Foundations of Health Midterm (Ch.1-7)

How social systems influence behaviors: Encouraging selection of healthy behaviors (as a coping strategy)

For example, college students often go through stressful periods throughout their academic career, particularly around exam time Some students may decide to cope with this stress by "blowing off steam." This can take many forms, from binge drinking to going for a run, each selection having a different effect on health

Causes of mortality vs. Actual causes of death. Know the difference and examples of both

Top leading causes of mortality 2015: heart disease, cancer. Chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer's, Diabetes, influenza and pneumonia, etc Actual causes of death in the US 2015: tobacco, diet and physical inactivity, alcohol consumption, microbial agents, toxic agents, motor vehicles, etc Top Leading Causes of Mortality - Heart disease - Cancer • Heart disease and cancer account for 35% of deaths - Chronic lower respiratory diseases - Unintentional Injuries (including overdose) - Stroke - Alzheimer's disease - Diabetes - Influenza and pneumonia - Kidney disease - Suicide or self harm Actual Causes of Death • Actual causes of death in the U.S - Tobacco - Diet and physical inactivity - Alcohol consumption - Microbial agents (infection) - Toxic agents (includes environmental factors) - Motor vehicles - Firearms - Sexual behavior - Illicit drug use

what is the human microbiome?

We share many of our organ systems, including the pulmonary, skin, and especially the gastrointestinal system, with the human microbiome made up of billions of bacteria, viruses, and other microorganisms. According to Morens and Fauci of the National Institute of Allergy and Infectious Diseases: Specifically, our gut flora represents a complex "external" organ system...that have evolved with us over millennia and appear to affect our health, including by preventing and modifying infection. ...Infants who start life with or develop "reduced" flora (e.g., via pre- or postnatal antibiotics) may be at increased risk of IDs (infectious diseases) and EIDs (emerging infectious diseases). Variations in the microbiome may also affect the occurrence of certain chronic diseases, allergies, and malnutrition. Humans have had a dramatic impact on our microbiome in recent years through extensive use of antibiotics and the development of antibiotic resistance. Today, the Centers for Disease Control and Prevention estimates that there are over 2 million infections per year with antibiotic resistant bacteria and over 20,000 deaths per year Antibiotics Resistance -humans have has a dramatic impact on our microbiome in recent years through extensive use... antibiotics and the development of antibiotic resistance -today, the Centrw for Disease Cintrol and Prevention estimates that there are over 2 million infections per year w/ antibiotic resistant bacteria and over 20,000 deaths per year -The use of antibiotics to treat specific human bacerial infection, it became common clinical practice to try antibiotics as a first line approach when the cause of the problem was not clear or was most likely due to a virus -antibiotics also kills good bacteria which allows the resistant bacteria to gain a better foothold in your body

what does population health do?

focuses on big pic issues and determinants of disease. Also emphasizes focus on the Research evidence as a basis for understanding the cause or etiology of the disease and the intervention That can improve the outcome

What does the high-risk approach do?

focuses on those w/ highest probability of developing the disease and trying to get them to the same levels as the rest of the population -Risk factors include wide range of exposures from cigarette smoke and other toxic substances to high risk sexual behaviors

The 7 S's: Single case/small series:

get case reports of rare disease or small number of cases and tracking them overtime

what are the three approaches to population health in the population health approach model?

health care, traditional public health, and social interventions

examples of chronic diseases

heart disease, cancer, stroke, diabetes and arthritis

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: sensory organ function

impairment in vision or hearing that impairs function. In most countries, the quality of health ranges from 85% to 90%. We might consider a score of less than 85% as poor and greater than 90% as very good.

BIG GEMS: Behavior

implies actions that increase exposure to the factors that produce disease or protect Indivuduals from disease. Ex: cigarette smoking, exercise, diet, alcholol consumption, unprotected sex, and seat belt

RERIE process (Evidence-based public health approach): Implementation: When: Secondary Intervention

occur after the development of a disease or risk factor, but before symptoms appear. They are aimed at early detection of disease or reducing risk factors while the individual is asymptomatic

BIG GEMS: Socio-economic-cultural

socio-economic factors have been defined as education, income, and occupational Status. These measures are determinants of disease from breast cancer to tuberculosis to occupational Hazards. Cultural and religious beliefs also determinants of disease since some beliefs include decisions Abt treatments ,affecting outcome of disease. Disease more common in lower socioeconomic groups

BIG GEMS: Environment

sudden natural disasters like earthquakes or volcanic eruptions, iodine deficiencies from low Iodine levels food producing soil. The built environment produces determinants ranging from indoor air Pollution, to "infant-proofed" homes, to hazards on the highway

PERIE process (Evidence-based public health approach): Implementation: When: Primary Intervention:

take place before the onset of the disease. They aim to prevent the disease from occurring.

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: Mobility

the ability to walk without assistance

are contributory causes thought of as causes of the disease? are they immediate?

yes

are determinants (causes of causes) underlying/ "upstream" factors that bring about disease?

yes

Principles of the Ethical Practice of Public Health

•Public health programs and policies should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community •Public health programs and policies should be implemented in a manner that most enhances the physical and social environment •Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public •Public health institutions should ensure the professional competence of their employees •Public health institutions and their employees should engage in collaborations and affiliations in ways that build the public's trust and the institution's effectiveness

what are the different strategies we use in public health to mitigate noncommunicable diseases?

•Screening •Multiple Risk Factor Reduction •Cost-Effective Treatments •Genetic Testing •Research -screening for early detection and treatment of diseases -multiple risk factor interventions -identification of cost-effective treatments -genetics counseling and intervention -research

PERIE process (what does it stand for?); Evidence-based public health approach

Problem, Etiology, Recommendations, Implementation, Evaluation

Police power and examples

(gives authority to the states to create requirements that relate to public health) -May need examples of it for essay questions: alcohol drinking age, medicaid expansion, water sanitation, vaccinations, restaurant inspections, education (some have a school nurse or dental care on-site), sale of tobacco (especially with vaping), etc •Regulation of healthcare professionals and facilities •Automobile safety •Isolation/quarantine •Vaccinations •Medicaid Expansion •Use of helmets •Restricting sale of tobacco products •Restaurant inspections •Communicable diseases •Water sanitation

PERIE process (Evidence-based public health approach): Recommendations: Effectiveness and Evidence based Scale

-A = Must—A strong recommendation. B = Should—In general, the intervention should be used unless there are good reasons or contraindications for not doing so. C = May—The use of judgment is often needed on an individualby-individual basis. Individual recommendations depend on the specifics of an individual's situation, risk-taking attitudes, and values. D = Don't—There is enough evidence to recommend against using the intervention. I = Indeterminant, insufficient, or "I don't know"—The evidence is inadequate to make a recommendation for or against the use of the intervention at the present time.

