Disease, prevention, & control

Risk Factors

Use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters Surgical procedures Injections Contamination of the health care environment Overuse or improper use of antibiotics

Quarantine

separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Isolation

separates sick people with a contagious disease from people who are not sick.

Fungi

- Fungi are plant-like multi-celled organisms. - They form a separate kingdom with about 50,000 species. - Fungi cause many plant diseases. A fungus was the cause of the Irish Potato Famine (Phytophthora infestans). - Fungi only cause diseases (known as mycoses) in humans but most are fairly mild, e.g. ringworm, thrush, and athletes foot. Why are Fungal Infections no longer always considered fairly mild?

Protozoa

- Protozoa are single celled microorganisms belonging to the protista kingdom - Diseases caused by protozoa included: Malaria (Plasmodium) Giardiasis (Giardia lamblia) Amebiasis (Entamoeba histolytica) - Amebic Dysentery

The Epidemiology Triangle

--------The agent is the cause of the disease Can be bacteria, virus, parasite, fungus, mold Chemicals (solvents), Radiation, heat, natural toxins (snake or spider venom) ---------The host is an organism, usually human or animal, that harbors the disease -------Pathogen disease-causing microorganism or related substance Offers subsistence and lodging for a pathogen Level of immunity, genetic make-up, state of health, and overall fitness within the host can determine the effect of a disease organism can have upon it.

Viruses

-Antibiotics have no effect on viruses -Most drugs that destroy viruses also destroy the host cell -the best protection against viruses is provided by -vaccinces (i.e. weakened strains of the virus that trigger the immune system) -Many viruses mutate continuously rendering vaccines ineffective

Risk factors

1. Age. Seasonal influenza tends to target young children and older adults. 2. Living conditions. Living in close quarters (dorms, barracks, nursing homes) more likely to develop influenza. 3. Weakened immune system. Cancer treatments, anti-rejection drugs, corticosteroids and HIV/AIDS can weaken your immune system. This can make it easier to catch influenza and may also increase your risk of developing complications. 4. Chronic illnesses. Chronic conditions, such as asthma, diabetes or heart problems, may increase risk of influenza complications. 5. Pregnancy. Pregnant women are more likely to develop influenza complications 6. Obesity. People with a BMI of 40 or more have an increased risk of complications from flu.

Airborne

1. Agents present in nasopharynx or respiratory tract are disseminated in salivary droplets during coughing, sneezing or breathing. 2. The droplets are very small and soon evaporate leaving the agent floating in the air. 3. They are breathed in by the next victim. 4. Diseases spread in this manner include mumps, measles, chicken pox, colds, and influenza (viral); and whooping cough, diphtheria and tuberculosis (bacterial).

Metazoa

1. Diseases caused by worms include: - Enterobiasis (or Pinworm Infection) - Ascariasis (or Roundworm Infection) - Hookworm Disease 2. May also get infestations by arthropods (e.g. lice, fleas, mites, scabies), but they are not very serious.

Water- And Food-Borne

1. Food may become contaminated (e.g. Salmonella, Clostridium botulinum). 2. Agents passed in feces may find their way into the water supply (the fecal-oral route). Cholera and typhoid are transmitted in this manner. 3. Sanitary reforms in the late-19th century reduced the risk of these diseases by ensuring clean water supplies. 4. Risks of infection may be reduced by good personal hygiene, but infection is still easier than might be realized.

Mean of transmission

1. Most infectious diseases are associated with a particular means of transmission. 2. There are numerous means of transmission, but a few broad categories may be identified.

treatment

1. Prevent Get the vaccine Eat well, sleep well, be healthy Cough and sneeze into tissues Wash hands 2. Anti-viral At the first sign of flu, you can take a prescription medication to reduce the severity and duration of the flu. Will antibiotic help?

