HLTH 236 Exam 1

relationship between SES and an increased risk of being affected by health disparities

Income Education Occupation status The "healthy worker" effect

Future Directions using SES

Lifestyles Mental health Access to healthcare Social network and support Exposure to psychosocial, physical, chemical, stressors SES and disability prevalence Acculturation

Minorities are more likely to

Live in poverty Receive high-cost mortgages Be unemployed

Health disparities

"a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. due to injustice

Secretary's Task Force Report on Black and Minority Health.

10-volume •documented "excess"deaths from seven disease conditions (cancer, cardiovascular diseases, chemical dependency, diabetes, homicide, unintentional injuries,and infant mortality •experienced by African Americans, Hispanics, Native Americans, and Asian and/or Pacific Islander, and Alaskan Native populations.

Which amendment paved the way for equal educational opportunities. Select one: a. 15th b. 14th c. 19th d. 13th

14

How long did the Tuskegee Syphilis Study last? Select one: a. 30 years b. 10 years c. 40 years d. 20 years

40 years

Emancipation Proclamation

After more than 240 years of slavery, President Abraham Lincoln issued the Emancipation Proclamation on January 1, 1863, announcing, "that all persons held as slaves" within the rebellious areas "are, and henceforward shall be free

3 Determinants of Health

Behavior & Lifestyle : 80% - Tobacco use, poor nutrition Environmental Exposure : 20% - Poor communities, residential crowding, violence, pollution - Social environment • Risk and prevalence of chronic and infectious disease Healthcare; 10% - Access, lack of preventive and primary health services

Illness behaviors

Behaviors people engage in with the aim of relieving effects of illness Illness behaviors strongly linked to socio-demographic factors, such as •Gender-Utilization of medical services higher in women than men •Ethnicity- Utilization of medical services lower among Hispanics & Blacks compared to Whites & Asians •Education •Social class/income-Utilization of medical services greater among higher SES than lower •Family Structure

Health Services

Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas. Lack of access, or limited access, to health services greatly impacts an individual's health status. (For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.)

Explicit Health Behavior

Clearly developed or formulated, Fully and clearly expressed or demonstrated

Comparative Mortality

Crude mortality rates cannot be compared , Age adjusted and specific mortality rates can be compared more accurately

Preventative behaviors -Secondary

Early diagnosis and treatment of existing disease and/or health condition in order to avoid further debilitative effects •EX: Screenings (Self BE for & pap smears for cervical cancer) Aim: Catch it early to avoid advancement

Voting Rights Act 1965

Eliminated discriminatory election ( practices and suspended literacy tests and provided for the appointment of federal examiners (this and the CRA dismantled the most limiting components of the "Jim Crow Laws" and fulfilled the constitutional guarantees contained in the 14th and 15th amendments)

Health Care Utilization

Enabling Factors Predisposing Factors Perceived need for Health Care Service

Determinants of health

Factors which directly cause illness and disease or are risk factors that affect the health of a population, community, or individual Socio-environmental factors Physical Environmental factors Individual factors Access to Health services

Physiological Theories

Genetic differences among racial/ethnic populations

Implicit Health Behavior

Implied or understood though not directly expressed, Contained in the nature of something though not readily apparent

According to the lecture, committee recommendations for reducing racial and ethnic disparities in health care include which of the following: Select one: a. Marketing b. Promote less-desirable procedures c. Fundraising d. Increase awareness about disparities

Increase awareness about disparities

Chronic

Long-Term

15th Amendment

Male Voting rights; (however, a plethora of insidious methodologies for preventing African Americans from exercising their voting rights were successfully implemented by racist whites who dominated the corridors leading to the voting booths. Voter qualifying tests (e.g., literacy tests), discriminatory enforcement of registration rules, poll taxes, and outright racial gerrymandering)

Nationality

Membership to a Nation or sovereign state, citizenship, place of residency, sense of national identity

Mortality Crossover

Mortality rates that illustrate two groups of individuals vary in one way for younger versus older individuals

Mortality

Number of deaths within a population

Prevalence Rates

Number of existing cases of a disease in a population at some designated time. Divide number of cases by total number in population at a given time

Directive 15

Office of Management and Budget (OMB) issued in 1977 (the "Race and Ethnic Standards for Federal Statistics and Administrative Reporting" contained in Statistical Policy Directive No. 15.) Directive 15 is an attempt to standardize data collection so that comparisons of races could be made by creating categories to classify individuals.

