Carries messages between the spinal cord and various internal organs and is not under our conscious control. This system has two parts: sympathetic and parasympathetic.
antigen - ANSWER Foreign substance whose presence stimulates the production of antibodies in cell tissues.
autoimmune disorders - ANSWER The body fails to recognize its own tissue, producing antibodies to fight itself. A viral or bacterial infection often precedes onset. E.g., multiple sclerosis, systemic lupus erythematosis. p.
arteriosclerosis - ANSWER Stiffening or hardening of artery walls.
angina pectoris - ANSWER Chest pain that occurs because the muscle tissue of the heart is deprived of adequate oxygen or removal of carbon dioxide and other wastes interferes with the flow of blood and oxygen to the heart. p.
antibodies - ANSWER Proteins produced in response to stimulation by antigens; then combine chemically with the antigens to overcome their toxic effects.
basal metabolic rate - ANSWER The rate at which the body uses energy while at rest to keep vital functions going, such as breathing and keeping warm.
blood pressure - ANSWER The force that blood exerts against vessel walls. Consisting of diastolic and systolic pressures. p.
cell-mediated immunity - ANSWER A slow-acting immunologic reaction involving T lymphocytes from the thymus gland; effective in defending against viral infections that have invaded the cells, and against fungi, parasites, foreign tissues, and cancer. p.
central nervous system - ANSWER Containing the brain and spinal cord. The control center; it sends/receives electrochemical messages through neurons.
chromosomes - ANSWER a structure of nucleic acids and protein found in the nucleus, carrying genetic information in the form of genes.
cerebrum - ANSWER The main portion of the brain consisting of the two hemispheres.
cardiovascular system - ANSWER The transport system of the body responsible for carrying oxygen and nutrients to the body and carrying away carbon dioxide and other wastes to the kidneys for excretion; composed of the heart, blood vessels, and blood.
dialysis - ANSWER A procedure in which blood is filtered to remove toxic substances and excess fluid from the blood of patients whose kidneys do not function properly.
endocrine system - ANSWER A bodily system of ductless glands that secrete hormones into the blood to stimulate target organs; interacts with nervous system functioning. p.
enzymes - ANSWER Breaks down lipids, proteins, and carbs. p.
hormones - ANSWER Secreted by the endocrine system, esp. the pituitary gland and hypothalamus. Catecolamines important in the adrenal glands for steroids/for stress responses during sympathetic arousal. E.g., oxytocin, vasopressin (AKA antidiuretic hormone), somatotropic hormone, gonadotropic hormones, thyrotropic hormone, adrenocotricotropic hormone. p.
hypothalamus - ANSWER The part of the forebrain that acts to regulate water balance and stimulate appetite and sexual desire; helps to maintain blood pressure and heart rate, and controls breathing rate; plays a major role in regulation of the endocrine system, especially with control over the release of hormones from the pituitary gland, such as those associated with stress.
humeral immunity - ANSWER A rapid immunologic response mediated by B lymphocytes that secrete antibodies into the blood; active primarily against bacterial infections and viral infections that do not invade the cells. p.
immunity - ANSWER The body's defense against injury from invading organisms, conferred by the mother at birth, acquired through disease, or produced by vaccinations and inoculations. p.
lipids - ANSWER Substances that are not soluble in water; must be transported in blood plasma. Includes fats, cholesterol, and lecithin. Excess of lipids in blood (hyperlipidemia) is common in diabetes, alcoholism, kidney diseases, etc., esp. in heart disease. p.
lymphocytes - ANSWER Types of white blood cell. B lymphocytes involved in Humoral immunity. T lymphocytes involved in Cell-mediated immunity. See p. 39.
metabolism - ANSWER The result of chemical reactions taking place in body cells, includes the production of new cells; controls body functions, and the energy to warm the body and enable it to work. p.
myocardial infarction - ANSWER A heart attack brought about when a clot has formed in a coronary vessel, and blood flow to the heart is obstructed. p.
neurons - ANSWER???
non specific immune mechanisms - ANSWER A general set of responses to any infection that is engaged by the presence of an invader. p.
neurotransmitter - ANSWER Chemical that regulates nervous system functioning. p.