Indirect Physical Contact

1. The causal agent may be transmitted via an inanimate object (fomite). 2. Sharp instruments which penetrate the skin may carry infection (e.g. surgical instruments, syringes, razor blades, needles). 3. Dust and soil carrying an infectious agent may gain access through a cut to cause diseases such as tetanus (Clostridium tetani) or gas gangrene (Clostridium perfringens).

recent research and treatment

1. The flu virus changes (antigenic shift) every year so it is impossible to develop a vaccine that will permanently protect from the flu. 2. Recent research shows: When Avian (bird) flu combines with a common flu, it creates a potentially very dangerous flu. We need to understand the genetics of flu to be better prepared for outbreaks A combination anti-viral drug therapy may be the next best option to preventing flu death A healthy people study shows that they are better prepared to fight H1N1 (swine flu) and that those who have been vaccinated or recovered from one flu virus may be able to stave off a closely related flu virus despite antigenic shift.

Vector-Borne

1. Transmission is by an organism (the vector), in most cases an arthropod (and generally an insect). 2. Two mechanisms: a) Mechanical - e.g. flies, cockroaches, mice, rats. b) Bites - e.g. mosquitoes (malaria, yellow fever, dengue), fleas (bubonic plague), ticks (Lyme disease) and mites (typhus).

Direct Physical Contact

1. Venereal diseases (e.g. syphilis, gonorrhoea, genital herpes) are transmitted by direct contact during sexual intercourse. 2. A few diseases (e.g. leprosy, yaws) may be transmitted by direct contact of a non-sexual nature.

Other causal Agents

1. Viroids cause diseases in plants, but have not been identified in human diseases; 2. Prions cause Creuzfield Jacob disease, mad cow disease, and similar diseases in other animals.

National Impact of HAI Prevention

18% Reduction of standardized infection ration (SIR) of central-line associated bloodstream infections in 2009 5% reduction of surgical site infection SIR in 2009 10% reduction per year of hospital-onset invasive MRSA incidence rate from 2005 - 2009 BSI prevention between 2001 and 2009 58% reduction in ICU patients 2009 - 3,000 - 6,000 lives and $414 million in costs saved Since 2001 - 27,000 lives and $1.8 billion in costs saved

Influenza (flu)

A contagious respiratory illness caused by influenza viruses. There are different strains, primarily Type A (most common) and Type B. Infects the nose, throat, and lungs to cause mild to severe illness Can lead to death.

It's not always bad...

ATTENUATION OF RISK We need to believe that the world is a reasonably safe place to be It's a coping mechanisms for the risks of every day life Otherwise, we may never leave home

MEANS OF TRANSMISSON

Airborne Food- And Water-Borne Vector-Borne Direct Physical Contact Indirect Physical Contact

Where can HAI be acquired?

Anywhere health care is delivered. Inpatient acute care hospitals Outpatient settings such as ambulatory surgical centers and end-stage renal disease facilities, and Long-term care facilities such as nursing homes and rehabilitation centers.

CDC's Role

Authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases. CDC routinely monitors persons arriving at U.S. land border crossings and passengers and crew arriving at U.S. ports of entry for signs or symptoms of communicable diseases. When alerted about an ill passenger or crew member by the pilot of a plane or captain of a ship, CDC may detain passengers and crew as necessary to investigate whether the cause of the illness on board is a communicable disease.

If people are so positive, how can we motivate them to act?

Avoid underestimation and underresponse

infectious Disease agents

Bacteria Viruses fungi protozoa metazoa

bacteria

Bacteria are about 1000 times smaller than animal cells (i.e. 1-10 micrometers). They can replicate every 15-20 minutes. A single cell can produce 5,000,000,000,000,000 cells in 24 hours. Bacteria perform many useful functions in nature, and have been put to use by humans (e.g. sewerage farms, food industry). Only a minority of around 200 species cause health problems.

Bacteria

Bacteria are single-celled organisms belonging to the Monerans kingdom. Bacteria contain DNA but they do not have a nucleus. There are 1,600 known species, but there may be 10 to 100 times more waiting to be discovered. Major sub-types include: cocci - round or oval bacilli - rod-like spirochetes - spiral or corkscrew shaped vibrios - curved rods shaped like commas.

bacteria

Bacteria are single-celled organisms belonging to the Monerans kingdom. Bacteria contain DNA but they do not have a nucleus. There are 1,600 known species, but there may be 10 to 100 times more waiting to be discovered. Major sub-types include: cocci - round or oval bacilli - rod-like spirochetes - spiral or corkscrew shaped vibrios - curved rods shaped like commas.

complications of flu

Bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

period of contagiousness

Beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick.