Policy Making

Policies at the local, State, and Federal level affect individual and population health. (Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products)

Determinants of health

Policy Making Social Factors Health Services Individual Behavior Biology and Genetics

The 1966 Highway Safety Act is an example of which determinant of health: Select one: a. Genetics b. Biology c. Policymaking d. Health service

Policymaking

Preventative behaviors - Primary

Primary •Strategies used to avoid diseases •EX: Vaccinations

Civil rights act of 1964

Prohibited discrimination in public accommodations such as mass transportation, restaurants, and hotels on the basis of race, color, religion, or national origin; shifted government policy away from the support of racially discriminatory social norms

Socio- Environmental Theories

Risk Exposure Resource Deprevation

Acute

Short-Term

Race

Social Category, Physical appearance due to particular historical social and political forces, Focused on physical characteristics

Ethnicity

Social category, Shared Cultural identity with distinct behavioral characteristics, Focused on Common cultural traits

Theories of health disparities

Socio- Environmental Theories Psychological/Behavioral theories Physiological Theories

Biology and Genetics

Some biological and genetic factors affect specific populations more than others. (For example, older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging)

Adjusted Rates

Statistical procedures applied to make crude rates more comparable

Specific Rates

Stratified rates

Incidence Rates

The rate a disease develops in a group of people over a certain period of time. Number of new cases. Divide the number of new cases by the number of people at risk and multiply

Psychological/Behavioral theories

Weathering Hypothesis John Henryism

The number of years that are lost due to untimely death are referred to as: Select one: a. LLYP b. YLLP c. LYPL d. YPLL

YPLL

YPLL

Years of Potential Life Lost •The number of years that are lost due to untimely death, Based upon average life expectancy, Does not include quality of life in the calculation

Healthy People 2020

address the relationship between health status and biology , individual behavior, health services, social factors, and policies and emphasizing an ecological approach to disease prevention and health promotion. focuses on both individual-level and population-level determinants of health and interventions

All of the following are categories under SANBS four categories except: Select one: a. Category 1: Regular donor who described their ethnic group as White or Asian b. Category 2: White and Asian donors donating for the first time as well as Coloured c. Category 3: Black donors amongst whom HIV and hepatitis are more widespread d. All are correct

all are correct

Apartheid played a role in the differential spread of HIV and in the legacy of inequalities in all of the following: Select one: a. Health b. Income c. Education d. All of the answer choices are correct

all of the answer choices are correct

Epidemiologist use race/ethnicity to operationalize which of the following: Select one: a. None of the answer choices are correct b. All of the answer choices are correct c. Genetic traits d. Social practices

all of the answer choices are correct

Predisposing Factors

are an individual's inclination to use health services, most notably one's attitudes toward using health care. These attitudes may be facilitating or inhibiting and are largely influences by cultural beliefs and prior experiences. (For example, if someone distrusts the medical establishment, or has had negative experiences with the medical establishment, he/she may be less likely to seek health care services. Conversely, is one has a great relationship with a medical provider, he/she is more likely to continue visiting this provider in the future.)

Enabling Factors

are resources that either facilitate or inhibit someone seeking health care services. (For example, having a car is a facilitating factor because it provides transportation, a useful resources for physically traveling to a health care provider.) ( Having no health insurance would be an inhibiting factor because it often deters one from seeking health care services).

According to the lecture, all of the following countries exceed the US life expectancy, except: Select one: a. Japan b. Spain c. Argentina d. Greece

argentina

Gender differences in life expectancy are consistently larger than whites, for which group: Select one: a. Hispanic b. American Indian c. Black d. Asian and Pacific Islander

asian and pacific islander

Heart disease is the leading cause of death for all of the following groups except: Select one: a. Whites b. Alaskan Natives c. Blacks d. Asian/Pacific Islanders

asian/pacific islanders

Health equity

attainment of the highest level of health for all people. Achieving health equity requires to focused on avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities."

Cause-specific Mortality

attributed to a particular cause/disease/illness

Life Expectancy

average years a person can expect to live a healthy/productive lifestyle that is determined at a particular age