pituitary gland - ANSWER A gland located at the base of and controlled by the brain that secretes the hormones responsible for growth and organ development. The "master gland" that tells other glands to secrete. p.
peripheral nervous system - ANSWER Contains 2 divisions--somatic and autonomic. p.
parasympathetic nervous system - ANSWER Part of the autonomic nervous system. Responsible for vegetative functions, the conservation of energy, and the damping down of the effects of the sympathetic nervous systems. p.
phagocytes - ANSWER White blood cells that ingest microbes. Overproduced when an infection occurs for protection. E.g. macrophages and natural killer (NK) cells. p.
respiratory system - ANSWER The system of the body responsible for the intake of oxygen, exhalation of carbon dioxide, and regulation of the relative composition of the blood. p.
specific immune mechanisms - ANSWER Always acquired after birth for specific invaders, includes cell-mediated and humoral immunity. p.
spinal cord - ANSWER Part of the central nervous system. Major neural pathway that connects the brain to the peripheral nervous system. p.
sympathetic nervous system - ANSWER Part of the autonomic nervous system. The part of the nervous system that mobilizes the body for action and expends energy. p.
The major parts and functions of the brain--forebrain, cerebellum, and brainstem. - ANSWER Forebrain) 2 parts: diencephalon (thalamus and hypothalamus) and telencephalon (the two hemispheres of the cerebral cortex, i.e. the 4 lobes of the brain).
Cerebellum) Part of the hindbrain. It coordinates voluntary movement, the maintenance of balance and equilibrium, and the maintenance of muscle tone and posture.
Brainstem) the central trunk of the brain, consisting of the medulla oblongata, pons, and midbrain, and continuing downward to form the spinal cord.
See pp.19-20 for functions.
What is the general functional difference between the sympathetic and the parasympathetic nervous systems? - ANSWER The sympathetic system prepares to respond to emergencies, strong emotions and activity. The parasympathetic system regains homeostasis after the sympathetic system does its thing and controls organs and such under normal circumstances.
Explain ways the endocrine system is different from the nervous system. - ANSWER The endocrine system controls slow-acting responses of long duration, the nervous system handles fast-acting, short-duration responses.
How do the endocrine and sympathetic nervous systems participate in our responses to an emergency? - ANSWER The sympathetic system utilizes the endocine system's ducts to receive hormones to initiate the flight/fight/freeze responses. Then, the endocrine
system ceases secreting those hormones to cease the build of fast-acting responses so that the parasympathetic can take over and recover homeostasis.
Passage of food through the digestive system. - ANSWER Food lubricated by saliva in mouth; bolus passes through the esophagus to stomach. Then into duodenum, small intestine, large intestine, and colon. Rectum time, then anus.
Describe the basic of three disorders of the digestive system - ANSWER Gallstones: Comprised of cholesterol, calcium, bilirubin, and inorganic salts. They move into the duct of the gallbladder and cause painful spasms. May need to be removed surgically. Infection and inflammation of the gallbladder-cholecystitis may be a precondition of stones.
Dysentery Similar to diarrhea except that blood, mucus, and pus are also excreted Caused by a protozoan that attacks the large intestine or by a bacterial organism Rarely life threatening here, major cause of death overseas.
Peptic Ulcer- An open sore in the lining of the stomach or duodenum. Results from the hypersecretion of hydrochlorlic acid and occurs when pepsin digests a portion of the stomach/duodenum. Aggravated by stress, not caused by it.
p.
Anatomy of the respiratory system, how it works, etc. - ANSWER Includes the nose, mouth, pharynx, trachea, diaphragm, lungs and abdominal muscles. Air is inhaled to the primary bronchi. Each bronchus enters a lung. Then bronchioles, alveolar ducts, and alveoli. Alveoli exchange oxygen and carbon dioxide with capillaries. Controlled movement of inspiration by the medulla. Coughs occur to clear out buildup of mucus in airways. p.
The disorders of the respiratory system. - ANSWER Asphyxia: lack of oxygen and too much carbon dioxide. Might be from respiratory obstruction, from reinhaled air, etc. Increases respiratory activity.
Anoxia: a shortage of oxygen. People rapidly become disoriented, lose sense of danger, pass into coma. Pilots in danger--must be heavily trained to notice.
