Health_Sci 3300 Exam 2

MissouriTotal potential savings by 2030 if the state reduces average BMI by 5%:

$13.3 billion Potential cases avoided by 2030 if the state reduces average BMI by 5%: Diabetes 179,659 Coronary Heart Disease & Stroke 152,070 Hypertension 133,798 Arthritis 75,434 Obesity-Related Cancer 13,704

Master Settlement Agreement (1998)

***$206 billion to 46 states over a 25-year period*** Ban on billboard ads and marketing to youth "Settlement money" used to fund educational and prevention programs Industry agreed to restrictions on advertising Disappointingly, states used very little of settlement money for tobacco control ***$1.7 billion to American Legacy Foundation - "Truth Campaign"*** - used lessons learned from California campaign

Percentage of U.S. adults aged 18 years or older who were current cigarette smokers in 2016

***15.5% of all adults (37.8 million people): 17.5% of males, 13.5% of females*** Nearly 32 of every 100 non-Hispanic American Indians/Alaska Natives (31.8%) About 25 of every 100 non-Hispanic multiple race individuals (25.2%) Nearly 17 of every 100 non-Hispanic Blacks (16.5%) Nearly 17 of every 100 non-Hispanic Whites (16.6%) Nearly 11 of every 100 Hispanics (10.7%) 9 of every 100 non-Hispanic Asians (9.0%) ***Note: Current cigarette smokers are defined as persons who reported smoking at least 100 cigarettes during their lifetime and who, at the time they participated in a survey about this topic, reported smoking every day or some days.*** Thousands of young people start smoking cigarettes every day. Each day, more than 3,200 people younger than 18 years of age smoke their first cigarette. Each day, an estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers.

Prohibition

***18th Amendment Prohibited alcohol in 1919***. Repealed 14 years later by ***21st Amendment***. Eighteenth Amendment was effective in reducing diseases caused by alcohol. However, organized crime flourished. Prohibition against drugs such as heroin, marijuana, and cocaine is generally accepted However, "the war on drugs" may not be working. It is expensive, empowers criminals at home and terrorists abroad, and sends thousands of people to prison for minor offences. more info: page 201-203

Epidemiology of Obesity

***Among men, 73% are overweight & 33% are obese*** ***Among women, 63.9% are overweight & 35% are obese*** Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%) ***Black women (80.3%) are more likely than white women (60.2%) to be overweight or obese*** ***Black men and white men have approximately the same prevalence of overweight & obesity***

Prevalence of Smoking by US Region

***Current cigarette smoking was highest in the Midwest and lowest in the West***. •Nearly 19 of every 100 adults who live in the Midwest (18.5%) •Nearly 17 of every 100 adults who live in the South (16.9%) •About 13 of every 100 adults who live in the Northeast (13.3%) •About 12 of every 100 adults who live in the West (12.3%) ps://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm

Behavior & the Social Environment

***Most important predictor of health is socioeconomic status (SES)*** Health gradient holds at all levels of the social scale Health also affected by gender, marital status, race & ethnicity In U.S., racial & ethnic minorities have poorer health than whites Health disparities are a big concern of public health

Misuse of alcohol, facts, rates

***Motor vehicle fatalities (35-40% involve alcohol)*** Chronic liver disease & cirrhosis Home injuries Drownings Fire fatalities Job injuries Cancer (3-5% of all cancer deaths) ***Underage drinking is responsible for more than 4300 deaths in the US each year.

Chapter 16 Lecture-Obesity

***Page 238***

Transtheoretical Model Stages

***Precontemplation*** is the stage in which people are not intending to make a change in the foreseeable future (6months). People may be in this stage because they are uninformed or under-informed about the consequences of their behavior. Or they may have tried to change a number of times and become demoralized about their ability to change. ***Contemplation*** is the stage in which people are intending to change in the next 6 months. They are more aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time. Both groups tend to avoid reading, talking or thinking about their high risk behaviors. They are often characterized in other theories as resistant or unmotivated or as not ready for health promotion programs. ***Preparation*** is the stage in which people are intending to take action in the immediate future. These individuals have a plan of action, such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book or relying on a self-change approach. These are the people that should be recruited for action- oriented smoking cessation, weight loss, or exercise programs. ***Action*** is the stage in which people have made specific overt modifications in their life-styles within the past 6 months. This is the end all be all of many behavioral modification programs. ***Maintenance*** is the stage in which people are working to prevent relapse but they are not changing their behaviors as frequently as do people in action. They are less tempted to relapse & increasingly more confident that they can continue their change.