The definition of health disparity put forth by Health People 2020, includes the following types of disadvantages, except: Select one: a. Economical b. Biological c. Social d. Environmental

biological

According to Williams (2010), which of the following group racial/ethnic group is becoming the model minority with some health indicators. Select one: a. Asian women b. Hispanic women c. Black women d. White women

black women

Sickle cell disease is developed when: Select one: a. Mother carries the gene b. Father carries the gene c. Grandmother carries the gene d. Both parents carry the gene

both parents carry the gene

Factors linked to changing trends in gender-role attitudes in the contemporary United States include all of the following except: Select one: a. Changing familial structure b. Increasing labor force c. Decreasing labor force d. Changing household structure

changing household structure

he "weathering hypothesis" refers to all of the following except: Select one: a. Climate changes affect levels of chronic disease b. Age reflects higher levels of exposure to adverse conditions c. Greater wear and tear on physiological systems d. Individuals residing in unhealthy contexts

climate changes affect levels of chronic disease

Which president was the first to apologize for the Tuskegee Syphilis Study. Select one: a. Reagan b. Clinton c. Jimmy Carter d. Bush

clinton

John Henryism

developed by Sherman James, hypothesis assumes that lower SES individuals in general, and African-Americans in particular, are routinely exposed to psychosocial stressors ( that require them to use considerable energy each day to manage the psychological stress generated by these conditions. The hypothesis further assumes that individuals exposed to excess psychosocial stressors will respond differently, with varying degrees of success. The John Henry Hypothesis predicts that individuals in lower SES categories who utilize active coping skills related to the excess stressors are more likely to suffer from hypertension due to their effort

Inequality in Health

differences in both health experience and health status between countries, regions, states, and socioeconomic groups

Health Care Disparities

differences in the presence of illness, health outcomes, or access to care, within a population

Dissimilarities

differences that are not attributed to injustice or unfairness

The Office of Management and Budget responded to the need to standardize data collection on race and ethnicity by developing: Select one: a. Directive 13 b. Directive 14 c. Directive 15 d. Directive 16

directive 14

Population profiling continues to be a tool for analysis/interventions in _____ research. Select one: a. Heart b. Racial c. Ethnographic d. Epidemiological

epidemiological

Health equity can be defined as the attainment of the average level of health for all people. Select one: a. False b. True

false

If a health belief is explicit, that means it is understood though not directly expressed. Select one: a. False b. True

false

Illness behaviors are weakly linked to socio-demographic factors, such as gender, ethnicity, and income levels. Select one: a. False b. True

false

Non-Hispanic black person are the least likely to be insured when compared to white and Hispanics. Select one: a. True b. False

false

Prevalence and incidence are equal most of the time. Select one: a. True b. False

false

Social determinants of health reflect political and physical conditions in the environment. Select one: a. True b. False

false

The Western Province Blood Transfusion Service faces the same political struggles as SANBS with using the terms race/ethnicity measurements: Select one: a. False b. True

false

When calculating the years of potential life lost, one must include the quality of life in the calculation. Select one: a. True b. False

false

Health behaviors are shaped by all of the following except: Select one: a. Culture b. Genetics c. Beliefs d. Attitudes

genetics

Race could be characterized by all of the following except: Select one: a. Genetically defined b. Based on physical appearance c. Subjective d. Every society differs on racial classification

genitcally defined

19th Amendment

guaranteed all American women the right to vote

Delaying medical treatment and not participating in preventative care are related to which determinant of health: Select one: a. Health Services b. Individual Behaviors c. Genetics d. Social Factors

health services

High socioeconomic status (SES) correlates to: Select one: a. Healthier individuals and communities b. Unhealthy individuals and communities

healthier individuals and communities

According to the lecture, health disparities have led to all the following circumstances except: Select one: a. Higher incidence of chronic diseases b. Lower quality of health services c. Higher mortality rates d. Higher routine medical care

higher routine medical care

All of the following shaped the health status of Black in the late 1800s, except: Select one: a. Segregation b. Poverty c. Racism d. Immigration

immigration

According to the lecture, health behaviors are _______ reflections of a person's health beliefs. Select one: a. Implicit b. Implicit and Explicit c. None of these d. Explicit

implicit and explicit

Health Disparities

incidence, prevalence, mortality, and burden of disease within a population

An ecological approach focuses on which of the following: Select one: a. None of these b. Population c. Individual and Population d. Individual

individual and population

Health disparities more closely relates to which of the following terms: Select one: a. Risk factors b. Inequity c. Inequalities d. Health care disparities

inequalities

Perceived need for Health Care Service

is one's belief that he/she does (or does NOT) need to utilize health care services for health issues. If one does not perceive a need for an action, including health behaviors, he/she is much less likely to engage in that behavior.