How can we explain and predict health behaviors? : Theories and Models: Intrapersonal: Stages of change model

-ALSO KNOWN AS TRANSTHEORETICAL MODEL --1st stage, ppl won't consider changing behavior but will listen to pros/cons or be educated in it -2nd, contemplation stage in ppl aware of issue. They begin weighing pros/cons of behavior, not actively making a decision but showing how it could be helpful -3rd, making a plan of action like telling a person your'e making a change to hold yourself accountable -4th, start taking action, such as replacing unhealthy behavior with a healthier one -5th, maintenance. Try to prevent yourself from relapsing (self-help programs, writing down things that can cause you to relapse so you can prevent yourself from falling back into the behavior) -also a bidirectional model, stages not always linear or unidirectional -The underlying assumption of this model is that people go through a set of incremental stages when changing behavior rather than making significant changes all at once 1st stage: precontemplation, implies that an individual has not yet considered changing his or her behavior. At this stage, efforts to encourage change are not likely to be successful. However, efforts to educate and offer help in the future may lay the groundwork for later success. 2nd phase: contemplation, implies that an individual is actively thinking about the benefits and barriers to change. At this stage, information focused on short- and immediate-term gains, as well as long-term benefits, can be especially useful. In addition, the contemplation stage lends itself to developing a baseline—that is, establishing the current severity or extent of the problem in order to measure future progress. 3rd: d preparation. During this phase, the individual is developing a plan of action. At this point, the individual may be especially receptive to setting goals, considering a range of strategies, and developing a timetable. Help in recognizing and preparing for unanticipated barriers can be especially useful to the individual during this phase 4th: action phase, when the change in behavior takes place. This is the time to bring together all possible outside support to reinforce and reward the new behavior and help with problems or setbacks that occur. 5th: maintenance phase, in which the new behavior becomes a permanent part of an individual's lifestyle. The maintenance phase requires education on how to anticipate the long-term nature of behavioral change, especially how to resist the inevitable temptations to resume the old behavior

Sources of law: Constitutions (state and federal)

-Another implication of constitutional law is the supremacy of the U.S. Constitution even over international law. Human rights and standards incorporated into international documents are not directly enforceable in the United States. These rights and standards are only enforceable in the United States through enactment of federal or state laws. n Hurley v. Eddingfield). In the case, a licensed physician refused services to a pregnant woman despite being offered prepayment and despite the fact that the physician knew that no other qualified physician was available. As a result, the woman did not receive medical care and both she and her unborn child died. The court established what has been called the no-duty principle No duty principle- This principle holds that healthcare providers (whether they are individuals or institutions) do not have an obligation to provide health services. A right to health care can be created within a state via its constitution. It can also be created in the United States or within a state by legislative action , federal law includes the 1986 Treatment for Emergency Medical Conditions and Women in Labor Act, which provides a right to emergency medical care usually provided through hospital emergency departments. This act establishes a right to health care by those seeking emergency services and establishes a duty on the part of hospital emergency departments to provide these services. Patients have the right to receive care and the hospital has a duty to provide an "appropriate" examination. The institution also has the duty to stabilize an emergency situation by providing as much treatment as possible within its capacity When a hospital does not have the capacity to treat the emergency condition, it is required to transfer the patient to another facility in a medically appropriate fashion. These rights and duties are limited to emergency conditions in hospital emergency departments and do not provide more general rights to health care -Constitutional law, however, does not usually directly mandate roles for government in the area of health.

Sources of law: Legislative statutes (state and federal)

-Legislative law, or statutes, is written by legislative bodies at local, state, and federal levels. -Legislative law may place requirements or prohibition on future activities. Statutes may authorize governmental regulation, such as professional or institutional licensure; require specific activities, such a restaurant inspections; prohibit other activities, such as smoking in public places; or provide funding to pay for governmental services or reimburse those who provide the services, such as health care. -Most developed countries have incorporated a right to health care in their constitution or have created rights to health care as part of the legislative process, usually as part of a healthcare system that provides universal coverage.

Significance of the use of antibiotics to public health

-Misuse of antibiotics in human medicine has been common. In many developing countries antibiotics are available over the counter. In addition to the use of antibiotics to treat specific human bacterial infection, it became common clinical practice to try antibiotics as a first line approach when the cause of the problem was not clear or was most likely due to a virus. Widespread use of low-dose antibiotics in farm animals for prevention of disease and increased growth has also contributed to the development of antibiotic resistance. New drugs, greater use of vaccines, increased use of handwashing, more judicious use of antibiotics in humans, and reduced use of antibiotics in animals for growth and disease prevention are all being recommended as part of a concerted effort to address antibiotic resistance

RERIE process (Evidence-based public health approach): Evaluation: Qualitative vs. Quantitative data

-Qualitative data can serve a variety of functions in public health. It can generate ideas or hypotheses for further study, provide key information on the reasons for success or failure of an intervention, and provide explanations for findings of quantitative research. -Quantitative research often includes a large sample and focuses on numbers, whereas qualitative research often looks in depth at a small sample, producing descriptions and allowing for a thorough exploration of the phenomenon of interest. Qualitative research on e-cigarettes may provide examples of the range of uses of qualitative research. -Qualitative research may also help explain quantitative research findings. For instance quantitative research might conclude that e-cigarette use is growing among 16-18 year olds but not among 12- 16 year olds. The insights provided by individuals of these ages may help explain these findings

What is herd immunity and how we achieve it?

-Some infections, especially those viruses that are highly contagious, can be controlled by vaccinating a substantial proportion of the population, often in the range of 70%-90%. In this situation, those who are susceptible rarely, if ever, encounter an individual with the disease. This is known as herd immunity or population immunity. When a population has been vaccinated at these types of levels for diseases—such as chickenpox, measles, and polio—those who have not been vaccinated are often protected. -Herd immunity protects those who are susceptible—Long-term immunity from the disease or the vaccine makes it possible to protect large populations. At least 80% of the population needs to be vaccinated to interrupt the spread of the infection to the remaining susceptible people. a situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely -herd immunity- trying to get to 70-80%

Sources of law: judicial law (cases)

-State courts, such as the Supreme Court of Indiana, have addressed the meaning of a license to practice medicine (the Indiana Supreme Court tackled this in Hurley v. Eddingfield). In the case, a licensed physician refused services to a pregnant woman despite being offered prepayment and despite the fact that the physician knew that no other qualified physician was available. As a result, the woman did not receive medical care and both she and her unborn child died. The court established what has been called the no-duty principle

dread effect

-The dread effect is present with hazards that easily produce very visual and feared consequences. It explains why we often fear shark attacks more than drowning in a swimming pool. The dread effect may also be elicited by the potential for catastrophic events, ranging from nuclear meltdowns to a poisoning of the water supply. -could be worried about getting a disease since someone you loved got it and you witnessed the horror of it to the point where you modify your behavior to avoid it -Hazards that easily produce very visual and feared consequences

PERIE process (Evidence-based public health approach): Implementation: Who:

-The individual (clinical care) -Groups of people (vulnerable populations) -Everyone in a community or population

Combining interventions to address complex problems

-The population health approach requires the combined and integrated use of multiple interventions

How can we explain and predict health behaviors? : Theories and Models: Intrapersonal: theory of planned behavior

-This theory is based on the idea that intention is the main predictor of behavior r. The theory proposes that behavioral intention is influenced by an individual's attitude toward performing a behavior, his or her beliefs about whether people important to him or her approve or disapprove of the behavior, and his or her beliefs about their control over performing the behavior. --behavior depends on their influences and themselves -how easy it is for a person to act on that behavior (easier, the more likely) -individual's attitude, beliefs, etc influence behavior -religion, our self-efficacy (what we believe we can control) influence our behavior -subjective norms

Population health status measures: under 5-mortality (WHO)

-Thus, a new measurement known as under-5 mortality has now become the standard health status measure used by the World Health Organization (WHO) to summarize the health of children. -Today, the under-5 mortality and HALEs are used by the WHO as the standard measures reflecting child health and the overall health of a population.