Leading causes of death - history

***The top 3 killers in the 1900's = Infectious origin. - these have moved down or disappeared from the 2013 list.*** *Heart disease - from the 1900's list to the 2013 list heart disease moved from 4th to 1st, and cancer from 8th, to 2nd. *The diseases at the top of the 2013 list have complex causes and no clear etiological agent. *There are no vaccines or environmental solutions to the problems of cancer and heart disease. *Center for disease control and prevention (CDC), observed that the leading causes were not root causes, but were merely the diagnoses identified at the time of death. - The disease result from inborn (largely genetic) and external factors.

Dangers of ThirdHand Smoke

***Thirdhand smoke is contamination on the surfaces of objects that remains after the second-hand smoke has cleared*** Thirdhand smoke mixes and settles with dust, drifts down to carpeting and furniture surfaces, and makes its way deep into the porous material in paneling and drywall. It lingers in the hair, skin, clothing, & fingernails of smokers—so a mother who doesn't smoke in front of her kids, smokes outside, then comes inside and holds the baby is exposing that child to thirdhand smoke. The new compounds are difficult to clean up, have a long life of their own, and many may be carcinogenic. In addition to cancer, thirdhand smoke could be responsible for ***asthma attacks & allergic reactions***

Emphasis on youth in smoking

***Tobacco companies must recruit 2 million smokers a year to replace those who die or quit*** Most smokers begin smoking in their teens Ads focus on young people Joe Camel Ads focus on women - claim that smoking helps them lose weight Laws prohibit sale of tobacco to minors, but ineffective

Psychological and Sociologic Models used to explain Behavior & Behavior Change

***Transtheoretical Model of Change Stage of Change Health Belief Model (HBM) Locus of Control The Ecological Model***

summary of healthy people 2020

***Weight and growth*** ↑proportion of adults who are @ healthy wt (BMI 18.5-24.9) ↓ proportion of adults who are obese ↓ proportion of children (2-11 years) who are overweight or obese (healthy pediatric BMI=5th-84th %) ***Food and Nutrient consumption*** ↓saturated fat intake in population 2 years and older ↑ intake of vegetables and fruits in the population 2 years and older ↑ grain product intake & calcium intake in population 2 years and older ↓sodium intake in population 2 years and older ***Iron Deficiency and Anemia*** ↓Fe deficiency anemia in children and childbearing women ↓ anemia in pregnant women in the 3rd trimester by 20% ***Schools, Work Sites, and Nutrition Counseling*** ↑ work-site nutrition & weight management education Include nutrition assessment planning at care sites ↑% of schools that offer nutritious foods and beverages outside of school meals ↑ number of states with nutrition standards for food & beverages provided to preschool-age children in child care ***Food security*** ↑ food security to 94% of the households

Sex education in schools

- Highly controversial ***Opponents*** have argued for years that teaching young people about sex encourages them to indulge in immoral behavior. When AIDS came along, the controversy became more intense because it meant that sexual behavior could be a matter of life and death. ***Opponents*** argue that condoms are only partially effective in preventing pregnancy and sexually transmitted diseases and that young people should be taught that they can protect themselves only by abstinence. Many ***proponents*** of explicit education about safe sex argue that young people have sex no matter what they are taught and that they should be informed about how to protect themselves.

Changing the Environment

- More effective than trying to change individual behavior - Change focus from blaming the victim - Pioneered in injury control programs (see chapter 17) - Effective in tobacco control programs - Now thinking of how to apply it to improving diet and physical inactivity

Tobacco facts, rates

-***Accounts for 30% of all cancer deaths*** - accounts for 21% of cardiovascular disease deaths -Causes chronic obstructive lung disease, infant deaths due to low birth weight, and burns due to accidental fires. -***Of the 480,000 deaths attributed to smoking-35,000 were caused by second hand smoke.***

Sex Education

-American attitudes about sex are notoriously ambivalent. -Though movies and television shows frankly depict sexual activity, many people are puritanically reluctant to talk about how people can protect themselves against the natural consequences of that activity: unintended pregnancy and sexually transmitted diseases. ***For example, the tenure of Joycelyn Elders as President Clinton's Surgeon General was extremely controversial because she spoke out openly on these issues, recommending condom use and masturbation, until she was forced by political pressures to resign her office.***

Smoking Education

-Many people who are concerned about their health and that of their families do in fact adjust their behavior in accordance with new information. ***For example, the 1964 Surgeon General's ***(Dr. Luther Terry)*** report called Smoking and Health, the first authoritative statement from the federal government that smoking caused cancer and other life-threatening diseases, had a significant impact on the prevalence of smoking in the United States. Many people quit the habit after learning the information, and the ***prevalence of smoking began to decline for the first time after 1964***.

