BBH 302 Exam 2
Asian Paradox
- Leading cause of death is cancer, but when compared to other groups, it has the lowest rates -good birthing outcomes, but low levels of prenatal care
TB Trends
- between US born and foreign born Asians, foreign born asians have overall highest rates - In US born --> Blacks have the highest, then whites are number 2
AI/AN Census Data
- indian health services are federal! which means if the government shuts down, they get no services!!! -22% live on a reservation -20% spoke another language -26% live in poverty
Select all of the public health interventions covered in this paper that reduced opioid addictions in the 19th century.
- revolutions in bacteriology and public health - the development of alternative analgesics such as aspirin - stricter prescription laws - admonitions about morphine in the lay and professional literature
Which of the following are the leading causes of DEATH in Hispanic populations?
-Cancer -Heart Disease -Unintentional Injuries
Relationship between breast cancer and childbearing
-Childbearing is a protective factor - decreased birth rates indicate higher risk for cancer
Suicide Trends for YOUTH
-Highest in AI+AN
Suicide Trends for ADULTS
-Highest in Whites (specifically white men) - 2nd Highest is AI+AN
Which of the following was reported to be disparity (poorer outcomes) in both AI/AN men AND women, compared to Non-Hispanic White men and women?
-SMOKING -falling in the last 3 months -diabetes -obesity -leisure time physical activity
Hawaiin and Pacific Islanders Unique Disparities
-TB -Asthma -Personal care-=proxy
Which of the following were the 4 main barriers to participation in clinical research among African Americans?
-Trust -logisitics of the research process -communication -experimentation
Weathering (Incidence vs. Prevalence)
-age, when we reach 65 the life expectancy gap narrows -see major differences because blacks are developing diseases earlier in life, even if it is the same period of time
AI/AN Unique Disparities
-diabetes -infant mortality -alcoholism
Black Paradox
-prostate cancer: high screening -Breast cancer: high screening, but at later stage
Problem with Asians being the "model minority"
-they will get ignored. -underrepresentation in programs because they wont be included. -Many are still poor!
The authors state that there are 3 areas that need greater attention in order to achieve health equity. Which of the following are the 3 areas highlighted?
-working with multiple health and non- health sectors for health improvement of all populations, with a focus on at-risk communities -developing targeted strategies that address structural determinants related to health inequities that are rooted in social position, racism and discrimination, and access to social and health resources -developing targeted interventions for addressing disparities through increased awareness, education, and behavioral change targeting all perspectives and stakeholder groups
Highest rates of Heart Disease in which 2 groups?
1. Blacks 2. Non-Hispanic Whites
Drug Overdose
1st: 2nd: AI/AN
Health in all policies approach
A collaborative approach that health and health promotion are impacted by policies that are managed by non-health government and non-government entities
1st and 2nd highest asthma rates in what 2 populations?
Adults : - 1St: NH+OPI Children: -1st: Blacks -2nd: NH+OPI
In the movie, Drs. Collins and David described a research study that they conducted which showed that unfavorable birth outcomes in African American women were not due to genetics. What finding led them to this conclusion?
African women had birth outcomes similar to white americans Differences in living experiences and stressors is what is thought to cause this
Unique leading cause of death in Asians
Alzheimers
Indian Health Services (IHS)
An agency in the Department of Health and Human Services that provides comprehensive health care and services to native populations from federally recognized tribes
TB rates in NON-US BORN persons
Asians (1) --> Hispanics (2) --> Blacks (3)
Septicimia
Associated with: -longer hospital stays - long term illness such as infant mortality, cancer, HIV
What is the the HIGHEST in NH/OPI populations?
Asthma
Major health disparities in NH/OPI
Asthma (highest, blacks are second) High use of illicit drug disorder Low rates of cancer (despite low rates of screening) High rates of mental illness
Amenable Deaths
Avoidable deaths that could be prevented if individuals received adequate and timely health care
Why is it that blacks have a high rate of cancer screening, yet high incidence rates and even higher (the highest) mortality rates for cancer?
Because black women are getting screenings too late. Later than white women, thus white women have higher rates of Incidence but lower rates of Mortality than black women. (breast cancer) Black men have higher rates of incidence and mortality. Could be a result of the resource disparity between blacks and whites.
What population has the highest rates of cancer mortality rates in all sites?
Black men and women Whites men and women are second highest in mortality
Nurse Eunice Rivers
Black nurse that recruited for the Tuskeegee Study
Infant mortality rates
Blacks (1) --> AI/AN (2)
HIV/AIDs rates
Blacks (1) --> Hispanics/Latinos (2)
TB rates in US BORN persons
Blacks (1) --> Whites (2) --> Hispanics (3)
Non-Hispanic Black
Blacks who are not of Hispanic/Latino origin
What are the major cancer disparities for white men and women?
