CPH Exam- a mixture of everything

WHO's definition of a community:

"A social group determined by geographic boundaries and/or common values and interests, community members know and interact with one another, the Community functions within a particular social structure, and the community creates norms, values, and social institutions."

CDC's interpretation of "Evaluation of Programs"

"Evaluation can be approached as a systematic investigation of the merit, worth, or significance of a program."

A primary communication tool for confirming understanding is called:

"Teach back"

Levels of Government in Public Health and the Application of PH Law

Federal State Local

Health Insurance Portability & Accountability Act (HIPAA)

Federal legislation passed in 1996. Passed by Congress (Law). Regulation: the Department of Health & Human Services, through the Office of Civil Rights, created the regulations to implement the law. *HIPAA Privacy Rule *HIPAA Security Rule ^ Regulations on the Law known as HIPAA

PRECEDE-PROCEED: Reinforcing Factors

Feedback and reward system for behavior change

Aquired Immunity

Immunity that develops during your life time

Epidemiologic Transition

The process of change in the distinctive causes of death in each stage of the demographic transition

T/F: Case control studies are typically retrospective.

True

True or False: Hepatitis A is a virus.

True

T/F: Among the sentinel chickens in FL, we are looking for West Nile Virus.

True It's in 47 states (2019) 543 persons sick.

Endemic

confined to a particular country or area

Measures of Central Tendency

mean, median, mode

Ppb means

parts per billion

Solid Waste Disposal Act (SWDA)

(1965) First federal effort to improve waste management. Regulates the treatment, storage, or disposal of solid non hazardous and hazardous waste and outlines environmentally responsible methods for getting rid of trash at the household, municipal, commercial and industrial levels.

State Powers

-10th Amendment gives states ALLL powers that are neither given to the federal government nor prohibited by the Constitution -"The powers delegated by the proposed Constitution to the federal government are few and defined. This which are to remain in the State governments are numerous and indefinite." - James Madison, The Federalist No. 45

Superfund Regulations:

-Created and administered by the EPA -Requires that responsible parties must assume liability for the cleanup of environmental hazards they cause -Superfund Sites • Any land contaminated by hazardous waste and identified by the EPA as a candidate for cleanup because it poses a risk to human health and/or the environment. • Sites are placed on the National Priorities List (NPL)

Critical Components of Community Health Practice according to WHO:

-Identification of stakeholders -Community Mobilization -Community Assessment -Community Based Participatory Research

Standard 2x2 Table of Test Results:

-The 2x2 Table at right provides a structure to evaluate virtually all common clinical tests. -However, the informational isn't always presented in exactly the format that is clinically useful.

Intervention Mapping

1.) Develop a Logic model of the problem (similar to precede-proceed)

Tertiary Audience - Health Communication

A group w/ indirect influence on the primary audience

Six Sigma Process

A process of measuring, analyzing, improving, and then controlling processes once they have been brought within the Six Sigma quality tolerances or standards.

Hazard

A source of potential damage or harm

Which of the following is calculated by dividing the number of new cases of disease by the total population at risk? A. Cumulative incidence B. Incidence density C. Point prevalence D. Prevalence rate

A- Cumulative Incidence

Attributable Risk

AR = [a/a + b] − [c/c + d] Subtracting the exposed from the unexposed.

Hill's Criteria for Inferring Causation: Plausibility

An association is more likely to be causal when it's biologically plausible.

non-point source pollution

water pollution that does not have a specific point of origin Ex: urban runoff, agricultural runoff etc.

Z-score formula:

z=(x-μ)/σ Or z= (observation - mean) / standard deviation

Which of the following phases of the policy-making process includes the "window of opportunity"? A. Policy modification B. Policy rulemaking C. Policy formulation D. Policy implementation

C

Which of the following is defined as a community's ability to survive, adapt, and thrive? A. Community capital B. Community development C. Community organization D. Community capacity

Correct Answer D

In low resource countries during an outbreak, what simple, low-tech sanitation measure can dramatically reduce the spread of enteric bacteria and viruses? 1.Disposing of stagnant water 2.Sleeping under an insecticide-soaked bednet 3.Vaccination of those individuals who work on the water supply 4.Add chlorine to water storage containers

4.- adding chlorine is one of the best, low cost ways to reduce the spread

How can one identify and anticipate challenges to program implementation?

A formative evaluation and pilot implementation can be helpful steps in addition to including a process evaluation, Human Resources management, and a monitoring plan will provide quick insight into emerging issues

Task Force

A task force is an action-oriented group that is tasked with addressing an issue or priority. The appointment of a task force may be time-limited. Members are brought together by an overseeing committee of institution.

The probability of an event occurring assuming that another event has occurred is called a: 1. Joint probability 2. Simple probability 3. Conditional probability 4. Marginal probability

Answer is 3- conditional probability

Which term is used to characterize the social conditions unequal distribution of environmental hazards? A. Environmental equity B. Environmental Justice C. Environmental pollution D. Environment democracy

B

Compared to the situation in 1900, the prevalence of deaths due to infectious diseases in the U.S. is: A. About the same B. Much less C. Much more D. About the same, but caused by different pathogens such as HV

B, more are dying from non-communicable disease

In some cases of food Bourne illness, Hemolytic Uremic Syndrome is caused by which organism? A. Listeria B. E. Coli strain 0157:H7 C. Cryptosporidium D. Salmonella

B- E. Coli strain 0157:H7 Fatal condition, caused by eating contaminated food sources

The Four P's of public health social marketing services include:

Product, price, place, and promotion The design and characteristics of the product, the purchase price set, the place (channels of distribution) where the good or service is offered and the means of promotion to increase awareness of the product are the essential factors in determining the marketing mix for any good or service.

Fomites

objects contaminated with infectious material that contains the pathogens Serve as a mechanism for transfer between hosts Ex. Park water fountain

PRECEDE stands for:

predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation

Demographic and epidemiologic transitions

progressive improvement in health from a global perspective *Shift in the patterns of morbidity and mortality from causes primarily related to infectious diseases to those with chronic diseases There was also a demographic transition with a shift from high birth rates and high mortality rates in more agrarian societies to lower birth and mortality rates in developed societies. United States- Chronic Disease Developing Countries- infectious disease

Water Quality Act of 1965

resulted from Silent Spring; required states to clean up rivers

T/F: Each state will organize its own Public Health effort in it's own way.

True

T/F: Public Health leadership is a communication act.

True

Why are z-scores important?

they let us compare 2 scores that come from 2 different normal distributions

Joseph Lister (1827-1912)

1. Used carbolic acid on wounds to kill germs 2. First doctor to use an antiseptic during surgery

Key concepts in community-led public health action

1 empowerment 2 community capacity 3 participation 4 relevance 5 issue selection 6 critical consciousness

What are the 4 MAPP assessments?

1. Community Themes and Strengths 2. Forces of Change 3. Community Health Status 4. Local Public Health System

General State PH Functions

4 functions are paramount: -regulation -financing -resource allocation -provision of services

Dangers of ill-constructed Land Fills:

Air pollution & ground water contamination

Outcome:

All possible results that stem from exposure to a causal factor *varies -Morbidity = presence of an illness, or illnesses -Mortality = death

Distribution- Disease Distribution:

Analysis of patterns Who is getting the MMD? Where is the MMD occurring? Does the number of MMD change over time?

Which of the following programs represents the greatest health expenditure at the state level? A. Direct public health care B. Medicaid C. State employee health benefits D. State Children's Health Insurance Program (SCHIP)

B

Cryptosporidium can become a problem in municipal water supplies because it: A. Bioaccumulates in fish B. Can survive the chlorine treatment process C. Can infect the lungs when water is vaporized such as in a shower D. Can bore directly through the skin

B

Bias

Bias: systematic error in the design or conduct of a study -The systematic error arises from flaws either in the method of selection of study participants (effect: selection bias) or -Procedures for gathering exposure/disease information (effect: Misclassification bias) -Effect of a bias: Erroneous results leading to misleading conclusions

A crucial step for establishing positive team interdependence is: A. Determining deadlines B. Attending group meetings C. Establishing group member roles D. Managing communication patterns

C

Disease: Sleeping sickness

Causative Agent: Trypanosoma brucei Vector(s): Glossina spp. Common Name: Tsetse fly Transmission: Biological

In the US, which is the largest source of radiation to the general public? A. Automobiles B. Radon Gas C. Medical use of x-rays D. Nuclear waste

C- medical use of X-rays

Multiple Intervention Strategies for Program Planners

Can include: -Health communication -health education -health policy -environmental change -health related community service -community mobilization

Disease: Yellow Fever

Causative Agent: Yellow fever virus Vector(s): Aedes aegypti, Aedes albopictus Common name: Mosquito Transmission: Biologica

Disease: Lyme Disease

Causative Agent: Borrelia burgdorferi Vector(s): Ixodes scapularis Common Name: Deer tick Transmission: Biological

Disease: Trachoma

Causative Agent: Chlamydia trachomatis Vector(s): Musca domestica Common Name: Housefly Transmission: Mechanical

Risk factors are:

Characteristics, attributes, or exposures such as hypertension, unsafe sex, alcohol consumption, unsafe water that can increase the likelihood of developing disease or injury.

critical consciousness

Community members discuss the root causes of problems and plan actions to address them

Empowerment

Community members gain or expand their own power to create change

Exposure:

Contact with a disease-causing factor Ex. Obesity, alcohol, smoking, etc Multiple exposures may play a role in one disease.

Exposure

Contact with a hazard

A key public health tool used to plan for emergencies is_____________. Often used when addressing live audiences.

Convello's Message Maps Message Maps allow everyone charged with sharing information to work in sync. Messages are presented in 3 short messages in fewer than 27 words each. This approximates to one "sound bite" in typical broadcast media.

Determining whether to continue or modify but not terminate a program is a reasonable objective of a: A. Formative evaluation B. Summative evaluation C. Qualitative evaluation D. Quantitative evaluation

Correct Answer A

Nuclear Waste Policy Act of 1982

Created in 1982, and delegated responsibility for high level radioactive waste management to the federal government and designated the U.S. Department of Energy as the agency to coordinate efforts to site, construct, and operate permanent repositories for nuclear waste products.

Leading by example best exemplifies which of the following styles of leadership: A. Strategic B. Visionary C. Delegative D. Participative

D

The times observed for completing a sorting task are scored in terms of order to finish. This is an example of: A. Continuous data B. Interval data C. Nominal data D. Ordinal data

D

What is the portal of entry for carbon monoxide poisoning? A. Dermal B. Transplacental C. Oral D. Respiratory/Inhalation

D

If a food contaminated with a virus, such as hepatitis A, is left out for 4 hours in a kitchen at a temperature of 85 degrees Fahrenheit, the virus count in the food: (A) Increases exponentially because viruses multiply rapidly under these conditions (B) Increases slowly because the food temperature is still not as high as body temperature (C) Can increase or remain the same depending on the acidity of the food (D) Does not change

D. Viruses can ONLY grow in living cells and will not multiply under these circumstances. (Bacteria is different than viruses).

Have an Action Plan (program planning)

Details as to WHO will do what, WHEN, WHAT, will be NEEDED, BARRIERS, COLLABORATORS/ who should be involved. *really important*

Planning Models

Defined as visual representations and descriptions of steps or phases in the planning process and are the means by which structure and organization are given to the successful development and delivery of health promotion programs. All planning models have the components of the Generalized Model.

Water Quality: Point Source

Direct discharge into water Sewer treatment plants, dumping toxins, & industrial facilities

Pandemic

Disease that occurs over a wide geographic area and affects a very high proportion of the population.

Evaluation in public health begins with..

Engaging stakeholders and determining what metrics will count

Public Health: Assurance

Evaluate Assure competent workforce Link to/ provide care Enforce Laws

Comprehensive Air Quality Act of 1967

First attempt to develop a regional approach for the control of air pollution through the designation of Air Quality Control Regions. Retained oversight of air quality at the level of the states. The Clean Air Act of 1970 ultimately would move power from the level of the states to the level of the federal government, specifically the EPA.

Important Attributes of Public Health:

Focus is on the Population. Emphasis is on Prevention. Orientation is toward the Community. Efforts are directed at Systems. Overarching role is one of Leadership.

What does HACCP stand for?

Hazard Analysis Critical Control Points (HACCP)

Flavivirus:

Hepatitis C, Yellow fever, Dengue fever A genus of viruses that include mosquito-transmitted diseases. Classified as water related because part of the vector's lifestyle occurs in water.

What is the chain of infection a model of?

How pathogenic microorganisms are transmitted from one person to another

Main Steps of a Research Project from a Statistical Point of View

Identify research questions Data collection Data description Modeling Diagnostics Conclusion

Needs and resource assessments:

Identifying, analyzing, and prioritizing the needs of a population

Hill's Criteria for Inferring Causation: Experimental Evidence

If experimental evidence exists, then association is likely to be causal. Such evidence, however, is seldom available in human populations.

Water Quality: Non-Point Solution

Indirect discharge into water

Public Health: Policy Development

Inform, educate, empower Mobilize community partnerships Develop policies

The "emics" Endemic:

Is the ongoing, usual level of, or constant presence of a DDD within a given population or geographic area

The goal is social marketing-

Is to raise the value of the new product relative to the old, in terms of time, money, and other consumer values

The Federalist Papers supported the passage of the U.S. Constitution. Name one of the writers.

James Madison, Alexander Hamilton, John Jay

PRECEDE- PROCEED: Predisposing Factors

Knowledge, attitudes, beliefs etc. that predispose one to change

Most common pathogens associated w/ foodborne dz outbreaks:

Land Animals: Ex: chicken, dairy, beef, pork, Turkey, eggs Causes 44% of foodborne dz Salmonella, Campylobacter, & Listeria monocytogenes Aquatic Animals: Ex: fish, mollusks Causes 27% of dz Scombroid toxin, Ciguatoxin Plants: Ex: broccoli, vegetable row crops, fruits, seeded vegetables, grains and beans, sprouts, root, and underground vegetables Causes 26% of dz Ex: Listeria Monocytogenes (Dewey-Mattia, 2018)

What is the most DEADLY food borne disease?

Listeria Monocytogenes also gets into one's central nervous system (CNS) makes them vulnerable to more complications Pregnant women are 10x more likely to become infected w/ Listeria. Poses a risk to both the woman and the fetus, potentially causing miscarriage, still birth, or pre-term labor and delivery.

Successful Collaborations

Made up of interdependent stakeholders, have a constructive way to deal with differences and or conflicts, share decision-making and power, have expectations and responsibilities clearly defined and mutually agreed upon, through either formal or informal agreements, and acknowledge that the process is fluid and dynamic

Toxic Substances Control Act (1976) (TSCA)

Mandated manufacturers of chemicals to develop safety and health data on chemicals and mixtures and required the EPA to regulate substances and mixtures that may pose risk of injury to health or the environment.

An extension of Mobilizing for Action through Planning & Partnerships (MAPP), called MAP-IT was developed in 2010 to allow communities to implement their own adaptation of Healthy People 2020. The steps for MAP-IT are:

Mobilize Assess Plan Implement Track

Immune System & Immunization

Network of organs, cells, & tissues -Skin -Lymphatic system -Thymus -Bone marrow -Spleen -White Blood Cells (WBCs; Leukocytes)

VOCs (volatile organic compounds) & NOx (nitrogen) + Sun light/heat =

OZONE

MAPP Steps

Organizing for Success & Partnership Development; Visioning; Four MAPP Assessments; Identify Strategic Issues; Formulate Goals & Strategies; The Action Cycle

Federal Water Pollution Control Act of 1972 (FWPCA)

Original legislation that later was renamed the Clean Water Act of 1977. Established national standards for the nations waterways and set limits on allowed pollutant discharges.

The "emics" Epidemic:

Outbreak or occurrence of a DDD from a single source, in a group, population, community or geographical area, in excess of the usual level of expectancy (i.e.- more than what we are used to see)

What are the 2 leading Health Promotion Planning Models?

PRECEDE-PROCEED & Intervention Mapping

2 Planning Models taught by Dr. Liller in her program planning course-

PRECEDE/PROCEED INTERVENTION MAPPING

Louis Pasteur (1822-1895)

Pasteurization Created the very first PH Laboratory in 1888 Sometimes known as the father of Preventative Medicine Showed microbes caused fermentation and spoilage Disproved spontaneous generation of microorganisms Developed pasteurization Demonstrated what is now known as Germ Theory of Disease

Safe Drinking Water Act (1974)

Permits EPA to set standards for drinking water; drinking water issues must be disclosed

T/F: Arthropods are the main factors responsible for biological vector transmission.

True

MAPP Action Cycles

Plan, Implement, & Evaluate

2 Phases of Natural History of Disease-

Pre-pathogenesis: before the disease agent interacts with the host Pathogenesis: after an agent has interacted with the host

PATCH (1983) planning model

Planned Approach to Community Health- CDC model in partnership w/ state and local health departments and local communities to work on community health problems After patch came APEX-PH.

MAPP Action Cycle

Planning, implementation, and evaluation

Strategies in program planning

Plans of action for achieving goals and objectives. Examples: social marketing campaigns, community outreach, etc.

The "Trait Theory"-

Promoted by Ralph Stogdill in the 1930s, expanded on the great man theory by enumerating the personality traits that were necessary for successful leadership, though critics again noted that these did not necessarily have to be innate but could be learned depending on the leadership situation.

Purpose of Cohort Studies

Purpose: Study causes of diseases or outcomes to look at different types of preventions and possibly treatments for diseases Key Feature: Investigator selects subjects according to their exposure levels and follows them to see if they develop the disease/outcome of interest Setting: typically done if a Randomized Control Trial is not ethical, feasible, or is too expensive. Moderate or large effect expected. Good design if little is known about exposure so that we can evaluate/follow it to learn about the many effects of an exposure. Good study design especially if Exposure is rare.

Distribution- Disease Frequency:

Quantification of MMD in the population How often does the MMD occur in the population?

Responsibility Assignment Matrix AKA: RACI matrix/model

R- Responsible A- Accountable C- Consulted I- Informed A responsibility assignment matrix or linear responsibility chart that describes the participation of various roles in completing tasks or deliverables for a project or business process.

Assessments used in research related to Health Literacy are:

Rapid Estimate of Adult Literacy in Medicine (REALM) & the Test of Functional Health Literacy in Adults (TOFHLA)

3 Primary Measures of Association:

Ratio, Proportion, & Rate

Safe Drinking Water Act (1974) (SDWA)

Regulated the public drinking water systems. Allowed the EPA to set Maximum containment levels for water pollutants in drinking water

Functions of Global Health Systems

Regulation Financing (via taxes, premiums and direct payments) Resource allocation Providing services

Measures of Association

Relative risk, risk difference and odds ratio

Clean Water Act (CWA)

Renamed in 1977 to CWA from the Federal Water Pollution Control Act. Established national standards for waterways and set limits on pollutant discharges

Mobilizing for Action through Planning and Partnerships (MAPP)

Replaced APEX-PH Planning Model Steps are: 1.) organizing for success and partnership development 2.) Visioning 3.) Four MAPP Assessments 4.) Identifying strategic issues 5.) Formulating goals and strategies 6.) An action cycle

Community Right to Know Act

Required private and public facilities to report publicly their waste production for hazardous wastes

PRECEDE-PROCEED: Enabling Factors

Resources & new skills to bring about behavior change

IMPORTANT Toxicology Formula

Risk = Toxicity x Exposure

Gold Standard, used to assess communication skills among patients and providers:

Roter Interaction Analysis System (RIAS), allows a trained observer to code interactions of health care providers and patients. This gold standard has been used in hundreds of published studies world wide.

Koch's Postulates

Set of rules for proving that a microorganism causes a specific disease.

Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF)

Seven item word recognition test to provide clinicians with a valid quick assessment of patient health literacy. The REALM-SF has been validated and field tested in diverse research settings and has excellent agreement w/ the 66 item REALM instrument in terms of grade level assignments.

SMART stands for:

Specific, Measurable, Attainable, Realistic, Time-bound

Descriptive Epidemiology

Studies w/ characterizing the amount and distribution of health and disease within a population -outcomes are classified by person, place, and time such as: WHO, WHAT, WHEN, WHERE, WHY -these studies are used to determine hypotheses to be studied later in analytic studies

T/F: *Most teratogens effect the embryo during organogenesis, a critical stage of early development when tissues and organs are formed.*

TRUE

SMART objectives

Targets that are specific, measurable, achievable, realistic and time constrained. Performance measurement is always related to goals and objectives. How each organization performs is primarily measure through quantitative measures from available data. A value matrix may be a useful way to assess the capacities and activities deemed important by stakeholders. Through strong organizational support, joint accountability, and shared measurement, a collaboration can create a transparent environment resulting in better project management and success in achieving the goals and objectives

Which of the Bradford Hill Criteria is most important?

Temporality- exposure must come before disease

The Evidence Base that supports The Guide to Community Preventative Services, found strong evidence for health communication campaigns that use multiple channels. The guide recommends...

That one channel must be mass media combined with the distribution of FREE or reduced price Health related products. As with all recommendations in the "Community Guide", a lack of evidence does not mean that an approach does not work— only that there are sufficient publications demonstrating a clear effect. The community guidelines have also changed since being written in 2009.

Who created the Superfund?

The EPA

Where did the 3 core functions of Public Health come from?

The IOM report titled "the Future of Public Health" in 1988. This report/book was integral to defining public health and details the rich history of PH. Very important document.

Air Pollutants are chemicals in the atmosphere whose concentrations are high enough to cause harm.

True

Federal- State Relationship: true or false The federal government provides important funding (nearly 50%), responds to situations that cross state lines (Ex. Natural disasters, infectious disease outbreaks) and sets broad National guidelines.

True

TRIP stands for

Turning Research Into Practice Clinical search engine database

Effects of Smog: Headaches Shortness of breath/wheezing Asthma attacks Pulmonary inflammation Chest pain Burning eyes & throat (irritated mucus membranes)

U.S. Ozon Limits in ppb: -1997 to 2008: limit was 84 -2008 to present: 75 -New EPA proposal: 60-70

Disability (epidemiology):

Umbrella term for impairments, activity limitations, and participation restrictions

Practitioners are urged to take _________ _________ regarding health literacy, in that understanding should be confirmed with everyone, and no one should be placed in a situation where they feel uncomfortable or judged.

Universal Precautions

VMOSA consists of which of the following?

Vision, Mission, Objectives, Strategies, Action plan

Big Data Characteristics

Volume, Value, Variety, Velocity, and Veracity

Objectives should answer the following questions:

Who, what, how much, and by when

What was the bacteria in the Black Plague?

Yersinia Pestis

Isolation

You have been infected with the disease. Separation of an infected person.

Environmental Teratogens

lead, mercury, PCBs, X-rays 50% unknown 25% multifactorial 7% major environmental 8% monogenic 10% chromosomal

Public Health Assessment:

monitor health, diagnose and investigate

PROCEED stands for

policy, regulatory, and organizational constructs in educational and environmental development

Primary audience-

the person or people to whom your message is addressed, the decision-makers

Cohort Study

(Observational) A of epidemiologic study where a group of exposed individuals (individuals who have been exposed to the potential risk factor) and a group of non-exposed individuals are followed over time to determine the incidence of disease Formal definition: A study in which two or more groups of people that are free of disease and that differ according to the extent of exposure (e.g. exposed and unexposed) are compared with respect to disease incidence. -Cohort Studies are the observational equivalent of experimental studies but the researcher cannot allocate the exposure.

Ozone & the EPA:

*recently the EPA strengthened its guidelines on Ozone* *EPA strengthened the guidelines ~ reduced the NAAQS acceptable level of ground level ozone to 70 parts per billion (ppb) or 0.7 parts per million (ppm) Guidelines- - O.2 ppm for no more than 2 hours exposure -0.1 ppm for 8 hours per day exposure doing light work -0.08 ppm for 8 hours per day exposure doing moderate work -0.05 ppm for 8 hours per day exposure doing heavy work

Incidence Rate (IR)

- # new cases of disease in candidate population divided by person-time of observation Formula: # of new cases of disease / person time of observation - This measure is a TRUE RATE because it directly integrates time into the denominator

Benefits from the detection of early disease depends on..

- Can the disease be detected early? -What are the sensitivity and specificity of the test? -What is the PPV? -How serious is the problem of false positives? -What is the cost of early detection? *Funds, Resources, Emotional Impact -Are subjects harmed by the screening test? -Is there benefit from early detection via screening?

Community Coalition Action Theory

- Includes stages for coalition development - formation, maintenance, and institutionalization. - Includes engagement and consensus-building efforts among diverse organizations and individuals to address community-level issues. - Make sure you have trust and representation of the priority population. -coalitions engage in the core processes that include analyzing the problem, assessing needs and assets, action planning, implementing strategies, and monitoring outcomes

Social marketing in public health is..