Hyperventilation: a disruption of the oxygen-carbon dioxide balance. Deep breathing causes reduced carbon dioxide in blood. Causes blood vessel constriction-->reduced flow to brain, difficulty seeing, thinking and may be dizzy.
Stops breathing? Brain issues/death after only 2 minutes.
p.
The major parts of the cardiovascular system — heart, arteries, veins, left and right atria, left and right ventricle — and related organs--kidney and liver. - ANSWER heart, the pump which circulates blood.
aorta, major artery leaving the heart.
arteries, smaller vessels to reach cell tissue.
veins, brings deoxygenated blood back to the heart.
left atria, takes in blood from the lungs and gives it to the aorta.
right atria, pumps the deoxygenated blood back to the lungs for oxygenation.
left ventricle, takes in blood from the lungs and gives it to the aorta.
right ventricle, pumps the deoxygenated blood back to the lungs for oxygenation.
kidney,
liver,
p.
The nature of three major cardiovascular disorders. - ANSWER Atherosclerosis: due to deposition of cholesterol, etc. on the walls of arteries; plaque narrows the arteries Major cause of death Tissue damage may result; may lead to blood clots A disease of lifestyle! Angina pectoris and myocardial infarction are associated with atherosclerosis.
Phlebitis: inflammation of the vein wall, accompanied by water retention and pain. Results from an infection around the vein, from varicose veins, tumor pressure or pregnancy. May cause blood clots!
Varicose veins: superficial veins that are dilated or swollen. lower extremity veins are most susceptible from greater gravitational pressure.
p.
The nature of genetic materials. - ANSWER ??? p.35-
What events initiate an immune response? - ANSWER Incubation period, nonspecific symptoms, acute phase, decline.
Whether infection is produced depends on 3 factors: the number of organisms, the body's defensive capacity, and the virulence of the organism (determined by aggressiveness and toxigenicity). p.
The nature of transmission. - ANSWER The invasion of microbes and their growth in the body.
Types: Direct (kissing, intercourse, handshaking), indirect (AKA environmental; airborne, dust, water, soil, food), biological (when an agent, e.g. a mosquito, picks up microbes and changes them to be conducive to the human body and gives them to us), mechanical (a carrier that isn't directly involved in the disease process; bad water, rats, mice, flies, dirty hands).
p.
The nature of the immune system--nonspecific immunity, cell-mediated, and antibody-mediated. - ANSWER nonspecific immunity: mediated in 4 ways--through anatomical barriers (e.g. the skin and mucus membranes), phagocytosis (when white blood cells ingest microbes), antimicrobial substances (chemicals mobilized by body to kill invading microbes, e.g. hydrochloric acid, lysozyme, ect.), and inflammatory responses (a local reaction to infection. Capillaries enlarge, histamine is released. Capillary permeability increases allowing more white blood cells in, though area becomes reddened and fluids accumulate). cell-mediated: slower-acting response involving T lymphocytes from the thymus. The T cells secrete chemicals that kill invaders when properly stimulated by an antigen. Tc and Th cells respond to specific antigens. Th enhances Tc, B and macrophage cells via cytokines. Particularly effective against cancer, foreign tissue, parasites, fungi.
antibody-mediated:?
p.
Lesson 3/Chapter 3 - ANSWER "Health Behaviors"
assertiveness training - ANSWER Techniques that teach people how to be appropriately assertive in social situations; often included as part of health behavior modification programs, on the assumption that some poor health habits, such as excessive alcohol consumption or smoking, develop in part to control difficulties in being appropriately assertive. p.
vulnerable - ANSWER A condition of susceptibility to a specific health problem due to heredity, health practices or family environment. p.
abstinence-violation effect - ANSWER A loss of control feeling that occurs when one has transgressed self-imposed rules, such as not to smoke or drink.
contingency contracting - ANSWER A process by which a person enters into a formal agreement, or contract, with another person, that describes what rewards or penalties are contingent on the occurrence or nonoccurrence of a target behavior. p.
classical conditioning - ANSWER The pairing of a stimulus with an unconditioned reflex, such that over time the new stimulus acquires a conditioned response, eliciting the same behavior; the process by which an automatic response is conditioned to a new stimulus. p.