Bladder, Oral/pharynx, Lukemia/Lymphoma (mortality and incidence are highest) And melanoma (because of skin tone)
#1 leading cause of death in Asians
Cancer
#1 leading cause of death in hispanics/latino
Cancer
Major Barriers to Optimal health in Blacks
Centuries of Institutionalized racism Genetic Fatalism Urbanization and poverty Distrust of the medical system (Tuskegee study - the reason for informed consent)
The Asian sub population - Vietnamese and Cambodian Women have what cancer?
Cervical Cancer
Think back to the reading and lesson on levels of racism. The authors state that "Commodity food assistance programs, common on reservations, have provided high-calorie, high-fat foods that often replace a more healthy menu for low-income populations." Is this an act of omission or commission?
Commission
Latino Health Paradox or Hispanic Mortality Paradox
Despite generally being lower income and having lower education, Hispanics/Latinos in the U.S. tend to be healthier (in general) than other ethnic groups.
Unique leading cases of death in Hispanics/Latino
Diabetes Chronic liver disease (despite low alcohol use) Cirrhosis
Major Health Disparities in AI/AN
Diabetes Second highest in infant mortality (after blacks)
In NH/PI what is personal care Proxy to?
Disability
Disempowerment
Efforts to derive of power, authority, or influence: make weak, ineffectual or unimportant. Similar to marginalization
Which of the following health behaviors did the authors suggest may account for high rates of motor vehicle accidents in AI/AN populations?
Excessive alcohol use
Research has shown that African-Americans are more likely to participate in research studies that involve injections and medications than surveys and blood/urine samples.
FALSE
Health care coverage was high in survey respondents who lived in Indian Health Service Contract Health Service Delivery Areas, compared to Non-Hispanic Whites in those areas.
FALSE Approximately 23% of AI/AN persons reported that they had "no health plan" and ~28% that they had "no personal doctor." This compares to rates of approximately 12% and 19% for Whites in these areas.
Asian Paradox
Good outcomes in breast cancer, despite low rates of mammograms Good birth outcomes, despite low levels of prenatal care
Major Health disparities in Asians
H. Pylori Infection (associated with stomach cancer) High rates of Hep B (associated with liver cancer) Highest rates of TB in NON-US BORN PERSONS
Who is largest emerging population in the US?
HISPANICS/LATINOS 2nd = Africans
#1 Leading cause of death for AI/AN
Heart Disease
#1 cause of death in NH/OPI
Heart disease
#1 leading cause of death in blacks
Heart disease
Which of the following describes the Latina Birth Outcomes Paradox?
Hispanic women experience lower rates of low birth weight and mortality, despite lower socioeconomic status and inadequate health care
Latina Birth Outcomes Paradox
Hispanic/Latina women have similar birth outcomes as women of higher socioeconomic status and those with better healthcare access.
Obesity rates
Hispanics (1) --> Blacks (2)
Major Health Disparities for Hispanics/Latino
Hispanics/Latinos are the second highest in HIV/AIDS (after blacks)
Unique causes of death in Blacks
Homicide Septicemia Stroke HIV (US Born blacks have the highest rates of TB - then whites - then hispanics)
Major Health Disparities in Blacks
Infant mortality (highest compared to other populations) Maternal Mortality Hypertension Asthma (second highest rates after NHPI)
Major Barriers to Optimal Health in Asians
Language and cultural barriers Traditional vs. conventional medicine Dietary practices (fruit and vegetable intake, low dairy intake, Nitrates from processed foods) Limited access in the working poor - Poor working conditions - Crowding - Uninsured and underinsured - Fear of public charge
Major Barriers to Optimal Health for Hispanics/Latinos
Large proportion of the immigrant population Cultural and language barriers Disconnect with conventional medicine and traditional beleifs Urbanization and poverty
The Asian sub population - Vietnamese Men have what cancer?
Liver Cancer
Despite lower rates of alcohol uses, which of the following was higher in Hispanic/Latino populations?
Liver Disease - Hep B might explain these rates
Septicemia in blacks is caused by
Long term hospital stays, infants being in the hospital longer,
Asian are low in what cancer?
Low breast cancer and low rates of screening
What is the Alcohol Paradox for AI/AN populations?
Lower rates of alcohol use, but higher rates of alcohol misuse/overdose
Breast cancer rates were lower in Hispanic/Latina woemen, despite:
Lower rates of mammography use
Unique leading cause of death for AI/AN
Motor Vehicle Accidents Suicide (second highest after whites) Chronic Liver disease (low alcohol use) Cirrhosis
More careful prescribing of opioids for acute and chronic pain is an example of which level of opioid drug misuse prevention?
Primary
What condition is highly associated with the homelessness rates in blacks?
Schizophrenia
Urine toxicology is an example of which level of opioid drug misuse prevention?
Secondary
Factors such as macroeconomics, cultural values, socioeconomic status, and social support are known as:
Social Determinants of Health
Which of the 6 approaches applied in the integrative population health equity framework applies to the conditions in which people live, work and play, include things like housing, transportation, and racism?