Short answer question: what is the purpose of an IRB?

-To protect your research subjects -IRB must approve most huma research before it can begin -created to ensure ethical conduct of research -uses the framewoek set forth by the Belmont Report to review research proposals -Incentive cannot be manipulation (cant be money, can be gift card or socks)

Sources of law: What do we mean by "Health in all Policies"?

-an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity -policies adopted by different sectors must reinforce one another. For instance, a health in all policies approach targeting health and development in early childhood may include education policies that provide opportunities for women of childbearing age among all income-levels to attain a college education; employment policies that allow mothers to take maternity leave while maintaining their salary and health benefits; and housing policies that require landlords to maintain safe structures free of hazards for young children, such as avoiding lead poisoning and asthma triggers. -wellness in all policies -health in all policies

How can we explain and predict health behaviors? : Theories and Models: Intrapersonal: Health Belief Model. Constructs

-an intrapersonal theory, as it focuses on individuals' characteristics, including their perceptions and thought processes prior to taking health-related action. personal beliefs influence health behavior. The model proposes that people will be more likely to take action if they believe they are susceptible to the condition; they believe the condition has serious consequences; they believe taking action would benefit them, with the benefits outweighing the harms; and they are exposed to factors that prompt action and believe in their ability to successfully perform the action -focuses on your perceptions/ beliefs of benefits/threats Self-efficacy is extent to your belief that you have control over something -if i get the vaccine i dont have to wear a mask Perceived susceptibility to problem: dont believe its serious so dont view it as a threat -construct: ques to action (like a family member living w/ osteoporosis and is fine so why should i worry?) - constructs: risk susceptibility, risk severity, benefits to action, barriers to action, self-efficacy, and cues to action

Population health status measures: Utilizing information to make health decisions: Advantages and Disadvantages of Inform of Decision:

-approach implies that the clinician has all the essential information and can make decisions that are in the patient's best interest. The role of the clinician is then merely to inform the patient of what needs to be done and to prescribe the treatment, or write the orders Clinician has all the essential information to make a decision that is in the patient's best interest Advantages : May be efficient and effective when patients seek clear direction provided by an authoritative and trusted source Disadvantages : Patient may not gain information and understanding of the nature of the problem or the treatment Inform of Decision Clinician aims to convey his or her decision as clear and unambiguous action or order Advantages : Patients may favor if they do not seek out feel they cannot handle independent decision- making responsibilities Disadvantages : Patient may not be prepared to participate in the implementation of the decision Patients accept the clinician's recommendation without necessarily understanding or agreeing with the underlying reasoning Disadvantages : Patient may not accept responsibility for the outcome of the treatment

What is cost- effectiveness?

-combines issues of benefits and harms with financial costs -Cost-effectiveness is a concept that combines issues of benefits and harms with issues of financial costs. It starts by considering the benefits and harms of an intervention to determine its net-effectiveness or net benefit. Neteffectiveness implies that the benefits are substantially greater than the harms, even after the value (or utility), as well as the timing of the harms and benefits, are taken into account. Only after establishing net-effectiveness do we take into account the financial costs. Cost-effectiveness compares a new intervention to the current or standard intervention. It usually asks: Is the additional net-effectiveness of an intervention worth the additional cost? At times, it may also require us to ask: Is a small loss of net-effectiveness worth the considerable savings in cost?

Cost effective interventions to address the burden of non-communicable diseases

-compares new intervention to the current or stander interventions -if the additionally net-effectiveness worth the additional cost? -is a small loss of net-effectiveness worth the considerable savings in costs? Increased costs and decreased effectiveness (non cost-effective) Increased costs and increased effectiveness (may be cost-effective if increased costs ae worth large increase in effectiveness) -Decreased costs and increased effectiveness (cost-effective, best) -decreased costs and decreased effectiveness... Ex of Cost-Effective Interventions -mammogram -childhood vaccination -cigarette cessation programs -minimally invasive- knee surgery -home health for IV antibiotics Genetic Counseling and Intervention -Uses -predicting the risk of disease -pharmacogenetic testing -reproductive testing

What does BIG GEMS stand for?

-factors that increase or decrease chances of developing conditions that threaten quantity and/or quality of life -Behavior: -Infections -Genetics -Geography -Environment -Medical care -Socio-economic-cultural (BIG GEMS)

How can we explain and predict health behaviors? : Theories and Models: Population and Community Level: Diffusion of Innovation

-focuses on how idea, product, or social practice is adopted by a population -proposes adoption or refusal on adoption of innovation based on values of market, what its replacing, testing it before adopting it, etc -3 diff types of ppl: early adopters (try new things right away), early majority adopters (influencers), and late adopters (looked at all factors before using it; more skeptical) -offer all info to late adopters to get them to adopt it -convince them it'll solve their problems -think of relative advantage, compatibility, complexity, trialability, and observability Observability is outcome, trialability is trying things out -contributed the concept of different types of adopters, including early adopters (those who seek to experiment with innovative ideas), early majority adopters (often opinion leaders whose social status frequently influences others to adopt the behavior), and late adopters (or laggards—those who need support and encouragement to make adoption as easy as possible). marketing efforts may initially target early adopters with an approach encouraging innovation and creativity. This may be followed by an approach to opinion leaders who can help the innovation or behavior change become mainstream -Knowledge: Before people can adopt an innovation, they must know it exists. Communication channels, such as media, friends, family members, and physicians, are influential in this stage. Persuasion: In the persuasion stage, people develop an opinion about the innovation. That opinion may be positive or negative. The perceived characteristics of the innovation are particularly influential in the persuasion stage. Decision: During the decision stage, people decide to either adopt or reject an innovation Implementation: During the implementation stage, an innovation is tried. Confirmation: During the confirmation stage, support is sought for the decision, so that there is continued adoption, continued rejection, later adoption, or discontinuance of the innovation. - A critique of this model is that people do not always go through the set of stages consecutively, but instead may revert back to an earlier stage before moving through the other stages.