conflict theory - ANSWER
discriminative stimulus - ANSWER An environmental stimulus that is capable of eliciting a particular behavior; e.g., the sight of food may act as a discriminative stimulus for eating. p.
health behavior - ANSWER Behaviors undertaken by people to enhance or maintain their health, such as exercise or the consumption of a healthy diet. p.
health habit - ANSWER A health-related behavior that is firmly established and often performed automatically, such as buckling a seat belt or brushing one's teeth. p.
health belief model - ANSWER A theory of health behaviors; the model predicts that whether a person practices a particular health habit can be understood by knowing the degree to which the person perceives a personal health threat and the perception that a particular health habit will be effective in reducing that threat. p.
health locus of control - ANSWER The perception that on'es health is under personal control; is controlled by powerful others, such as physicians; or is determined by external factors, including chance. p.
primary prevention - ANSWER Measures designed to combat risk factors for illness before an illness has a chance to develop. p.
relapse - ANSWER The greatest risk in health habit modification. Alone or with a formal support group, individuals relapse, especially with addictive habits. Relapses happen within 3 months of changing the habit. It's a cycle, back and forth, between abstinence
and relapse. p.
stages of change model - ANSWER AKA, Transtheoretical Model of Behavior Change. Conceptualized as a spiral, as relapse is the rule, not exception. Originally for addiction, now for change in general. Helps explain why intervention rates are so low--many addicts are in precontemplation (~50-60%)
p.
self efficacy - ANSWER The perception that one is able to perform a particular action. p.
stimulus control intervention - ANSWER Interventions designed to modify behavior that involve the removal of discriminative stimuli that evoke a behavior targeted for change and the substitution of new discriminative stimuli that will evoke a desired behavior. p.
self monitoring - ANSWER Assessing the frequency, antecedents, and consequences of a target behavior to modified; also known as self-observation. p.
Why health habits are not as strongly interdependent and stable as people think. - ANSWER 1) Different habits are controlled by different factors. E.g, stress impacts one habit, ease of access another.
Different habits are controlled by different factors for different people. E.g., one's overeating may be only in public, another's, only in private.
Factors controlling the behavior may change. The initial instigation may not be relevant anymore. You ran in Gym, but now, out of school, you don't run anymore.
Factors over the course of the behaviors history may change. Smoking was legal, and now, often it's not.
?????? pp.49-
What individual, family, health professional, and community problems do people face when trying to adopt wellness behaviour? - ANS Many times, individuals do not see any short-term benefits from being healthy.
What types of information are included in disease prevention community campaigns? - ANS p.
What are the major components of the theory of reasoned action/theory of planned behavior? What are the limitations of this theory? - ANSWER A theory that wishes to directly relate health attitudes to behavior. Composed of behavioral intentions of three components: attitudes toward the action, subjective norms for the action, and perceived behavioral control.
Shortcomings--doesn't explain spontaneous change well, nor long-term change. communication about health may provoke instead of inform. People may have a false sense of complacency, etc., etc. pp.58-
What are major elements of the health belief model?
What are the shortcomings of this model? - ANSWER The most influential model. Two factors to change: whether the perceived threat exists and whether the change will help reduce that threat. This model focuses on beliefs about risks, not on emotions about perceived risks, which might predict better. It leaves out the perception of even being able to engage in a particular change (wanting to change doesn't mean can change). pp.56-57 What are the five elements of the Stages of Change Model? - ANSWER -Precontemplation (no intentions to change, possibly no idea problem exists)
-Contemplation (awareness of problem, no commitment to change, often years-long stage)
-Preparation (an intention to change, but no decisive action, though modifications/attempts may have been made)
-Action (modify behavior to overcome, rid of cues, modification of lifestyle/environment)
-Maintenance (6+ months after action stage. Work to prevent relapse, consolidate gains made.) pp.70-
Abstinence-violation effect: What is it? Why is it important to health behavior? A feeling of loss of control.etc. this effect makes easier the relapse considering the violation causes the resolve-to-change to falter. Esp. true with addictions. p.
Why is it important for caregivers and health professionals to adapt their explanations and expectations for preventive action when young children are concerned? ANSWER Children are not able to understand cognitively. BUT: they can understand simple information from age 3-4, esp. if the implications are made clear. p.51?