We have to consider:

Beliefs, values, norms, and expectations Language skills and orientations Health literacy levels (language and numbers) Motivation to seek health information Media use patterns Social network membership

ENVIRONMENTAL FACTORS

Biological, Physical and Social Overcrowding Sanitation Vector Zones (Stagnate Water, etc.) Housing Geography Political/Economic Measures Societal Customs

Prevention

CDC has the following funded activities to prevent HAIs: State Healthcare-associated Infection (HAI) Prevention Infrastructure Antimicrobial Stewardship Healthcare-associated Infection (HAI) Data Validation Hemodialysis BSI activity Injection Safety activity

NHSN

CDC's National Healthcare Safety Network - most widely used healthcare-associated infection tracking system. NHSN provides data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections. It allows healthcare facilities to track blood safety errors and important healthcare process measures.

Surveillance and Data

Categories of Influenza Surveillance by CDC: 1) Looking for novel viruses 2) Outpatient influenza surveillance 3) Mortality surveillance (who died) 4) Hospital surveillance 5) Geographic spread of influenza

Federal isolation and quarantine are authorized for these communicable diseases:

Cholera Diphtheria Infectious tuberculosis Plague Smallpox Yellow fever Viral hemorrhagic fevers Severe acute respiratory syndromes New types of flu (influenza) that could cause a pandemic. The President can revise this list by Executive Order.

national data

Collected by CDC Reports trends Deaths Complications

We all perceive differently

Concept of risk is highly complex, but communication messages must be designed to ensure that they target individuals and groups effectively. To do this we must find ways to segregate differences and needs and include the real concerns they have about the risk we are communicating about.

Indications for Isolation/Quarantine

Dangerous and contagious disease Exposed "well" can be separated from "ill" Resources available to support interventions Ensure essential needs Monitor health status Provide medical care Implement isolation of those who become ill Continue only long enough to ensure not contagious (e.g., quarantine = incubation period)

Bacteria

Diseases caused by bacteria include: anthrax (Bacillus anthracis) bubonic plague (Yersinia pestis) cholera (Vibrio cholerae) diphtheria (Corynebacterium diphtheriae) gonorrhoea (Neisseria gonorrhoeae) leprosy (Mycobacteria leprae) syphilis (Treponema pallidum) tetanus (Clostridium tetani) tuberculosis (Mycobacteria tuberculosis) typhoid (Salmonella typhi) typhus (Rickettsia prowazeki)

Virus

Diseases caused by viruses include" AIDS chicken pox common cold encephalitis herpes hepatitis influenza measles mumps poliomyelitis rabies shingles smallpox rubella (German measles) yellow fever

How flu spreads

Droplets made when people with flu cough, sneeze or talk. Droplets can land in the mouths or noses of people who are nearby Touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.

Federal Authority to Isolate and Quarantine

EXCEPTIONS International importation of disease Interstate spread of disease Certain Indian lands Federal reservations (prisons, hospitals, etc.)

VRE

Enteroccocci are normally present in the human intestines and in the female genital tract. Vancomycin is an antibiotic that is used to treat some drug-resistant infections caused by enterococci. Enterococci become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). VRE can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures. Most VRE infections occur in hospitals.

Step 1-The Sender

Expressing a message The message needs to have a purpose, goal, or objective Without one of these the message will not be clear In health risk communication our goals are: To motivate individuals to act To inform individuals about a health threat To teach how to minimize harm To persuade to do the right thing To entertain To inspire

Fear is Powerfully Motivating!

Fear is a basic human emotion, grounded in the biological necessity for protections from danger. So it has a powerful impact on risk perception. Creates a subtle balance between fear, facts and trust... See-saw in which trust is the fulcrum and facts and fear balance each other.