Education

-Provide information Smoking is bad Recommended dietary allowances -Health education in schools Sex education is controversial -Physicians' recommendations can be effective

1990s Broad Attack on Tobacco

-class action lawsuit by state attorneys general -FDA commissioner Kessler proposed to regulate Tobacco -"Mr. Butts" leaked tobacco company documents -tobacco industry on the defensive

Leading causes of death - from the 2000's to today

1. Tobacco 2. Poor diet and physical inactivity 3. Alcohol consumption 4. Microbial agents 5. Toxic agents 6. Motor vehicles 7. Firearms 8. Sexual behavior 9. Illicit drug use They.... -***Account for almost half of all deaths -Most are preventable*** -Most are premature -***Most are caused by individual behavior*** -Targets for public health intervention

Controversies over public health laws

1905 - ***Jacobson v. Common wealth of massachusetts*** - upheld state rights to require vaccination for the "common good" more info ***page 200***

Regulatory Restrictions on Smoking

1965 Warning Labels - Congress passed the Federal Cigarette Labeling and Advertising Act (FCLAA). ***1967 Federal Communications Commission - Fairness Doctrine - counter-advertising*** ***1971 - negotiated total ban on advertising*** 1992 - EPA -- environmental tobacco smoke is carcinogenic 1990s - nonsmokers rights movement 1997 President Clinton announces an Executive Order making federal workplaces smoke-free. The ***2009 Tobacco Control Act*** requires that new cigarettes be reviewed by the FDA before being allowed on the market. This law, among other things, ended the tobacco industry's ability to introduce new products without oversight, ushering in a new era where tobacco products are subject to public health-based regulation No product introduced after Feb. 15, 2007 can carry a greater health risk when measured against an earlier, "predicate" product. ***Effective July 22, 2010***, the law prohibits the tobacco industry from distributing or introducing into the U.S. market any tobacco products for which the labeling or advertising contains the descriptors "light," "low," "mild," or any similar descriptor, ***irrespective*** of the date of manufacture

National Estimated Cost of Obesity

2009 study by the Centers for Disease Control and Prevention, along with RTI International (a nonprofit research group), found that the direct and indirect cost of obesity "is as high as ***$147 billion annually."*** The study was based on figures collected in 2006. The study found that in 2006, obese patients spent an average of $1,429 more for their medical care than did people within a normal weight range. That is a 42 percent higher cost for people who are obese According to the MO Dept of Health and Senior Services, regardless of health status, Missouri taxpayers pay $191 per person each year for medical expenses directly attributed to obesity related health costs.

How Much Exercise?

30 minutes most days. 50-85% of max heart rate Minimum of 150 kilocalories per day, e.g., walking briskly for about 30 minutes More is better 40 percent of Americans get no exercise Lower SES is associated with more inactivity Children get less exercise as they get older Obesity in children is correlated with the amount of time spent watching television

Summary Chapter 15 Continued

6. The nonsmokers rights movement has helped to make smoking socially unacceptable, which has contributed to reductions in the prevalence of smoking. 7. One of the most effective measures to reduce smoking is to raise taxes on tobacco. Young people are especially sensitive to price and are less likely to take up the habit when the cost of cigarettes is high. 8. California's voter-initiated multipronged tobacco-control program in the 1990s, which reduced the prevalence of smoking in the state, had an evaluation component that produced evidence about the effectiveness of various measures. 9. The Master Settlement Agreement (MSA) of 1998 included payment of $206 billion to the states over 25 years and restrictions on advertising. 10. Part of the MSA was a $1.7 billion payment to create the American Legacy Foundation. The Foundation used these funds to run an ad campaign, called the "truth" campaign, which has been very effective at reducing youth smoking. 11. In 2009, Congress passed, and President Obama signed, the Family Smoking Prevention and Tobacco Control Act, which authorizes the FDA to regulate tobacco products

Obesity + tobacco + alcohol

=***$432 billion per year in health care costs in the US.***

Example of Health Promotion Program

AIDS Prevention in San Francisco, CA ***Pages 213-214***

More tobacco facts

Accounts for ***30%*** of all cancer deaths In the US, of the ***480,000*** deaths attributed to smoking- including more than ***41,000*** deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.1 Health officials have known that more than 1 billion people around the world smoke and ***5 million*** people each year from tobacco-related illness, according to the World Health Organization die-***600,000*** from Second Hand Smoke. In a new report, the World Health Organization finds that tobacco is expected to kill ***7.5 million*** people worldwide by 2020, accounting for 10% of all deaths

Health Belief Model

Addresses the relationship between a person's beliefs and behaviors ***Page 211, picture on other quizlet***

Missouri Smoking Facts

Adult Current Cigarette/Smokeless Tobacco Use In Missouri, the percentage of adults (ages 18+) who currently smoke cigarettes was **25.0%*** in 2011. Across all states and D.C., the prevalence of cigarette smoking among adults ranged from 11.8% to 29.0%. ***Missouri ranked 43rd among the states***. The percentage of adults who currently use ***smokeless tobacco*** was 5.3% in 2011. Across all states and D.C., the prevalence ranged from 1.4% to 9.8%. Missouri ranked 37th among the states.