- Social marketing incorporates the basic principles of marketing to modify individual behaviors - Public health practitioners and health agencies are in the business of marketing health improvement - The ultimate goal of social marketing is to change the social norms of a community - Public health must convince people to believe that the benefits of changing individual behaviors outweigh personal sacrifices

Dose Time Relationship Acute & Chronic

-Acute Toxicity: the ability of a substance to do systemic damage as a result of a ONE TIME exposure Ex: Hydrogen Sulfide exposure -Chronic Toxicity: the harmful systemic effects produced by LONG TERM, LOW LEVEL exposure to chemicals Ex: Asbestos exposure

Common disinfectants used in water systems:

-Chlorine, -Iodine, -UV Radiation

Individualized Decision Making- Screening Value Judgement

-Risk of Dying -Benefits of Screening -Harms of Screening *False positive results leading to unnecessary interventions and anxiety *Over-diagnosis *Cost *Discomfort *Embarassment -Values and Preferences

Social Justice & Disparities

-Social Justice requires that public health practitioners examine questions of how some groups face disproportionate risk of disease, called health disparities -Public Health practice should examine the fundamental causes of disease, such as environmental conditions, occupational exposures, genetics, or lifestyle factors

PH History- Ancient Greece (500-323 BC)

-importance of personal hygiene -physical fitness *Olympics -Naturalistic concept *disease caused by imbalance between a man and his environment

Morbidity Measures

-incidence -prevalence -attributable risk -relative risk

Chain of Infection Model: (In order w/ examples)

1. Agent AKA- germs Ex- bacteria, viruses, parasites, etc. 2. Reservoir AKA- where germs live Ex- people, animals/pets (dogs, cats, reptiles etc.), wild animals, food, soil, & water 3. Portal of Exit AKA- how germs get out Ex- mouth (vomit, saliva), cuts in the skin (blood), during diapering and toileting (stool) 4. Mode of Transmission AKA- Germs get around Ex- contact (hands, toys, sand), droplets (when you speak, sneeze, or cough) 5. Portal of Entry AKA- how germs get in Ex- mouth, cuts in the skin, eyes, etc. 6. Susceptible Host AKA- next sick person Ex- babies, children, elderly, people with weakened immune systems, unvaccinated individuals, anyone, etc.

Facilitation takes work and in a meeting of multiple stakeholders it becomes important for the facilitator to prioritize his or her role. Above all the facilitator should: 1. Be neutral 2. Focus on the content 3. Take notes 4. Listen to the active speakers

1. Be neutral A facilitators job is to encourage participants of a meeting to contribute ideas not to be weighing in on people's ideas as this may be polarizing.

CLAS Standards (Culturally and Linguistically Appropriate Services) is completed through:

1. Governance, Leadership, and Workforce 2. Communication and Language Assistance 3. Engagement, Continuous Improvement, and Accountability

What is the chain of infection in order?

1. Infectious Agent (causative agent) 2. Reservoir 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6. Susceptible Host

Key considerations when developing or designing an Intervention:

1. Is it an appropriate fit for the group's purpose? 2. Does the intervention strategy make a difference in behavior or outcome? It it effective? 3. Is there sufficient detail to replicate the intervention? 4. Is it simple enough that people can do what is required? 5. Do you have the resources (time, money, & people)? 6. Does it fit with local needs, resources, and values?

Intervention Mapping Steps 1-6

1.) Developing a logic model of the health problem 2.) Developing program outcomes and objectives with a logic model of change 3.) Doing a program design 4.) Producing the program 5.) Developing a program implementation plan 6.) Developing an evaluation plan

Public Health Law: Ethics Section

1.) Moral principles that guide rules for professional behavior 2.) Supports ethics decision making goving you a series of questions designed to provoke rigorous deliberation among ph professionals. a. Analyze ethical issues b. Evaluate the ethical dimensions of the various public health options, and c. Providing justification for one particular ph action

A General Model of Program Planning

1.) Take stock of your community- do a situational analysis (don't rush this), asset mapping (what are the positive strengths within the community? Is it the organizations or the interagency collaborations etc., or a SWOT Analysis (strengths, weaknesses, opportunities, and threats) both internal and external factors, Needs Assessments, Resource Assessment, or maybe several ! 2.) Have a good understanding of Needs 3.) Set Goals and Objectives: Goals- broad statements of intent, while Objectives- are more detailed and focused 4.) Develop the Intervention(s) (use sound theory and logic) 5.) Implement the Intervention(s) 6.) Evaluate the Results If you know these six steps, you essentially know the many planning models.

During an evaluation, what 3 questions are you answering?

1.) are you doing the right thing? 2.) are you doing the right things right? 3.) are you doing enough of the right things to make a difference? Then, you need to be able to measure the change, creating the fourth question.

To inform a policy decision so that an intervention will result in the largest possible number of persons benefitted, which of the following statistics provides the most useful indication of the magnitude of exposure to a factor and subsequent development of disease? 1. Likelihood ratio 2. Absolute risk difference 3. Relative risk ratio 4. Prevalence rate

2. Absolute risk difference Absolute risk difference is simply the difference in outcome rates, subtracting one group's rate from another. It is a more useful indicator of caseload for managers and policymakers. Relative risk is the ratio of the probability of an event occurring in an exposed group to the probability of that event occurring in a comparison, non-exposed group. Dividing one group's rate by another in this manner is useful for identifying risk factors, but the ratio can be large whether the number of persons in each group is big or small, so relative risk is not a good estimator of caseload. Likelihood ratios are more commonly used in relation to interpreting diagnostic tests. Prevalence rates alone can be more cumbersome and are not as informative as incidence rates for diseases that aren't chronic. Studies have shown that people have difficulty making accurate decisions when presented with ratios rather than risk differences.

Microbial food contaminants such as Salmonella, Campylobacter, and E. Coli may multiply rapidly at warm temperatures. What is the "danger zone"?

40 or 41-140 F

Definition of a Community

A community consists of a group of people who share a sense of collective identity, common values, goals, and institutions Communities may be defined by geographic, administrative, cultural, or social boundaries

Usually disease is caused by:

A complex interaction between genes and the environment (genes/biology, disease in the middle, environment/lifestyle)

Chlorofluorocarbons (CFCs)

A family of organic compounds whose properties make them ideal for use in refrigeration and air-conditioning. Are non-toxic, non-flammable chemicals that contains atoms of carbon, chlorine, Florine, that are used in aerosols.

Secondary audience- Health communication

A group that potentially has direct and immediate influence over the primary audience Depending on the primary audience and topic, you may seek out secondary audience figures, such as religious leaders or rock stars. You hope they take up the issue and promote it.

The definition of a population:

A group with common characteristics in terms of person, place, and time. -Fixed: permanent event -Transient/dynamic: condition that can be changed

Six Sigma Quality

A high level of quality associated with approximately 3.4 defective parts per million.

example of cross sectional study

A study that compares the prevalence of high BP among current Massachusetts Turnpike toll booth collectors with the current prevalence of high BP of current turnpike office workers.

Multiple Determinants of Health

A term that refers to the fact that what determines health outcomes arises from multiple places, including the social and economic environment, the physical environment, genetics, medical care, and health-related behaviors. Diagram- Policies and interventions (top) (Middle) Physical environment 1. Behavior 2. Individual 3. Biology Social environment Access to quality health care (bottom

Count data, such as the number of events occurring in a specified period of time, are often described by which probability distribution?

A. Binomial B. Chi-square C. Normal D. Poisson Correct answer: D

Which of the following is the equation for Return on Investment (ROI)?

A. Cost of investment / financial return B. (Financial Return - Cost of Investment) / Cost of Investment C. (Financial Return + Cost of Investment) / Financial Return D. Financial Return / Cost of Investment Correct Answer- B

Teratogens

Agents that induce structural abnormality, growth deficiency, or functional alteration during prenatal development.

State PH Systems

All are organized differently based on: History and geography, politics and political will, the nature of the population, the health system, the needs, challenges, and assets of the state. The Director may be a cabinet appointee, may report to a Board of Health or be buried in a larger umbrella organization. The agency can be large and complex or small and focused. May be centralized or decentralized Relate to local jurisdictions and/or grantees differently

Hill's Criteria for Inferring Causation: Consistency

An association is more likely to be causal when it is observed in different population groups.

The "emics" Pandemic:

An epidemic that is widespread across a country, continent, or a large populace, possibly worldwide (HIV/AIDS)

Executive Board/Committee

An executive board is a formal group whose membership may be elected. It may provide oversight, strategy development, governing, and planning for a larger entity.

Hazard Analysis Critical Control Point (HACCP)

An internationally recognized system for reducing the risk of safety hazards in food.

Strategic Planning:

An organizational management activity that is used to set priorities, focus energy, and resources, strengthen operations, ensure that employees and other stakeholders are working toward common goals, establish agreement around intended outcomes/results, and assess and adjust the organization's direction in response to a changing environment.

The Plague: "Black Death"

At the time of the Black Death epidemic the cause was unknown. Appeared it was spread

What level of government typically provides the oversight and guidance to prioritize public health needs and resources that focuses program planning and evaluation?

Board of Health

The Comprehensive Unit-based Safety Program (CUSP):

CUSP provides a structure to support significant care improvements. This innovative program partners frontline staff, physicians, unit managers, and executive leaders to tackle patient hazards. CUSP is a 5- Step Intervention. CUSP PRE STEPS: Step 1- Assemble a core team Step 2- Choose an executive champion Step 3- Evaluate the safety culture Step 4- Gather unit-based data CUSP STEP 1: Educate staff on the science of safety. CUSP STEP 2: Have staff members identify safety defects CUSP STEP 3: Partner w/ the executive champion CUSP STEP 4: Learn from defects CUSP STEP 5: Implement teamwork tools

Epidemiology as an Observational Science

Capitalizes on naturally occurring situations *we observe the natural phenomena" -Observe exposure and outcomes among people in the real world, Ex: people choose to smoke and they are observed to see the outcomes -different from laboratory science where the researcher is controlling the exposure

Disease: Bilharzia

Causative Agent: Schistosoma mansoni, S. japonicum, S. haematobium Vector(s): Biomphalaria spp., Bulinus spp., Oncomelania spp. Common Name: Snails Transmission: Biological

Precede-Proceed Model

Consists of eight phases that provide a framework for intervention. It is an educational and ecologic model that incorporates planning for evidence-based best practices, interventions, and integration of evaluation methods for improvement of quality.

Which theory is best illustrated by the following statement: "Learning occurs because of a reciprocal interaction of the person, environment, and behavior." A. Social Cognitive Theory (SCT) B. Theory of Planned Behavior C. Diffusion of Innovations Theory D. Transtheoretical Model of Change

Correct Answer- A

Safe Harbor provisions are intended to protect patient privacy by defining: A. The covered entities with which patient data may be shared B. Which data elements to remove to create Dr-identified data sets C. Encryption protocols and internet routes for transmitting data D. Data use agreement provisions for sharing confidential data sets

Correct Answer- B The Safe Harbor Convention defines which data elements to remove from personal health records to create de-identified data sets for the public to use. Safe Harbor has been in place for decades and more recently has proven inadequate. Other legislation, like HIPAA in the US, not Safe Harbor, defines covered entities with which personal health data may be shared directly.

Which condition must be met in order for the Odds Ratio to approximate the Relative Risk? A. The disease must be common B. The disease must be rare C. The exposure must be common D. The exposure must be rare

Correct Answer: B

A budget statement for a public health program provides a detailed itemization of expenses and... A. Fees. B. Taxes. C. Grants. D. Revenue

Correct answer: D

An incremental approach to program planning in public health: A. Uses multiple sources and methods to collect similar information B. Provides an intensive, detailed description and analysis of a single project C. Produces a plan where the specification of every step depends upon the results of previous steps D. Results in plans that may be immediately necessary but may overlap or leave gaps

Correct answer: D Explanation: Issel writes that though the incremental approach to program planning may address an immediate need (I.e.: closing bathhouses in the early days of the HIV/AIDS epidemic) it may also leave gaps (i.e.: did not identify the virus). The incremental approach to program planning will address only part of the problem, may be the result of disjointed efforts and leave many factors unaccounted for.

Comprehensive Environmental Response Compensational and Liability Act (CERLA):

Created with the intent of providing cleanup of existing inactive and abandoned hazardous waste sites through the creation of superfunds. Was strengthened by the Superfund Amendments and are authorization Act of 1986.

Stakeholder involvement and feedback:

Critical to development of the program and the vision, mission, objectives, strategies, and actions (VMOSA).

PRECEDE-PROCEED: Phase 4

Crucial phase- where you determine if administration is going to be favorable to your program, how much money/budget, the resources, what policies are in place etc. the more aligned you are with policy and administration, the better off your program will be !!! administrative and policy assessment and intervention alignment Educational Strategies for the program along with the administrative and policy factors; budgets and resources

When the accumulation of rain flows over roadways and grasses, it washes pollutants, into local bodies of water. How is this pollution classified? A. Organophosphate pollution B. Chlorofluorocarbon pollution C. Point Source Pollution D. Non-point source Pollution

D

Which of the following is defined as a community's ability to survive, adapt and thrive? A. Community capital B. Community development C. Community organization D. Community capacity

D

Planning Model: MAP-IT

Developed in 2010 to allow communities to implement their own adaptation of Healthy People 2020 Steps are: Mobilize Assess Plan Implement Track

Health Communication- "Engagement"

Engagement refers to creating a level of trust and familiarity toward individuals before informing or attempting to persuade.

History of Epidemiology:

Epidemics throughout time led to description and investigation of communicable diseases *John Snow (cholera- Broad Street London Pump) *Black Death *Edward Jenner *Influenza

Mortality-

Epidemiologic term for death. Types of Mortality Calculations: -Crude MR -Age Specific MR -Cause Specific MR -Infant MR

Mortality:

Epidemiological term for death Types of Mortality: -Crude MR: # of deaths from ALLL causes -Age Specific MR: # of deaths from all causes in a specific age group -Cause Specific MR: # of deaths from a specific cause -Infant MR: # of deaths of infants less than 1 years of age

Randomized Controlled Trial (RCTs)

Experimental Study, investigator does assign an exposure randomly to groups -RCTs investigate the role of some "agent" in the prevention or treatment of disease -The agent can be a treatment, screening program, intervention, etc. -The investigator "controls" the agent -It is because of this "control" that the RCT is considered the "gold standard" of all Epidemiologic studies.

Social marketing approach for communication in public health-

Focuses on the needs and wants of the intended recipient of the communication

Impact of Different factors on risk of premature death (came out in New England Journal): To improve health, focusing on healthcare alone is not enough.

Health care is 10% Social and Environmental Factors 20% Individual Behavior 40% Genetics 30%! And while healthcare is important, it can't be the only thing we focus on to reduce premature death. Majority rests w/ one's behavior/lifestyle as a major risk factor.

According to Robert Hornik, what is the largest error in health communication campaigns?

Inadequate reach, with often less than 50% of the intended audience receiving the message. The next question is related to dose- there is no known "dose" set for health communication programs to determine how well their intended message was received.

Collective Impact Framework

Includes 5 conditions that have been shown to lead to success in collaborative efforts— 1. A common agenda 2. Shared measurement systems 3. Mutually reinforcing activities 4. Continuous communication 5. Backbone support organizations The idea of "mutually reinforcing activities" as described by Kania and Kramer emphasizes that diverse stakeholders working together will accomplish the MOST if each participant undertakes the specific set of activities at which it excels in a way that supports and is coordinated with the actions of others .. differentiated activities through a mutually reinforcing plan of action." Thus the activities fall within an overarching plan.

Indicators & Measures

Indicators are used to determine if a program is implementing their program as expected and achieving their outcomes. They show progress towards a specific goal and/or objective. They must be precise, documentable, and/or measurable.

3 ethical principles of the Belmont Report set forth in 1979:

Justice, beneficence, and respect for people These principles serve as the cornerstone of current guidelines for ethical treatment of humans subjects in research. Created by the former U.S. Department of Health, Education, and Welfare (now the Department of Health and Human Services), the Belmont report was entitled: "Ethical Principles and Guidelines for the Protection of Human Subjects of Research" and is an important historical document in the field of medical ethics. Dated April 18, 1979, the document is named for the Belmont Conference Center, where it was drafted.

What led to the first State Board of Health in the U.S. and where did it occur?

Lemuel Shattuck's report to the Sanitary Commission of Massachusetts MA has the oldest PH dept (1869).

Median:

Median is one measure of central tendency of a dataset. To find the median of a set of values, the values MUST first be arranged in ascending or descending order. The median is the data point at which there are equal numbers of data points above and below. Example- a data set has 11 data points in total. When arranged in ascending order, there are five data points below and five data points above so the one left is the median. If there were an even number of values in the data set, the Median would be the mean of the two middle values.

Public Health Communication- Mediums and Channels, what are they/definitions:

Messages are shared through mediums such as sound, print, visual images, and are disseminated through a channel such as speaking, radio, magazines, and social media. The components work together so that others perceive what the original sender intended as the meaning.

Incidence-

Number of NEW cases or disease that develop in a population AT RISK during a specified time period. When discussing incidence, these 3 key concepts MUST be considered: -NEW disease events, or for diseases that can occur more than once *usually first occurrence of disease -Population AT RISK (candidate population) CANT have disease already, should have relevant organs Ex: we would not calculate incidence of prostate cancer with women in the denominator b/c women don't have a prostate -TIME must pass for a person to move from health to disease 2 Types of Incidence covered in this- Cumulative Incidence (CI) & Incidence Rate (IR)

Prevalence-

Number of existing cases of disease / Number in total population (at a point or during a period of time) Ex- City A has 7,000 people w/ arthritis on January 1st, 2009 -Population of City A = 70,000 -Prevalence of arthritis on January 1st 7,000 / 70,000 = .10 x 100 = 10%

VMOSA: Objectives-

Objectives are much more specific than vision and mission statements. They should answer the questions of: Who, what, how much, and by when These objectives can be behavior-, community-, and process oriented, which is related to how the program will be implemented. Examples: colon cancer example are: 60% of the population aged 50 years and older (who and how much) will have a colonoscopy done (what) within 3 years of the program and repeated within a 10 year period (by when). A community objective might be that there will be a 50% increase in the number of health centers (who, what, how much) that offer colonoscopy within 5 years of the program (by when). A process objective (related to activities) would be that 10 health educators will be hired by the health department (who and how much) to participate in the colon cancer prevention activities (what) three months before the start of the program (by when). SMART Objectives are specific, measurable, achievable, relevant, and time limited.

The Epidemiologic Triangle

One of the long-standing models used to describe the etiology of infectious diseases Includes three major factors: agent, host, and environment (illustrates the relationship between these factors)

Balance: Public Good vs. Individual Rights (PH Law)

PH intervention: Childhood vaccinations Public Good: Reduce vaccine preventable disease incidence Individual Right: Religious freedom (1st Amendment); parental autonomy PH Intervention: Helmet Laws (Florida) Public Good: Reduce death and head injury Individual Right: Violation of "personal freedom" according to Gov. Jeb Bush)- was repealed because of this PH Intervention: Mandate Of Flu Vaccine for Health Care Workers Public Good: controlling influenza outbreaks Individual Right: Due process (5th & 14th Amendments); right to free exercise of religion (1st Amendment) PH intervention: Quarantine/Isolation Public Good: Infectious DZ control Individual Right: Freedom of movement; due process (5th & 14th Amendment) PH Intervention: Ban on Handguns in Homes Public Good: controlling gun violence Individual Right: 2nd Amendment "protects an individual's right to bear arms"

The relationship between incidence and prevalence:

Prevalence is related to incidence and duration Prevalence = incidence x duration of disease 1. Incidence decreases but people are living longer with the disease = increased prevalence 2. The incidence increases but the duration is short = decreased prevalence 3. The incidence decreases and the duration is short = decreased prevalence

The 4 P's of Public Health Social Marketing:

Price, Promotion, Place, & Product

Four P's of Social Marketing:

Price- the products price in terms of time, money, and other consumer values Place- the physical location such as its positioning or HOW the consumer sees the PRODUCT serving their needs, and the PROMOTIONAL strategy Price, place, product, & promotion

3 Modes of Public Health Prevention

Primary, Secondary, Tertiary Primary- prevention of disease before it occurs —-targets pre-Pathogenesis, EX: vaccinations, seatbelts & bike helmets, preventing the development of risk factors, encouraging healthy eating, sunscreen, etc. Secondary- activities to limit the progression of disease or identifying disease before it becomes serious —- occurs during the EARLY Stages of Pathogenesis; EX: mammography, newborn screening, BMI screening, blood pressure management Tertiary- programs or interventions focused on restoring function and preventing further complications —- occurs in the LATER stages of Pathogenesis EX: rehabilitation programs for strokes or fractures, medications to lower sugar for diabetes, physical therapy, etc.

As collaborators move forward with implementing changes, it is important to have a system of:

Shared accountability and performance measurements Short term and long term goals help the group to continue to build on successes and maintain momentum and will indicate if the strategies seem to be working. This can be accomplished through creating logic models and using planning frameworks.

Resource Conservation and Recovery Act (RCRA)

Similar to CERCLA, but prevents hazardous waste problems at active sites. Identifies hazardous waste under the criteria of ignitability, corrosivity, reactivity, and toxicity, and tracks from generation, transportation, treatment, storage, and disposal in a cradle to grave system. It also mandated the accurate record keeping of all these steps of hazardous waste management.

Situation Analysis (Context- implement context specific health interventions based on situation analysis and organized goals)

Situation analysis refers to the consideration of community demographic, social, and economic parameters in any given community In conjunction with the highest priority issues, goals and resources of the planning committee. It is a critical step in which program planners "take stock" of the community and all of the related elements as planning begins to provide the needed context for planning.

Objectives

Specific, focused statements detailing how to achieve the organization's goals.

T/F: There are more than 3,000 species of mosquitoes worldwide.

TRUE

T/F: today, municipalities are responsible for solid waste disposal- including recycling, composting, landfilling, and combustion.

TRUE

Drinking Water Standards are regulated by:

The EPA Several pathogens are regulated by the EPA: -Cryptosporidium -Giardia lamblia -Legionella -Enteric viruses

Public Health Ancient Rome

The Roman empire spent loads of money on bringing clean water into people's homes since they thought that unclean water caused illnesses. Ancient Rome built sewers, toilets and public baths to bring the waste out of people's homes

ASPH defined leadership as:

The ability to create and communicate a shared vision for a changing future; champion solutions to organizational and community challenges; and energize commitment to goals.

Policy Advocacy

The actions of a group to raise awareness or influence public opinion for or against policies or proposed policy changes This can be executed via media campaigns, PSAs, official proclamations, public demonstrations, or other highly visible events or through the distribution of information via various communication channels (publications, presentations, print or online)

Goals

The broad, long-term accomplishments an organization wishes to attain.

Public Health Ethics

The discipline that examines what practices make good conduct in a particular situation or dilemma

Vectorial Capacity

The key metric that determines if a given insect can serve as an efficient biological vector is known as its vectorial capacity. VC is determined by several variables and can be calculated by using the following formula: V= {ma^2 p^nb / -1n p} In this formula, V is the overall vectorial capacity; m is the density (number of vectors per acre) of the vector; a is the probability the vector will feed on the vertebrate host of interest for the pathogen (in public health this is generally humans); and p is the daily survival probability (the chance that an individual insect will live to see another day), n is the extrinsic incubation period (the time in days that it takes from when a vector insect takes an infected blood meal for the pathogen to develop in the insect to the point where it can be transmitted to another susceptible host. Or, simply put, n is the time it takes for an INFECTED vector to become INFECTIOUS. Finally, b is the competence of the vector. This can be thought of as the proportion of vectors that take up the pathogen that actually become infectious.

Likelihood Ratio (LR)

The likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder. Used in relation to interpreting diagnostic tests.

VMOSA Mission:

The mission describes what the group is actually going to do and why. Mission statements are more concrete than vision statements, they should be One Sentence, Outcome- Oriented, and Inclusive. A mission statement related to the previous vision of a colon free community might be: "Build primary and secondary prevention of colon cancer through comprehensive community and state health initiatives"

Secondary audience-

The ones influencing the primary audience Remember the practice vignette about co-sleeping.

Epidemiology:

The study (scientific, systematic, and data driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhoods, schools, city, state, country, global).

What is epidemiology?

The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems. Epidemiology uses statistical principles to evaluate the health of a population. These evaluations may include: mortality, morbidity, disease, within specific groups, cultures, races, frequency of disease and determinants. Epidemiology seeks to determine who, what, when, where, and why.