Signs and symptoms of flu

Fever or feeling feverish/chills Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (very tired) Vomiting and diarrhea

Epidemiologic patterns

Flu seasons are unpredictable and can be severe. Over a period of 30 years, between 1976 and 2006, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. Each year, on average, 5 percent to 20 percent of the U.S. population gets the flu 200,000 hospitalized Costs an estimated $10.4 billion a year in direct medical expenses and an additional $16.3 billion in lost earnings annually.

Need for Public Health Legal Tools

Global spread of highly contagious diseases New diseases or disease strains Bioterrorism preparedness Zoonotic diseases Reassessment of traditional public health legal authorities

Civil Commitment

Government's restriction of a person not guilty of a crime Must balance: Community's right to be protected from harm by individuals Against Constitutionally protected freedoms of individuals Authority resides at several levels of government

Definition of Health Communication

Health Communication encompasses the study and use of communication strategies to inform and influence individual and community decisions that enhance health." -Plotrow, Kineaid, Rimon

HOSPITAL ACQUIRED INFECTIONS

Health care-associated infections (HAIs) or nosocomial infections, are infections that people acquire while they are receiving treatment for another condition in a health care setting.

Examples

Health professional-patient relationship Will-power: you will not eat the black bun whopper to see if your poop turns green. Individuals search for health information Individual adherence to medication regiments (taking full course of antibiotics) Images of health in mass media and culture (maybe not Kim Kardashian) Educating consumers on how to access adequate health care services Telehealth technologies

host factors

Hereditary Genetic Factors Host Resistance to Infectious Disease Nutrition, Weight and Health Biologic Factors Economic/Education Factors Psychosomatic Lifestyle Economic/Education Factors

Causative agents

Hospital-acquired infections are caused by viral, bacterial, and fungal pathogens. The most common types are bloodstream infection (BSI) pneumonia (eg, ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI)

Myth # 4: chicken soup will speed your recovery from the flu

Hot liquids can soothe a sore throat and provide much needed fluids. But chicken soup has no other specific qualities that can help fight the flu.

Risk Communication

How do we communicate health risk when it is perceived higher or lower than it really is?

What are the potential pitfalls?

How do we communicate threats to communities in order to protect them? How do we communicate risks that may be unknown to us? How do we get feedback from the community on how they prefer to receive messages?

Outrage Bias

I can't believe it! Why aren't they doing anything? The more outrage experienced by the person, the more likely risk will be highly perceived "The risks that kill you are not necessarily the risks that anger and frighten you". -P. Sandman

Enforcement

If a quarantinable disease is suspected or identified, CDC may issue a federal isolation or quarantine order. Public health authorities at the federal, state, local, and tribal levels may sometimes seek help from police or other law enforcement officers to enforce a public health order. U.S. Customs and Border Protection and U.S. Coast Guard officers are authorized to help enforce federal quarantine orders. Breaking a federal quarantine order is punishable by fines and imprisonment. (Typhoid Mary) Federal law allows the conditional release of persons from quarantine if they comply with medical monitoring and surveillance.

Who's talking to whom?Primary levels of health communication

Intrapersonal- Internal mental states and psychological processes (self-talk) Interpersonal- How personal relationships shape health outcomes Group- Interdependent coordination of group members in health teams, support groups, AA Organizational-Coordinates interdependent groups, mobilizes specialists (CDC) Societal- Dissemination and utilization of relevant health information through different media sources to broad audiences to promote health education and general health.

Issues with Isolation and Quarantine

Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease. In addition to serving as medical functions, isolation and quarantine also are "police power" functions, derived from the right of the state to take action affecting individuals for the benefit of society.

Isolation and Quarantine

Isolation: separation (for period of communicability) of known infected persons to prevent transmission of an infectious agent Quarantine: restriction of activities during the incubation period of healthy persons exposed to a communicable disease to prevent transmission if infection occurs Social Distancing: voluntary, recommended limitation of physical contact

Federal quarantine rarely used

Large-scale isolation and quarantine was last enforced during the influenza ("Spanish Flu") pandemic in 1918-1919. In recent history, only a few public health events have prompted federal isolation or quarantine orders. Examples?