Why does message framing influence health behavior motivation? - ANSWER Messages that stress problems are better for behaviors with unknown outcomes. Messages that stress benefits are better for behaviors with known outcomes. Recommendations always help change behavior. Self-motivation plays a major role in change. p.
Lesson 4/Chapter 4 - ANSWER "Primary Prevention"
anorexia nervosa - ANSWER A condition produced by excessive dieting and exercise that yields body weight grossly below optimal level, most common among adolescent girls. p.
bulimia - ANSWER An eating syndrome characterized by alternating cycles of binge eating and purging through such techniques as vomiting and extreme dieting. p.
breast self exam (BSE)- ANSWER The monthly examination of the breasts to identify changes in the underlying tissue; a major technique for the early detection of breast cancer. p.
obesity- ANSWER An excessive amount of body fat, thought to be linked to many diseases, such as heart disease. p.
relapse prevention - ANSWER A set of techniques designed to keep people from relapsing to prior poor health habits after initial successful behavior modification; includes training in coping skills for high-risk-for-relapse situations and lifestyle rebalancing. p.
set point theory (of weight) - ANSWER The concept that each individual has an ideal biological weight that cannot be greatly modified. p.
secondary prevention - ANSWER Includes measures taken to detect and halt or reverse a health problem.
tertiary prevention - ANSWER Comprises measures taken to limit or slow the damage from a severe injury or progressive disease, to prevent disability, and to rehabilitate the client.
testicular self exam (TSE) - ANSWER The procedure of palpating the testes to feel for changes in the underlying tissue; a primary method of discovering the presence of early testicular cancer. pp.91-
Distinguish among primary, secondary, and tertiary prevention. - ANSWER -Primary prevention includes measures taken to prevent disease or injury.
-Secondary prevention includes measures taken to detect and terminate or reverse a health problem.
-Tertiary prevention includes measures taken to limit or delay damage from an acute injury or advanced disease, to prevent disability, and to rehabilitate the patient.
Name three advantages of regular aerobic exercise. - ANSWER Boosts slow-wave sleep
Decreases menstrual length
Decreases use of energy sources, such as glutamine
.Table 4.1 on p. 82
Identify factors that influence whether or not people exercise regularly. - ANSWER If their families regularly exercised, those who have a positive attitude toward exercise, those who think they are athletic, who have support to engage in activity, who enjoy exercise, and those who believe that you should be responsible and healthy. Gender (boys more). Age (youth more). Physical factors (thin more). Health status (at-risk more). p.
What are typical tests performed for screening various types of cancers? - ANSWER BSE, TSE, Mammograms, Colorectal cancer testing.
What are some challenges to people receiving/ conducting these tests? - ANSWER It's difficult to find lumps yourself. Fear of discovering lumps deterrent. Guidelines of BSE has changed. p.
Identify health risks associated with obesity. - ANSWER Increased death rates for all cancers. Atherosclerosis, hypertension, diabetes, gallbladder disease, arthritis, heat failure. Increased risk in surgery, childbearing, and anesthesia administration. Increased disability. Early mortality. pp.99-
Why are obesity rates among children and adolescents increasing? - ANSWER Genes, sedentary activities (e.g. video games, etc.), children are encouraged to overeat. p.
What are some treatments/interventions for obesity? Dieting - to most, may be harmful, Insufficient means to weight loss; Surgery - gastric surgeries, last resort; Appetite-suppressing drugs - often used with behavioral interventions, often regain weight quickly; Multimodal approaches - screening, self-monitoring, controlling eating, exercising, controlling self-talk, social support, and relapse prevention.
What is the BMI and how does it differ from weight as a measure of body size? - ANSWER BMI is a measure of body fat based on your weight in relation to your height. It's more accurate for health reasons.
Are there any limitations to the use of BMI to categorize people's body size? - ANSWER BMI cannot tell the difference between fat and muscle. BMI does not distinguish types of fat, each of which can have different metabolic effects on health. BMI cannot consider where the body holds fat.
Why is proper sleep important for health? -ANSWER Bad sleep influences cognition, mood, work performance, quality of life. Diabetes and bad sleep are linked. Poor vagal tone, lessened efficacy of flu shots, reduces pain tolerance, decreases immunities