Social Determinants of Health
H. Pylori infection increases the risk of _________ cancer, and Hep B increases the risk of ___________ cancer.
Stomach Liver
The Asian sub population - Korean Men have what cancer?
Stomach Cancer
In what ways does chronic stress impact pregnancy and birth outcomes?
Stress hormones might trigger labor Stress can constrict blood flow to the placenta, which can stunt the babies growth Inflammation inside the uterus which can trigger premature labor
Rates of mental health problems and psychological distress are high in Native populations. In AI/AN, for which mental health problem is the morality rate the second highest?
Suicide
Hispanics are more likely than Non-Hispanic Whites to live near the most polluted, hazardous waste sites that are potential threats to human health and the environment. What is the term for these sites?
Superfund sites
Apart for AI/AN men in the Southwest, AI/AN men and women were more likely to be tested for HIV than Whites.
TRUE
Opioid overdose prevention is one of the Centers for Disease Control and Prevention's top 5 public health challenges.
TRUE
Population health interventions are mostly tested on middle-class, White populations.
TRUE
Underrepresentation of African Americans in clinical research may lead to the inability to recognize factors related to disease prevalence, treatment, and health care that may be different in this population.
TRUE
Cancer Incidence is higher in whites, but mortality is higher in Blacks
TRUE - It's not because they dont get screened, it is because blacks get screened too late - also a tumor specific to black population that is very aggressive when untreated
Whites are often used as default?
TRUE - Lowest growth rate as well
Which of the following historical events played a major role in the lack of trust in the research process in African-Americans?
The Tuskeegee Study
Indian Health Service (IHS)
The agency responsible for providing healthcare services to American Indians and Alaska Natives is:
Genetic fatalism
The idea that there is nothing you can do to intervene in terms of health fate People not wanting do something because their family members died of one event so they think they will too
Asian Enigma
The paradox of low rates of gastric (stomach) cancer in certain parts of Asia, despite high rates of H. pylori infection, which increases risk of gastric cancer
Foreign born Asians fair far worse in terms of TB than US born Asians
True
True or False: Cancer is the #1 leading cause of death in Asian populations, yet they have the lowest Cancer incidence rates
True
Rates of what infectious disease was second highest in Hispanic/Latino Populations?
Tuberculosis
Which race is the most residentially segregated?
WHITES
What population has the highest rates of cancer incidence rates in all sites?
White women
Lung cancer trends
White women (1) --> Black women (2) Black men (1) --> White men (2)
Which three populations are high in suicide rates?
Whites (1) --> American Indians/Alaskan Natives (2) --> Asians (3)
Which age group was most highly impacted by heroin addiction treatment admissions between 2001 and 2011?
Whites ages 20-34
Non-Hispanic White
Whites who are not of Hispanic/Latino origin
Helicobacter Pylori (H. pylori) Infection
bacteria that infects the stomach. Most infected people are asymptomatic. Can be passed from person to person via saliva, feces or vomit.
Genetic Fatalism
belief that an individual is destined to develop a disease due to a family history of the disease. There is also a belief that no intervention (lifestyle or medical) is likely to change this destiny
genetic fatalism
everyone around you dies (Mom) = you will get it too regardless of what you do -wont adhere to what they are supposed to do
Hispanic/Latino Paradox
have better health outcomes than average population despite higher poverty rates
African women had birth outcomes similar to white americans
if not genetics, environment and stressors such as discrimination
Which of the following was considered the most prominent facilitator to clinical research participation among African-Americans?
involving the community in the research process, research planning and implementation
NA/AI Alcohol Paradox
low use of alcohol, but greater burden for those that do use it.
Asians and Screening
lowest rates
Incidence
number of new cases of disease during a specified time interval
Prevalence
number of total cases (new and preexisting) at a specific point in time. Usually expressed as a percentage during a specific year.
Asian Enigma
paradox in low rates of gastric (stomach) cancer in certain parts of Asia, despite high rates of Helicobacter Pylori infection, which increases the risk of gastric cancer
Model Minority
perception that Asian/Pacific Islander populations are the healthiest and wealthiest of all racial/ethnic minorities
Hopelessness and cultural loss
plays a role in health disparities Disempowerment AI and Hawaiins Structural racism
Safety Net Program
secondary prevention approach to providing goods or services (e.g., health care, food, education, etc., often for free) to individuals or communities who may have limited access to these goods and services.
Model Minority
the perception that Asian/Pacific Islander populations are the healthiest and wealthiest of all racial/ethnic minorities
Community-based participatory research
the process of engaging communities in the research process in order to improve the development of relevant interventions
Life course perspective
the study of the effects that risk and cumulative exposures have on health over the lifespan
Disempowerment
to deprive of power, authority, or influence: make weak, ineffectual, or unimportant
Social marketing approach
well suited for translating complex educational messages and behavior change techniques into concepts for a specific target audience
Peter Buxton
white whistleblower on Tuskeegee