Resistance to Risk

MOST PEOPLE BELIEVE THEIR RISK IS MUCH LESS THAN THE AVERAGE PERSON Most people think very highly of themselves I won't get heart disease or die of a stroke I'm not at risk of becoming a drug addict I won't get pregnant I drive better than most people.

So Optimism Bias...

Makes it easier to recognize risk relative to others Makes a person feel more in control if he/she knows more about the risk Is much more common that the pessimistic bias (we're all going to die!!!)

bacteria

Many bacteria can be killed by heat (e.g. boiling, cooking, pasteurisation). Many bacteria are susceptible to antibiotics. However, there is a growing problem of antibiotic resistance due to natural selection.

MANAGEMENT

Medical care includes: Symptomatic treatment of shock, hypoventilation, and other complications, and Empiric broad-spectrum antimicrobial therapy.

MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria Resistant to certain antibiotics called beta-lactams (methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin). Most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur

Conclusion

Much still needs to be done to decrease the burden of HAIs. Health care personnel should adhere to protocols with reference to hand washing and sterilizing surgical instruments and other equipment. Decrease the improper use of antibiotics. More and more states should report HAIs to NHSN in order to understand the problem better.

flunet

National influenza laboratories from 77 countries Data is only a few weeks old Tested thousands of specimens (in last 2 weeks) Positive for influenza viruses: (75.8%) as influenza A (24.2%) as influenza B

Burden of the Problem

On any given day, about 1 in 25 hospital patients has at least one healthcare-associated infection. There were an estimated 722,000 HAIs in U.S acute care hospitals in 2011. About 75,000 hospital patients with HAIs died during their hospitalizations. More than half of all HAIs occurred outside of the intensive care unit.

Consequences of Risk Perception

Perception of risk often does not track with reality... i.e. Get HIV from a toilet seat, not sexual partner; Get Ebola from a bowling ball Often facts about risks play little to no role in determining perceptions of risks when those facts aren't given in a way that addresses trust, benefits and control.

Federal Authority to Isolate and Quarantine

Power to isolate and quarantine to protect public health is a police power 10th Amendment generally reserves such powers to the states States are generally responsible for public health matters within their borders

Step 3: Receiving a message

Recipient receives the message. Based on their personal schema, they will interpret the message, but: Your message may not be interpreted the way you intended!!! Remember: Construct messages with your audience in mind? Who are they? What do they want to hear, what do they need to hear right now, what do they already know, who do they trust in order to believe the message. Messages need to be designed and crafted. (may be some ethical issues...) Are there distractions or "noise" preventing the message to be clear? (emotions, physical discomfort, prejudices)

How Do Public Health Agencies Make Decisions?

Scientific approach: • The data speak for themselves. • We can explain the issue with statistical significance. • Progress is incremental with evidence-based hypothesis testing. • The scientific method can solve most dilemmas.

State, local, and tribal law

States have police power functions to protect the health, safety, and welfare of persons within their borders. To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine. Laws can vary from state to state and can be specific or broad. In some states, local health authorities implement state law. In most states, breaking a quarantine order is a criminal misdemeanor. Tribes also have police power authority to take actions that promote the health, safety, and welfare of their own tribal members. Tribal health authorities may enforce their own isolation and quarantine laws within tribal lands, if such laws exist.

HICPAC

The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal advisory committee It was assembled to provide advice and guidance to CDC and the Secretary of DHHS regarding the practice of infection control and strategies for surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance and related events. The primary activity of the Committee is to provide advice on periodic updating of existing CDC guidelines and development of new CDC guidelines.

Most people are optimist

The Optimism Bias: The reasoning leading one to believe that the hazard in question is not actual a threat to them personally. As a result, when we communicate health messages: DON'T: "THIS INCLUDES YOU" DO: MANY WILL DIE

The Epidemiology Triangle

The environment is the favorable surroundings and conditions external to the human or animal that cause or allow the disease or allow disease transmission Environmental factors can include the biological aspects as well as the social, cultural, and physical aspects of the environment Time accounts for incubation periods, life expectancy of the host or pathogen, duration of the course of illness or condition.