Sources of power for the federal, state and local governments: State: Police power

-gives authority to the states to create requirements that relate to public health ay need examples of it for essay questions: alcohol drinking age, medicaid expansion, water sanitation, vaccinations, restaurant inspections, education (some have a school nurse or dental care on-site), sale of tobacco (especially with vaping), etc -Doesn't mention health, so public health and health care are under the authority of the stages. This is referred to as Police Power (pass legislation and protect common good) --The use of this authority, known as police power, allows states to pass legislation and take actions to protect the common good. The authority to protect the common good may justify a wide range of state actions, including the regulation of healthcare professionals and facilities; the establishment of health and safety standards in retail and other occupational settings; and the control of hazards ranging from requiring the use of car restraint systems, to vaccinations, to restricting the sale of tobacco products The use of state police power is limited by the protections afforded to individuals. These protections are known as rights and are created either through the U.S. Constitution, through a state's constitution, or through laws passed at the federal or state levels The U.S. Constitution allows, but does not require, governments to act to protect public health or to provide healthcare services. This has been referred to as the negative constitution. Thus, while governments often have the authority to act, they are not required to do so For instance, the Supreme Court has not found an obligation on the part of states to act to prevent child or spousal abuse even when the state is fully aware of specific circumstances or a court has issued a restraining order

population health approach: health care

-health care helps sick or disapbled and ppl that are asymptomatic Systems for delivering one-on-one individual health services including those aimed at prevention, cure, palliation, and rehabilitation Examples: Clinical preventive services including: vaccinations, Behavioral counseling, screening for disease, and preventive medications

Population health status measures. Measurements that summarize the health of populations: Infant mortality rates and life expectancy

-infant mortality rate is up to 1 years old (if died at 8 months it wouldnt count as infant) . In the 1900s, two measurements became standard for summarizing the health status of populations: the infant mortality rate and life expectancy. Despite its name, life expectancy cannot be used to accurately predict future life spans, especially for newborns. Accurate prediction requires assuming that nothing will change. That is, accurate prediction requires the death rates at all ages to remain the same in future years. A substantial decline in life-expectancy could occur in the United States in the coming years as a result of the obesity and opioid epidemics.

RERIE process (Evidence-based public health approach): Implementation: How

-information (education), motivation (incentives), and obligation (requirements). -Motivational interventions should be carefully constructed and judiciously used, or they may result in what has been called victim blaming. For example, victim blaming in the case of cigarette smoking implies that we regard the consequences of smoking as the smokers' own fault.

Levels of social influence on health: social and community networks (interpersonal/community)

-interpersonal (outside of you) -institutional/organizational (governed by rules/regulations) -community (informal and formal) (rules in the community that are heavily implied) (e.g., now firefighters Required to have access to PTSD counseling but wasn't before cuz community rule of firefighters Having to be tough)

uncontrollability effect

-may have a major impact on our perceptions and actions. We often consider hazards that we perceive as in our control as less threatening than ones that we perceive as out of our control. Automobile collisions, for instance, are often seen as less hazardous than commercial airplane crashes, despite the fact that statistics show that commercial air travel is far safer than travel by automobile. -Hazards out of our control perceived as more threatening

if a HALE score is 80% for Nigeria, what would be some of the reasons for the 20% health loss?

-mobility, self-care, etc

How can we explain and predict health behaviors? : Theories and Models: Interpersonal: Social cognitive theory

-originally known as the Social Learning Theory, focuses on the interaction between individuals and their social systems. According to the theory, changing behavior requires an understanding of: ■ Individual characteristics, such as knowledge, skills, and beliefs ■ Influences in the social and physical environment, such as peer influence, level of family support, characteristics of the neighborhood, and work and school environments that help or hinder opportunities for health ■ Interaction among all these factor A key concept of the theory is reciprocal determinism, the dynamic interplay among personal factors, the environment, and behavior. The theory proposes that changing one of these factors will change them all

QALY- Criteria for establishing cost effectiveness (p. 140b) Quality Adjusted Life Years. Ideal intervention: cost goes down, effectiveness goes up

-quality adjusted life years -ask number of life years saved by an intervention -1 QUALY may be 1 year of life

PERIE process (Evidence-based public health approach): Recommendations: Effectiveness and Evidence based

-recommendations are summaries of the evidence about which interventions work to improve health outcomes. They indicate whether action should be taken. -quality of the evidence is often scored as good, fair, or poor. Good quality implies that the evidence fulfills all the criteria for quality. Poor quality evidence implies that there are fatal flaws in the evidence and recommendations cannot be made. Fair quality lies in between having no fatal flaws and fulfilling all the criteria for quality --A substantial impact may imply that the intervention works 8,9 8,9 h i 8 98 extremely well for a small number of people, such as a drug treatment for cigarette cessation

Screening and Case Finding (know for exam)

-screening- same criteria used for noncommunicable diseases -screening for STDs, TB, HIV -COVID-19 before medical procedures or before events -case finding implies confidential interviewing of those diagnosed with a disease ans asking for their recent close physical or sexual contacts -aka contact tracing Treatment for those diagnosed and their contacts -undetectable = untransmissible

What does the improving the average approach do?

-seatbelts, masks, non-smoking campus -focuses on the entire population and aims to reduce risk for everyone

What is Multiple Risk factor reduction?

-strategy to intervene simultaneously on a series of risk factors, all of which contribute to a particular outcome -strategy intervene simultaneously in a serious of risk factors, all of which contribute or a particular outcome this strategy intervenes simultaneously in a series of risk factors, all of which contribute to a particular outcome, such as cardiovascular disease or lung cancer Multiple risk factor reduction is most effective when there are constellations, or groups of risk factors that cluster together in definable groups of people. It may also be useful when the presence of two or more risk factors increases the risk more than would be expected by adding together the impact of each risk factor. • Multiple risk factor reduction is a strategy to intervene simultaneously on a series of risk factors , all of which contribute to a particular outcome - Most effective when there are constellations, or groups of risk factors that cluster in definable groups of people • Useful strategy when the presence of two or more risk factors increases the risk more than would be expected by adding together the impact of each risk factor

RERIE process (Evidence-based public health approach): Problem: burden of disease and mortality/morbidity

-the occurrence of disability and death due to a disease -disability = morbidity -death (rates obtained from death certificates) = mortality

Criteria for Health screening

1. The disease produces substantial death and/or disability 2. Early detection is possible and improves outcome 1. Early detection w/o improved outcomes is called lead-time bias 3. There is a feasible testing strategy for screening 1. Screen groups that are at an increased risk 2. Sequential testing - two or more tests to confirm 4. Screening is acceptable in terms of harms, costs, and patient acceptance

10 categories of social determinants of health

1.Social status (higher social status gives more access to money and better healthcare access) 2.Social support or alienation 3.Food (Mississippi nearest grocery store was 1 hour away so relied on canned foods) 4.Housing (no access to housing can affect mental health) 5.Education (health literacy; access to education affects understanding) 6.Work (physical labor has more health affects) 7.Stress 8.Transportation (can't work if dont have a car or not in walking distance from work) 9.place/geography (ppl that live near factories deal with pollution) 10.Access to health services

Elements of the Modern Koch's postulates

1. Evidence of an epidemiological association between the presence of the organism and the presence of a disease in human beings 2. Isolation of the organism from most of those with the disease 3. Transmissions to definitively establish that an organism is a contributory cause of the disease -Transmission from person to person has been documented in outbreaks of the disease, and has been used to confirm the final criteria of Modern Koch's postulates.