Variations on health education

Advertising - "Just say no" anti- drug campaign during the ***Reagan administration*** -Harvard school of public health campaign, writing "designated drivers" into sitcom scripts to help advocate to stop drinking and driving. -***Social norms approach*** -based on study from the 1980's

Obesity rates among all children in the United States

Approximately 17% (or 12.5 million) of children & adolescents aged 2—19 years are obese. Since 1980, obesity prevalence among children & adolescents has almost tripled. There are significant racial & ethnic disparities in obesity prevalence among U.S. children & adolescents. In 2007—2008, Hispanic boys, aged 2 to 19 years old, were significantly more likely to be obese than non-Hispanic white boys, & non-Hispanic black girls were significantly more likely to be obese than non-Hispanic white girls. 1 of 7 low-income, preschool-aged children is obese. County obesity rates are variable within states. Even states with the lowest prevalence of obesity have counties where many low-income children are obese & at risk for chronic disease. (Data from the National Health and Nutrition Examination Survey) (Data from the Pediatric Nutrition Surveillance System)

Summary Chapter 13

As infectious diseases have become less predominant causes of death in the United States, a major focus of public health programs has shifted to people's ***behavior***. An analysis conducted by a group of public health leaders has concluded that the top three actual causes of death are ***smoking, poor diet and physical inactivity, and alcohol consumption.*** Other behavioral factors that are among the top nine causes of ***death are firearms, sexual behavior, motor vehicles, and the illicit use of drugs***. For public health to significantly reduce the death rates beyond what it can achieve in controlling infectious diseases, it must find ways to promote behavioral change. Two approaches that government has traditionally taken to persuade people to change their behavior are education and regulation. ***Education*** about health includes simply informing people about risks, which can be an effective strategy when new knowledge becomes available, as occurred with the 1964 Surgeon General's report called Smoking and Health. Food labeling is also part of an educational effort to encourage Americans to eat a healthier diet. ***Regulation*** is another effective approach to promoting behavioral change, although it is often unpopular. Historically, the most ambitious attempt to regulate Americans' behavior was ***Prohibition***, which did in fact improve their health by reducing the rate of cirrhosis of the liver. Whether the Prohibition-like approach currently used for control of illegal drugs is effective has not been demonstrated. Research in the social and behavioral sciences has led to the development of theories of why people behave as they do and how they can be influenced to change their behavior. The evidence indicates that health promotion programs are most effective when they target individuals at many different levels of influence.

Smoking by Education & Poverty Level

By Education2 Current cigarette smoking was highest among persons with a general education development (GED) certificate and lowest among those with a graduate degree. •About 24 of every 100 adults with 12 or fewer years of education (no diploma) (24.1%) •Nearly 41 of every 100 adults with a GED certificate (40.6%) •Nearly 20 of every 100 adults with a high school diploma (19.7%) •Nearly 19 of every 100 adults with some college (no degree) (18.9%) •Nearly 17 of every 100 adults with an associate's degree (16.8%) •Nearly 8 of every 100 adults with an undergraduate degree (7.7%) •Nearly 5 of every 100 adults with a graduate degree (4.5%) By Poverty Status2 Current cigarette smoking was higher among persons living below the poverty* level than those living at or above this level. •About 25 of every 100 adults who live below the poverty level (25.3%) •About 14 of every 100 adults who live at or above the poverty level (14.3%) *Poverty thresholds are based on U.S. Census Bureau data. Current estimates on poverty in the U.S. $12,140 for individuals, ***$25,100 for a family of 4*** The official poverty rate is 13.5 percent, based on the U.S. Census Bureau's 2015 estimates. That year, an estimated 43.1 million Americans lived in poverty according to the official measure

Health Risks of Obesity

Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, &colon) Hypertension (high blood pressure) Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) Stroke Liver & Gallbladder disease Sleep apnea & respiratory problems Osteoarthritis (a degeneration of cartilage & its underlying bone within a joint) Gynecological problems (abnormal menses, infertility)

The Average American Woman

Dieting & Weight Statistics Has your perspective of your body weight been distorted by the media? (It probably has, in some way.) ***The average American woman is approximately 5'4" tall & weighs 166.2 pounds. Women: Height (inches): 63.8, Weight (pounds): 166.2,*** Waist circumference (inches): 37.5 http://www.cdc.gov/nchs/fastats/body-measurements.htm ***The average American model is 5'11" tall & weighs 117 pounds.*** Most fashion models are thinner than 98% of American women. Four out of five American women say they're dissatisfied with the way they look. On any given day, almost ***half*** of the women in the United States are on a diet. Kate Upton is currently being criticized for being too heavy by those in model industry and the "Skinny Girl" blog. Kate is 5'11 approximately 141 pounds-BMI 20.23 which is considered normal.