Which of the following categories was NOT added to the 2000 US Census from the 1990 US Census? Select one: a. Samoan b. Japanese c. African American d. Asian Indian

japanese

The Secretarys Task Force Report on Black and Minority Health was released in 1985 by who: Select one: a. Margaret Heckler b. None of these c. W.E.B. DuBois d. Booker T. Washington

margerat heckler

Socioeconomic Status

measure of social and economic characteristics that typically include measures of Income Poverty level Wealth Education Work status/occupation Place of residence

According to the Tuskegee lecture, which of the following is associated with the sentiments some may feel towards government research. Select one: a. Jealousy b. Pride c. Sadness d. Mistrust

mistrust

According to the lecture, the number of ill individuals among a group of people at risk for the illness at a given time refers to which key term: Select one: a. Incidence b. Mortality c. Morbidity d. Prevalence

morbidity

According to the lecture, the number of deaths in a population at a given time refers to which key term: Select one: a. Mortality b. Morbidity c. Prevalence d. Incidence

mortality

Which mortality measures the death of an infant at 0-28 days old. Select one: a. Neonatal b. Natal c. None of these options d. Infant

neonatal

Incidence

number of persons contracting/new cases of a disease

Prevalence

number of persons who have/all cases a particular disease/condition

14th Amendment

paved the way equal educational opportunities with the Supreme Court's declaration in Brown v. Board of Education that racially segregated schools violate the equal protection of the laws guaranteed by the Fourteenth Amendment

Individual Behavior

plays a role in health outcomes. ( For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced.)

Which of the following cases endorsed the development of state and local Jim Crow laws? Select one: a. Buchanan v. Warley b. Brown v. Board of Education c. Plessy v. Ferguson d. Korematsu v. United States

plessy v ferguson

Getting vaccinated is an example of which type of prevention: Select one: a. Primary b. Tertiary c. Secondary d. Quaternary

primary

Nontraditional gender roles among Black women are fostered which of the following: Select one: a. Decrease participation in the labor force b. Insider status in society c. Prominent roles in the family d. Lower birth-rates

prominent roles in the family

An unsuccessful legislative proposal to abolish the collection of data on race/ethnicity by Californias public services is described by: Select one: a. Proposition 2004 b. Proposition 54 c. Proposition 45 d. Proposition 23

proposition 54

Post NeoNatal Mortality Rate

rate of newborns dying between 28 and 364 days of age

13th Amendment

ratified in 1865 outlawed slavery in the U.S. and all territories

Health care disparities

refers to differences specifically within the healthcare system, access to health care, quality of health care, and utilization of health care services that are a result of injustice.

Health care dissimilarities

refers to the same differences within the health care system (access to health care, quality of health care, and utilization of health care services) that are NOT a result of injustice.

Social Factors

reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning and quality of life outcomes. Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment.

Health behaviors that have benefits to the person practicing the behavior can be described as all of the following except: Select one: a. Preventative behaviors b. Health enhancing c. Risk behaviors d. Illness behaviors

risk behaviors

Resource Deprevation

says that racial/ethnic disparities in health status exist because minorities are more likely than whites to live in communities that are lacking in the necessary infrastructure to support a healthy lifestyle. (Infrastructure includes road ways, food sources, safety, and health care services, to name a few.)

Illness behaviors are more closely linked to which type of preventative behavior: Select one: a. Tertiary b. Primary c. Secondary d. None of these

secondary

Weathering Hypothesis

seeks to explain the differences between African-Americans and Whites in pregnancy outcomes. It proposes that social stress in the community, in the environment and the society, affects African Americans and other minorities negatively. Specifically, these populations are said to actually "weather" or age at accelerated rates because of increased exposure to stress. We know that excess stress has numerous health implications, including premature aging and associated conditions

The term "double disadvantage" is in reference to which social category: Select one: a. Sexism and Racism b. Sexism c. Neither Sexism or Racism d. Racism

sexism and racism

According to the Tuskegee lecture, the role of Nurse Rivers was important because: Select one: a. She gained the confidence of the participants and was credited by some for the success of the study b. She performed all of the necessary research to make final conclusions about syphilis c. She wrote the book "Bad Blood" which describes the success of the study d. None of the choices are correct

she gained the confidence of the participents and was credited by some for the success of the study

Age-specific Mortality

specific age group

Inequity in Health

systematic, unfair, or unjust, yet potentially avoidable differences in access to health services across defined population groups

All of the following are examples of risk behaviors, except: Select one: a. Taking prescribed medication b. Not using a helmet c. Smoking d. Illicit drug use

taking prescribed medicine

Risk Exposure

theory says that high prevalence of social or environmental health risks in predominantly minority communities lead to a higher prevalence of disease and death. (Because the United States is a highly racial segregated country, different rates of health risk in different communities place different populations at different levels of risk in those communities.)