How can we explain and predict health behaviors? : Theories and Models: Planning Frameworks: PRECEDE_PROCEED: precede (social assessment, epidemiological assessment, behavioral and environmental assessment, educational and organizational, and administrative and policy assessment)

1: Social assessment: Assess people's perceptions of their own needs and quality of life through data collection activities such as surveys, interviews, focus groups, and observation 2. Epidemiological assessment: Determine which health problems are most important for which groups in a community, often by analyzing data from vital statistics, state and/or national surveys, etc. This step should assist in identifying subpopulations at high risk and provide data to set measurable objectives for the program 3. Behavioral and environmental assessment: Identify factors, internal and external to the individual, that contributes to the health issue of interest. Literature searches and theory application provide guidance during this step. 4. Educational and organizational assessment: Preceding and reinforcing factors that initiate and sustain behavior change are identified, such as an individual's knowledge, skills and attitudes, social support, peer influence, and availability of services. 5. Administrative and policy assessment: Identify policies, resources, and circumstances that may help or hinder implementation of the intervention.

How can we explain and predict health behaviors? : Theories and Models: Planning Frameworks: PRECEDE_PROCEED: proceed

6. Implementation: The intervention is implemented. 7. Process evaluation: Process evaluation assesses the extent to which the intervention was implemented as planned. 8. Impact evaluation: Impact evaluation assesses the change in the factors identified in steps 3 and 4. 9. Outcome evaluation: Outcome evaluation assesses the effect of the intervention on the health issue of interest.

Components of Health Law, Policy and Ethics: health care

: Access, quality, and cost of health care Organizational and professional structures for the delivery of care Issues: Rules governing Medicare and Medicaid, as well as laws governing private insurance Hospital governance and professional licensure

Interventions to address the burden of communicable diseases.

A range of public health tools are available to address the burden of communicable diseases. Some of these are useful in addressing noncommunicable diseases as well, but they have special applications when directed toward infections. These include: ■ Barrier protections, including isolation and quarantine ■ Immunizations designed to protect individuals as well as populations ■ Screening and case finding ■ Treatment and contact treatment ■ Efforts to maximize the effectiveness of treatments by preventing resistance Barrier protection -face mask or mosquito nets Immunizations Screening- check for diseases Treatment- isolated Preventing resistance- extent to which we can curtail disease from mutation -Communicable diseases are not only the causes of widespread epidemics of disease, but they can also become endemic or be regularly present and become routine causes of death Communicable and noncommunicable infectious diseases play a key role in maternal deaths associated with childbirth, infant, and early childhood deaths, as well as deaths of malnourished infants and children.

Components of Health Law, Policy and Ethics: bioethics

Application of individual and group values and morals to controversial areas Issues: End-of-life care, stem cell research, use of new technology , protection of research subjects

PERIE process (Evidence-based public health approach): Problem: Differences or changes in the distribution of disease

Are the differences or changes real or are they artifactual?

How social systems influence behaviors: shaping norms

Certain behaviors may become generally accepted among social groups. An attitude of "everyone else is doing it" can have a strong influence on an individual's decision to partake in the activity. For example, in some communities, perhaps it is rare for anyone to wear a helmet while biking. So an individual who has always used a bicycle helmet in the past may decide to forego it because nobody else wears one in his new community.

Population health status measures: Utilizing information to make health decisions: Advantages and Disadvantages of Informed consent

Clinician has the responsibility to convey a recommendation to the patient. The patient must decide whether to accept or reject Advantages: Patient gains information and understanding of the nature of the problem or the treatment Disadvantages: Time consuming compared to informing of the decision Informed Consent Harms and benefits of treatment are weighed by the clinician in making a recommendation Advantages: Patient may be prepared to participate in the implementation of the decision Disadvantages: May require elaborate paperwork to implement formal informed consent process Clinician has a responsibility to provide information on the aim of the recommendation, the potential benefits and harms, and the process that will occur. The patient has the right to ask additional questions and look at available alternatives Advantages: Patient may accept responsibility for the outcome Disadvantages: May increase emphasis on legal documents and malpractice law

How can we explain and predict health behaviors? : Theories and Models: Population and Community Level

Diffusion of Innovation

How social systems influence behaviors: enforcing patterns of social control

Enforcing patterns of social control: Having rules and regulations in place creates structure for society, which can affect health. For instance, having a curfew for teenagers to be off the streets by midnight unless accompanied by an adult may assist in preventing violence.

population health approach: traditional public health

Group- and community-based interventions directed at health promotion and disease prevention Examples: Communicable disease control, control of environ- mental hazards, food and drug safety, reduction in risk factors for disease

examples of contributory causes

HIV virus and smoking cigarettes

How can we explain and predict health behaviors? : Theories and Models: Intrapersonal models

Health Belief Model. ConstructsStages of Change modelTheory of Planned Behavior

PERIE process (Evidence-based public health approach): Evaluation (was the intervention or combination of interventions successful?): what is RE-AIM?

How well specific interventions work and are accepted in practice

PERIE process (Evidence-based public health approach): Etiology: how do we establish contributory causes of disease?

In contributory cause, we go beyond group association and establish three definitive requirements: 1. The "cause" is associated with the "effect" at the individual level. That is, the potential "cause" and the potential "effect" occur more frequently in the same individual than would be expected by chance. Therefore, we need to establish that individuals with lung cancer are more frequently smokers than individuals without lung cancer. 2. The "cause" precedes the "effect" in time. That is, the potential "cause" is present at an earlier time than the potential "effect." Therefore, we need to establish that cigarette smoking comes before the development of lung cancer. 3. Altering the "cause" alters the "effect." That is, when the potential "cause" is reduced or eliminated, the potential "effect" is also reduced or eliminated. Therefore, we need to establish that reducing cigarette smoking reduces lung cancer rates. -establish contributory causes of a disease through epidemiological studies

indirect and direct transmission (on exam)

Indirect transmission: incommunicable disease from your bed, breastmilk Indirect -Airborne- carried by dust or droplet nuclei suspended in air -Vehicle borne- inanimate objects (food, water, bedding) -Vector-borne - mosquitoes, fleas, ticks Direct: droplets -direct contact (skin-to-skin, kissing, sex) -droplet spread- large, short-range aerosols produced fro, sneezing , coughing, and talking

Sources of power for the federal, state and local governments: Federal: The Interstate Commerce Clause