Stages of Change (Transtheoretical Model)

Emphasizes the concept of a change process, each stage of which is a success to be celebrated. The focus is on readiness to change. The health educator must know which interventions to use to move the process along. The stages are ***Precontemplation, Contemplation, Preparation, Action, Maintenance, and Termination.*** ***Page 211***

Public health in the news - Juul

F.D.A. Targets Vaping, Alarmed by Teenage Use Sept. 12, 2018 WASHINGTON — The Food and Drug Administration on Wednesday declared that teenage use of electronic cigarettes has reached "an epidemic proportion," and it put makers of the most popular devices on notice that they have just ***60 days to prove they can keep their devices away from minors.*** The order was part of a sweeping government action that targeted both makers and sellers of e-cigarettes. If Juul Labs and four other major manufacturers fail to halt sales to minors, the agency said, it could remove their flavored products from the market. It also raised the possibility of civil or criminal charges if companies are allowing bulk sales through their websites.

Tobacco facts: pt.2

FACT: Big Tobacco gave free cigarettes to psychiatric facilities. Freeeeee cigs! F-R-E-E. One giveaway was even called Operation Santa Claus. Ho, ho, ho -- here's a potential lifelong addiction that's also super deadly. People with mental health or substance abuse issues have accounted for 40% of the cigarettes sold in the U.S. That adds up to about $37 billion in Big Tobacco's pockets. And while people may believe smoking helps to relieve stress, nicotine actually increases your heart rate, tenses your muscles, and decreases the oxygen to your brain

Public Policy Level

Free, confidential HIV testing

Abstinence-only education

George W. Bush According to ***Richard Daines, the new york state commissioner of health, stated that this program is an example of failed national health care policy directive, based on ideology rather than on sound evidence.***

Genetics role in obesity

How do genes affect obesity? Science shows that genetics plays a role in obesity. Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome.However genes do not always predict future health. Genes and behavior may both be needed for a person to be overweight. In some cases multiple genes may increase one's susceptibility for obesity and require outside factors; such as abundant food supply or little physical activity.For more information on the genetics and obesity visit Obesity and Genetics: A Public Health Perspective.

Obesity Rates in 2030

If states' obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase ***10 times*** between 2010 and 2020—and double again by 2030. Medical costs associated with treating preventable obesity-related diseases could increase by up to $66 billion per year by 2030, and the loss in economic productivity could be as high as $580 billion annually. http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2012/09/new-report-finds-adult-obesity-rates-could-exceed-60-percent-in-13-states-by-2030.html

Biomedical Basis of Smoking's Harmful Effects

In 1989, the United States surgeon general released a report listing 43 carcinogens in cigarette smoke. ***Now the count is more than 50*** ***Nicotine is an addictive drug*** Raises blood pressure and heart rate May cause spasms in blood vessels of heart ***Tars - provide flavor*** Damage cilia & irritate respiratory tract Carbon monoxide Interfere with oxygen carrying capacity of blood Other ingredients Arsenic, benzene, are also carcinogenic Alter clotting properties of blood Raise blood cholesterol and reduce HDL

Historical Trends

Intensive use began in early 20th century Free distribution to soldiers during world war Women began smoking during and after World War 2 Smoking peaked in mid-1960s at over 42% of adults Lung cancer trends followed smoking trends about 20 years later ***1964 - first Surgeon General's report*** - ***Dr. Luther L. Terry*** Smoking rates began to decline

Ecological Model of Health Behavior

Intrapersonal level (psychology) Interpersonal level - family, friends, coworkers Institutional level - school, workplace Community level - churches, community organizations Public policy level - government regulations (***sometimes community & institutional levels are combined) Read pages 228-230 in textbook*** -Picture on other quizlet

Regulation

Laws against murder and assault Traffic regulations Restrictions on alcohol, drugs, & tobacco Age restrictions on many behaviors Sexual behavior is hard to regulate