PH Communication/ Social Marketing Definition Impressions-

The term for exposure of content on a channel such as print ads or TV spots. Ex- website analytics have tracking services that can provide accurate counts of impressions.

Federal Level of Government in PH AKA- "Federalism"

The term used to support that the constitution of the US establishes authority to enact laws, including those pertaining to public health The distribution of powers between the states and the federal government

The 6 criteria air pollutant threshold limits are revised every 5 years.

True

True/False: Public Health professionals seek to break any leg of the Epi. Triangle or break any link in the Chain of Infection to prevent disease and transmission.

True

VOCs stand for:

Volatile Organic Compounds

1915 Welch-Rose Report

Welch-Rose Report commissioned by the Rockefeller Foundation laid the blue ring for schools of public health in the United States. This is a sentinel event in public health, because it's when schools of public health first started being created.

Hill's Criteria for Inferring Causation: Specificity

When an exposure is associated with a specific outcome (ONLY), For example, a cancer site or even better a particular histological type of cancer, then it is more likely to be causal. There are exceptions, however, for example, smoking causing several forms of cancer.

Diagnostic Testing

Why is this topic so important? -Directs decision-making * appropriate treatment * prognosis -Based on known information * what is the probability or likelihood of disease? * what is the probability or likelihood of no disease? Calculation Heavy

A British Epidemiologist who is known as one of the founders of medical statistics? Additionally, his research on Cholera and the River Thames was vital to our understanding of disease spread. He subscribed to the conventional theory that cholera was carried by polluted air rather than water. This is known as the Miasmic Theory.

William Farr His research on cholera and the River Thames was vital to our understanding of disease spread.

MAP-IT (2010) Program

a planning guide or model used to assist communities in adapting Healthy People 2020 Steps: Mobilize, Assess, Plan, Implement, & Track

Artificial Immunity (Active)

antibodies developed in response to a vaccination

The Natural History of Disease

course or progression of a disease process from onset to resolution

Calculate attributable risk:

incidence in exposed - incidence in unexposed

The National CLAS Standards-

national standards for culturally and linguistically appropriate services in health care

Ppm stands for

parts per million

direct contact transmission

person to person transmission

Belmont Report (1979)

summarizes the basic ethical principles and guidelines for the protection of human subjects of research. (Respect for persons, beneficence and justice)

Policy advocacy

the actions or endeavors individuals or groups engage in order to alter public opinion in favor or in opposition to a certain policy Examples: media campaigns

Risk

the probability that a hazard will cause a harmful response

Determinants of health

the range of personal, social, economic, and environmental factors that influence health status Biological, environmental, behavioral, organizational, political, and social factors

The Love Canal

toxic waste site in New York filled with drums of waste that leaked.

vehicle transmission

transmission by an inanimate reservoir (food, water, air)

Cryptosporidium

transmitted via feces; causes waterborne illness Crypto is a microscopic parasite that causes diarrheal disease.

Lethal Dose (LD50)

• Most common measure for ACUTE Toxicity • The dose level at which 50% of the test population will die.

McKinsey 7-S Framework

Developed by Thomas Peters & Robert Watwrman, places shared values at the center and then interconnects three hard elements (strategy, structure, and systems) and three soft elements (skills, style, and staff) to create a model for leadership within an organization or within a community. Shared values is the center and then strategy, structure, systems, skills, style, and staff form an interconnected circle surrounding the center.

Passive Immunity

Develops after you receive antibodies from someone or somewhere else

Passive immunity:

Develops in response to an infection or vaccination Can either be natural or artificial

Transformational theories

Focus on the relationship leaders develop with others, the intrinsic personality characteristics and traits of leaders, leadership roles, and team motivation.

Challenges to Program Implementation

-can be mitigated by ensuring ample consideration in advance during the planning stages Challenges can include: funding, fidelity of implementation, staffing, communication problems, and low participation.

PH History- Sanitation Revolution

-clean water; water treatment -food inspection -soaps, disinfectant, and pharmaceuticals -personal hygiene (bathing) -Public work departments, garbage collection, landfills, and street cleaning -Public health departments and regulations

Bradford Hill Criteria for Causality is useful for:

-critically reading Epidemiologic studies -designing studies -interpreting the results of studies

Mortality Measures

-crude MR -age specific MR -cause specific MR -Infant MR

Globilization

-emerging infectious disease -reemergence of infectious diseases -emergence of chronic conditions -growing mental health challenges -health disparities between industrial and non-industrial countries (mirror or are mirrored by economic disparities)

Performance Measurement

Answers "what works." Gives the opportunity to assess the types and levels of contribution of f each organization in the collaboration. These measures of contribution can include each organization's contribution of time, staff, leadership roles, services, referrals, funding etc. Performance measurement can be a means to achieve quality improvement and track progress

Sentinel Events in Public Health

-the Plague or the Black Death -1798 Edward Jenner & the smallpox vaccine -1832 cholera epidemic and John Snow -1881-1914 the Panama Canal -The 1918 Influenza Pandemic -The 1952 London Fog -Minimata Disease, 1956: Minimata, Japan

Ten Greatest Public Health Achievements of the 20th Century (1900-1999)

-vaccination -motor-vehicle safety -safer workplaces -control of infectious diseases -decline in deaths from coronary heart disease and stroke -safer and healthier foods -healthier mothers and babies -family planning -fluoridation of drinking water -recognition of tobacco use as a health hazard

Common State Health Functions (typically in health departments):

-vaccinations - tobacco prevention and control - food safety - emergency preparedness and response -health promotion -hiv/aids and Sti's

Natural Immunity (Active)

Antibodies developed in response to an infection

Artificial Immunity (Passive)

Antibodies received from a medicine, e.g., from a gamma globulin injection or infusion

Natural Immunity (Passive)

Antibodies received from mother, e.g., through breast milk

Logic models

A logic model is a graphic depiction (road map) that presents the shared relationships among the resources, activities, outputs, outcomes and impact for your program. It depicts the relationship between your program's activities and its intended effects.

Hazardous Waste

Any material that can be harmful to human health or the environment if it is not properly disposed of From home: pesticides, cleaning products, paint, auto products, etc. (Most common) Medical waste Industrial hazardous waste (chemicals, solvents, & heavy metals) Radioactive waste Mining waste

MAPP Panning Model

MAPP: Mobilizing for Action Through Planning and Partnerships Consists of: -organizing for success and partnership development -Visioning -4 MAPP Assessments (Community Themes & Strengths Assessment, Local Public Health System Assessment, Community Health Status Assessment, & Forces of Change Assessment) -Strategic Issues -Formulation of Goals and Strategies -Action Cycles- Plan, implement, & evaluate

National Cancer Institute's Health Communication Process Wheel Phases (In detail)

Phase 1- Planning & Strategy Development Phase 1, generally includes analysis of the problem, the ecological setting, the target population(s), the core intervention strategy, and the partnership mix. Formative research is done at this stage, depending on how much is already known about the problem, the solutions, and the intended recipients of the communication Phase 2- Developing & Pretesting Concepts, Messages, and Materials Phase 2, Focuses on developing and producing specific concepts, messages, materials, and media to achieve program objectives Protesting of procedures and materials w/ intended users occurs in this phase. With social media platforms this is no longer a "once and done" activity but tends to reiterate throughout the course of the program Phase 3- Implementing the Program Phase 3, requires a tactical plan defining what will be done, when, where, how, and with what money for each piece of the program. Having partners engaged and ready to do their share is essential before the outset of this phase. Once launched, smart programs monitor key performance indicators to make sure the program is on track Phase 4- Assessing Effectiveness & Making Refinements Phase 4, leads to assessing the outcomes and impact of the program. This is when results will be published as well as shared through various settings w/ stakeholders, the public, media, and so on. As suggested by the wheel shape, the process repeats and what is learned is then applied to the next cycle of programming.

True or False- In Outcome Evaluations, one is generally testing whether exposure to the communication campaign results in the desired behavior change or results in the desired precursor to behavior change, such as knowledge acquisition or attitude change.

True

True/False: The chain of infection helps illustrate, how an infectious agent develops and spreads.

True

T/F: Ground Level Ozone is a principal component of smog.

True; — rest of chemical reactions between VOCs and nitrogen — harmful to human health -responsible for aging lung tissue , reducing resistance to colds, and breathing issues

T/F: As a result of the sanitary movement in the U.S., the mortality rate between 1900-2001 dramatically decreased.

True; life expectancy increased almost 30 years and we believe that only 5 of those years in life expectancy gain were attributable to medical care. The other 25 years of increase in life expectancy was due to public health advancement.

The Plain Writing Act of 2010

requires federal agencies to use clear communication that the public can understand and use. This Act was born out of the ACA 2010. Requires all federal agencies to use clear communication so that citizens may "find what they need, understand what they find, and use what they find to meet their needs.

mortality rate (death rate)

number of deaths per 1,000 people Mortality rates measure the number of deaths in a population within a specific window of time. The numerator is the number of deaths that occur and the denominator is the number of people in the population during that window of time. Highly fatal diseases, such as liver cancer, have a short duration because new cases are added to a population, they are quickly resolved through death. Thus, the numerator for both measures of incidence and mortality will be approximately the same IF the window of time is the SAME.

1964 Surgeon General's Report on Smoking and Health

required labels on cigarettes Surgeon General- Luther Terry (was a smoker but accumulated the evidence of smoking on health) Truly a sentinel event because it shows how a report led to impact products and save lives through policy.

The primary greenhouse gases in the Earth's atmosphere are

water vapor, carbon dioxide, methane, nitrous oxide, and ozone

T/F: the responsibility of the States to ensure that the National Ambient Air Quality Standards (NAAQS) are being met.

True

T/F: the systematic application of health communication science to practice was captured first in the National Cancer Institute's "Pink Book."

True

What is critical for Fidelity of Implementation?

"Fidelity of Implementation" - the program implemented as originally intended and affording to the plan -Training for program implementation and delivery is critical -Provide self-efficacy and morale for program staff -Program quality and fidelity can be managed by using a variety of strategies ranging from group development (for staff) and ongoing training focusing on communication and program processes.

Industrialization and Urbanization 1800s

"New" PH Problems: - Slums - Poverty - Disease - Worse than 1000 years before! - English working class had a life expectancy of 7 years! With science and growth, and technology came growth and industry. Industries were large futures and that meant that people flocked to the cities. Rapid movement of people in cities created crowded living conditions which lead to the frequent and rapid spread of disease and then the Great Sanitary Awakening.

CDC's Media Relations Office developed this tool for scientists to use when publishing studies that will be released to the public...

"Single Overriding Communication Objective" or SOCO Forces authors to present their info in one paragraph, list 3 key facts for their audience to remember, and provide a main message.

Definition of Public Health Law: (Gostin, 2000)

"The Legal powers and duties of the state to assure the conditions for people to be healthy, and... The limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for the protection or promotion of community health"

The US government defines health literacy as...

"The degree to which individuals can obtain, process, understand, and communicate about health related information needed to make informed health decisions." Several frameworks can lay out the determinants, applications, and outcomes for health literacy.

Herd Immunity Vaccine Threshold:

%= the approximate amount of the population to create herd immunity and keep the population safe Disease: Mumps, Threshold: 75-86% Polio, Threshold: 80-86% Smallpox, Threshold: 80-85% Diphtheria, Threshold: 85% Rubella, Threshold: 83-85% Pertussis, Threshold: 92-94% Measles, Threshold: 83-94% Why do we need such high vaccination rates for pertussis and measles? -These are extremely infectious, airborne conditions that can linger in a room for quite a while after. Thus, they demand higher vaccine rates to keep the population safe.

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with States to implement Environmental Standards such as NAAQS? (A) By creating a memorandum of understanding focusing on cost sharing of environmental burdens (B) By establishing air quality monitoring stations (C) By using a State Implementation Plan (SIP) approved by the EPA (D) By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant

(C) By using a State Implementation Plan (SIP) approved by the EPA The Constitutional division of powers between the Federal and State governments means that both levels of government must operate on mutual respect, recognizing that cooperation rather than conflict better serves the public interest. The natural continuum of the environment cuts across geopolitical boundaries and rightly elicits the concerns of both Federal and State governments. To avoid or minimize contradictory measures and standards among States, the Federal government provides the umbrella (uniform) guidance and standards for ambient air quality and requires States to participate in the implementation by developing a plan that meets Federal requirements. That plan is known as the SIP and contains a number of air quality control measures.

Maslow's Hierarchy of Needs

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization Individuals are motivated to satisfy or pursue food, drink, or shelter before focusing on esteem or self-actualization. Hierarchy of needs expresses the basic logic of Abraham Maslow's need-based model of human motivation. This model posits that needs must be met in the following order: physiological needs, safety-security, belongingness, esteem; then self-actualization.

Strategies used to Prevent Epidemics & the Spread of Disease:

* Pasteurization * Disinfection (hand washing) * Barrier contraceptive methods * Antibiotics * Quarantine * Vaccination

Other FEDERAL Agencies w/ public health responsibility or impact:

*Environmental Protection Agency (EPA) *Department of Housing *Department of Agriculture *Department of Homeland Security *Department of Defense *Veterans Affairs *Department of Education *Department of Transportation

Legionella pneumonia

*Spread through contaminated water (Air conditioning system)* Involves the GI tract • First Discovered in 1976 -34 people attending the American Legion bicentennial conference in Philadelphia, PA & died of a severe respiratory like flu disease -the bacteria responsible: Legionella pneumophila -SOURCE: contaminated water that contained the bacteria -Approximately, 8,000 to 18,000 persons are hospitalized with Legionnaires DZ each year in U.S. -Less severe illness called Pontiac Fever can also be caused by this bacteria -Pontiac Michigan Symptoms: headache, cough, high fever, muscle aches, etc. • To prevent major outbreaks: - Proper maintenance of water systems, such as: drinking water systems, hot tubs, air conditioning lines, and a plumbing lines

Clinical instruments to assess health literacy in patients (be familiar generally):

-the Newest Vital Sign -the Numeracy Understanding in Medicine Instrument (NUmi) - the eHealth Literacy Scale (eHEALS)

Types of Validity

- Validity in research is essential so that we know what we are measuring is what we want to measure and we are saying what we expect to be saying about our study 2 Types we Consider in RCTs: -Internal Validity: assesses how well the study was conducted For example, in ALL research studies we take a lot of measurements and they need to be accurate and accurate amongst all participants. So the methods used to measure people must be as rigorous as they can be among all participants. Investigators should be blinded to the intervention as should any assessors and everyone should be trained using a standardized protocol. Another aspect of internal validity is the inclusion and exclusion criteria. A rigorously designed and implemented study has HIGH internal validity and usually has a very long list of inclusion and exclusion criteria. -External Validity: assesses how generalizable the study results are So can our study results be generalized to the Target population or the population we are most interested in? Can the results be replicated under different conditions? In general, the HIGHER the INTERNAL VALIDITY is, the LOWER THE EXTERNAL VALIDITY WILL BE and vice versa. There is always a trade off. If you're testing a new treatment for efficacy in a specific population you need to have HIGH internal validity, but the external validity will be limited as it is only relevant to that specific population that you study. If your implementing a well tested intervention in a community, you will likely have HIGH EXTERNAL VALIDITY, but you're giving up some of that rigor found in the internal validity. It's always a balancing game with these types of studies.

Important Questions that the public wants to know related to non-emergency communication written by Nelson:

- What did you find? (Description) - Why did it happen? (Explanation) - What does it mean? (Interpretation) - What needs to be done about it? (Action)

Threats to Internal Validity (the rigor in which the study is conducted):

- Why is it important? * Prevents the detection of spurious (false) associations * Ensures valid conclusions are made - Threats to internal validity can be lumped into three categories: *Bias *Chance *Confounding

Age of Reason and Enlightenment (1650-1800 AD)

- birth of modern medicine -Era fueled by science and interest in science/finding explanations - Dr. William Harvey *1628 theories of circulation *exploring how the body worked - Edward Jenner *1796 cowpox experiment *coined the term vaccine (vacca, Latin for cow)

Public Health Ancient Greece

- described patterns of disease and their symptoms, but little was known about the causes - Hippocrates disease could be caused by the public (weather, water quality) and by health practices (diet, exercise) - hyper focuses on strict diet and exercise to increase health

Retaining Participants in RCTs

- one of the challenges -really challenging in longer clinical trials -Study requires ACTIVE participation and cooperation of participants —- when designing a study, think about why would participants drop out of a study? Ask yourself, what is the burden on the participant? You want to keep that as minimal as possible by looking at the feasibility and support of the interventions, commitment to the objectives of the study, and you can retain participants through incentives (monetary) or keep participants engaged. Another challenge: -What is you have an unequal number of dropouts in each group? This can cause analytical problems, however this can be dealt with using advanced statistical methodology. However it's something to consider. -What are strategies for increasing compliance? *considered in the Design phase by looking at the intervention itself and the burden of the intervention, the questionnaires, all elements that are done to measure things and then.. *what you can do Throughout the study to keep participants engaged.

Early Public Health Functions:

- sanitation - nuisance control - viral records (birth/death) - quarantine, control of communicable diseases - maternal and child health (children's bureau was established in 1912 and they quickly realized how quickly they needed to have their presence in any other state to promote the health of women's and children.

Federalism & PH Law

-10th Amendment of the U.S. Constitution (Bill of Rights) gives the states ALLLL powers that are *neither given to the federal government *nor prohibited by the Constitution Meaning- if it does not say it in the constitution, the federal government does not do it. Thus, it is up to the States. -Federal preemption *Doctrine giving federal law precedence *Federal preemption occurs in many areas of PH law Meaning- if the Federal Government enacts a law, it is the Law of the Land over State & Local authority. It supersedes/preempts local/state law.

Human Rights and Social Justice

-APHA Code of Ethics has affirmed the right to health as a general ethical principle * Article 25 of the Universal Declaration of Human Rights -Social Justice: * "fair, equitable, and appropriate treatment in light of what is due or owed to groups."

Roman Empire (23 BC - 476 AD)

-Adopted Greek health values -Great engineers *sewage systems *aqueducts to bring clean water into Rome and into the city, and designed advanced plumbing and sewage disposal systems that rival ours today -Administration *public baths *water supply *markets Romans collected taxes to support public systems that's exited the safety of the water supply to create public baths and also that inspected markets and food establishments.

History of Public Health

-Ancient Greece -Roman Empire -Middle Ages -Birth of Modern Medicine -"Great Sanitary Awakening" -Modern Public Health

Influenza & Antigenic Drift

-Antigenic Drift : MINOR * Minor change within subtype *****Point Mutations *Occurs in A and B Subtypes * May cause Epidemics

Influenza & Antigenic Shift

-Antigenic Shift: MAJOR *MAJOR CHANGE ****New Subtype ****Exhange of gene segments *Occurs ONLYYYY in A Subtypes *May cause PANDEMIC

Topics Related to Biological & Genetic Factors that Influence Health-

-Biological Basis for Public Health -Disease Transmission -Immunity -Global Burden of Disease -Human Genetics & Genomics -Injuries and Violence -Physical Environment *Air, water, soil -Social Environment -Food Safety -Hazardous Waste -Chemical Agents -Policies & Federal Law

Chance, Bias, & Confounding:

-Chance is merely random variation, happens no matter what we do. * As we increase the sample size of our study, the impact of chance diminishes. The larger the sample size, the less of a chance of chance affecting our study results. -Bias is usually the unintended mistake of the researcher. * Not lessened or otherwise affected by sample size (increasing sample size won't fix) * Often must prevent/minimize at the design stage, since control during analysis may be difficult/impossible. -Confounding is NOT a mistake, but must be controlled * Also not impacted by sample size * Can be minimized/controlled for in the design and/or analysis phases of a study

Dr. John Snow (1813-1858)

-Classic tale of basic epidemiology -bridges science and social problems -Founding Father of Epidemiology -At the time there were lots of ideas and theories about the disease, but Snow used factual information. -Cholera outbreak in London -Broad Street Pump (removed the pump handle himself) -Snow developed a theory of the source of the outbreak *before people's understanding of the role of bacteria in causing disease *without any of the modern laboratory supports or computer analysis

Confounding:

-Confounding is a distortion in the measure of the association between exposure and outcome - A mixing of effects ** the association between exposure and disease is distorted because it is mixed with the effect of another factor that is associated with the disease. -Confounding is a problem of comparison, a problem that arises when important extraneous factors are differentially distributed across groups that are being compared.

Diagnosis vs. Screening

-Diagnosis *Patient presents w/ symptoms *Suspect a particular disease *Multifactorial *Clinical Decision Making -Screening *Testing is usually conducted independent of symptoms *Univariable *To classify individuals with respect to their likelihood of having a particular disease

Renaissance (1400-1600 AD)

-Disease, spread by traders and explorers -Killed 90% of indigenous people in New World -First glimpse of globalization -heavy emphasis on arts, literature, music, and creative expression Travel opened different worlds to people but also increased smallpox, measles, and typhoid.

Hippocrates (460-377 BC)

-Father of Western Medicine -Causal Relationships *disease and climate, water, lifestyle, and nutrition -Coined the term epidemic *Epis ("on" or "akin to") *Demos ("people")

Local Powers in PH: Home Rule Powers

-Home Rule Authority gives local officials the ability to enact ordinances or regulations that are specific to the community, not otherwise prohibited -some states don't have Home Rule where as some jurisdictions have Home Rule (laws & regulations) Ex: New Orleans banning cigarette smoke in bars to protect the public's health (example of home rule) The state law supersedes the Local Law.

Critical Components of Community Health Practice:

-Identification of Stakeholders -Community Mobilization -Community Assessment -Community Based Participatory Research

Public Health History

-Likely as old as mankind, -water and sanitation, -religious based food and cleansing rituals, ancient Chinese practice of "variolation" exposing otherwise healthy individuals to smallpox in order to inoculate them against acquiring the disease, -theories of disease

State-Local Relations in Public Health

-Local/Decentralized: local health departments are units led by local governments, which make most fiscal decisions -Mixed

Role for Epidemiology in Public Health

-Monitor health of a population -Respond to emerging public health problems -Promote research and use evidence-based interventions -Evaluate the effectiveness of interventions -Findings provide foundations for public health policy -Set funding priorities for research and intervention programs

Toxic Waste Site: The Love Canal

-Near Niagara Falls • disposal of toxic chemicals in 1952 • halogenated organic compounds, chlorobenzenes, and dioxin • high rates of miscarriage, birth defects, and cancer Why is it important? It's a sentinel event in PH History. Illustrated the LINK between hazardous chemicals and human health.

Cumulative Incidence (CI)

-Number of new cases of disease = numerator -Number in candidate population over a specified period of time = denominator -cumulative incidence estimates the probability or risk that a person will develop disease DURING A SPECIFIED TIME -Note that the candidate population is comprised of people who are "at risk" of getting the disease -Used mainly for FIXED POPULATIONS because it assumes that everyone is followed for the entire time period

Water Quality: [slide]

-Organophosphates (Widely used in insecticides) -Chlorofluorocarbons (Volatile organic compounds)

The EPA has set national outdoor air quality standards for the following six common air pollutants:

-Particulate Matter (PM) -Ozone (O3) -Carbon Monoxide (CO) -Nitrogen Dioxide (NO2) -Sulfur Dioxide (SO2) -Lead (Pb)

Other Unique Features of RCTs *Use of Placebo & Blinding: Goals*

-Placebos are used to make the groups as comparable as possible -Blinding: subjects do not know if they are receiving treatment or placebo (single blind); neither subjects nor investigators know who is receiving treatment or placebo (double blind). -Purpose of blinding: to avoid bias in ascertainment of outcome -Placebo allows study to be blind

The Planned Approach to Community Health (PATCH) Model:

-Planning model developed in the mid-1980s by the Centers for Disease Control and Prevention (CDC) in partnership with state and local health departments and several community groups -Capacity building is a very important part of the PATCH model Uses the broad participation of a wide spectrum of people at the local community level in goal determination and action Community health problems are first prioritized, and then community members select the one to address. Phases in the process include community mobilization, data collection and organization, selection of health priorities, intervention plan development and evaluation.

Ethics of Community Planning (Applying to field work)

-Priority setting * A component of health planning that involves the community in decisions related to allocation of scarce resources -Reciprocity * Community input regarding decisions by listening and speaking to the community -Transparency * Not concealing information

Multiple Political Perspectives in Public Health Law

-Public Health practice strategies must be responsive to diverse cultural values *Ideological left *Ideological right *Personal libertarianism *Economic libertarianism First, tension between autonomy and public good. Second, the law. Third, review Multiple perspectives.