Disparity

those differences that are indicative of injustice or unfairness

Crude Mortality Rate

total number of deaths within a time period cannot be compared

According to the Tuskegee lecture, the government doctors felt betrayed by the governments failure to defend the study. Select one: a. True b. False

true

Brazil is home to one of the largest immigrant populations of Japanese people outside of the country of Japan? Select one: a. True b. False

true

Differential access to socioeconomic and political power contribute to disparities in health? Select one: a. False b. True

true

Expressing one's desire to use a condom is an explicit way to express one's health belief. Select one: a. False b. True

true

Prevalence rates when compared to incidence rates are generally larger. Select one: a. False b. True

true

Risk behaviors are defined as any behavior that puts an individual at risk for negative consequences. Select one: a. True b. False

true

Scholars find black men to be more liberal than white men, regarding women employment outside the home. Select one: a. True b. False

true

Socioeconomic status (SES) is the measure of social and economic characteristics that typically include measures of income, poverty level, wealth, education, work status by occupation, and place of residence. Select one: a. True b. False

true

The South African National Blood Service were found in political conflict after taking what actions: Select one: a. Laundering money for the organization b. Infecting the population with HIV c. Using race/ethnicity to classify blood safety d. Not properly disposing of needles

using race/ethnicity to classify blood safety

Low SES and Health

• Increased morbidity and mortality • More likely to suffer from mental disorder • Martial distress and disrupted parenting o Children with depression, substance abuse, behavior problems • Barriers o Health care, child care, transportation, etc

Closing the Gap on SES Disparities

• Providing health coverage • Improving economic conditions • Increasing educational opportunities • Introducing culturally sensitive health promotion efforts

Plessy v. Ferguson

•1896 •endorsed the development of state and local "Jim Crow" laws requiring the separation of the races

Tuskegee

•1932-1972, Macon County, Alabama •600 black men, 399 with Syphilis and 201 without disease •withheld adequate treatment from a group of poor black men who had the disease •told the men they were being treated for "bad Blood." •men received free medical exams, free meals, and burial insurance •Summer of 1973, a class-action lawsuit filed by the national Association for the Advancement of Colored People (NAACP)

Slavery

•African Americans arrived in 1619 •lasted 244 years

Preventative behaviors -Quaternary

•Avoidance of over-treatment

Risk behaviors

•Behaviors which are associated with increased risk/susceptibility to adverse health consequences (e.g., illness, injury).

Preventative behaviors -Tertiary

•Fighting the disease and/or health condition when signs/symptoms present to minimize complications •EX: Medication therapy adherence, changing diet/exercise regimen

Leading causes of death

•For whites, blacks, American Indians, Alaskan Natives, and Latinos, heart disease is the leading cause of death and malignant tumors (cancer) is the second leading cause of death •For Asians and Pacific Islanders, malignant tumors is the leading cause of death while heart disease is the close second

Socio-economical Model

•Intrapersonal •Interpersonal •Organizational •Community •Public Policy

NeoNatal Mortality Rate

•Number of deaths during the first 28 completed days of life per 1000 live births in a given year or other period

Morbidity

•Number of individuals with a disease, illness, injuries, and disabilities within a population •Number of ill individuals among a group of people at risk for the illness at a given time

Birth Rates

•Number of live births at a given time •Divide the # of live births in selected time by the population size at midpoint of a selected time period then multiply

Margaret Heckler

•Secretary of U.S.Department of Health and Human Services •Secretary's Task Force Report on Black and Minority Health.

Importance of Studying Minority Health

•The public cost of disparities •The costs of health disparities to business •Direct Costs •Indirect Costs

Booker T. Washington

•founder and president of Tuskegee Institute in Alabama •Negro Health Improvement Week was launched in 1915 •became so successful that around 1932 it was adopted by the U.S. Public Health Service as part of the new federal Office of Negro Health Works •1951, however, the Office of Negro Health Works was decommissioned in the name of integration

Infant mortality rate

•infants under the age of 1 •Probability of dying between birth and exactly one year of age expressed per 1,000 live births •Number of infant deaths among infants 0-365 days at a given period of time divided by the population size at midpoint times of multiplier (generally 1000).

National Center on Minority Health and Health Disparities

•lead, coordinate, support and assess the NIH effort to eliminate health disparities •research, •research infrastructure •public information and community outreach.

W. E. B. Du Bois

•published The Philadelphia Negro •used social science methods to describe social and economic conditions that shaped the quality of life and health status of African Americans