Interstate commerce clause: since public health falls under state law, federal gov't uses commerce to incentivize states to do different things the major source of federal authority in public health and health care. It provides the federal government with the authority to tax, spend, and regulate interstate commerce Federal authority is often exerted through incentives to the states. For instance, states may be offered federal funding or matching funding if they enact specific types of legislation, such as the rules governing Medicaid or definitions of blood-alcohol levels for driving under the influence. The U.S. Constitution's supremacy clause declares that legitimate federal laws are the supreme laws of the land and they preempt or overrule state laws that conflict with them Third, the U.S. Constitution grants individual rights. Some of them, such as freedom of speech, religion, and assembly and the right to bear arms, are explicit in the document. Others have been inferred by the U.S. Supreme Court, such as the right to procreation, privacy, bodily integrity, and travel. --These inferred rights are often the basis for individual protections in public health and health care, including the right to utilize contraception, have an abortion, and limit the state and federal authority to use quarantine and other travel restrictions Constitutions often limit the role of government and define its processes. Constitutional law, however, does not usually directly mandate roles for government in the area of health. -since public health falls under state law, federal gov't uses commerce to incentivize states to do different things

population health approach: social interventions

Interventions with another nonhealth-related purpose, which have secondary impacts on health Examples: Interventions that improve the built environment, increase education, alter nutrition, or address socioeconomic disparities through changes in tax laws; globalization and mobility of goods and Populations

Why are some behaviors easier to change than others??

It is relatively easy when one behavior can be substituted for a similar one and results in a potentially large payoff. In these situations, knowledge often goes a long way. For instance, the substitution of acetaminophen (Tylenol) for aspirin to prevent Reye's Syndrome was relatively easy. Similarly, the Back-to-Sleep campaign was quite successful in reducing the rate of death from SIDS. In both of these cases, an acceptable and convenient substitute was available, making the needed behavioral change much easier to accomplish. Along with knowledge, incentives—such as reduced cost, increased availability, or improvements in ease of use—can encourage rapid acceptance and motivate behavioral change. For instance, easier-to-install child restraint systems have increased their use. Greater insurance coverage and widespread availability of modern mammography equipment has led to an increase in the number of mammograms performed The most difficult behaviors to change are those that have a physiological component, such as obesity, or an addictive element, such as cigarette smoking. Individual interventions aimed at smoking cessation or long-term weight control generally succeed less than 30% of the time—even among motivated individuals In addition, physical, social, and economic barriers can stand in the way of behavior change, even if individuals themselves are motivated

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: 6 factors

Mobility Cognition Self-care Pain Mood Sensory organ function

unfamiliarity effect

Our degree of familiarity with a potential harm or a potential benefit can greatly influence how we perceive data and translate it for our own situation. Knowing a friend or relative who died of lung cancer may influence how we perceive the information on the hazards of smoking or the presence of radon. It also may explain why we often see the danger of sun exposure as low and food irradiation as high, despite the fact that the data indicate that the degree of harm is the other way around. --Hazards we lack experience with may elicit more fear

Components of Health Law, Policy and Ethics: public health

Population health and safety, including governmental efforts to provide services to entire populations, as well as vulnerable groups Issues: Food and drug laws and procedures, environmental laws and procedures, regulations for control of communicable diseases

How can we explain and predict health behaviors? : Theories and Models: Planning Frameworks: Social Marketing. The 4 P's

Product (behavior or innovation) Price (benefits, barriers, and cost) Place (target audience and where) Promotion (campaign or program to reach target) ■ Product: Identifying the behavior or innovation that is being marketed ■ Price: Identifying the benefits, the barriers, and the financial costs ■ Place: Identifying the target audiences and how to reach them ■ Promotion: Organizing a campaign or program to reach the target audience(s) -uses branding; examples (■ The Truth® campaign—Developed by the American Legacy Foundation, it aims to redirect the perception of smoking being seen as a teenage rebellion to the decision to not smoke being a rebellion against the alleged behavior-controlling tobacco industry. ■ The National Youth Anti-Drug campaign—It uses social marketing efforts directed at young people, including the "Parents. The Anti-Drug." campaign. ■ The VERB™ campaign—It focused on 9- to 13-year-olds, or "tweens," with a goal of making exercise fun and "cool" for everyone, not just competitive athletes.)

How do we compile public health information to measure the Health of a population and how we communicate that information?

Public health data is collected in a wide variety of ways. These methods are often referred to as public health surveillance. Data from public health surveillance is collected, published, and distributed without identifying specific individuals. Statistics ("Vital Statistics") and reportable diseases: Vital statistics: birth, death, marriage, divorce; reporting of key communicable and specially selected noncommunicable diseases (e.g., elevated lead levels, child and spouse abuse, etc.)Also may include other public government records such as accident and police reports -use: Required by law— sometimes penalties imposed for noncompliance; births and deaths key to defining leading causes of disease; reportable disease may be helpful in identifying changes over time -Vital statistics very complete because of social and financial consequences; reportable disease often relies on institutional reporting rather than individual clinicians; frequent delays in reporting data Surveys— sampling: National Health and Nutrition Examination Survey (NHANES); Behavioral Risk Factor Surveillance System (BRFSS)Also includes disease specific registries (e.g., Surveillance, Epidemiology End Results (SEER) cancer registry) -use: Drawing conclusions about overall population and subgroups from representative samplesRegistries attempt to include all those with a disease in order to be representative of the population -Well-conducted surveys allow inferences to be drawn about larger populations; frequent delays in reporting dataDifficult to include all potential patients in disease registries Self-reporting: Adverse effect monitoring reporting of drugs and vaccines as reported by those affected -use: may help identify unrecognized or unusual events -useful when dramatic unusual events closely follow initial use of drug or vaccine; tends to be incomplete; difficult to evaluate meaning because of selective process of reporting Sentinel monitoring: Influenza monitoring to identify start of outbreak and changes in virus type -use: Early warnings or warning of previously unrecognized events -Can be used for "real-time" monitoring; requires considerable knowledge of patterns of disease and use of services to develop Syndromic surveillance: Use of symptom patterns (e.g., headaches, cough/fever, or gastrointestinal symptoms, plus increased sales of over-the-counter drugs) to raise alert of possible new or increased disease -Use: May be able to detect unexpected and subtle changes, such as bioterrorism or new epidemic producing commonly occurring symptoms -May be used for early warning even when no disease is diagnosed; does not provide a diagnosis and may have false positives Social media: Data on outbreaks using key words from social media -use: Detect and monitor course of influenza epidemic -Potential for immediate data obtained from a large number of individuals Accuracy and precision of the data for early and ongoing surveillance needs to be established

Population health status measures: Utilizing information to make health decisions: Advantages and Disadvantages of shared decision making