More Ethical Concepts in PH

-Public Trust * Avoid interventions that employ force or command without reason -Fiduciary Trust * Serving the public in a way that maintains the public's trust -Conflicts of Interest * Actions regarding a primary interest are influenced by a secondary interest

Federal Government Functions in Public Health

-Regulation -Allocation of funds *major funded of public health efforts at the state and local levels, major purchaser of health care services -Provision of Care *Indian Health Services, Maternal and Child Health, Aging Services -Persuasion *through development of standards and guidelines, training and technical assistance, policy and program direction, and national goals

Middle Ages (476 - 1450 AD) "The Dark Ages"

-Shift away from Greek and Roman values And instead we see a movement toward a more spiritual religious approach to health. The church during this time advocated the idea that faith and prayer were preferred methods to treat illness. *physical body less important than spiritual self *decline of hygiene and sanitation -Important Public Health Advances *Quarantine of ships *Isolation of diseased individuals

Police powers (reserved powers)

-States retain police powers to protect public's health (coercive effects) -Powers exercised by states to: *Enact laws and promulgate regulations *That are used to protect public and to promote the common good *states power to protect the public and promote the public good such as mandatory/compulsory vaccination (Covid-19) *Not to be confused w/police -Contrasted with criminal law powers *PH Law doesn't require probable cause warrants *In PH Law, you can Enforce protections without a court hearing *In PH Law, we operate within a "More probable than not" standard of evidence vs. Criminal Law which operates in "Beyond a Reasonable Doubt"

Dealing with Bias:

-Study Design Stage *Subject selection *Subject/Study personnel blinded to subject status *Training (standardized training, training renewals, etc.) -Data Collection *Everyone a part of the study team should understand the definitions of your exposure and your outcomes *Measurements- what we're using and how we are doing it, standardized protocol *Standardization *Quality Control making sure the data are collected as anticipated, is there missing data, are people filling out the answers correctly, etc.

WHO Recommendations for Screening- Policy Making

-The condition should be an important health problem (prevalence/severity). -There should be a treatment for the condition. -Facilities for diagnosis and treatment should be available. -There should be a latent (asymptomatic stage) stage of the disease. -There should be a test or examination for the condition. -The test should be acceptable to the population. -The natural history of the disease should be adequately understood. -There should be an agreed policy on who to treat. -The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. *Financial, but also non-financial value (anxiety/inconvenience). -Case-finding should be a continuous process, not just a "once and for all project."

The U.S. Dept. Of Health and Human Services

-The largest and most familiar agency dedicated to health, which includes: *Centers for Disease Control and Prevention (CDC) *National Institute of Health (NIH) *Food and Drug Administration (FDA) *Substance Abuse and Mental Health Services Administration *Agency for Health Care Quality and Research (AHCQR) *Agency for Toxic Substances and Disease Registry (ATSDR) *Centers for Medicare and Medicaid Services (CMS) *Health Resource and Services Administration (HRSA) *the Indian Health Service (IHS) *Administration for Children and Families *Administration on Aging

Ecological Study / (Correlational)

-Unit of analysis: population or groups as a whole vs. individual data -Exposure status: Based on the population as a whole -Time can vary -Ecological Fallacy: making assumptions about individuals based on study findings at the population level

Diagnostic Test "Performance"

-There are several potential methods for measuring the performance and clinical value of a test which are linked to characteristics of the rest and of the population examined. -Prevalence = (TP + FN) / Total -Sensitivity = TP / (TP +FN) *assess the True Positives in the population* -Specificity = TN / (TN + FP) *assess the True Negatives in the population* -Positive Predictive Value (PPV) = TP / (TP + FP) -Negative Predictive Value (NPV) = TN / (TN + FN) When looking at the 2x2 Chart and calculating PPV & NPV, you are looking across the chart.

Cross Sectional Study

-Time: Snap-shot in time *if study includes a particular point in time = point prevalence* -Population: individual level -Population: selected without regard to exposure or disease status -Measure: Prevalence of Disease -if we want to calculate a Measure of Association: Odds Ratio One of the drawbacks of the study- -CANNOT DETERMINE CAUSE AND EFFECT Meaning, we cannot determine which came first either the cause or the effect because we are collecting information on both of those things at the same time.

Goal of Randomization in RCTs

-To achieve baseline comparability between compared groups on factors related to outcome -Compared groups are the same EXCEPT for the "treatment" -Randomization provides balance between the groups with respect to known and unknown factors. -The larger the groups, the better randomization works.

Case Control characteristics

-USES ODDS RATIO -participants are chosen on the basis of their disease status -Good for Rare Disease -Good for diseases w/ long latency periods -info collected from both groups about exposures in the past -longitudinal (retrospective- LOOKS BACK to the exposure) -no long term follow up needed -can evaluate multiple exposures

Cohort Study characteristics

-USES RELATIVE RISK -Uses NEW CASES of disease -Good for RARE EXPOSURE -loss to follow up is a problem (selection bias can occur) -Can be Prospective, Retrospective, & Ambi-directional -Better for verifying temporal sequence (cause/exposure preceded the effect/outcome)

Ethical Theories to Support Public Health

-Utilitarianism *Promotes the goal of the "greatest good for the greatest number" -Communitarian *Individuals inseparable from community life and no one person and no one community can ever be completely self-determining (that is we should look at the total vs. the individual rights) Contrary to communitarianism.. -Liberalism *Focuses on individual rights and freedom to choose, seeks to guarantee individual freedom without state infringement on personal choice

22 Public Health Leadership job tasks:

-Utilize critical analysis to prioritize and justify actions and allocation of resources -Apply team building skills -Apply organizational change, management concepts, and skills -Apply conflict management skills -Implement strategies to support and improve team performance. -Apply negotiation skills -Establish and model standards of performance and accountability -Guide organizational decision-making and planning based on internal and external assessments -Prepare professional development plans for self and others -Develop strategies to motivate others for collaborative problem solving, decision -making, and evaluation -Develop capacity-building strategies at the individual, organizational, and community level -Communicate an organization's mission, goals, values, and shared vision to stakeholders - Create teams for implementing health initiatives -Develop a mission, goals, values, and shared vision for a organization or the community in conjunction with key stakeholders -Implement a continuous quality improvement plan a -Develop a continuous quality improvement plan -Evaluate organizational performance in relation to strategic and defined goals -Implement organizational strategic planning processes -Assess organizational policies and procedures regarding working across multiple organizations -Align organizational policies and procedures with regulatory and statutory requirements -Maximize efficiency of programs -Ensure that informatics principles and methods are used in the design of data systems

Federal Government Responsibilities in Public Health

-ensure all levels of government have the capabilities to provide essential public health services -act when health threats span more than one state, region, or the entire nation -act where the solutions may be beyond the jurisdiction of individual states -act to assist the states when they lack the expertise of resources to effectively respond in a public health emergency (natural disaster, bioterrorism, emerging disease, etc.) -Facilitate the formulation of public health goals (in collaboration with state and local governments and other relevant stakeholders) Other Responsibilities: Federal government plays a crucial role in- -providing leadership, through regulatory powers, in setting health *goals *policies *standards -contributing operational and financial resources -financing research and higher education -supporting the development of scientific and technological tools needed to improve the infrastructure and effectiveness of public health at all levels

The Great Sanitary Awakening (1800s-1900s)

-growth in scientific knowledge -humanitarian ideals -connection between poverty and disease -water supply and sewage removal -monitor community health status Poverty, slums, and overcrowded cities led to the frequent and rapid spread of disease which led to people trying to understand how/why/what was happening, which led to the "great sanitary awakening." People noticed the connection between health and their environment. To reduce poverty, address the spread of disease, they linked it back to water and the need to remove sewage and waste. This leads to Dr. John Snow.

Less Common State Health Functions: (likely not in a health dept. but maybe)

-health facility regulation -environmental health -drinking water regulation -substance abuse prevention -health professional licensing -medical examiner/coroner -environmental regulation -mental health -Medicaid -disability services -family planning -school health

Sir Geoffrey Vickers

-historic leader in public health -lawyer, solider, a pioneer in the science of system's analysis, and actually a public health advocate who penned these words for a Lancet article in 1958 really signifying that public health is often shaped by the public's response to circumstances and the situations that affect their health

Analysis of Data from Experimental Studies

-initial analysis always looks like our 2 x 2 Table -Once randomized always analyzes intention to treat -Data is set up like our familiar 2 x 2 table. -Measure of Treatment Effect b/c experimental/clinical trials are measured prospectively: Relative Risk or RD RR = rate in exposed/ rate in unexposed

London Fog or London Smog (1952-3)

-issues with airborne pollutants from factories that fuel the industrial might of London -the smog was so severe that impacted holistic aspects of population quality of life * people couldn't come out of their homes, traffic was stopped, life was cancelled etc. -Helped PH understand the confluence of emerging employment in factories, urbanization, and the economy and its impact on health

Sentinel Event - Influenza 1918

-moved across the globe but really affected troops in WWI -eventually changed the way we thought about infectious disease; quarantine, surveillance, health communications, prevention etc

"Public Health" is the Public's Health

-population health as a focus -it assumes a societal commitment to improving the public's health -focus on the conditions and factors that affect health both individually and in the aggregate rather than focus on disease -the "public's health" is affected by multiple factors, including some not obviously related to health

Congenital Disorders: How many birth defects affect babies born in the U.S. each year?

1 in every 33 babies = approx. 120,000 babies yearly

Chain of Transmission- Six Steps *using the common cold as an example*

1. Causative agent: any microorganism that can cause infection (e.g., the common cold virus) 2. Reservoir or source: The environment where the agent resides; water sources, feces, bodily secretions (e.g., an individual's nasal cavity) 3. Portal of exit: How the agent leaves the reservoir of the host (e.g., when the host sneezes) 4. Mode of transmission: How the agent travels to another host; this may be direct or may include an intermediate or indirect contact (e.g., droplets are inhaled by another individual) 5. Portal of entry: Where the infectious agent enters a susceptible host (e.g., an opening, including the nose or mouth) 6. Susceptible host: Individual or animal that is susceptible to infection (e.g., person w/ low immune system)

Six Sigma Steps Acronym- DMAIC

1. Define- craft a problem statement, goal statement, project charter, process map, or customer requirement. 2. Measure the current process. 3. Analyze the cause of issues. 4. Improve the process. 5. Control

CDC Evaluation Framework

1. Engage stakeholders 2. Describe the program 3. Focus the evaluation design 4. Gather credible evidence 5. Justify conclusions 6. Ensure use and share lessons learned

Tasks in Public Health Communication

1. Ensure health literacy concepts are applied in communication efforts 2. Identify communication gaps 3. Propose recommendations for improving communication processes 4. Exercise a variety of communication strategies and methods targeting specific populations and venues to promote policies and programs 5. Communicate effectively and convey information in a manner that is easily understood by diverse audiences (persons w/ limited English proficiency, those with lowered health literacy skilled or are not literate, individuals with disabilities and those who are deaf or hard of hearing). 6. Choose communication tools and techniques to facilitate discussions and interactions 7. Assess the health literacy of populations served 8. Use risk communication approaches to address public health issues and problems 9. Set communication goals, objectives, and priorities for a project 10. Inform the public about health policies, programs, and resources 11. Apply ethical considerations in developing communication plans and promotional initiatives 12. Create and disseminate educational information relating to specific emerging health issues and priorities to promote policy development 13. Communicate the role of public health within the overall health system (national, state, county, and local government) and its impact on the individual 14. Communicate with colleagues, patients, families, or communities about health disparities and health care disparities 15. Communicate lessons learned to community partners or global constituents 16. Apply facilitation skills in interactions w/ individuals and groups 17. Communicate results of population health needs and asset assessments 18. Communicate with other health professionals in a responsive and responsible manner that supports a team approach to maintaining health of individuals and populations 19. Provide a rationale for program proposals and evaluations to lay, professional, and policy audiences 20. Communicate results of evaluation efforts

5 keys to safer food (WHO)

1. Keep Clean 2. Separate raw and cooked foods 3. Cook foods thoroughly 4. Keep food at safe temperatures -Do not leave food at room temp for more than 2 hours -Refrigerate at less than 5 deg celsius 5. Use safe water and raw materuals

Relationship Between Sensitivity & Specificity

1. Lowering the criterion of positivity results in increased sensitivity, but at the expense of decreased specificity. 2. Making the criterion of positivity more stringent increases the specificity but at the expense of decreased sensitivity. 3. The goal is to have both high sensitivity and high specificity, but this is often not possible or feasible. 4. For continuous data, the decision for the cutpoint involves weighing the consequences of leaving cases undetected (false negatives) against erroneously classifying healthy persons as diseased (false positives). 5. Sensitivity should be increased when the penalty associated with missing a case is high (e.g. minimize false negatives) - when the disease can be spread - when subsequent diagnostic evaluations are associated with minimal cost and risk 6. Specificity should be increased when the costs or risks associated with further diagnostic techniques are substantial (minimize false positives - e.g. positive screen requires that a biopsy be performed)

VERY IMPORTANT In response to the IOM the Future of Public Health Report, the 10 essential PH services were founded:

1. Monitor health 2. Diagnose and investigate Underneath core function- assessment 3. Inform, educate, and empower 4. Mobilize community partnerships 5. Develop policies Underneath core function- policy development 6. Enforce laws 7. Link to/ provide care 8. Assure competent workforce 9. Evaluate 10. Research (system management) Underneath core function: assurance In the middle of this cycle, is: Research/System Management

10 Essential Public Health Services

1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems.

Public Health Leadership in Action: 10 Essential PH Services

1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population based health services. 10. Research for new insights and innovative solutions to health problems.

United Nations Sustainable Development Goals (17 of them):

1. No poverty 2. Zero Hunger 3. Good Health and Well- Beijing 4. Quality education 5. Gender equality 6. Clean water and sanitation 7. Affordable & clean energy 8. Decent work & economic growth 9. Industry, innovation, and infrastructure 10. Reduced inequalities 11. Sustainable cities and communities 12. Responsible consumption and production 13. Climate action 14. Life below water 15. Life on land 16. Peace, Justice, and Strong Institutions 17. Partnerships for the goals

how ozone forms

1. Oxygen in the atmosphere 2. Nitric oxide, byproduct of combustion 3. Sunlight breaks up nitric oxide 4. Ozone formed by three oxygen atoms

3 ethical principles of the Belmont Report

1. Respect for persons -Treat participants as autonomous agents -informed consent, free from coercion 2. Beneficence -Protecting participant well-being -Ensuring benefits of research are greater (>) than the risks 3. Justice -Burdens distributed fairly (distributive Justice) -Participate in decisions (procedural Justice)

What are the Six Core Functions of Patient-Clinician Communication to encourage health outcomes?

1. Responding to emotions 2. Managing uncertainty 3. Enabling patient self management 4. Fostering healing relationships 5. Making decisions 6. Exchanging information The figure looks like a web, and all parts are interrelated and point toward health outcomes.

PRECEDE-PROCEED STEPS

1. Social Assessment: focuses on quality of life of the population 2. Epidemiological assessment: encompasses the health issue and the behavioral, genetic, and environmental issues related to each other and to the quality of life (Phases 1 & 2, respectively) 3. The educational & ecological assessment: with the predisposing, reinforcing, and enabling factors. It is the phase in which the input of theory is important. Predisposing factors include knowledge and affective traits such as attitudes and beliefs that predispose one to change. Enabling factors are those resources and skills that are necessary for behavior change. Also, there are barriers in these categories too. The reinforcing factors involve feedback and reward systems that the program participants receive after their behavior change. 4. Administrative & Policy assessment and intervention alignment: in which the health program is designed and the educational strategies and administrative policy factors need to be taken into consideration. Program budgets and resources are critical in this phase. 5. The Implementation of the program 6-8: Focus on Program Evaluation, from the most immediate or process evaluation to the farthest outcome evaluation.

The Generalized Model in Program Planning..

1. assessing needs: on the basis of the collection & data analysis, what are the health needs within your population? What are the priorities? Are there priority populations that need to be selected for the program? 2. setting goals and objectives: What will happen? A goal is a broad statement of intent whereas objectives are more focused and answer questions such as: who, what, how much, and by when — they are specific, measurable, action oriented, relevant, and time limited (SMART). 3. developing interventions: How will you meet your goals and objectives— is your intervention based on sound theory and logic? 4. implementing interventions: How will you put your intervention into action? 5. evaluating results: What happened? Did the intervention meet its goals and objectives? How can you improve the quality of the program? Did you conduct formative and summarize evaluations? Based on these steps, MOST planning models can be understood.

Robert Koch postulates about microorganisms that cause disease:

1. microorganisms must be present in diseased animal 2. microorganisms must be cultivated in pure culture 3. If microorganisms is introduced into healthy animal it should cause disease symptoms 4. microorganisms isolated from experimental animal should have the same characteristics as the original microorganism.

Health Communication Program Cycle

1. planning and strategy development 2. developing and pretesting concepts, messages, and materials 3. implementing the program 4. assessing effectiveness and making refinements

Phases of PRECEDE-PROCEED

1. social assessment (Quality of Life, don't focus on a health issue for this. Focus on quality of life) 2. epidemiological assessment (Health Issues and Behavioral, Genetic, & Environmental Issues) 3. educational and ecological assessment (includes Predisposing, Reinforcing, and Enabling Factors) Theory is important in this phase!!!! Predisposing Factors- knowledge, attitudes, beliefs, etc. that predisposes one to change Enabling Factors- resources and new skills to bring about behavior change Reinforcing Factors- feedback and reward system for behavior change 4. administrative and policy assessment and intervention alignment Educational strategies for the program along with the administrative and policy factors; budgets and resources 5. implementation 6. program evaluation (Phases 6-8) - from the most immediate or process evaluation (is the program implemented as planned) through the impact evaluation (did your knowledge, attitudes, beliefs, behaviors, and environmental change?) to the farthest outcome evaluation (health and quality of life changes- this phase may take many years because it's the health change and quality of life) 7. impact evaluation 8. outcome evaluation Determine a health issue by what is changeable.

1974 Lalonde Report - "The White Paper"

10 years after the 1964, Surgeon General's Report on Smoking and Health," in Canada Marc Lalonde (secretary of health for the nation of Canada) wrote a very important report titled: "1972 Lalonde Report on the Health of Canadians" which reframed how we address public health from a disease control perspective to a health promotion perspective. He doesn't just link biology and healthcare to health but discussed the impact of the environment and lifestyle. The Lalonde Framework diagram includes 4 tenets that surround Health (the word Health is in the middle of the diagram): Human Biology, Health Care Organization, Lifestyle, and Environment.

U.S. Sanitary Reform-

1850 "Report of the Sanitary Commission of Massachusetts" 1869 MA State Board of Health Health records, vital public health statistics as tools to fight disease System of sanitary inspection. Vaccination programs

When did the EPA ban DDT?

1972

An anti-vaccine group is pressuring government to stop requiring vaccination of children because the disease incidence rate has become very low. The health department is defending the vaccination stance and looking for a way to explain this to legislators. In terms of systems theory, the relationship over time between required vaccination and decrease in incidence rate is a: 1) Positive feedback loop 2) Outflow effect 3) Negative feedback loop 4) Inflow effect

3) negative feedback loop Explanation: according to systems theory, negative feedback loops are patterns of interaction where results to a change in an original element dampens or buffers its effect. Positive feedback loops on the other hand, are patterns of interaction where results to a change in an original element magnifies (reinforces) its effect, thus moving a system away from its equilibrium state.

Causality Model- Bradford Hill Criteria

9 aspects of association: 1. Strength of association 2. Consistency 3. Specificity 4. Temporality 5. Biological gradient 6. Plausibility 7. Coherence 8. Experiment 9. Analogy

A researcher wants to conduct a study of hookah use in a college town. He plans to use the PRECEDE-PROCEED Planning Model. Which of the following is an example of a reinforcing factor in this situation? A. Feeling relaxed after using hookah B. Self-efficacy to decline using hookah C. Having multiple hookah cafes around campus D. Knowledge of the health effects of hookah use

A

In 1980, the U.S. Congress enacted the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), which is commonly known as: A. Superfund B. Clean Indoor Air C. Environmental Protection D. Resource Conservation

A

New vaccines for influenza must be developed every year because: (A) Mutations result in new strains of the virus that are not affected by existing vaccines. (B) The virus produces enzymes that break down existing vaccines (C) The human body produces enzymes that break down existing vaccines (D) The human body produces antibodies that inactivate the vaccine

A

Recreational water quality in the United States is most affected by which of the following types of pollution? A. Urban run off after a rain event B. Factory wastewater C. Oil spilled from boat motors D. organic decomposition from weeds and rushes

A

Which of the following is a common threat to validity with adapting an evidence based practice to a specific population? A. Maintaining fidelity B. Obtaining grantor approval C. Having resources available D. Achieving community uptake

A

Arthropods

A group of organisms that have jointed appendages, an exoskeleton, bilateral symmetry, and reproduce sexually; insects, arachnids, millipedes and cenitpedes, and crustaceans Invertebrate animals such as spiders, crustaceans, insects, etc. most bite the host creating a wound that serves as that portal of entry.

Population

A group of people with a common characteristic in terms of person, place, and time (e.g., age, sex, geography, religion, education, occupation, behaviors, life course, etc.) Types of Population- Fixed: membership based on an event which is PERMANENT (Ex: all babies born in Tampa in 2018) Transient/Dynamic: membership based on a condition that can change (Ex: students of a particular university or members of a gym)

Health communication interventions do well when..

A 15-percentage-point change is generally measured within a year of the program onset.

Hill's Criteria for Inferring Causation: Coherence

A cause and effect interpretation of an association should not conflict with what is known about the natural history and biology of the disease, or its distribution in time or place.

Hill's Criteria for Inferring Causation: Temporality

A cause should NOT precede the outcome (disease), but also the timing of the exposure should be compatible with the latency period (in non-infectious disease) or the incubation period (in infectious disease).

Parens Patriae

A legal doctrine that gives the state the authority to act in a child's best interest or an individual who is elderly and cannot care, advocate for themselves and require assistance.

Coalition

A coalition is a formal alliance of organization that act jointly. They have a clearly defined leadership structure and may have shared or pooled resources. They can be time limited or sustained over a long period of time. Coalitions can be created at the community, state, regional, or national level.

Patient-centeredness in Health Communication

A defining principle that places the patient's needs and abilities at the heart of any communication encounter, whether clinical or in public health Reference- 6 core functions of patient clinician communication to improve health outcomes 1. Responding to emotions 2. Managing uncertainty 3. Enabling patient self management 4. Fostering healing relationships 5. Making decisions 6. Exchanging information

contingency leadership model

A model that determines if a leader's style is (1) task-oriented or (2) relationship-oriented and if that style is effective for the situation at hand

Program Planning Models- Assessment Protocol for Excellence in Public Health (APEX-PH)

A project among several public health organizations including CDC, APHA, and National Association of County and City Health Officials (NACCHO). This planning model is used specifically for LOCAL health departments. The MAPP (mobilizing for action through planning and partnerships) Model essentially replaced APEX-PH.

Hill's Criteria for Inferring Causation: Strength

A strong association is more likely to be causal. The MEASURE of strength of an association is the Relative Risk (RR) and NOT statistical significance.

Trait-based Leadership Theory

A theory of leadership that tries to reveal a set of universal traits and skills that are relevant in all leadership situations. Primarily concerned w/ traits that distinguish leaders from other people and the magnitude of differences between the two groups. Early trait based approaches posited that leaders possessed innate heritable qualities that differentiated them from the general population. Later, research on leadership emphasized behavior rather than traits. More recent literature focuses on a combo of traits and behaviors, but has not explicitly identified a set of traits, innate or otherwise, that constitute a leader.

Path-Goal Theory of Leadership

A theory that states that the most important aspect in leadership is the follower's expectation that a task can be accomplished and that it will lead to rewards.

In most cases, a planning process should begin with...

A thorough needs assessment because needs assessments provide a logical place to start the process, help ensure the appropriate use of planning resources, identify important public health problems, determine the capacity of a community to address a specific need, and provide a focus for the development of a resulting intervention Sometimes, a needs assessment isn't needed if there has been one completed recently, funding is readily available to address a specific issue or the planners employee has specified the need.

Case Control Study

A type of epidemiologic study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls Observational study Good if: -Disease is RARE -Disease has a LONG induction and LATENCY period -Little is known about the disease -Selection of the cases -Selection of the controls -Typically sampling on whether or not individuals have your outcome of interest. We recruit out individuals based on whether or not they have our condition/outcome of interest. Then we look back to see if they had our exposure of interest.