Summary Chapter 15

MAJOR THEMES 1. Tobacco is at the top of the list of leading actual causes of death, killing over 480,000 people each year from cardiovascular disease, lung cancer and other lung diseases, other cancers, burns, and infant deaths. 2. Tobacco contains nicotine, an addictive drug, and tars, which provide flavor. Tars have long-term effects, causing cancer and damaging the lungs; nicotine acts rapidly, raising blood pressure and heart rate, and may cause spasms in blood vessels. 3. The habit of cigarette smoking became popular early in the twentieth century. Women began to smoke later than men. The prevalence of smoking peaked in the 1960s and began to decline after the publication of the surgeon general's report in 1964. 4. Until recently, the federal government's efforts to discourage smoking were mostly limited to educational measures, including the surgeon general's reports, labels on cigarette packs, and some mild limitations on advertising. After evidence developed that second-hand smoke caused many of the same harmful effects as active smoking, many state and local governments enacted bans on smoking in indoor public places. 5. Tobacco companies have invested heavily in advertising to attract young smokers to replace the smokers who die or quit. State laws banning the sale of cigarettes to minors have generally not been enforced.

Dangers of Second Hand Smoke pt.3

Many in the United States Continue to be Exposed to Secondhand Smoke7 An estimated 88 million nonsmokers in the United States were exposed to secondhand smoke in 2007-2008. Children are at particular risk for exposure to secondhand smoke: 53.6% of young children (aged 3-11 years) were exposed to secondhand smoke in 2007-2008. While only 5.4% of adult nonsmokers in the United States lived with someone who smoked inside their home, 18.2% of children (aged 3-11 years) lived with someone who smoked inside their home in 2007-2008. Disparities in Secondhand Smoke Exposure Racial and Ethnic Groups Although declines in cotinine levels have occurred in all racial and ethnic groups, cotinine levels have consistently been found to be higher in non-Hispanic black Americans than in non-Hispanic white Americans and Mexican Americans.7,8,9 In 2007-2008: 55.9% of non-Hispanic blacks were exposed to secondhand smoke. 40.1% of non-Hispanic whites were exposed to secondhand smoke. 28.5% of Mexican Americans were exposed to secondhand smoke. Low Income Secondhand smoke exposure tends to be high for persons with low incomes: 60.5% of persons living below the poverty level in the United States were exposed to secondhand smoke in 2007-2008.7 Occupational Disparities Occupational disparities in secondhand smoke exposure decreased over the past two decades, but substantial differences in exposure among workers remain. African-American male workers, construction workers, and blue collar workers and service workers are among some of the groups who continue to experience particularly high levels of secondhand smoke exposure relative to other workers.10

Promoting Healthy Eating

Many social, cultural, and economic factors contribute to dietary patterns. Learn from tobacco control success. Enhance self-efficacy and provide social support. Apply California's "5-A-DAY" Campaign for Better Health. Increase access to healthier foods options. ---Restaurants, schools, worksites Reduce less healthy foods in public venues. ---High calorie drinks and fast food in schools ---Limit or tax sugar-sweetened beverages (SSBs) and junk food. Social environment promotes overeating-(parties, holidays, tailgating, etc.) Advertising by food industry, including ads aimed at children Very difficult to change eating patterns "5-a Day" campaign to increase consumption of fruits & vegetables Food labeling Best hope is to focus on children, starting with breast-feeding

Poor diet and physical inactivity - facts, rates

Obesity -Deaths increased 22% since 1990 -Obesity prevalence 33.1% of men, 35.2% of Women (BMI > 30) -80% of AA Women & 57.4 % of White Women Overweight (BMI 25- 29.9) -70% of White & AA Men Overweight (BMI 25-29.9) ***The number of deaths attributed to obesity has increased 22% since the 1990s, the largest change among actual caused of death.*** Heart disease and stroke Diabetes Cancer Discussed further in Chapter 16

Epidemiology of Obesity

Obesity has become a major health concern. 1 in every 3 adults is obese3 and almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th percentile of the CDC growth chart).4 More than one-third (34.9% or 78.6 million) of U.S. adults are obese. [Read abstract Journal of American Medicine (JAMA) Prevalence of overweight & obesity have been increasing since 1960s in males & females of all ages Higher SES is associated with lower rates of overweight & obesity, especially among women http://www.cdc.gov/CDCTV/ObesityEpidemic/index.html

Behavior of obesity

Obesity is caused by the unhealthy eating patterns combined with inadequate physical activity, each a faction that influences people's health whether or not they weigh too much. Only 1% to 3% of Americans eat recommended number of servings from all food groups Main vegetables are iceberg lettuce, potatoes including chips and fries, & canned tomatoes Increased intake of sweetened beverages, less milk

Smoking Diseases & Death: part 2

On average, smokers die ***10 years earlier*** than nonsmokers. If smoking continues at the current rate among U.S. youth, 5.6 million of today's Americans younger than 18 years of age are expected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger who are alive today.