Shared Decision Making Clinicians serve as a source of information for patients Advantages: May increase the control the patients have over their own lives Disadvantages: time consuming for patients and clinicians Patients can expect to be informed of the existence of a range of accepted options and be assisted in their efforts to obtain information Advantages: May increase the types of information considered in decision making Disadvantages: May increase the costs of health care Shared Decision Making Patients may seek information on experimental or alternative approaches Advantages: May reduce the adversarial nature of the relationship between clinicians and patients Disadvantages: increase the stress/anxiety for patients Considerations are part of the decision-making process (i.e., cost, risk-taking attitudes, the distress/discomforts of treatment) Advantages: May improve the outcome of care by increasing the patient's understanding and commitment Disadvantages: May shift the responsibility for bad outcomes from the clinician to the patient Patients are often directly involved in the implementation of care • Health communications: Methods for collecting, compiling, and presenting health information • Addresses how we perceive, combine, and use information to make decisions • Data from different sources are increasingly being combined to create integrated health data systems or databases

How can we explain and predict health behaviors? : Theories and Models: Interpersonal model

Social Cognitive Theory

Social Justice vs. Market Justice

Social Justice: setting a minimum bar of levels of income, basic housing, employment, education, & health care should be seen as fundamental RIGHTS (for the common good) Market Justice: emphasize individual responsibility, minimum obligation to the common good, & fundamental freedom to all individuals to be left alone -market more individual and social justice more collectivist -fisical development is more market based -Differences: The common good (social justice) Individual responsibility (market justice)

How social systems influence behaviors: Providing opportunities to engage in healthy behaviors

The opportunities, or lack thereof, in our surroundings can have a strong influence on our health. For instance, having access to a community pool can encourage individuals to learn to swim, thus preventing drowning, while also serving as a form of physical exercise and social cohesion.

Epidemiologic Transition

The process of change in the distinctive causes of death in each stage of the demographic transition -describes the changing pattern of disease that ha been seen in many countries as they have experiences social and economic development -Underdeveloped countries- infectious diseases, maternal and prenatal conditions, malnutrition -Developed countries- cardiovascular diseases, diabetes, cancers, chronic respiratory ailments, depression, Alzheimer's -Note: newly emerging diseases raise possibility that communicable diseases can dominate the pattern of disease and death in developed countries

GINI index

a mathematical formula that measures the amount of economic inequality in a society -Gini index is score that reflects income disparities (countries w/ highest disparities in income are more developed, have better health w/ the more money a country has) -see ppt -Gini index: poorest health outcomes come from health disparity; not the lowest group) -income inequality strongly associated w/: -higher rates of mortality -poorer population in health -infant mortality

BIG GEMS: Medical care

access and quality of it. When high number of ppl vaccinated, makes unvaccinated population More safe. Smoking cessation efforts can help smokers quit and treatment of infectious diseases may reduce Spread to others

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: self-care

activities of daily living, including dressing, eating, bathing, and use of the toilet

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: mood

alteration in mood that limits function

PERIE process (Evidence-based public health approach): Problem: Differences or changes in the distribution of disease: Group associations

are established by investigations that use information on groups or a population without having information on the specific individuals within the group. These studies have been called population comparisons or ecological studies confounding variable: That is, there is no evidence of an association at the individual level (like more people are drowning and ice cream sales increasing) Population comparisons (Ecological studies). No information on specific individuals within the group

PERIE process (Evidence-based public health approach): Etiology: case control studies

are most useful for establishing requirement number one; that is, the "cause" is associated with the "effect" at the individual level. Casecontrol studies can demonstrate that cigarettes and lung cancer occur together more frequently than would be expected by chance alone. To accomplish this, cases with the disease (lung cancer) are compared to controls without the disease to determine whether the cases and the controls previously were exposed to the potential "cause" (cigarette smoking).

PERIE process (Evidence-based public health approach): Etiology: randomized controlled trials

are most useful for establishing requirement number three—altering the "cause" alters the "effect." Using a chance process known as randomization or random assignment, individuals are assigned to be exposed or not exposed to the potential "cause" (cigarette smoking). Individuals with and without the potential "cause" are then followed over time to determine who develops the "effect."

PERIE process (Evidence-based public health approach): Etiology: Cohort studies

are most useful for establishing requirement number two—the "cause" precedes the "effect." Those with the potential "cause" or risk factor (cigarette smoking) and those without the potential "cause" are followed over time to determine who develops the "effect" (lung cancer).

PERIE process (Evidence-based public health approach): Problem: Course of disease

asks how often the disease occurs, how likely it is to be present currently, and what happens once it occurs.

PERIE process (Evidence-based public health approach): Problem: Distribution of disease

asks such questions as: Who gets the disease? Where are they located? When does the disease occur? Let us see how understanding the distribution of disease may help generate ideas or hypotheses about the disease's etiology (cause).

Sources of law: Administrative regulations

common law, statutes and implied powers of the administration.

BIG GEMS: Infection

direct cause of disease. We are increasingly recognizing early or long-standing exposures to Infections may contribute to development or protection against disease. Cancer in liver, gallstones, etc are important determinant of diease. Early exposure to infections may reduce Diseases ranging from polio to asthma

Levels of social influence on health: General socioeconomic, cultural and environmental conditions

education, housing, work, access to Healthcare services

BIG GEMS: Geography

influences frequency and presence of disease. Infectious diseases such as malaria and lyme Disease only occur in defined geographical areas. Areas that produce radon contribute to lung cancer

The 7 S's: Self-reporting:

keeping track over recent changes (change in incidence patterns). Trying to see if there's a surge in cases of things. You as a consumer encouraged to report symptoms of covid

Levels of social influence on health: Individual lifestyle factors

knowledge, attitude, beliefs, personality, age, sex, genetics

The 7 S's: Statistics:

looking at data available to us. Like with death records, the cause of death. Look at upstream factors to see why they died of this cause (obesity, smoking, etc) to find a trend

Which of the following factors would be more likely to lead to eradication of dieases? Which of the following would not lead to eradication? (these could be on exam)

making eradication possible: ■ No animal reservoir—Smallpox is an exclusively human disease. That is, there is no reservoir of the disease in animals. It does not affect other species that can then infect additional humans. This also means that if the disease is eliminated from humans, it has nowhere to hide and later reappear in human populations. ■ Short persistence in environment—The smallpox virus requires human contact, and cannot persist for more than a brief time in the environment without a human host. Thus, droplets from sneezing or coughing need to find an immediate victim and are not easily transmitted except by human-tohuman contact. ■ Absence of a long-term carrier state—Once an individual recovers from smallpox, he or she no longer carries the virus and cannot transmit it to others. Smallpox contrasts with diseases such as HIV/AIDS and hepatitis B, which can maintain long-term carrier states and be infectious to others for years or decades. ■ The disease produces long-term immunity—Once an individual recovers from smallpox, very effective immunity is established, preventing a second infection. ■ Vaccination also establishes long-term immunity—As with the disease itself, the live smallpox vaccine produces very successful long-term immunity. Smallpox has not mutated to become more infectious despite the extensive use of vaccination. ■ Herd immunity protects those who are susceptible—Long-term immunity from the disease or the vaccine makes it possible to protect large populations. At least 80% of the population needs to be vaccinated to interrupt the spread of the infection to the remaining susceptible people. ■ Easily identified disease—The classic presentation of smallpox is relatively easy to identify by clinicians with experience observing the disease, as well as by the average person. This makes it possible to quickly diagnose the disease and protect others from being exposed. ■ Effective postexposure vaccination—The smallpox vaccine is effective even after exposure to smallpox. This enables effective use of what is called ring vaccination. Ring vaccination for smallpox involves identification of a case of smallpox, vaccination of the individual's household and close contacts, followed by vaccination of all those within a mile radius of the smallpox case. In the past, households within 10 miles were typically searched for additional cases of smallpox. These public health surveillance and containment efforts were successful even in areas without high levels of vaccination.