Evaluation Plan Methods Grid

A useful tool to delineate roles and responsibilities of stakeholders along with shared understanding of the evaluation plan Shown on page 156 of study book It's a table that has the evaluation question, followed by the indicator/performance measure, method, data source, frequency, and responsibility.

What is a z-score?

A z-score (or standard score) is the number of standard deviations a particular score is / away from the sample mean. (2 marks)

Ascertaining the Outcome in RCTs:

A) Goals -High follow-up rates: don't lose people, we want to retain them -Uniform follow-up for compared groups: must be equally vigilant in follow-up in all compared groups B) Penalty of non-uniform ascertainment puts the study at risk of the of the outcome to be BIAS

The infectious agent that causes malaria is known as which of the following? A. Protozoan parasite B. Bacterial parasite C. Viral parasite D. Fungal parasite

A- Malaria is caused by members of the protozoan genus plasmodium Protozoa (protozoan plural) is known as single cell Eukaryote which are free living or parasitic and feed upon organic matter and other microorganisms or tissues and debris

Which phase of the precede-proceed planning model addresses the determination of the health problem & related behavioral & environmental determinants?

A- social assessment B- educational/ecological assessment C- epidemiological assessment D- administrative & policy assessment Correct Answer- C The other answers are incorrect due to those phases describing other phases and processes of the model. These other phases cover quality of life (social assessment), determining what factors need to change (educational/ecological assessment), and administrative and policy issues (administrative & policy assessment).

Which of the following statements best describes an intent to treat analysis?

A. Dermal absorption of particulates and gaseous emissions B. Inhalation of particulates and gaseous emissions C. Ingestion of agricultural products that have accumulated settled particulates D. Ingestion of drinking water that has accumulated settled particulates Correct Answer- B

Which of the following describes an effort toward secondary prevention?

A. Giving aspirin to people with existing heart disease to lesson the risk of heart attack B. Providing bicycle helmets to grade school children to decrease the incidence of bicycle related head injuries C. Giving folic acid to pregnant women to prevent birth defects in their babies D. Providing speech therapy to patients who have had a stroke to improve communication Correct Answer- A

Administrative law judges, who adjudicate conflicts involving the decision-making of units of government agencies:

A. Have at the federal and state level full judicial power, like all trial judges B. Are elected as non-partisan candidates within congressional districts C. Ensure complicated with constitutional requirements of due process D. Are in all respects the same as hearing officers within government agencies Correct answer: C

Incidence & Prevalence Relationship:

Prevalence = incidence x duration of disease

Objectives of Program Planning:

Answer Who? What? How much? By when? And should be SMART: Specific, Measurable, Achievable, Relevant, Time- Limited. Example: Bicycle helmet use will increase (what) among children ages 5-11 (who) by 25% (how much) by the end of the program (by when).

Public Health Surveillance

Acquisition, use, retention and transmission of data about the population's health that supports essential functions of the public health system A public health exception to confidentiality or HIPAA: a doctor reports a patients Protected Health Information (PHI) to the State Health Department due to a STI.

Federal Noise Control Act of 1972

Act to abate noise in the ambient environment and communities through investigation of sources, controlling noise pollution, and enacting policies.

Surveillance Systems: Active

Active Surveillance: -health department contacts health care providers and laboratories requesting information about conditions or disease Actively surveilling the latest of diseases and trends Advantage: -more complete data -occurs when proactively requesting information Disadvantage: -timely & requires resources *Useful when you must identify all cases.*

Advisory Board/Committee

Advisory boards can serve multiple functions, such as informing the design, implementing and evaluating public health programs, identifying resources, reviewing policy, making recommendations, and providing input to decision-makers.

Population

All the inhabitants of a given area Examples: US citizens, USF Students, adolescent mothers, smokers, etc. Some population subgroups have poorer health outcomes.

Which of the following disinfection methods is most commonly used in US Drinking water supply systems? A. Ozonation B. Bromination C. Chlorination D. Ultraviolet irradiation

Answer- C Although disinfection can be accomplished with ozonation, bromination, chlorination, and ultraviolet irradiation, MOST US municipalities use Chlorination.

Supremacy Clause

Article VI of the Constitution, which makes the Constitution, national laws, and treaties supreme over state laws when the national government is acting within its constitutional limits.

Using RR vs. OR in Study Design

As it pertains to STUDY DESIGNS, if you think of moving forward in time with your study such as a Cohort study where you're looking forward in time a RCT you're looking forward in time as well, and you can actually calculate incidence, that's where you can use the relative risk (RR) because you can actually calculate risk. Whereas, in a Cross-sectional study and in a case control study, you are either looking at one point in time or looking back in time and can't calculate risk. Therefore, you calculate the Odds Ratio instead.

The United States Public Health System

As the United STATES, the responsibility for public health rests with the state and public health authority is derived with the states. Each state has some kind of governmental agency with responsibility for public health and statutory authority for the functions of the agency.

What is formative evaluation?

Assesses the feasibility and appropriateness of a program before full scale implementation. Ex: focus groups for discussion

APEX-PH Program (1987) planning model

Assessment Protocol for Excellence in Public Health: included CDC, APHA, and NACCHO (Was done for a lot of health departments) Was replaced by... MAPP

Alma-Alta International Conference on Primary Health Care (1978)

Attempted to reorient global health systems toward primary care, Children's health, and family planning vs. just emphasizing critical care (hospitals) over primary care or PH preventative services

Public Health Scope of Legal Authority

Autonomy- Free from external influences over independent decision-making Examples- -Mandatory Vaccination (limitation or violation of autonomy) -Isolation: Separation of an infected person -Quarantine: Detention of healthy persons exposed to contagious disease -4th Amendment: Protects against unreasonable searches and seizures However, in PH law the standard is much lower. Thus, it doesn't apply to unlicensed businesses. Meaning, we can have warrant less search and seizures and random inspections to adhere to protocol, regulations, etc. Our authority in PH to keep the public healthy, is lower than other parts of the law such as criminal law.

A primary technique for preventing food-borne disease in cafeteria-type food service establishments is: (A) Encouraging customers to wash their hands before eating (B) Maintaining warm foods at a sufficiently high holding temperature (C) Weekly application of pesticides to control cockroaches (D) Annual physical examinations of food service workers

B

HACCP is a food safety system employed to: A. Detect bacterial contamination in food after it happens B. Identify and control problems that may cause foodborne illness before they happen C. Isolate and identify bacterial pathogens from foodborne illness outbreaks D. Set temperature limits for food containing eggs

B

The Clean Air Act directs the Environmental Protection Agency (EPA) to establish national ___________ air quality standards? Hint- NAAQS A. Pollution B. Ambient C. Surrounding D. Clean

B

The exposure standard for lead in children has been lowered over the years because even small amounts can result in: A. Childhood cancers, such as leukemia B. Impaired cognitive development C. Impaired formation of bone mineral D. Reduced rate of growth

B

Disease: Malaria

Causative Agent: plasmodium falciparum, P. malariae, P. ovale, P. knowlesi, P. vivax Vector(s): Anopheles spp. (A. gambiae most common) Common Name: mosquito Mode of Transmission: Biological

Which of the following best describes the value of an enterprise after all debts have been deducted from the assets? A. Profit B. Equity C. Liability D. Revenue

B

Which of the following is currently the most common cause of unintentional death for adults in the U.S. ? A. Motor vehicle accident (traffic) (this was for youth & kids) B. Unintentional poisoning (drug abuse) C. Unintentional gunshot wounds D. Unintentional walls

B

Which of the following is the HACCP employed to do: A. Detect bacterial contamination in food AFTER it happens B. Identify potential problems that may cause foodborne illness C. Isolate & identify bacterial pathogens from a foodborne outbreak D. Set temp limits for raw food

B

Which of the following relationships most accurately describes a positively skewed distribution of human body weight measurements? A. The mode is greater than the mean. B. The mean is greater than the median. C. The mean is less than the median. D. The mode is equal to the mean.

B

Out of a population of 500,000 people, 500 were observed for 2 years. 5 developed disease. What is the incidence density rate? A. 5/500 B. 5/1,000 C. 5/500,000 D. 500/500,000

B- Incidence rates measure the number of new cases of a disease that emerge in an at-risk population within a window of time. When expressed as a fraction, the numerator is the number of new cases that emerge. The denominator is the number of people in the at-risk population during that same window of time. Mortality rates measure the number of deaths in a population within a specific window of time. The numerator is the number of deaths that occur and the denominator is the number of people in the population during that window of time. Highly fatal diseases, such as liver cancer, have a short duration because as new cases are added to a population, they are quickly resolved through death. This, the numerator for both measures of incidence and mortality will roughly be the same if the window of time is the same.

The most important reason for reduced mortality during the initial stage of the demographic/Epidemiologic transition in a population: A. Increased use of antibiotics B. Improved sanitation C. Increased Immunization D. Screening for common infectious diseases

B- outweighs antibiotics AND vaccines

The "safe harbor" provisions are intended to protect patient privacy by defining: A. The covered entities with which patient data may be shared B. Which data elements to remove to create de-identified data sets C. Encryption protocols and internet routes for transmitting data D. Data use agreement provisions for sharing confidential data sets

B; the Safe Harbor convention defines which data elements to remove from personal health records to create de-identified data sets for public use Other legislation, like HIPPA, defined the covered entities with which personal health data may be shared directly.

In an urban community, which of the following is most likely to contribute to the heat Island effect? A. Reducing housing density B. Increasing the use of air conditioning C. Minimizing areas of vegetation growth D. Increasing the number of power plants

C

The z-score measures the relative position of one observation relative to others in a data set. What components are needed to compute a z-score? A. Median and range B. Mean and range C. Mean and Standard Deviation D. Median and Standard Deviation

C

Which definition describes an organization balance sheet? A. A review of true expenses B. An annual overview of fundraising C. A summary of assets and liabilities D. The amount of money owed to personnel

C

Which of the following professionals make up the largest percentage of the public health workforce? A. Epidemiologists B. Health educators C. Nurses D. Sanitarians

C

A local public health department (LHD) must make significant budget cuts. Area managers are directed to review and compare current services, service utilization, and costs to areas of need identified a recent community health needs assessment completed by the LHD. This approach, as a prelude to decision-making, is based on: A. Internal assessment and strategic goals B. External assessment and department policy review C. Internal assessment and external assessment. D. Strategic planning and maximizing program efficiency.

C Justification: "in the context of Public Health, assessment is the beginning of the continuum of problem identification, priority setting, strategic planning, intervention, and evaluation. Assessment can either be internal, addressing processes within an organization, or external, addressing processes within the community."

Which of the following best describes how vaccines work? A. Most vaccines work by providing artificially produced antibodies that can attack specific pathogens B. Most vaccines trigger the body's innate immune system which results in macro oh that engulf the pathogens C. Most vaccines work by triggering the body's adaptive immune system including antibody production that can target a specific pathogen D. Most vaccines work through epigenetic mechanisms that turn on genes that produce specific antibodies

C-

Which of the following best describes herd immunity: A. The phenomenon by which some people are naturally resistant to a disease B. The time it takes for a disease to spread in a population C. Resistance within a population of a certain infection D. A persons resistance to diseases that are transmitted by other mammals such as cows

C- Herd Immunity is vital to PH

Safe drinking water is vital to public health. Which of the following should not be in potable water? A. Chlorine B. Disinfectant residue C. Radionuclides D. Fluorides

C- radionuclides are any man made element that contain radiation that may cause cancer after being exposed via drinking water for extended periods of time.

The most likely contaminants causing the described symptoms are: A. Sulfur dioxide B. Particulates C. Carbon Monoxide D. Carbon Dioxide

C;

Disease: Rocky Mountain spotted fever

Causative Agent: Rickettsia rickettsii Vector(s): Dermacentor variabilis Common Name: Tick Transmission: Biological

Disease: West Nile Fever

Causative Agent: West Nile virus Vector(s): Culex spp. (quinquefasciatus/pipiens and tarsalis most common in U.S.) Common Name: Mosquito Transmission: Biological

Disease: Plague

Causative Agent: Yersinia pestis Vector(s): Xenopsylla cheopis Common Name: Flea Transmission: Biological

Disease: Zika

Causative Agent: Zika virus Vector(s): Aedes aegypti Common Name: Mosquito Transmission: Biological

Disease: Breakbone fever

Causative Agent: Dengue virus Vector(s): Aedes aegypti, Aedes albopictus Common Name: mosquito Transmission: Biological

Disease: Guinea Worm

Causative Agent: Dracunculus medinensis Vector(s): Cyclops spp. Common Name: Water fleas (copepods) Transmission: Biological

Disease: Leishmaniasis

Causative Agent: Leishmania donovani, L. infantum, L. chagasi Vector(s): Litzomyia spp. Common Name: sandflies Transmission: Biological

Disease: River Blindness

Causative Agent: Onchocerca volvulus Vector(s): Simulium spp. (major vector S. damnosum in Africa) Common Name: Black flies Transmission: Biological

Example of SMART objective

Children (who) in the program increased (what) 50% (how much) of their swimming skills by the end of the program (by when).

Community Coalition Action Theory (CCAT)

Coalitions engage in core processes that include analyzing the problem, assessing needs and assets, action planning, implementing strategies, and monitoring outcomes Another definition: Engagement and consensus building efforts are critical among diverse organizations and individuals to address community level issues while recognizing the importance of leadership, membership, process, structures, engagement, resources, assessment, and planning. Stages of coalition development include: formation, maintenance, and institutionalization According to CCAT, communities can develop capacity to deal with problems and actively participate in making changes in the community. If changes are self-developed and self-imposed, sustainable change is more likely.

Relevance

Community members create an agenda for change based on their perceived needs, available resources, and shared power

Participation

Community members develop and contribute leadership skills, knowledge, and resources through their involvement in community change

Astin Social Change Model of Leadership

Compared to McKinsey 7-S, the Astin model identified seven critical values, all of which begin with the letter "C": consciousness of self, congruence, commitment, collaboration, common purpose, controversy with civility, and citizenship. All of these are interconnected around the eighth "C"— change, which is of course what leadership is ultimately about.

Solid Waste, Modern Landfill:

Composed of a bottom, landfill liner which separates the trash from the leachate ground water as we don't want those to mix. Aquifer is deep down below. Trash is on top, Methane gas recovery system is in the middle, clay cap (cover), and leachate treatment system. A well to monitor ground water is also there. At the base of the landfill the leachate collection system is there.

Which of the following is true about newborn screening programs? A. All states in the U.S. screen for the same set of genetic conditions in newborns B. Most of the genetic conditions screened for follow an autosomal recessive pattern of inheritance C. Almost all babies who have a positive newborn screen end up being diagnosed with the same condition D. In the U.S., most state new born screening started in the 1900s.

Correct Answer- B; these babies inherit 2 non working copys of a gene. Why these answers are wrong:

A smoking cessation campaign highlights better health outcomes and a healthier environment. Which of the following social marketing principles is used in this campaign? A. Focusing on behavioral outcomes B. Maintaining a market perspective C. Prioritizing consumers' rather than marketers' benefits D. Developing a strategic marketing mix of communication elements

Correct Answer- C

An outbreak of pneumonia has occurred at a resort, and you determine that Legionella is the organism that is responsible. To find the source of the bacteria, one of the highest priorities would be to check: (A) Food handlers for infected cuts and sores (B) For dead animals on the property (C) Hot tubs, showers, and fountains and the water sources that supply them (D) Employees who have come to work with influenza

Correct Answer- C

Which of the following components of a strategic planning process in a public health agency has logical priority over the others? A. Preparing an action plan for eradicating giardiasis in the municipal water system B. Developing the operating budget and staffing plan for the agency C. Reviewing (and revising) the vision and mission statements for the agency D. Setting strategic goals for a three year cycle

Correct Answer- C The initial activity in the prevailing strategic planning paradigm is the review and (as needed) revision of the organization's mission and vision statements and it's core values. This provides a philosophical foundation for subsequent steps in the strategic planning process.

The best example of community engagement and empowerment refers to which of the following? A. Teaching community members how to best communicate with providers B. Conducting health needs and assets assessment with communities and sharing the information C. Teaching self-determination to community members D. Reciprocal Transfer of knowledge and skills among all collaborators and community partners

Correct Answer- D

Which of the following disinfection methods is MOST COMMONLY used in US drinking water supply systems? A. Ozonation B. Bromination D. Chlorination E. Ultraviolet Irradiation

Correct Answer- D

Which of the following best describes the value of an enterprise after ALL debts have been deducted from the assets? A. Profit B. Equity C. Liability D. Revenue

Correct Answer- Equity

The principal difference between other industrialized countries and the US in terms of providing universal health care coverage is that: 1. This is recognized as a basic human right in the other countries' founding document, but not in the US Constitution 2. All hospitals are owned by and all physicians are employees of the other governments while the US takes a free market approach 3. The other countries spend more per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population 4. The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population

Correct Answer: 4 Other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population

Which term below refers to the concept of confirming conclusions from qualitative data through multiple data sources, multiple methods, multiple theories, or multiple data collectors? A. Triangulation B. Systemic review C. Data cleaning D. Meta-analysis

Correct Answer: A

The following information shows the incidence risk of oral cancer in cigarette smokers to non-smokers: Oral Cancer Rates per 100,000 Smoker: 35.0 Non-Smoker: 18.0 The attributable risk (AR) of oral cancer due to cigarette smoking is equal to: A. 35.0/18.0 B. 35.0 - 18.0 C. 35.0 x 18.0 D. 35.0 + 18.0

Correct Answer: B

Which statistical term represents a range of values around an estimate of a population parameter, which indicates the amount of uncertainty associated with that estimated population parameter? A. Point estimate B. Confidence Interval C. Attributable risk D. Range

Correct Answer: B Explanation: the computed interval with a given probability, e.g. 95%, that the true value of a variable such as a mean proportion, or rate is contained within the interval.

What does the formula below represent? True Positives + False Negatives / Total Sample Size A. false positive rate B. Prevalence C. Accuracy D. Sensitivity

Correct Answer: B, Prevalence

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with States to implement Environmental Standards such as NAAQS? (A) By creating a memorandum of understanding focusing on cost sharing of environmental burdens (B) By establishing air quality monitoring stations (C) By using a State Implementation Plan (SIP) approved by the EPA (D) By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant

Correct Answer: C The constitutional division of powers between the Federal and State Governments means that both levels of government must operate with mutual respect, recognizing that cooperation rather than conflict better serves the public interest. The natural continuum of the environment cuts across geopolitical boundaries and rightly elicits the concerns of both Federal and State governments. To avoid or minimize contradictory measures and standards among States, the Federal government provides the umbrella (uniform) guidance and standards for ambient air quality and requires States to participate in the implementation by developing a plan that meets Federal requirements. That plan is known as SIP and contains a number of air quality control measures.

Which of the following is a common threat to validity with adapting an evidence based practice to a specific population? A. Maintaining fidelity B. Obtaining grantor approval C. Having resources available D. Achieving community uptake

Correct answer- A

Which of the following is the largest source of funding for core local public health services in the United States? A. Federal funding B. State sales tax revenues C. Local government revenues D. Medicaid and other fee revenues

Correct answer- A

Which theory is best illustrated by this statement: "Learning occurs because of a reciprocal interaction of the person, environment, and behavior." A. Social cognitive theory B. Theory of planned behavior C. Diffusion of innovations theory D. Transtheoretical model of change

Correct answer- A

Which of the following is the most commonly occurring mosquito-borne disease in the United States? A.) West Nile neuro-invasive disease B.) malaria C.) dengue D.) yellow fever

Correct answer- A; West Nile Neuro-invasive disease (WNVND) is common throughout the US, particularly in the warm months when mosquito populations are highest and people spend more time outdoors. Malaria, Dengue Fever, and Yellow Fever rarely occur on the U.S.

Theory is defined as: A. A branch of philosophy that deals with morality B. A tested set of hypotheses listed in order of importance C. A construct to explain the nature of phenomena D. A verified fact that the majority does not believe to be true

Correct Answer: C. Ethics is a branch of philosophy that deals with morality. Hypotheses testing is defined as a tested set of hypotheses listed in order of importance

An incremental approach to program planning in public health: A. Uses multiple sources and methods to collect similar information B. Provides an intensive, detailed description and analysis of a single project C. Produces a plan where the specification of every step depends upon the results of previous steps D. Results in plans that may be immediately necessary but may overlap or leave gaps

Correct Answer: D

Determining whether to continue or modify but not terminate a program is a reasonable objective of a: A. Formative evaluation B. Summative evaluation C. Qualitative evaluation D. Quantitative evaluation

Correct answer- A Explanation: formative evaluations are done to identify program strengths and weaknesses in order to guide improvement. Summative evaluations are conducted as a pass or fail examination that can lead to program termination. Qualitative, quantitative, or a mix of both methods can be used in either formative or Summative evaluations.

Which term below refers to the concept of confirming conclusions from qualitative data through multiple data sources, multiple methods, multiple theories, or multiple data collectors. A. Triangulation B. Systematic Review C. Data Cleaning D. Meta- analysis

Correct answer- A Data triangulation is when a finding or piece of data is verified with several different data sources or research methods. Triangulation adds credibility to findings. (Qualitative research)

In the planning process, the group being served is referred to as the: A. Pilot population B. Key informants C. General population D. Priority population

Correct Answer: Priority Population

The landmark Institute of Medicine report in 1988 entitled The Future of Public Health, identified three core functions of public health as: A. Epidemiology, health policy, and evaluation B. Surveillance, program development, and health policy C. Assessment, policy development, and assurance D. Administration, implementation, and monitoring

Correct answer - C

HACCP is a food safety system employed to: 1) Detect bacterial contamination in food after it happens 2) Identify and control problems that may cause foodborne illness before they happen 3) Isolate and identify bacterial pathogens from a foodborne illness outbreak 4) Set temperature limits for food containing eggs

Correct answer 2

Which definition describes an organization balance sheet? A. A review of true expenses B. An annual overview of fundraising C. A summary of assets and liabilities D. The amount of money owed to personnel

Correct answer C

Effective Policy dialogue facilitators: A. Value the policy dialogue process over its outcome B. Value an outcome ofer the policy dialogue process C. Rarely engage in preparatory stages before panels meet D. Moderate rather than interpose questions

Correct answer- A

A mother and her child have lived in an area with poor air quality for several years, yet only the child shows symptoms of an environmentally linked respiratory disease. Which of the following is the most likely reason? A. Young children show symptoms earlier than adults B. Young children have higher metabolic and respiratory rates C. Adults living in these area develop tolerance to air pollutants. D. Adults are more likely to have comorbidities that mask the symptoms

Correct answer- B

Voluntary evacuation plans for medically fragile individuals in a declared state of emergency need to be analyzed in terms of which of the following ethical principles? A. Incorporation of diversity B. Protection of individual liberty C. Feedback from the community D. Acting on information in a timely manner

Correct answer- B

Which of the following best describes the value of an enterprise after all debts have been deducted from the assets? A. Profit B. Equity C. Liability D. Revenue

Correct answer- B

Which of the following programs represents the greatest health expenditure at the state level? A. Direct public health care B. Medicaid C. State employee health benefits D. State Children's Health Insurance Program (SCHIP)

Correct answer- B

Which of the following relationships most accurately describes a positively skewed distribution of human body weight measurements? A. The mode is greater than the mean. B. The mean is greater than the median. C. The mean is less than the median D. The mode is equal to the mean.

Correct answer- B

Which source of United States law gives power to health departments? A. Treaties B. Statues C. Regulations D. Common law

Correct answer- B

Double-blinded (masked) studies are an important way to: A. Achieve comparability of cases and controls B. Avoids observer and interviewee bias C. Increase efficiency of study design D. Reduce the effects of sampling variation

Correct answer- B Double masking or blinding a study means that neither the patient nor the individuals involved in evaluating the outcome know the exposure status of any individual. This decreases risk of observer bias because the observer doesn't know the true exposure. It also decreases the risk of the interviewee bias because the participant doesn't know which exposure they are in.

To evaluate public health performance, we consider CAPACITY, PROCESS, and OUTCOMES. Which of the following represents an example of an "outcome"? A. An increase in the types of vaccines offered to protect against common childhood diseases B. Decrease in number of children age 0-2 with vaccine preventable disease C. Routine health care D. Increase in number of patients seen in the mobilization van

Correct answer- B Justification- Outcomes in program management and performance respond to the question of what impact will the planned program activity have? OR what change may we expect due to the program? The outcome may be short term, mid term, or long term. The increase in vaccination status meets this criteria. Answers A and D are examples of program activities or OUTPUTS, not outcomes.