How do the governments work together?

The federal government Acts to prevent the entry of communicable diseases into the United States. Quarantine and isolation may be used at U.S. ports of entry. Is authorized to take measures to prevent the spread of communicable diseases between states. May accept state and local assistance in enforcing federal quarantine. May assist state and local authorities in preventing the spread of communicable diseases. State, local, and tribal authorities Enforce isolation and quarantine within their borders. It is possible for federal, state, local, and tribal health authorities to have and use all at the same time separate but coexisting legal quarantine power in certain events. In the event of a conflict, federal law is supreme.

Federal Law- Who has what power?

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution. Under section 361 of the Public Health Service Act (42 U.S. Code § 264) The U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states. The authority for carrying out these functions on a daily basis has been delegated to the Centers for Disease Control and Prevention (CDC).

Myth # 2: Healthy people don't need to be vaccinated

The flu shot is recommended for healthy people who might spread the virus to others who are particularly susceptible.

myth # 5: you don't need to get a flu shoot every year

The influenza virus changes (mutates) each year. So getting vaccinated each year is important to make sure you have immunity to the strains most likely to cause an outbreak.

Step 2-Chosing a medium

The medium transmits the message. A "transmitter" or medium could be a phone call or a text message. In health communication we also use: Print advertisements, brochures, pamphlets Television/Movies Email/Internet Social Media Face-to-face interaction Uses oral, written, auditory (radio), or imagery. The transmitter chosen should match the audience

The Epidemiology Triangle

The mission of the epidemiologist is to break one of the legs of the triangle, which disrupts the connection between environment, host, and agent, stopping the continuation of an outbreak. The goals of public health are the control and prevention of disease. By breaking one of the legs of the triangle, public health intervention can partially realize these goals and stop epidemics An epidemic can be stopped when one of the elements of the triangle is interfered with, altered, changed or removed from existence.

Myth # 3: you can catch the flu from going out in cold weather without a coat, with wet hair or by sitting near a drafty window

The only way to catch the flu is by being exposed to the influenza virus. Flu season coincides with the cold weather. So people often associate the flu with a cold, drafty environment. But, they are not related.

Myth #1: you can catch the flu from the vaccine

The vaccine is made from an inactivated virus that can't transmit infection. So people who get sick after receiving a flu vaccination were going to get sick anyway. It takes a week or two to get protection from the vaccine. But people assume that because they got sick after getting the vaccine, the shot caused their illness.

Public Health Control Measures

Using good health risk communication, public health can limit the transmission of influenza through: Individual level measures Community measures Social measures Individual level hand-washing, vaccination, and cough etiquette Societal level school closures, managing mass gatherings Community Free vaccination at community events, health education about positive health behavior.

What Can We Do To Avoid HAIs

Very important aspect in preventing HAIs both for the healthcare providers and patients Being promoted very aggressively Hand Hygiene training interactive video available on the CDC website at http://www.cdc.gov/handhygiene/training/interactiveEducation/

viruses

Viruses are little more than a strand of DNA or RNA enclosed in a protein shell (capsid). Viruses vary in size and shape, but they are about 1,000 times smaller than bacteria. Most are too small to be seen by a light microscope. Viruses are completely parasitic. It is questionable whether they are a life form as they are incapable of an independent existence. They reproduce by hijacking a cell's ribosome, often causing the cell to burst apart.

Step 4: Feedback

What message did the receiver receive? Interpretation of the understanding to the sender (whisper down the lane). Message is "sent back" or not. Completes communication loop. You have to ask for this step. In public health, communication is often unidirectional. Helps to inform how messages can be tailored better in the future.

How do we communicate in Public Health?

When we are communicating specifically to: Send messages related to health or disease Educate people about diseases Encourage health practices such as screening tests, hand washing, or exercise Sustain health behaviors (i.e.- stay quit from smoking) Help empower to make better health decisions THIS IS HEALTH COMMUNICATION

How does the public make personal decisions?

• What works in animal models will work in humans. • Anecdotes are taken as evidence. • What "They say" (e.g. the media) is taken as truth/reality.