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: Cognition

mental function, including memory

PERIE process (Evidence-based public health approach): Problem: Differences or changes in the distribution of disease: three basic reasons that changes in rates may be artifactual rather than real:

o Differences or changes in the interest in identifying the disease o Differences or changes in the ability to identify the disease o Differences or changes in the definition of the disease

How can we explain and predict health behaviors? : Theories and Models: Planning Frameworks (2)

o Social Marketing. The 4 P'so PRECEDE_PROCEED

Key components of the system:

o Socioeconomic status o Culture o Religion

PERIE process (Evidence-based public health approach): Implementation: When: Tertiary Intervention

occur after the initial occurrence of symptoms, but before irreversible disability. They aim to prevent irreversible consequences of the disease. In the cigarette smoking and lung cancer scenario, primary interventions aim to prevent cigarette smoking

BIG GEMS: Genetics

play a role in development and progression of disease only occasionally the most important determinant of diseases

3 categories the 10 categories of social determinants of health (10 essential functions of public health) should go into

policy, assurance, assessment

How can we explain and predict health behaviors? : Theories and Models: Planning Frameworks: PRECEDE_PROCEED

provides a structure to design and evaluate health education and health promotion programs through a diagnostic planning process followed by an implementation and evaluation process (9 steps)

PERIE process (Evidence-based public health approach): Evaluation (was the intervention or combination of interventions successful?): what does RE-AIM stand for?

reach, effectiveness, adoption, implementation, and maintenance. - "RE" factors as evaluating the potential of the intervention for those it is designed to include or reach as well as those it has the potential to reach in practice. -The "AIM" factors examine the acceptance of the intervention in clinical or public health practice in the short and long term

Population health status measures: Health adjusted life expectancy (HALE). Includes quality of life: pain

regular pain that limits function

The 7 S's: Surveys:

sample size surveys to see how mental health changing overtime. Secondary data available to look at

Population health status measures: Disability-adjusted life year (DALY):Includes rates of specific diseases within a nation's population

the disability-adjusted life year (DALY), has been developed and used by the WHO to allow for comparisons and changes based on categories of diseases and conditions The DALY compares a country's performance to the country with the longest life expectancy, which is currently Japan. Japan has a life expectancy that is approximately 83 years Calculations of DALYs require much more data on specific diseases and disabilities than other measurements, such as life expectancy or HALEs. However, the WHO's Global Burden of Disease (GBD) project has made considerable progress in obtaining worldwide data collected using a consistent approach. Data is often not available on the disability produced by a disease. The WHO then uses expert opinion to estimate the impact. The GBD project presents data on DALYs divided into the following categories: ■ Communicable disease; maternal, neonatal, and nutritional conditions ■ Noncommunicable diseases ■ Injuries The Global Burden of Disease (GBD) project has produced a number of important conclusions using DALYs, including: Depression is a major contributor to most nations' DALYs and may become the number one contributor in the next few decades in developing, as well as developed, countries. Chronic disabling diseases, including hookworm, malaria, and HIV, affect the young and working-age population and are the greatest contributors to the burden of disease in many developing countries. Cancers, such as breast cancer, hepatomas (primary liver cancer), and colon cancer—which affect the working-age population and are common in many developing countries—have an important impact on the burden of disease as expressed in DALYs. Motor vehicle, occupational, and other forms of unintentional injuries have a disproportionate impact on the burden of disease compared to merely measuring deaths because these injuries produce long-term disabilities, as well as death at young ages. Obesity is rapidly overtaking malnutrition as a burden of disease in developing countries as early onset diabetes, heart disease, and strokes become major causes of death and disability among younger populations.

reciprocal determinism

the interacting influences of behavior, internal cognition, and environment -like you influence your peers and they influence you; how is it determined?Individuals and groups of individuals the dynamic interplay among personal factors, the environment, and behavior. The theory proposes that changing one of these factors will change them all

The 7 S's: Syndromic surveillance:

tracking changes in a syndrome overtime (are symptoms changing?) (delta variant doesn't affect taste and smell like the other variants did)

Healthy People 2030 -goals for our country as it relates to health (federal gov't and state coming together for these goals) -attain healthy, thriving lives and well-being free of preventible disease, disability, injury, and premature death -eliminate heaslth disparities, achieve health equity, and attain health litreacy to improve the health and well-being of all -create social, physical, and economic environments that promote attaining the full poteitnal for health and well-beong for all -Promote healthy development, healthy behaviorsd, and well-being across all life stages

true

If R naught value smaller, herd immunity might be larger -number of ppl vaccinated/have natural antibodies related to R naught value cuz harder to get disease if herd immunity larger (on exam?)

true

Perhaps older people are more likely to develop lung cancer and the aging of the population itself explains the real increase in the rates. To address this issue, epidemiologists use what is called age adjustment. To conduct age adjustment, epidemiologists look at the rates of the disease in each age group and also the age distribution, or the number of people in each age group in the population. Then they combine the rates for each age group, taking into account or adjusting for the age distribution of a population

true

The Life Course approach. Demographic situation in the U>S. Aging as a public health issue. By 2030, proportion of people over 65 is expected to be 25 percent of the population.

true

The life course approach, also known as the life course perspective or life course theory, refers to an approach developed in the 1960s for analyzing people's lives within structural, social, and cultural contexts (4 stages are child, adolescence, adulthood, and old age)

true

epidemic more focused like a state (sudden increase) -endemic is constant low grade prevalence -pandemic is several countries and continents (sudden increase) -know these differences for the exam

true

physiological component behaviors are hardest to change

true

private and public entities coming together to figure out public health -for emergencies -Overarching framework for integrating health issues into a broad range of social and economic issues -endorsed by the WHO -private and public entities work toward common goals to achieve improved health for all while rediucing health inequities What is health in all policies?: -sustainability in all policies -wellness in all policies -health in all policies -looks at diff factors that could impact a problem Ex: air pollution- public and private entities need to come together. Transport, pollution, waste management, etc

true

The 7 S's: Social media:

use key words to look for healthcare concerns of ppl (like facebook looking at key terms)

The 7 S's: Sentinel monitoring:

watching a disease overtime to see how its changing

how has public health changed overtime?

we were concerned w/ noncommunicable, now concerned w/ communicable