Societies have fostered discrimination against certain communities in various ways. Policy makers must address this to move toward health equity. One theory, which explains the reinforcing feedback loop of poor housing quality, lesser paying jobs, poor education, and poor health outcomes, may be summarized as: A. Social epidemiology B. Institutional racism C. Structural racism D. Causative factors

Correct answer- B As a result of institutional racism, racial stratification and disparities have occurred in employment, housing, education, healthcare, government, and other sectors. While many laws were passed in the mid- 20th century to make discrimination illegal, major inequalities still exist. Institutional racism is distinguished from the bigotry and racial bias of individuals by the existence of systematic policies and practices within institutions that effectually disadvantage certain racial and ethnic groups.

A distinctive foundation of the Comprehensive Unit-based Safety Program (CUSP) developed at Johns Hopkins and promoted by the Agency for Healthcare Research and Quality creates a culture of safety by focusing on: A. Detecting and reporting sentinel events B. Open attitudes and mutual respect C. Using standardized checklists D. Assuring professional expertise

Correct answer- B Justification- Comprehensive Unit Based Safety Program tools support change at the unit level to create a culture of safety (AHRQ, 2018). This is more fundamental than checklists alone, although empowering staff to participate in the use of checklists also has been part of CUSP's success in reducing the incidence of preventable adverse patient outcomes. Studies have found that working in an environment where open and mutual communication is present enhances clinical proficiency and job satisfaction (O'Daniel and Rosenstein, 2008). Sentinel events are events so egregious that a single occurrence is prima facie evidence of medical error (Ex- wrong site surgery); however, few such events have proven to be reliable indicators because many low-probability adverse outcomes are not entirely preventable despite all aspects of care being correctly done.

The biggest change in competencies for public health career professionals circa 2019 is: A. An increased emphasis in epidemiology and biostatistics course hours for entry to practice B. More emphasis on 'soft skills' for leading teams and on integration across technical skills C. Separate lists of competency items for public health analysts versus program managers D. A stronger focus on management and fiscal oversight

Correct answer- B Based on the nationwide job task analysis

Historically, which of the following had the greatest impact on average life expectancy? A. Vaccines for infectious disease B. Improvements in sanitation and hygiene C. Advances in medical care technology D. Increased application of health education

Correct answer- B Historically, improved sanitation and hygiene have had the greatest impact on lengthening life expectancies. The sanitarian movement, led by Edwin Chadwick in Great Britain in the last half of the first century, brought about improvements in municipal sanitation and waste systems and promoted public hygiene. Thomas McKeown and other public health investigators have demonstrated that declines in mortality during the 20th century occurred before the advent of vaccinations, antibiotics, and other modern medical treatments. Thus, these declines can be attributed to the efforts of the sanitarian movement.

When making decisions, public health leaders face the ethical challenge of: A. Ignoring the rights and liberties of those individuals affected by disease B. Creating maximum benefit for all while minimizing individual harm C. Maximizing resource expenditures D. demanding trust from health care providers serving patients

Correct answer- B Justification: ethical decision making in public health involves the common need to weigh the concerns of both the individual and the community. The need to exercise power to ensure health and at the same time to avoid potential abuses of power are at the crux of public health ethics. The 12 principles of ethical practice are in public health, provide guidance to public health professionals for ethical practice w/ respect to health, the community, and bases for action. These principles align w/ those identified in the Belmont Report of: respect for persons, beneficence, and Justice, but provide a more specific application to public health Practice.

Which of the following phases of the policy-making process includes a "window of opportunity"? A. Policy modification B. Policy rule making C. Policy formulation D. Policy implementation

Correct answer- C

If a population has a standard deviation, then the standard deviation of the mean of 100 randomly selected items from the population is: A. σ B. 100σ C. σ/ 10 D. σ /100

Correct answer- C The SD of the sample mean is given by: σ x Bar = σ / √n, here n= 100

Which of the following components of a strategic planning process in a public health agency has logical priority over the others? A. Preparing an action plan for eradicating giardiasis in the municipal water system. B. Developing the operational budget and staffing plan for the agency C. Reviewing and revising the vision and mission statements for the agency D. Setting strategic goals for a three year cycle

Correct answer- C Explanation: the initial activity in the prevailing strategic planning paradigm is the review and (as needed) revision of the organization's mission and vision statements and its core values. This provides a philosophical foundation for subsequent steps in the strategic planning process.

Which of the following statements best characterizes research findings about trait-based approaches to leadership theory? A. Intelligence, high energy, and initiative are necessary B. Personality traits are irrelevant C. No one set of traits has been established as necessary D. Leaders are born, not made

Correct answer- C Trait based approaches to leadership theory are concerned with traits that distinguish leaders from other people and the magnitude of differences between the two groups. Early trait based approaches posited that leaders possessed innate heritable qualities that differentiated them from the general population. Later, research on leadership emphasized behavior rather than traits. More recent literature focuses on a combo of traits and behaviors, but has not explicitly identified a set of traits, innate or otherwise, that constitute a leader.

A budget statement for a public health program provides a detailed itemization of expenses and ________. A. Fees B. Taxes C. Grants D. Revenue

Correct answer- D

Leading by example best exemplifies which of the following styles of leadership? A. Strategic B. Visionary C. Delegative D. Participative

Correct answer- D

The times observed for completing a sorting task are scored in terms of order of finish. This is an example of: A. Continuous data B. Interval data C. Nominal data D. Ordinal data

Correct answer- D

What strategy may be used to develop effective communication materials for populations with low health literacy? A. Engage members of the target population in the message develop process B. Take a "universal precautions" approach to message design C. Use targeted or tailored rather than generic materials D. All of the above

Correct answer- D

To help lay, professional and policy audiences understand the rationale for a program proposal, it is best to: A. Provide everyone with the same report, written in plain Language aimed for a Grade 10 reading level B. Recognize that policy or professional audiences prefer to see benefit or risk projections as ratios, lay audiences prefer them expressed in number-needed-to-treat or harm. C. Present a comprehensive literature review, summarize all the numbers in one table and let the facts speak for themselves D. Tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience

Correct answer- D While writing in plain language is always encouraged, there are important differences between lay, professional, and policy audiences in terms of information needs, perspectives, literary and numeracy. At times, confidentiality requirements also limit what can be revealed to groups outside an agency or the legislature to which reports. However, a so called "theatre of risk" format is an important universal framework to summarize anticipated benefit and harm numbers because studies show that all people have more difficulty making accurate decisions when presented w/ ratios rather than risk differences.

Given popularity of the phrase "evidence-based decisions", a member of a program advisory committee wants the next meeting's agenda to include a recent evaluation study published by an independent academic researcher. That study concludes that a governmental-guaranteed minimum annual incomes is the best solution to homelessness. The committee advises a program whose mandate is to oversee the operation of a health insurance program for children in families with income level lower than the federal poverty line. Should the study be added to the agenda? A. Add the item - government programs are obliged to follow the lead of their advisory committee B. Add the item - decisions must follow the evidence if evidence points to a different allocation of resources C. Refrain from adding the item - one member is not a quorum D. Refrain from adding the item - it is not germane to program decision needs.

Correct answer- D Explanation: Advisory committees are by definition advisory rather than supervisory. Their meetings benefit from an agency clearly defining the questions on which it needs advice. Unless evidence is being presented to inform policy discussion addresses those questions and limits to interpretation are made clear, then it is a distraction rather than an asset.

An incremental approach to program planning in public health: A. Uses multiple sources and methods to collect similar information B. Provides an intensive, detailed description and analysis of a single project C. Produces a plan where the specification of every step depends upon the results of previous steps D. Results in plans that may be immediately necessary but may overlap or leave gaps

Correct answer- D Issel writes, that though the incremental approach to program planning may address an immediate need (Ex- closing bathhouses in the early days of HIV/AIDS epidemic) it may also leave gaps (Ex: did not identify the virus). The incremental approach to program planning will address the ONLY part of the problem, may be the result of disjointed efforts, and leave many factors unaccounted for.

An investigator measures a continuous variable on four independent groups of people and would like to know whether the means of each group differ. What statistical method should the investigator use to answer this question? A. Logistic regression B. Cox regression C. Chi-square test of association D. Analysis of variance

Correct answer- D Analysis of variance is the only choice appropriate for continuous outcome variables. Logistic regression is used for nominal or ordinal outcomes. Cox regression is used for survival outcomes. Chi-square tests are used for categorical variables

Which component of epidemiology describes who gets the disease, where people with the disease are located, and how these aspects of disease change over time? -Determinants -Distribution -Frequency -Control

Correct answer- Distribution

Public health actions frequently involve a balancing of individual rights vs. the good of the community. Where that balance is struck is based on: 1. Explicit direction found in the Nations Constitution 2. Societal values 3. Science 4. Deontological principles

Correct answer: 2; societal values Explanation: The constitution does not provide explicit direction when it comes to balancing individual rights and promoting the common good. Public health policy and regulation, although based on scientific evidence and general moral considerations is not likely to be adopted where there is not general consensus and support by the public it serves to protect. The definition: "Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy" suggests the need for cooperative actions built on overlapping values and trust.

A short narrative or statement that describes the general focus and purpose of a program is called: A. A mission statement B. A long term goal C. A long range plan D. An objective

Correct answer: A

Which of the following is the largest source of funding for core local public health services in the United States? A. Federal funding B. State sales tax revenues C. Local government revenue D. Medicaid and other fee revenue

Correct answer: A

Which theory is best illustrated by the following statement? "learning occurs because of a reciprocal interaction of the person, environment, and behavior." A. Social Cognitive Theory B. Theory of Planned Behavior C. Diffusion of Innovations Theory D. Transtheoretical Model of Change

Correct answer: A

Waterborne diseases can result from fecal contamination. Which of the following would be classified as a waterborne disease? A. Cryptosporidium parvum B. Flavivirus C. Plasmodium spp. D. Borrelia burgdorferi

Correct answer: A Explanation: Cryptosporidium parvum, colloquially referred to as crypto, is a waterborne disease that is a major cause of gastroenteritis worldwide. It is a protozoan parasite that is resistant to chlorination, making its control difficult. Flavivirus is a genus of viruses that include mosquito-transmitted diseases such as Yellow Fever that are classified as water related because part of disease vector's lifestyle occurs in water. Plasmodium spp. is a family of parasites that causes malaria, which life Flavivirus, is water related. Borrelia burgdorferi is a bacterial species that causes Lyme disease, the vector is the deer tick.

The local health jurisdiction is seeking governmental funding to address breast cancer which has a lower incidence rate in group X than in group Y, though group X has a higher mortality rate. This is an example of: A. Health disparity B. Harm reduction C. Modifiable risk factors D. Life expectancy

Correct answer: A Explanation: Health disparity is defined as the difference in health status between two groups.

When beginning work with a coalition of community groups to improve health outcomes in the community, a key first step would be to: A. Develop a shared vision B. Develop an evaluation plan C. Develop a data collection plan D. Develop a logic mode

Correct answer: A Developing a shared vision is important in making sure that the coalition of community groups is on the same page. A shared vision allows the different coalition groups to come to a consensus on the definition of the health need or issue they are working on.

Measuring inputs, throughputs, outputs and outcomes of health systems is, to an increasing extent, relying on "big data" which is distinct from other data in terms of its: A. Volume, value, variety, velocity, and veracity B. Terabyte file size, proprietary ownership, encryption, and cost C. Storage in data warehouses isolated from internet access D. Importance, validation, curation, and credibility

Correct answer: A Explanation: in 2015, Brownson et Al. Identified "big data" among the important "macro trends" impacting public health. Volume, value, variety, velocity, and veracity distinguish "big data" from other data.

Municipal sewage is typically processed to remove organic material before disposing the treated water. In large cities, this treatment generally consists of: A. Biologics treatment in an aerated activated sludge system, followed by settling to remove sludge solids, then chlorination prior to discharge B. Chemical treatment by coagulation and flocculation, followed by settling to remove solids, then chlorination prior to discharge C. Filtering through sand beds to remove organic solids, followed by chlorination prior to discharge D. Super-chlorination to destroy organic materials, followed by discharge

Correct answer: A The aerated activated sludge secondary treatment process effectively removes organic materials from municipal storage. A mix of aerobic biological organisms termed "activated sludge" consume the organic materials. Sludge is removed from the treated water by gravitational setting, and the water is disinfected by chlorination before discharge (e.g. to a receiving River). The chemical coagulation/flocculation/settling process is used to treat water destined for the drinking water supply system and is usually required when the water is taken from a surface water source such as a lie or river. Filtering through sand beds is also used to treat drinking water, but not municipal sewage. Super chlorination is not an effective treatment for municipal sewage.

A distinctive foundation of the Comprehensive Unit-based Safety Program (CUSP) developed at Johns Hopkins and promoted by the Agency for Healthcare Research and Quality creates a culture of safety by focusing on: A. Detecting and reporting sentinel events B. Open attitudes and mutual respect C. Using standardized checklists D. Assuring professional expertise

Correct answer: B Explanation: CUSP tools support change at the unit level to create a culture of safety (AHRQ, 2018). This is more fundamental than checklists alone, although empowering all staff to participate in use of checklists alps has been part of CUSP's success in reducing the incidence of preventable adverse patient outcomes. Studies have found that working in an environment where open and mutual communication is present enhances clinical proficiency and job satisfaction (O'Daniel & Rosenstein, 2008). Sentinel events are events so egregious that a single occurrence is prima facie evidence or medics error (wrong site surgery); however, few such events have proven to be reliable indicators because many low-probability adverse outcomes are not entirely preventable despite all aspects of care being correctly done.

The t-distribution approaches which distribution as its degrees of freedom? A. Exponential distribution B. Normal distribution C. Binomial distribution D. Chi-square distribution

Correct answer: B Explanation: The overall shape of the density function of the t-distribution resembles the bell shape of the normal distribution with mean 0 and variance 1, except that it is a bit lower and wider. As the number of the degrees of freedom increases, the t-distribution approaches the normal with a mean of 0 and a variance of 1. Furthermore, both distributions are continuous. While a binomial distribution is bell-shaped, it is fundamentally different from the t-distribution, which is continuous, because the binomial distribution is discrete. While a chi-square distribution is roughly bell-shaped, it is right skewed and dissimilar to the t-distribution. An exponential distribution is convex and stretched to the right, meaning it beats little resemblance to a t-distribution as the degrees of freedom increase.

From Peter Drucker, often identified as the founding father of the science of management, it is clear that efficiency is most meaningful measured in terms of the: A. Perspective within an organization B. Perspective outside an organization C. Financial costs and efforts of the organization D. Units of time

Correct answer: B "Drunker comments that the organization is an abstraction... Specifically, there are no results within the organization. All the results are on the outside. The only business results, for instance, are produced by the customer who converts the costs and efforts of the business into revenues and profits though his willingness to exchange his purchasing power for the products or services of the business. Similarly, a hospital has results only in respect to the patient. But the patient is not a member of the hospital organization. For the patient, the hospital "is real" only while they stay there. His greatest desire is to go back to the "non-hospital" world as fast as possible." - the Effective Executive, (Harper & Row Publishers, 1967)

In the PRECEDE-PROCEED model, the step in program planning where planners use data to identify and rank health problems is called: A. Behavioral assessment B. Needs assessment C. Ecological assessment D. Environmental assessment

Correct answer: B Explanation: Needs assessment provides information about what is needed in the Target community. In the PRECEDE-PROCEED model, a needs assessment is the general umbrella term and may involve a social assessment, epidemiological assessment, behavioral, environmental, educational, or ecological assessment. Using a needs assessment allows the planned to determine the degree to which the needs are being met. Needs assessments help to identify the gap between what is and what should be.

Which of these has been defined as a core function of public health? A. Maintaining the census to define populations B. Consulting stakeholders to decide what best serves public interest C. Conducting research to solve all population health problems D. Acting in an ethical manner

Correct answer: B Explanation: the three core functions of Public Health have named as assessment, policy development and assurance, sometimes referred to as assessment, promotion and protection. Under this framework, 10 "essential public health services" have been identified. The correct answer here, describes the core function of policy development, where broad-based consultations with stakeholders occur to weigh available information and decide which interventions are most appropriate and ensure that the public's interest is served by measures that are adopted. The other two core functions are assessment, which emphasizes collecting and analyzing information about health problems and assurance, which seeks to promote and protect public interests through programs, events, campaigns, regulations, inspections, and other strategies, and making sure that necessary services are provided to reach agreed upon goals.

A management/leadership theory which posits that when staff are able to grow and develop, staff performance results are better, is an example of: A. Situational Leadership Theory B. Douglas McGregor Theory Y C. Contingency Leadership Theory (CLT) D. Path-goal Theory

Correct answer: B Path-goal Theory of leadership maintains that the leader can affect the performance, motivation, and satisfaction of followers. Contingent Theory involves the adoption of management style to meet the needs of all personnel. Douglas McGregor Theory Y assumptions that employees are highly motivated to do the work. Douglas McGregor Theory X states that employees are generally not satisfied with work and are motivated by salary alone.

Which source of United States law gives power to health departments? A. Treaties B. Statues C. Regulations D. Common law

Correct answer: B Statues are enacted by Congress AND state Legislators

Which of the following measures of variability is calculated by subtracting the 25th percentile of data from the 75th percentile of data? A. Variance B. Interquartile range C. Median absolute deviation D. Coefficient of variation

Correct answer: B The inter-quartile range is calculated by subtracting the 25th percentile of data from the 75th percentile of the data and is used to measure variability.

Generally, the largest single component in most public health budgets, and therefore the one with which managers must be most familiar is: A. Computer software and hardware B. Pharmaceuticals C. Personnel D. Shortfalls

Correct answer: C

Which of the following terms is expressed as a ratio? A. Male births / Male + Female Births B. Female births/ Male + Female Births C. Male Births/Female Births D. Stillbirths / Male + Female Births

Correct answer: C A ratio expresses one measure relative to another. In this case, the ratio expresses the number of male births compared to the number of female births.

In the funding applications that state public health departments typically submit every year, program and organizational budget requests: A. Are not included, only research project funding is described B. Are justified by reasonable numbers on accounting spreadsheets C. Need explanation in a budget narrative D. Tend to always be funded

Correct answer: C Explanation: State public health departments typically conduct needs assessments and program evaluations, but do NOT perform academic research projects and their financial accounting systems are not set up to hold research funds in anticipation of future project expenses. Dollar figure request items shown need to be explained in a section typically called the budget narrative. Since funding success depends upon politics will and is competitive against applicants from other programs, it is important to defend a budget request in clear and meaningful language.

The probability distribution for all possible values of a given sample statistic is called? A. Parameter B. Random sample C. Sampling distribution D. Sampling frame

Correct answer: C Explanation: the sampling distribution of a statistic is the distribution of values of the statistic over all possible samples of size n that could have been selected from the reference population.

It can be helpful to make sure that you are setting goals and objectives that are SMART. The R in SMART stands for: A. Reliable B. Resistant C. Realistic D. Rapid

Correct answer: C The "SMART" goal or objective is one that is SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, and TIME-bound.

What is one possible reason that self-reported data could be biased? A. Confounding threats to external validity B. Interviewers who may be biased and could misinterpret the responses or lead the respondents to answer a certain way. C. Respondents who may feel pressured to respond a certain way, given social norms or social desirability D. A sample size that is too large

Correct answer: C Explanation: Self-report data may be biased for many reasons, including because respondents may feel pressured to adhere to social norms or to provide socially desirable answers. These are not the only potential reasons for bias in self-reported data, but it is an important one. Additional sources of bias in self-report data may relate to sensitive subject matter or recall bias.

Policy analysis when designing public health programs is: A. Involves a straightforward statistical analysis of health and public polling data B. A subjective political task accomplished by legislative debate and trade-offs C. Complex, involving data collection and clarification of objectives D. Impossible to define because different policy areas require different approaches

Correct answer: C Explanation: The modified Bridgman and Davis framework for policy development shows policy analysis to consist of 3 elements: collect relevant data and information, clarify objectives and resolve key questions, and then develop options and proposals. It identifies policy analysis as a step between identifying issues and undertaking consultation before moving on to making decisions. In the book "social policy, public policy: from problem to practice [Edwards et Al., Allen and Unwin Publishers, 2001], the authors explain the importance of addressing such analysis questions as: "Where did the data and research come from and what was its significance in affecting the identification of the problem, the issues, and the options?" "How did key players interact and how were areas of disagreement identified?" "At what stage were option's developed and by whom and in what forums?" "Were criteria used to assess the options, if so, what were they? What can be understood about bureaucratic politics from these events?"

Which statement best describes the role of public health professionals in employed government positions with respect to authoring manuscripts about their work for publication in peer-review journals? A. Since, as government employees, they cannot sign copyright releases to publishers they cannot submit manuscripts as authors B. The role of government health departments does not include research nor writing for journals C. Conflict of interest and ethics rules allow public health department employees to write for government publications, but not for-profit journals D. It is challenging to find the time and gain necessary internal clearances, but sharing lessons learned through such publication is an important aspect of professionalism

Correct answer: D Explanation: While it is true that professionals in government employed positions are NOT free to sign copyright over to a publisher, publishers offer licensing agreements in lieu of copyright agreements which specifically enable government employees as authors. Historically, universities have supported their academic public health professionals to obtain grants, conduct research and submit resultant papers for publication whereas the main mission of public health departments has been service. Finding the time to do background research, having limited access for review of previous publications, writing, gaining internal approvals, then dealing with manuscript submission, have been a challenge for public health professionals. However, this is changing as more realize that peer-review journals are an important communication channel to share lessons learned among the global community.

In part due to the public attention focused on environmental pollution by Rachel Carson's book "Silent Spring," as well as studies such as those showing a drastic decline in the American Bald Eagle population, a ban was issued on the use of: A. Chlorofluorocarbon (CFC) refrigerant gases B. Leaded gasoline C. DDT pesticide D. Asbestos insulation materials

Correct answer: D Explanation: DDT is essentially non-toxic to humans and was widely used is past years as a general purpose pesticide. However, it was shown to bio-accumulate through the food chain of birds and cause thinning of the birds' egg shells, resulting in broken eggs and a severe decline in some species including Bald Eagles, falcons, and pelicans. "Silent Spring" raised public awareness on bio-accumulation, which led the EPA to ban its' use in 1972.

Which of the following level of evidence is at the top of the evidence pyramid that examines a number of relevant and valid studies on a topic, and combines results from those studies using accepted statistical methodology? A. Cohort studies B. Randomized controlled double-blind studies C. Case control studies D. Systematic reviews and meta-analysis

Correct answer: D The hierarchy of evidence has systematic reviews and Meta-Analysis at the top of the evidence pyramid, followed by randomized controlled studies, cohort studies, and case control studies.

What is a key principle when developing and assessing health communication messages? A. Reading level B. Text density C. Use of jargon D. All of the above

Correct- D

The principal difference between other industrialized countries and the U.S. in terms of providing universal health care coverage is that: A. This is recognized as a basic human right in the other countries' founding document but not in the US constitution B. All hospitals are owned by and all physicians are employees of the other governments while the US takes a free market approach C. The other countries spend more per capita on healthcare while achieving similar or better outcomes for a larger proportion of their population D. The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population

D

If a food contaminated with a virus, such as hepatitis A, is left out for 4 hours in a kitchen at a temperature of 85 degrees Fahrenheit, the virus count in the food: (A) Increases exponentially because viruses multiply rapidly under these conditions (B) Increases slowly because the food temperature is still not as high as body temperature (C) Can increase or remain the same depending on the acidity of the food (D) Does not change

D - viruses can only grow in living cells and won't multiply under these conditions

Which of the following is a common metric used to evaluate health Communication? A. Number reached B. Frequency of exposure C. Next day recall of message D. All of the above

D- all of the above Justification: each of these options can be used to evaluate a health Communication campaign. To adequately evaluate health Communication, you should track the extent to which your target audience remembers seeing or hearing your message (recall and reach), as well as how many times they were exposed to it (dose). These metrics can help attribute results to your campaign.

Under which circumstance would there be no ethical violation for an officer or employee of a governmental regulatory agency to accept food or beverage paid for by others? A. Any meal at any time can be accepted from anyone except when an actual regulatory transaction is taking place B. Breakfast or dinner alone at his or her hotel provided in lieu of an honorarium for speaking at an industry sponsored event C. Lunch provided on site by an organization to everyone involved during day long inspections of their operational facilities D. Meals of social events provided to all registrants at a regional conference attended as a registrant at an agency approved event

D- modest items of food and non- alcoholic refreshments such as soft drinks, coffee, and donuts, not offered as part of a meal are excluded from the definition of a gift and may be accepted pursuant to certain specific regulatory exclusions.