Environmental role in obesity

People may make decisions based on their environment or community. For example, a person may choose not to walk to the store or to work because of a lack of sidewalks. Communities, homes, and workplaces can all influence people's health decisions. Because of this influence, it is important to create environments in these locations that make it easier to engage in physical activity and to eat a healthy diet. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity 2001 identified action steps for several locations that may help prevent and decrease obesity and overweight.

Overweight among Children

Prevalence of overweight among 6- to 19-year-olds increased from under 5% in the 1960s to 16.9% in 2011-2012. ***High prevalence exists among Mexican American boys and African American girls.*** Type 2 diabetes is being diagnosed in children.

Dangers of Second Hand Smoke

Secondhand smoke exposure contributes to approximately ***41,000*** deaths among nonsmoking adults and **400 deaths** in infants each year. Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth. In children, ***secondhand smoke*** causes the following:3 Ear infections More frequent and severe asthma attacks Respiratory symptoms (e.g., coughing, sneezing, shortness of breath) Respiratory infections (i.e., bronchitis, pneumonia) A greater risk for sudden infant death syndrome (SIDS) In children aged 18 months or younger, secondhand smoke exposure is responsible for—an estimated 150,000-300,000 new cases of bronchitis and pneumonia annually, and approximately 7,500-15,000 hospitalizations annually in the United States.4

Smoking facts pt. 2

Smoking causes more deaths each year than all of these combined: Human immunodeficiency virus (HIV) Illegal drug use Alcohol use Motor vehicle injuries Firearm-related incidents More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history. Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths in men and women. More women die from lung cancer each year than from breast cancer. About 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD) are caused by smoking. Cigarette smoking increases risk for death from all causes in men and women. The risk of dying from cigarette smoking has increased over the last 50 years in men and women in the United States.

Smoking Diseases & Death

Smoking leads to disease and disability and harms nearly every organ of the body.1 More than 16 million Americans are living with a disease caused by smoking. For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. Smoking is a known cause of erectile dysfunction in males. **Smoking is the leading cause of preventable death.***

Other social factors influencing behaviors & health

Social Support Alameda study (1965) found that an individuals health status & risk of dying strongly associated with social network. Social support can buffer stress Stress Mortality is increased after death of a spouse, loss of a job, divorce, etc. Stress increases risk of heart disease, common cold Daily hassles Demographic factors Race/Ethnicity, Age, Gender, Marital Status Community Norms *** All these factors effect: Access to Health Choices Nutritional Choices Physical Activity Sexual Behavior Alcohol Consumption Violence***

Link & Phelan: Fundamental-Social-Causes Approach

Social conditions are fundamental causes of health inequalities ***High SES = High Access*** Healthy choices, knowledge and support Healthy work and home environment SES inequalities in mortality Exist across time, intervention, universal health coverage SES inequalities not due to Stress or Intellectual differences ***Link and Phelan argue that social status is the more fundamental influence because, regardless of the risks, persons with more resources, information, power, and useful networks are better able to marshal these resources to take advantage of what is known about preventing disease and maintaining health***. Thus, they argue, we should identify policies that can equalize such coping advantages so that one's socioeconomic status is not such a powerful determinant of health.

Diseases & Drugs role in obesity

Some illnesses may lead to obesity or weight gain. These may include Cushing's disease, and polycystic ovary syndrome. Drugs such as steroids, and some antidepressants may also cause weight gain.A doctor is the best source to tell you whether illnesses, medications, or psychological factors are contributing to weight gain or making weight loss hard.

Smoking Costs & Expenditures

The tobacco industry spends billions of dollars each year on cigarette and smokeless tobacco advertising and promotions. In 2016, ***$9.5 billion was spent on advertising and promotion of cigarettes and smokeless tobacco combined—about $26 million every day, and more than $1 million every hour.*** Price discounts to retailers account for 66.7% of all cigarette marketing (about $5.8 billion). These are discounts paid in order to reduce the price of cigarettes to consumers. Total economic cost of smoking is more than ***$300 billion a year, including*** ***Nearly $170 billion in direct medical care for adults*** More than ***$156 billion in lost productivity*** due to premature death and exposure to secondhand smoke.

Adult obesity rates

U.S. adult obesity rates remained mostly steady―but high―this past year, increasing in Kansas, Minnesota, New Mexico, Ohio and Utah and remaining stable in the rest, according to The State of Obesity: Better Policies for a Healthier America, a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). Arkansas had the highest adult obesity rate at 35.9 percent, while Colorado had the lowest at 21.3 percent. The 12th annual report found that rates of obesity now exceed 35 percent in three states (***Arkansas, West Virginia and Mississippi***), are at or above 30 percent in 22 states and are not below 21 percent in any. In ***1980, no state had a rate above 15 percent, and in 1991, no state had a rate above 20. Now, nationally, more than 30 percent of adults, nearly 17 percent of 2 to 19 year olds and more than 8 percent of children ages 2 to 5 are obese***. Obesity puts some ***78 million Americans*** at an increased risk for a range of health problems, including heart disease, diabetes and cancer.