Modes of Infectious Disease Transmission **Simplest to most complex**

Direct Contact: This is the SIMPLEST way a pathogen can be transmitted. Transmission requires direct contact w/ tissues, blood, bodily fluids, secretions from an infected person or animal. Indirect Contact: Indirect contact is similar to direct contact, BUT direct contact w/ bodily fluids or secretions is NOT required. The pathogen may be capable of surviving for varying periods of time on objects or surfaces and can be transmitted when an infected person comes into contact with the contaminated surface or object. Inanimate objects capable of transmitting a pathogen are known as fomites. Pathogens capable of being transmitted in this way include: influenza virus & norovirus. Airborne: Several pathogens are capable of being transmitted through the air. This is usually accomplished through droplets expelled from an infected Individual from a cough or sneeze. The effectiveness of pathogen transmission by an airborne route is a function of the droplet size necessary to carry the pathogen and the susceptibility of the pathogen to desiccation. Examples: influenza, measles, and severe acute respiratory syndrome (SARS) Water & Soil Borne: Pathogens transmitted in this manner can survive for long periods in either soil or water and are transmitted when an individual ingests contaminated soil, food, or water samples. Examples such as- Vibrio cholerae and Necantor americanus (hookworm) are good examples of said pathogens. Vector-Borne: these pathogens represent the MOST SIGNIFICANT (& complex) class of infectious agents worldwide. They fall into many classes: viruses, bacteria, unicellular eukaryotes, and multicellular invertebrates (worms). Insects are the most common vectors of infectious disease, but many other classes of organisms can serve as vectors, including ticks, snails, and copepods (water fleas). Vectors for pathology can either be mechanical (house flies) or biological (more common and way more dangerous).

The Epi. Triangle Explains that:

Disease occurs when an outside agent (entity that causes disease; can be chemical, physical, or biological) that's capable of causing the disease interacts with a vulnerable host (e.g., susceptible organism, human, animal) in an environment (conditions that are not part of the agent and/or host but influence their interaction) that's conducive to the spread.

Which of these groups of conditions include one or more single gene disorders that are part of the recommended uniform new born screening panel? A. Metabolic disorders (PKU, fatty acid oxidation disorders) B. Endocrine disorders (congenital adrenal hyperplasia) C. Hemoglobin disorders (sickle cell diseases) D. Hearing loss (connexin 26) E. All the above

E all the above

Climate Change

Earths temperature increased by 1.5 F in the past 100 years. -Affects weather patterns which also change disease patterns —warm winters and wet, hot summers *** increase vector borne disease) Ex: increases tick populations & Lyme disease —increased rainfall and flooding *** increase mosquito populations —Higher CO2 levels *** increase pollen Ex: increases asthma rates

Systems Thinking: SDOH

Economic stability: employment, income, expenses, debt, medical bills, and support Neighborhoods/Physical Environment: Housing, transportation, safety, parks, playgrounds, and walkability. Education: literacy, language, early childhood education, vocational training, and higher education Food: hunger and access to healthy options Community & Social Context: social integration, support systems, community engagement, and discrimination Health Care System: health coverage, provider attainability, provider linguistic and cultural competency, and quality of care Health Outcomes: mortality, morbidity, life expectancy, health care expenditures, health status, and functional limitations

In Health Communication- educational strategies vs. regulatory or policy strategies are best used-

Educational approaches work best when the recipient of the information has expressed an interest in, or commitment to, the desired behavior. In behavioral economics terms, the costs of doing the recommended behavior appear LOW, while the benefits of doing the behavior appear high. Ex- people who have already been diagnosed with an illness are more likely to follow a doctors instructions than those who are told they can prevent said illness Regulatory or policy approaches are necessary when the PERCEIVED COSTS of adopting a behavior are high, yet the BENEFITS appear low. Ex- many motorcycle riders prefer the freedom of not wearing a helmet- state helmet laws are necessary to prevent more head injuries and deaths.

Who led the Sanitation movement?

Edwin Chadwick in Great Britain

Stages of Change (Transtheoretical Model)

Emphasizes the concept of a change process, each stage of which is a success to be celebrated. The focus is on readiness to change. The health educator must know which interventions to use to move the process along. The stages are Precontemplation, Contemplation, Preparation, Action, Maintenance, and Termination. Stages of Change listed in Health Communication- precontemplation, contemplation, trial, repetition, and maintenance

21st Century Epidemiological Triangle consists of-

Environment (top of triangle), HOST (bottom left), Agent (bottom right) Vector is in the middle of the Triangle.

Morbidity:

Epidemiological term for disease Types of Morbidity: -Prevalence rate: # of EXISTING cases of disease -Incidence rate: # of NEW cases of disease

The interdisciplinary approach to epidemiology:

Epidemiology is an interdisciplinary science, meaning it uses information from many fields including: -mathematics -history -biostatistics -sociology -biology -demography & geography -behavioral sciences and psychology - law Etc.

Uses of Epidemiology

Epidemiology is used to used to identify and evaluate intervention strategies Overall goal of public health prevention is to prevent disease or decrease the negative impact of disease Epidemiology helps with health promotion, alleviation of adverse health outcomes, and prevention of diseases (infectious & chronic)

Robert Koch (1843-1910)

Established Koch's postulates - a sequence of experimental steps that verified the germ theory Identified cause of anthrax, TB, and cholera Developed pure culture methods -determined the vibrio that causes cholera

Robert Koch (1843-1910)

Established Koch's postulates - a sequence of experimental steps that verified the germ theory Identified cause of anthrax, TB, and cholera Developed pure culture methods. Koch's Postulates: 1.) the organism must be observed in every case of the disease 2.) it must be isolated and grown in pure culture 3.) when inoculated into a susceptible individual, it must cause disease 4.) the organism must be observed in and recovered from the experimental animal.

Quinn Patton's definition of Evaluation of Programs:

Evaluation- "the systematic collection of information about the activities, characteristics, and outcomes of programs, for use by people to reduce uncertainties, improve effectiveness, and make decisions.

What is the difference between evaluation, research, and monitoring? (CDC, 2022)

Evaluation: purpose is to determine effectiveness of a specific program or model and understand why a program may or may not be working. Goal is to improve programs. Research: purpose is theory testing and to produce generalizable knowledge. Goal is to contribute to knowledge base. Monitoring: purpose is to track implementation progress through periodic data collection. Goal is to provide early indications of progress (or lack thereof). Similarities: -Data collection methods and analyses are often similar between research and evaluation -Monitoring and evaluation (M&E) measure and assess performance to help improve performance and achieve results. Michael Quinn Patton said, "research seeks to prove, evaluation seeks to improve." Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate.

Which planning model should I use?

First, have a planning committee comprised of: -Members of the target population and those at risk -People who care about the program and will perform duties -People who have influence -Key leaders of organizational sponsor(s) -Others

Important: Once Congress passes a law that requires regulations, the administrative agency of the Executive Branch must stay within the bounds of the authority granted by Congress and follow specific procedures for rulemaking set forth in federal law. Steps below for rulemaking:

First, the administrative agency issues a notice of proposed rulemaking. Then, the regulatory agency will publish a Notice of Proposed Rulemaking (a draft) in the Federal Register, which explains the issue and how the agency plans to address it. During this time, interested parties and stakeholders may draft comments and provide feedback on important issues to consider. The administrative agency may insider these comments but has discretion on how to incorporate these comments and make considerations when drafting the Final Rule. The Final Rule is then published in the Code of Federal Regulations and has the force of law. *A similar rulemaking process also happens at the state level.* Ex: 1996, Health Insurance Portability & Accountability Act (HIPAA)

Public Health Laws

Formal practices enforced by authorities exemplified by statutes, regulations, and court decisions Public health law and ethics provide the framework for decision-making regarding interventions that keep populations healthy.

Categorize Stakeholder Engagement:

Four levels: Inform Consult Involve Collaborate/empower

Distribution

Frequency of disease, varies group to group

Functions described by APHA in 1968:

Functions of the State Health Department—— The state health department's mission to advance community health is carried forward through four basic functions: 1. Health surveillance, planning, and program development; 2. Promotion of local health coverage, 3. Setting and enforcement of standards; 4. Providing health services

The Conduct of a Clinical/ RCT

General Order of Conduct: -Hypothesis is formed -Study subjects recruited based on specific inclusion/exclusion criteria and their informed consent is sought -Subjects are randomly allocated to receive one of the two or more interventions being compared -Study groups are monitored for outcome under study (recurrence of disease, first occurrence of disease, getting better, side effects, etc.) -Rates of the outcome in various groups are compared

Strategy definition for Planning Evidence-Based Interventions to Meet Established Program Goals & Objectives

General plan of action that may encompass several activities and considers the characteristics of the priority population The developed strategy helps shape the methods selected to meet the educational and environmental objectives. Methods refer to the systematic approach or procedures used by presenters or health educators or speakers to share information, objectives and lesson materials, and can also refer to a specific part of an intervention, lesson, or presentation. Method selection is critical in the transmission, reception, and retention of information by audiences.

Bills of Mortality -1661 (London) John Graunt

Graunt thought that it was in the public's interest to have a deeper understanding of what was causing people to become ill or die so he cataloged afflictions, notorious diseases, causes of death, causalities and post them and call them "Bill's" This represents the beginning of someone attempting to catalog causes of mortality and causes of disease. Weekly list published in London which showed all the causes of death for that week.

What is the primary catalyst for climate change?

Greenhouse Gases (created by humans)

Which ozone is known as the bad ozone?

Ground level ozone

PH History- Later 19th Century

Growth in scientific knowledge -Louis Pasteur *1862 germs caused many diseases *1888 first Public Health Lab -Robert Koch *1883 identifies the vibrio that causes cholera, 20 years after Snow's discovery *discovered the tuberculosis bacterium

What is HACCP? Hazard Analysis Critical Control Point

HACCP is a management system in which food safety is addressed through the analysis and control of biological, chemical, and physical hazards from raw material production, procurement, and handling and the manufacturing, distribution, and consumption of the finished product. Steps: Conduct a Hazard Analysis - how do I control what's happening Identify the Critical Control Points - once I find these.. Establish Critical Limits - I establish limits and to ensure that the limits are met, we begin to monitor and introduce procedural rules. Establish Monitoring Procedures - If the rules are broken, we would take... Establish Corrective Actions - then I need data to report upon to see how well things are working or aren't thereby I establish.. record keeping.. Establish Record Keeping Procedures - records must be accurate and then verifiable Establish Verification Procedures

The Council on Linkages Between Academia & Public Health Practice

Has developed core competencies for three tiers of the public health professional in eight domains. The tiers reflect the career stages of the public health professional: Tier #1: front-line staff or entry level Tier #2: program management or supervisory level Tier #3: senior management or executive level The 8 Domains are: 1. Analytical/assessment 2. Policy development/program planning 3. Communication 4. Cultural competence 5. Community dimensions of practice 6. Public health science 7. Financial planning and management 8. Leadership and systems thinking

Definition of Health defined by WHO, 1948:

Health is a complete state of physical, mental and social well being and not merely the absence of disease or infirmity

health system vs. health care system

Health system comprises all organizations, institutions, and resources that produce actions whose primary purpose is to improve health the Health care system consists of those organizations, institutions, and resources that deliver health care to individuals Countries organize these system's differently.

The Risk & Global Burden of Infectious Disease- Disability Adjusted Life Years (DALYs)

Historically, the burden of infectious disease was measured by using gross mortality rates. However, many infectious diseases, while exhibiting low mortality rates, result in severe morbidity. The DALYs metric, is used to take the morbidity AND mortality into account when calculating the OVERALL burden of disease. DALY calculations are often used to determine the cost-effectiveness of various disease interventions. Measuring the cost per DALY is one way to help programs effectively prioritize spending on disease interventions. Ex: A recent study showed that interventions targeting malaria and some of the neglected tropical diseases, particularly onchocerciasis, are among the most cost effective ways to improve the health of populations in the developing world.

An Action Plan Consists of:

How the group will accomplish its objectives - what will happen - person responsible - date of completion - resources -barriers or resistance -collaborators

VMOSA Strategies:

How you will reach your objectives This may include- social marketing campaigns or community outreach activities An Action Plan is very helpful to determine and communicate to your group on how objectives will be accomplished Action Steps are developed for every stage of the intervention. Components of the action plan Include the step (what will happen), personal responsible (who will do what), date to be completed, resources required, barriers or resistance and how to overcome these and collaborators. Ex: if a step in an action plan is to develop a draft of a community health program on the risks for colon cancer, the following could apply: (page 167) Step: draft an education program on colon cancer Person Responsible: Sandy Jones from the planning committee and local university Date of completion: January of next year Resources: $1,500 for support of a student and meeting space and refreshments Barriers or Resistance: None anticipated as long as planning group sees the value of this program Collaborators: members of education subgroup and community health education programs

The seminal case, Jacobson v. Massachusetts (1905)

In Jacobson v. Massachusetts (1905), the Supreme Court upheld a state law in Massachusetts that required either compulsory vaccination of adult residents against smallpox or required the individual to pay a fine as a proper exercise of the state's police power. The court found that states, through local health authorities, may exercise its police power to impose reasonable regulations pertaining to mandatory vaccination to protect the public against the imminent danger of a threatened epidemic of communicable disease. Since Jacobson v. Massachusetts, states have enacted specific laws tying vaccination mandates to school attendance because states view this as an effective measure to protect the public from communicable disease, specifically when children are gathered in close quarters.

IMPORTANT- Types of Teratogens

Ionizing Radiation -Gamma or x-rays: Microcephaly or intellectual disabilities Chemicals -Accutane: birth defects -Alcohol: Fetal Alcohol Syndrome Cigarette Use: LBW, still birth, miscarriages -Dioxin: linked to cancer -Thalidomide: absence of long bones Pathogens -Rubella: Congenital defects -Syphilis: Microcephaly or intellectual disability -Toxoplasmosis: still birth, miscarriage, and developmental concerns *Most teratogens effect the embryo during organogenesis, a critical stage of early development when tissues and organs are formed.*

Mission vs. Vision

Mission statements identify the fundamental purpose of the organization, often by describing what the organization does, whom it serves, how it will reach those objectives, and how it differs from similar organizations. Vision statements describe what the organization is striving to achieve and, in this way, provides guidance to organizational members. Details where the organization aspires to go.

What is critical to the success of program planning efforts?

Needs & resource assessments

Mobilizing for Action through Planning and Partnerships (MAPP)

Only planning model that assist local health department 6 phases: 1. Organizing for success and partnership development 2. Visioning 3. Four MAPP Assessments 4. Identifying Strategic Issues 5. Formulating goals & strategies 6. An Action Cycle

Ozone in the Workplace

Ozone is found in the Earth's stratosphere. — Absorbs most of the sun's ultraviolet (UVB) radiation — stratosphere contains high concentrations of ozone (O3) compared to other parents of the atmosphere * still small in relation to other gases found in the stratosphere — Atmospheric Ozone CAN have a positive effect. Ground Level Ozone is a principal component of smog. — rest of chemical reactions between VOCs and nitrogen — harmful to human health -responsible for aging lung tissue , reducing resistance to colds, and breathing issues

Surveillance Systems: Passive surveillance

Passive surveillance: local and state health departments rely on health care providers or laboratories to report cases of disease Reporting is involved but there is no way to enforce adherence. Advantage: -Efficiency -Simple & requires relatively few resources -Occurs continuously Disadvantage: -Incomplete data due to underreporting -Underreport disease frequency Majority of Public Health surveillance systems are passive.

"The Great Man Theory"

Popularized by Thomas Carlyle in the mid 1800s, supported the idea that leaders were born, not made, though critics noted that leaders were only tasked to lead because of circumstances in which they found themselves.

What are the 2 planning models uses in Public Health, Health Promotion?

Predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation (PRECEDE)- policy, regulatory, and organizational constructs in educational and environmental development (PROCEED) and Intervention Mapping. In short, the 2 prominent planning models used in Health Promotion are: -PRECEDE-PROCEED -Intervention Mapping

What does PRECEDE-PROCEED stand for?

Predisposing, reinforcing, and enabling constructs in educational/environmental diagnosis and evaluation (PRECEDE)- Policy, regulatory, and organizational constructs in educational and environmental development (PROCEED).

Collaborative Agreements- Memorandum of Agreement (or Understanding)

Provide documentation of the agreement and help to minimize potential disagreements, provide accountability, describe deliverables, and act as a reporting or dissemination mechanism. Should be detailed and serve as a mechanism through which partners can assess the fulfillment of their commitments

Principal standard of CLAS

Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

Hazardous Material Transportation Act (HAZMAT)

Provided guidance on the transportation of hazardous materials and placed authority within the department of transportation. States must abide by these federal regulations but can place more stringent provisions. It covers any materials that are capable of creating an unreasonable risk to health.

Clean Air Act of 1970

Provided the establishment of NAAQS by regulating six classes of air pollutants (lead was added later) or criteria air pollutants, regulated vehicle emissions, and established protocols for regulating other air pollutants (hazardous air pollutants).

Biological & Molecular Basis for Public Health

Public Health -Based on the Premise that health events are NOT random -occur as a result of risk factors -Risk Factors are not randomly distributed in the population, rather they are influenced by biological and social determinants of health

Role of the Federal Government in Public Health

Public Health authority in the U.S. rests with the States —- no central authority for public health The Federal government only plays a supportive role, a persuasive role, and in some cases a direct role.

Interpretations of Relative Risk/ Risk Ratio (RR)

RR= 1.0 - no association between exposure and disease RR= 2.0 - two times the risk of disease in the exposed compared to the unexposed RR= 1.6 - 1.6 times the risk of disease in the exposed compared to the unexposed or 60% increased risk of disease in the exposed (1.6 - 1.0 = .60 = 60%) RR- 0.5 - 0.5 times or 1/2 the risk of disease in exposed compared to unexposed

Water:

Saltwater: 97.5% (ocean) [fresh water] - less than 3% Ice Caps & Glaciers: 79% (most of our fresh water is in ice caps & glaciers and replaced by precipitation) Ground water: 20% Water in lakes: 52% Water in soil: 38% [water vapor in atmosphere, water in living organisms, & water in rivers)

Sentinel Events: The Importance of the Response

Sentinel events in public health also refer to moments where paradigms were changed/shifted

What is used in public health communication for the in between (where the cost and benefits can be negotiated):

Social marketing

Types of Renewable Energy

Solar Uses- Solar Power Plant Wind Uses- Wind Power Plant Biomass Uses- Biofuels, Biopower, and Bioproducts Hydrogen Uses- Fuel Cells Geothermal Uses- Geothermal, Power Plant, Heat Pumps Ocean Uses- Tidal Power, Wave Power, Thermal Hydropower Uses- Hydropower Plant

Starting Point for Situation Analysis:

Starting place- identify stakeholders, potential collaborators, available staff and technical resources, and budget estimates. Next, assessing community capacity and readiness, and engaging in asset mapping can help identify specific information related to the community context that will support the implementation of the health intervention. Conducting a SWOT (strengths, weaknesses, opportunities, and threats analysis, will help identify existing community strengths or assets that support the intervention, identify weakness, and plan opportunities and potential threats- which can be external and internal.

Steps in a HACCP food safety system:

Step 1: conduct a hazard analysis to identify ALL biological, physical, and chemical hazards associated with a food product. Step 2: identify critical control points in food production where a measure can be applied to prevent, reduce, or eliminate a food safety hazard. Each measure applies at a critical control point MUST be grounded in an empirical parameter (such as setting limits on acceptable moisture levels). Step 3: There must be robust monitoring to assess whether the measures taken at each critical control point are effective and if corrective actions are necessary.

Why is surveillance important?

Surveillance is VITAL to Public Health: -Monitoring disease trends -Describing natural history of diseases -Identifying epidemics of new syndromes -Monitoring changes in infectious agents -Identifying areas for research -Planning Public Health policy -Evaluating public health policy/interventions

Infectious Disease Models (Useful to PH professionals) SEIR INFECTION MODEL:

Susceptible, Exposed, Infectious, Recovered (SEIR) *Simulate progress epidemic in a human population.* States of the SEIR infection model: LPi: latency period IPi: infectious period ti: first time individual is exposed to the virus as xLP: number of days for an exposed individual to become infected xIP: number of days for an individual to recover from disease

T/F: Estimated countries affected by West Nile Virus: Africa, Australia, Europe, Middle East, Asia, & North America

TRUE

T/F: In PH, when adopting or adapting an intervention, we typically start by reviewing the existing evidence-based interventions. Evidence-based is an important concept in public health and public health interventions. We want both of our goals and objectives to be evidence-based, meaning they reflect current scientific evidence related to the behavior. We also want to use evidence based interventions, which commonly refers to those interventions that have been systematically developed using best practices in developing the intervention as well as rigorously tested and shown to be effective in achieving the desired outcome.

TRUE

True or False: Maintaining warm foods above 140F (60 C) will kill actively growing bacteria.

TRUE

T/F: antigenic shift (major) typically occurs when the influenza virus comes into contact with an animal. Ex: avian flu virus

TRUE, this is novel virus. An antigenic shift (major) typically occurs when the influenza virus comes into contact with an animal. Ex: avian flu virus

T/F: Formative evaluations consist of a needs assessment or process evaluation. Summative evaluations consist of outcome evaluation or impact evaluation.

True

Public Health Sentinel Events (examples)

The Black Death/Plague: 1347- 1352 (1300s) * likely originated in China and was brought to Europe by tradesman/ships. Wreaked havoc across Europe with more than half the population dying from the plague. Overwhelmed communities, dead bodies everywhere, challenged the food supply and really cause major historical changes. 1661 John Graunt's Bill's of Mortality * First attempt to categorize why/how people died or got sick. 1796 Edward Jenner develops small pox vaccine and vaccinates his son first. Jenner noticed that several milk maids who were constantly around cows and milk, did not appear to get sick w/ small pox. He gave them cow pox which is a form of small pox. 1842 the Sanitary Condition of the Labouring Population in London - report by Sir Edwin Chadwick who reported on these horrible conditions. First report of its kind to link the environmental surroundings to health and physical disease. 1854 cholera outbreak and John Snow's removal of the Broad Street Pump which eliminated cholera (Father of Epidemiology) the agent of cholera was not known at this time. You don't need to know the agent to try and stop the disease. 1798 the United States Marine Hospital Service was formed to deal with diseases brought in by ports and within port cities 1799 first heath department was formed in port city *port cities were a large contributor to the spread of infectious disease, crowding, and then poor environmental conditions etc* 1912 U.S. Public Health Service Formed (It's origins were the Marine Hospital Service) The focus for many years has been on environmental, water, waste water, vaccines, communicable disease quarantine, etc. Emergence of a new focus on chronic disease and the impact of behaviors which led to 2 very important reports: 1974 Mark Lalonde who was the minister of health for Canada, issued a very important Report, titled "a new perspective on the health of Canadians" known as the Lalonde report- first time a nation announced that they were focused on health promotion and chronic diseases and the factors that contribute to chronic diseases and not just infectious disease 1979 Surgeon General's Report, USA - this was basically the answer to the Lalonde report, and the Generals Report was titled "healthy people" on health promotion and dz prevention beyond just focus on infectious/communicable diseases

Physical Environment: AIR

The Clean Air Act requires the EPA to set National Ambient Quality Standards for 6 Primary criteria air pollutants. 6 Criteria Air Pollutants: 1.) Sulfur Dioxide (acid rain)- causes respiratory effects; people w/ asthma and other susceptible Populations 2.) Nitrogen oxides (smog; acid rain)- Linked to respiratory effects; people w/ asthma 3.) Carbon monoxide- reduces oxygen to the body tissues; those with cardiovascular conditions especially. 4.) Ozone- Causes airway irritation, coughing & difficulty breathing; those with chronic obstructive pulmonary disease (COPDH or asthma 5.) Lead- Can cause neurological effects; children; can cameo affect kidney, immune develop and reproductive systems 6.) Particulate matter- smaller than 10 micrometers; can cause respiratory effects; especially with those who have asthma

What 2 Models offer explanation of why people are more likely to respond well to information when they feel they are more susceptible or already have an illness condition?

The Elaboration Likelihood Model & the Health Belief Model

Odds Ratio (OR)

The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. Odds ratios are most commonly used in case-control studies; however they can also be used in cross-sectional and cohort study designs as well. To calculate, picture our 2 x 2 table, we do cross product multiplication and then division. Multiply a x d / b x c

Panama Canal (Public Health)

The building of the Panama Canal was critical to improving and increasing trade. The original French contractors who were working on the canal suffered high rates of mortality due to mosquito borne infectious disease. New discoveries by scientists in Cuba and General Gorgas of the US Army came together to solve/control the mosquitoes. While the French abandoned the project, the U.S. stepped in and this disease control process enabled them to complete the Panama Canal and changed the way we thought about disease control.

Natural History of Disease

The course of disease from its beginning to end without clinical intervention. Pre-pathogenesis: before the disease agent interacts with the host Pathogenesis: after an agent has interacted with a host -3 types of prevention —-primary —-secondary —-tertiary Epidemiology is used to identify and evaluate intervention strategies. The overall goal of public health prevention is to prevent disease or decrease the negative impact of disease.

Hill's Criteria for Inferring Causation: Analogy

The existence of an analogy (for example, if a drug causes birth defects, then another drug could have also had the same effect) could strengthen the belief that an association is causal.

Actors in Global Health Systems

The government or professional body that structures and regulates the system. The population, including patients, who pay as households as individuals for and receive services from the health system. Financing agents, who collect and allocate funds to providers or purchase services as national or local levels Providers of services

Simplified Definition of the Transactional Model of Communication

The idea of a source transmitting messages through a channel to a receiver, in anticipation of a response.

Primary Audience in Health Communication

The individuals you hope will act

Air Pollution Control Act of 1955

The nation's first piece of federal legislation regarding air pollution. Identified air pollution as a national problem and announced that research and additional steps to improve the situation needed to be taken. It was an act to make the nation more aware of this environmental hazard.

Why are Biological Vectors more dangerous?

The pathogen in a biological vector is able to infect and develop within the vector, generally amplifying it's numbers, resulting in far more efficient transmission than transmission by a mechanics vector. Biological transmission requires the pathogen to be capable of infecting and developing within both an invertebrate and human host, which are very different environments. The key metric that determines if a given insect can serve as an efficient biological vector is known as its vectorial capacity.

T/F: a goal is a broad statement of intent whereas objectives are more focused and answer questions such as- who, what, how much, and by when (they are SMART).

True

Policy Development

The process of drafting new policies or revising existing policies. Conducting policy relevant research, communicating findings in a manner that facilitates action, developing partnerships, and encouraging efficient use of resources through the promotion of policies based on science- such as the promotion of evidence based health interventions

Policy Development

The process of drafting new policies or revising existing policies. Policy development entails conducting policy relevant research, communicating findings in a manner that facilitates action, developing partnerships, and encouraging efficient use of resources through the promotion of policies based on science— such as the promotion of evidence based health interventions

Needs Assessment

The process of identifying, analyzing, and prioritizing the needs of a priority population Other related terms- community analysis, community diagnosis, and community assessment

T/F: in preventative health communication, we define audiences as primary, secondary, and tertiary depending on how close they are to the ones whom you hope will act on the information.

True

Miasma Theory

The theory that diseases were caused by miasma or bad air arising from organic decay, filth, or other conditions of the local environment.

Public Health Communication:

The use of communication techniques and technologies to positively influence individuals, populations and organizations for the purposes of promoting conditions conducive to human and environmental health. The science and art of using communication to advance the health and well-being of people and populations. How people use messages to generate meanings within and across various contexts. Messages represent encoded pieces of information, such as thoughts that are put into words, gestures, glances, and symbols.

VMOSA Vision:

The vision communicates what your organization believes are the most ideal conditions for your community— the best it could be. These statements should be shared and understood by members of the community and should be broad, inspiring, uplifting, and easy to communicate. Ex. A vision might be- a community free of colon cancer

Douglas McGregor's Theory X and Theory Y

There are two approaches to motivating employees - strictly controlled/authoritative environment or less rigid environment/participative... Theories address leadership and the motivation of employees categorizing Theory X and Theory Y. Theory X- is motivating employees through coercive strategies or economic strategies Theory Y- refers to employees who are highly motivated by the satisfaction of achieving the tasks at hand

T/F: mission statements are more concrete than vision statements

True

Objectives Example:

These objectives can be behavior-, community-, and process oriented, which is related to how the program will be implemented. Examples: colon cancer example are: 60% of the population aged 50 years and older (who and how much) will have a colonoscopy done (what) within 3 years of the program and repeated within a 10 year period (by when). A community objective might be that there will be a 50% increase in the number of health centers (who, what, how much) that offer colonoscopy within 5 years of the program (by when). A process objective (related to activities & HOW the program is implemented) would be that 10 health educators will be hired by the health department (who and how much) to participate in the colon cancer prevention activities (what) three months before the start of the program (by when). SMART Objectives are specific, measurable, achievable, relevant, and time limited.

Hill's Criteria for Inferring Causation: Gradient

This criterion refers to the presence of an exposure-response relationship. If the frequency or intensity of the outcome increases when an exposure is more intense or lasts longer, then it is more likely that the association is causal.

T/F: mosquitoes cause more death and disease than any other animal on the planet.

True

opinion leaders

Those individuals held in great respect becasue of their position, expertise, or peronsality, who may informally and unintentionally influence others within the community

Gatekeepers

Those who formally or informally control access to a priority population or control specific aspects of a community

The way to get new policies created is:

Through grass roots efforts and other communication strategies that build up a demand among policymakers to address their constituents' needs.

T/F: the State of Massachusetts was the first to create a STATE board of Health.

True

T/F: the Superfund was created after the Love Canal (Niagara Falls) event.

True

Programs must have a rationale to be able to communicate with decision makers, especially those in charge of resources. This is done how?

To create a rationale, program planners must identify the health problems in global terms backed with data— and if possible, determine what economic costs are related to the problem. Cost-benefit and return on investment are beneficial here.

In Health Communication, the main goal for engagement is:

To establish feelings of mutual understanding. Engagement is the first step toward information of persuasion.

Evidence Base Pyramid

Top to Bottom Systematic Reviews [Meta-Analyses] Critically- Appraised Topics [Evidence Syntheses] Critically- Appraised Individual Articles [Article Synopses] Top 3 are known as "Filtered Information" *Filtered information means that all of the above types of study designs (anything critically appraised) have gone through an evaluation process, hence why it's called filtered.* Randomized Controlled Trials (RCTs) is still the Gold Standard for Epidemiological Studies Cohort Studies Case-Controlled Studies/ Case Series/Reports These 3 are known as "Unfiltered Information" Lastly... at the very bottom with the weakest quality of evidence is: Background Information / Expert Opinion

Toxicology:

Toxicology- the study of how chemicals cause injury to living cells Involves: • Dose- the AMOUNT of the chemical in the body • Risk- the PROBABILITY (or likelihood) that harm will occur in the body under a specific set of conditions Risk includes 2 considerations: 1.) the likelihood that an adverse reaction or harm will occur, 2.) and the consequence or level of harm that will result if the harm occurs Formula: Risk = Toxicity x Exposure

Prevalence rates are better used to describe chronic disease compared to incidence rate.

True

Selecting the appropriate method is critical in the transmission, reception, and retention of information by audiences.

True

T/F: "the great theory" (Thomas Carlyle mid-1800s) led to "the trait theory" (Ralph Stogdill 1930s) which then led to the development of "behavioral theories" of the 1940s which focused more on the roles and tasks of leaders and less on intrinsic traits. These theories led to the examination of differences between leadership tasks and management tasks and led to "contingency" theories of the 1960s that suggested that all leadership was situational. Later scholars considered "transactional" theories in leadership, which were quickly discredited and led to what we currently espouse as "transformational leadership" which focuses on the relationships leaders develop with others.

True

T/F: A biological vector (typically an arthropod) carries a pathogen from one host to another after becoming infected itself. Ex: Step 1- Infected mosquito bites uninfected person. Step 2- Infection spreads through body and into red blood cells. Step 3- Second mosquito bites infected person. Mosquito may now transmit infection to another person.

True

T/F: A government (federal) employee can use the government room rate offered by hotels whether they are on a personal or a business trip.

True

T/F: A mechanical vector carries a pathogen on its body from one host to another, NOT as an infection. Ex: Step 1- fly picks up pathogen from fecal matter and carries it on its body. Step 2- Fly transfers pathogen to food. Step 3- Person eats contaminated food and then gets sick.

True

T/F: Antigenic drift is the reason we need new flu vaccines every year and the reason we can get sick from the flu many times in our life.

True

T/F: Both legislation and regulation are similar in that they both carry the force of law. However, they are different because legislation is produced by the legislative branch (Congress who makes laws) and regulation is promulgated through the executive branch (The President of the U.S. & Federal agencies like the CDC & FDA).

True

T/F: Central to intervention mapping is the involvement of the community and planning group throughout — with much free/flowing brainstorming for each of these steps.

True

T/F: Evaluation falls into one of two broad categories: formative and Summative. Summative evaluations should be completed once your programs are well established and will tell you to what extent the program is achieving it's goals.

True

T/F: Federal law requires that landfill well water is routinely checked and that corrective action is maintained if needed.

True

T/F: Health communication planning begins once epidemiologic findings show that a health problem exists and that something can be done to lower the exposure or risk. This can be any variety of factors, including a change in an environmental condition, a policy, a behavior, or even an attitude that can lead to improvements in health. Health communication can be used to directly instigate or support these changes.

True

T/F: Health communication programs that adhere to a behavior change theory and design interventions that operationalize its constructs (Ex. An intervention using social cognitive theory might strive to build self-efficacy, provide vicarious learning, or demonstrate rewards) are stronger because they are built on logic models of HOW and WHY change is predicted. This logic model is the framework for the program evaluation.

True

T/F: Health disparity is defined as the difference in health status between two groups, often stemming from broader inequities.

True

T/F: Ideally, a screening test is introduced in the preclinical phase, prior to symptoms and diagnosis.

True

T/F: In general, materials should be written at a 7th grade reading level as this reflects the majority of American adults.

True

T/F: Majority of Public Health Surveillance systems are passive.

True

T/F: National Culturally and Linguistically Appropriate Services (CLAS) Standards are designed to advance health equity and eliminate health disparities through governance, communication, and engagement.

True

T/F: Newborn screening began in the 1960s when a scientist named Robert Gutherie designed a panel of blood test which would determine if a baby had PKU (metabolic disorder)

True

T/F: Observation and assessment are part of developing a new process or policy.

True

T/F: Organophosphates are often found in insecticides.

True

T/F: Poor health literacy is both a cause and a consequence of other health disparities, resulting in needless suffering and billions of dollars of wasted resources.

True

T/F: Prevalence rates alone can be more cumbersome and are not as informative as incidence rates for diseases that are not chronic.

True

T/F: Public Health falls beneath 'Reserved Powers.'

True

T/F: Public Health law and ethics provide the framework for decision making regarding interventions that keep populations healthy.

True

T/F: Public Health laws address the government's power and duty to protect the public's health and the limitations on those practices.

True

T/F: Public Health, our goal for early screening to identify individuals who may be at an increased risk for a certain disease. Early detection -> Early Treatment

True

T/F: Public drinking water systems use various methods of water treatment to provide safe drinking.

True

T/F: Stakeholder involvement and feedback are vital. Stakeholders assess the program and provide feedback throughout the planning and evaluation process. They are critical in the development of VMOSA (vision, mission, objectives, strategies, and actions).

True

T/F: Summative evaluations are conducted as a pass or fail examination that can lead to program termination.

True

T/F: The Children's Bureau was created in 1912 and they figured out that they needed a presence In every state to continue their work. So they created the very first , grants and aide funding approach from U.S. Congress so Congress would give each state that allotted money so that they could fund maternal child health initiatives. The availability of the funds from Congress mandated that the funds had to go to a Health department to supplement the family's need.

True

T/F: The WHO was created after WWII & established by the United Nations. The World Health Organization provides leadership on health matters, monitors and assesses health trends around the world, and is an important source of technical knowledge and consultation.

True

T/F: The practice of Public Health law balances assurance of the common good with the protection of civil liberties.

True

T/F: The social determinants of health determine the quality of life and overall health of individuals.

True

T/F: Vaccination will only prevent wide spread outbreaks if a large enough proportion of the population gets vaccinated.

True

Regulations: HIPAA

Under HIPAA: -Protected health information (PHI): any identifiable information of individual: demo data, health condition, or receipt of services -Privacy: Freedom from intrusion; having control over the extent, timing, and circumstances of sharing PHI -Security: Practices, policies, and procedures created to protect a person's PHI Ex: firewall systems etc; posting your password on a sticky note -Confidentiality: Patient disclosing information in a relationship of trust -Covered entities: can share information back and forth due to an arguable reason to share said information (doctors to health insurance company, etc.) When you release PHI without a person's permission, it's called a "breach."

Lemuel Shattuck (1850)

US teacher, statistician and legislator; published The Shattuck Report -recommended measures such as creation of state and local boards of health; collection of vital statistic data; provision of safe factories, food, water; provide vaccinations against disease Issues report on the Sanitary Commission of Massachusetts, where they did a similar survey of the living conditions of people in the state. Like Edwin Chadwick argued for population approaches to promoting health so did Lemuel Shattuck. Argued for- -Establishment of health records and vital records system -Improved conditions to fight disease -argued for inspections of a variety of institutions for TB control -argued that the government should be disseminating information to enable the public to understand and manage its own health — included chapters on mental health and alcoholism **** This comprehensive report (just like in GB), lead in 1869 to the creation of the first State Board of Health in the United States. The state of MA has the distinction of having the oldest public health department in the nation.

Relative Risk (RR)

Used in cohort studies to determine how strongly a risk factor is associated with an outcome. Risk of outcome in exposed/risk of outcome in unexposed. 1 is the null. Additional definition- relative risk is the ratio of the probability of an event occurring in an exposed group to the probability of that event occurring in comparison to a non-exposed (control) group. Dividing one group's rate by another in this manner is useful for identifying risk factors, but the ratio can be large whether the number of persons in each group is big or small so relative risk is not a good estimator of caseload.

Program Planning Models- Planned Approach to Community Health (PATCH) 1983:

Used in partnership with state and local health departments and local communities. It's Phases Are: 1.) Mobilizing the Community 2.) Collecting and organizing the data 3.) Choosing health priorities and target groups 4.) Choosing and conducting interventions 5.) Evaluating the PATCH process & interventions

Social marketing in public health-

Uses the term product to refer to a tangible good, such as soap, a condom, or a vegetable The product refers to services (Special Supplemental Nutrition Program for Women, Infants, and Children) or behavioral suggestions (washing your hands before eating, wearing a condom, eating more vegetables). The social marketer researches what the intended user would value on the new product company and s with what products they are presently using or what behaviors they are presently performing.

Federal- State Relationship:

What is federalism? * the constitution established a federal republic. * division of powers between the national government and the states. * supreme authority rests with the national government, but some powers are reserved to the states. Examples: National Government Powers -make treaties -establish and regulate postal system -regulate foreign and interstate commerce -make all laws necessary and proper to meet the responsibilities per the U.S. Constitution -coin money -tax imports/exports -declare war -protect copywriters and patents Shared Powers: -collect taxes -regulate banks -make and enforce lanes -establish and administer a judiciary -borrow money -provide for the common good State Government Powers: -establish local government -public education (schools) -conduct elections -provide for common good, protect health, morals & safety -professional licensure -regulations for marriage -regulate interstate commerce -ALL POWERS not delegated to the National Government or Denied to the States per the Constitution

Public Health defined by Institute of Medicine (IOM), 1988:

What we do collectively as societies to create conditions in which people can be healthy.

The Plague (the Black Death) 1334

Yersinia pestis, believed to originate in China in 1334 The plague appeared in 2 forms: the pneumonic plague and bubonic plague. Pneumonic was spread via airborne by sneezing and bubonic was spread by flea bites. A flea would bite a dead rat who had been infected with the plaque and then bite a human thereby transmitting the plaque to humans -Height of the Plague: 1348-1352 -At least 25 million deaths in Europe - ~1/3 of the population with more than 60 million deaths worldwide -Death of 25% to 50% of population

Active Surveillance is useful when:

You must identify all cases.

Analytic Epidemiology

a form of epidemiology that investigates causes and associations between factors or events and health Tries to determine the cause of a disease by looking at associations between people with and without an exposure and people with and without an outcome. Natural experiments in which subsets of populations have different levels of exposure and we look at the rates of disease Ex: smoking increases the risk of lung cancer by 5 times

Dose- Response Curve (DRC)

a formal graph of a drug's effects (on the y-axis) versus the dose given (on the x-axis) Assumptions: • Higher dose = greater effects • Deleterious effects are expected after reaching a threshold amount ^ This is an exception: Carcinogenic Rule Specifically, for any known carcinogen, there is NO SAFE THRESHOLD. • Lethal Dose 50 (LD50) -The Most common measure for ACUTE toxicity -The dose level at which 50% of the test population will die •LD0: There are NO resultant deaths.

Asset Based Community Development (ABCD)

a methodology that starts with identifying community assets and strengths, including local persons, community associations and networks, natural resources, and institutions, as a means of working with residents to create sustainable communities In contrast to needs-based approaches, ABCD is a method that identifies and builds on the strengths and resources in a community, including Human Resources— the gifts, talents, and capacities of local citizens. The focus of ABCD is to mobilize community development through appreciative inquiry and collaborative action. Steps include: mapping assets by conducting informal discussions and interviews (collecting stories), building relationships and organizing a core group of community leaders, mobilizing economic development and information sharing, convening the community (including broad representation) to develop a shared vision and plan, mobilizing assets for community development, and leveraging outside resources (people, activities, investments) to support the asset- based and locally defined development efforts

Intervention Mapping

a six-phase program planning model guided by diagrams and matrices that incorporate outputs of the assessment process with relevant theory to help develop appropriate interventions for priority populations

Intervention Mapping

a six-phase program planning model guided by diagrams and matrices that incorporate outputs of the assessment process with relevant theory to help develop appropriate interventions for priority populations. Expands upon PRECEDE- PROCEED and other planning models w/ better guidance in intervention components use of theory in general 1.) Develop a Logic Model of the problem (similar to PRECEDE- PROCEED) 2.) Develop Program Outcomes & Objectives with a Logic Model of change (uses change objectives)

What is HACCP?

a systematic approach, science based approach to identify and control problems and processes that may cause foodborne illness before they happen

Epidemic

a widespread occurrence of an infectious disease in a community at a particular time.

Thomas McKeown

argued that deaths from infectious diseases, such as T.B., pertussis, and measles, fell sharply after 1850 because of the change in social and environmental factors, especially better nutrition

Capacity building:

activities that enhance the resources of individuals, organizations, and communities to improve their effectiveness in taking action Capacity building in an organization are categorized by efforts of the organization to enhance its ability to competently achieve its (operational, programmatic, financial) goals now and into the future.

Physical Environment

air and water quality, housing and transit Noise, light, and soil, too. Host for the vectors that cause the disease—

attributable risk percent

among cases that are exposed, it is the percentage of those cases attributed to the exposure. It is assumed that the exposure is a cause of the outcome.

Edwin Chadwick (1800-1890)

an urban reformer with a background in law that was obsessed with eliminating the poverty of urban areas. He was appointed to a number of government investigations. He was a secretary of the Poor Law comission that initiated a search for conditions of the working classes. This led to his Report on the Condition of the Laboring Population of Great Britain. He believed that the disease was caused by sanitation problems. He wanted a modern sanitary system and efficient sewers and piped water. This caused the National Board of Health to be created. Published his survey in 1842 about the sanitary conditions of the laboring classes in GB. The report shocked everyone and described in graphic detail what living conditions were like in these tenements and these urban areas and really laid the groundwork for a population approach to health promotion.

Determinants

any factor that brings about change in a health condition or other defined characteristic -biologic agents -chemical agents -less specific factors: stress & lifestyle

How does WHO define a community?

as a social group determined by geographic boundaries and/or common values and interests, community members know and interact with one another, the community functions within a particular social structure, and the community creates norms, values, and social institutions.

What are the 3 core functions of public health?

assessment, assurance, policy development

A mosquito bites an individual who later develops a fever and abdominal rash. What type of transmission would this be?

biological vector transmission

Plasmodium spp.

causative agent of malaria Water-related because of the mosquito's lifestyle.

Mobilizing for Action through Planning and Partnerships (MAPP)

community driven strategic planning process for improving community health Facilitated by public health leaders, this framework helps communities apply strategic thinking to prioritize public health issues and identify resources to address them. MAPP is NOT an agency focused assessment process. Rather, it is an interactive process that can improve efficiency, effectiveness, and ultimately performance of local public health systems. Steps include- organizing, visioning, assessments, strategic issues, goals/strategies, and action cycle. The first 3 involve organization of the group, creating vision, and reviewing assessments that incorporate community themes and strengths of local public health systems, community health, and forces of change. From these steps, strategic issues are identified, then goals and strategies, and finally the action cycle linking planning, implementation, and evaluation.

Community capacity

community members gain skills, social networks, and access to power through their participation

Issue selection

community members participate in identifying issues; specific targets for change are chosen as part of a larger strategy

Quantification:

counting of cases of illness or other health outcomes -uses statistical measures -describe the occurrence of health outcomes -measure the association of outcomes w/ exposures -Quantifies variation of diseases and health outcomes according to subgroups of the population

Peter Drucker

creator and inventor of modern management

Quarantine

detention, isolation, of healthy persons and other measures taken to prevent the spread/exposure of an infectious/contagious disease You've been exposed in some way to the disease, but NOT necessarily infected.

The primary purpose of strategic planning is to:

determine the direction an organization will pursue

Minimata, Japan

epidemic of birth defects in Minamata, Japan, caused by mercury contamination of the bay from an industrial source. Poor families are more likely to live in these industrial areas, exposing pregnant women and fetuses to the polluted air and water. The Minimata Bay in Japan was where an industrial factory discharged methylmercury into the bay. The mercury got into the food chain and poisoned many. This showed the impact of manufacturing practices on health and how it could contribute positively To the economy but have severe negative impacts on health. Turning point for PH to consider manufacturing, environmental management, disease, health threats etc.

Stages of Coalition Development

formation, maintenance, institutionalization

Succession Planning Process

integrate with strategy, involve top management, assess key talent, follow development practices, monitor/evaluate Succession planing is "a deliberate and systematic effort by an organization to ensure leadership continuity in key positions, retain and develop intellectual and knowledge capital for the future, and encourage individual advancement."

Laws vs. Regulations

laws - enacted through a federal or state legislative process; they are a system of rules created for the protection or promotion of community health (done by Legislative Branch) Congress passes laws. regulations - (or rules) provide specific details to help implement the law, and are issued by state regulatory agencies (e.g. state board of pharmacy, state board of health); set of rules that describe the IMPLEMENTATION of legislation (done by the Executive Branch) The FDA passes regulations on those laws.

Transactional Leadership

leadership based on an exchange process in which followers are rewarded for good performance and punished for poor performance Transactional leadership occurs where a leader influences another through a reciprocal relationship of an exchange of things of value to advance both of their agendas. It could be through contingent reward where the worker performs a task and both benefit from the outcome or through punishment. It is more closely aligned with management functions, getting the job done and achieving expected outcomes.

U.S. Public Health System

responsibility for public health in the US rests at the level of the STATE, but per the Tenth Amendment to the US Constitution, which are known as the RESERVED POWERS. ——- The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the States respectively, or to the people. At the time the U.S. was being formed, we were all 13 individual colonies or states. All were along the coast, were populated, most coming from Europe and had diverse geographical/climate features, agricultural, industry, and different view points. It is crucial to remember that the responsibility for PH lies with the states per the 10th amendment in our constitution.

Food Safety: DANGER ZONE

temperature that foods at highest risk - 40 - 140 degrees F • Food-borne Illness outbreaks — tend to be detected on local or state levels Health agencies are required to report ALL cases of foodborne illness to CDC FDA investigates outbreaks that involve FDA regulated products

Absolute Risk Difference (ARD):

the difference in size of risk between the control and experimental groups Useful in policy making or caseload for managers. tells you how much better or worse the intervention/treatment is at reducing the risk of the bad outcomes ARD = ARC - ART

Ethics

the principles of right and wrong that guide an individual in making ethical decisions and promote rigorous deliberation

Program Planning

the process of identifying needs, establishing priorities, diagnosing causes of problems, assessing and allocating resources, and determining barriers to achieving objectives.

Steps in Water Treatment:

•The most common steps in water treatment used by community water systems (mainly surface water) include: 1.) Coagulation & Flocculation: first steps in water treatment. Chemicals with a positive charge are added to the water — neutralizes the negative charge of dirt and other dissolved particles in the water — causes the particles to bind with the chemicals to form larger particles, called Floc. 2.) Sedimentation: Floc settles to the bottom of the water supply due to its weight. 3.) Filtration: Once Floc is settled, the clear water on top will pass through filters — varying compositions (sand, gravel, & charcoal) and pore sizes — remove dissolved particles, parasites, bacteria, viruses, and chemicals 4.) Disinfection: After filtration, a disinfectant is added. — chlorine or chloramine — kills any remaining parasites, bacteria, or viruses — protect the water from germs when it is piped to humans and businesses