Physical Activity & Health

Weight control works best when healthy eating is combined with physical activity Exercise promotes health independent of weight control Exercise helps to prevent heart disease, high blood pressure, improves cholesterol, diabetes, some forms of cancer

Promoting Physical Activity

Which of the following is characteristic of a healthy weight loss diet? Remove environmental barriers & provide places to exercise Suburban lifestyle - must drive everywhere Build sidewalks, walking trails, bike paths Mall walking in shopping malls Police surveillance & neighborhood watches in high-crime neighborhoods Develop habits of exercise in children Physical education classes should focus on activities that can be practiced throughout one's lifetime All

Obesity: key facts

Worldwide obesity has nearly tripled since 1975. In 2016, more than ***1.9 billion adults***, 18 years and older, were overweight. Of these over 650 million were obese. 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese. Overall, about ***13% of the world's adult population*** (11% of men and 15% of women) were obese in 2016. Most of the world's population live in countries where overweight and obesity kills more people than underweight. 41 million children under the age of 5 were overweight or obese in 2016. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016. Obesity is preventable. http://www.who.int/mediacentre/factsheets/fs311/en/

Dangers of Second Hand Smoke pt.2

can cause cardiovascular disease, many respiratory problems, and cancer. Health Effects: Adults In adults who have never smoked, secondhand smoke can cause heart disease and/or lung cancer.3 Heart Disease For nonsmokers, breathing secondhand smoke has immediate harmful effects on the cardiovascular system that can increase the risk for heart attack. People who already have heart disease are at especially high risk.3,5 Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25-30%.3 Secondhand smoke exposure causes an estimated 46,000 heart disease deaths annually among adult nonsmokers in the United States.6 Lung Cancer Nonsmokers who are exposed to secondhand smoke at home or work increase their lung cancer risk by 20-30%.3 Secondhand smoke exposure causes an estimated 3,400 lung cancer deaths annually among adult nonsmokers in the United States.6

Weight Bias:a Social Justice Issue

http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddBriefWeightBias2009.pdf Science has documented clear, consistent evidence that overweight people face discrimination in employment, education, and health care. In a country where two out of three adults and one out of two children are overweight or obese, weight bias affects millions, at a steadily increasing rate. In 1995-96, weight discrimination was reported by 7% of US adults. In 2004-2006, that percentage rose to 12% of adults. " Obesity carries with it one of the last forms of socially acceptable discrimination."

Truth Campaign & CDC/FDA Examples

http://youtu.be/PbQ4JNpXPTY Shards of Glass http://youtu.be/zuh2w2sFRMI You Don't Always Die From Tobacco http://youtu.be/x7_B-9OyZls Unsweetened Truth https://www.youtube.com/watch?v=OoiryG6dJXY The Real Cost Commercial - Your Teeth http://www.youtube.com/watch?feature=player_embedded&v=GEWky9PEroU Tips from Smokers https://www.youtube.com/watch?v=loLpcd7gqNE Tobacco products kill more than just people. In fact, cats and dogs are twice as likely to get cancer if their owner smokes. Seriously, how messed up is that? Get on board @truthorange and let's #FinishIT. http://www.youtube.com/watch?v=5zWB4dLYChM&feature=player_embedded My Name is Terrie (died: September 16, 2013)

My plate plan

illustrates the five food groups that you need to eat regularly and provides a visual indication of how much of each group you need MyPlate is the current nutrition guide published by the United States Department of Agriculture, depicting a plate and glass divided into five food groups. It replaced the USDA's MyPyramid guide on June 2, 2011, ending 19 years of USDA food pyramid diagrams. MyPlate will be displayed on food packaging and used in nutrition education in the United States. MyPlate is divided into sections of approximately 30 percent grains, 30 percent vegetables, 20 percent fruits and 20 percent protein, accompanied by a smaller circle representing dairy, such as a glass of low-fat/nonfat milk or a yogurt cup.

Comprehensive sex education

programs that not only provide information about contraception, STDs, and pregnancy but also teach adolescents how to refuse unwanted sex and avoid unintended sex, increase their motivation to engage in safe sex, and change perceptions about peer norms and attitudes -***Studies have found this type of education in school's delays initiation of sex, reduces the number of partners and students are more likely to use condoms*** -***The decision on what students should be taught about sex is made by local school boards and depends on "community standards"***

The USDA was established by

***President Abraham Lincoln*** on May 15, 1862. Even in the midst of the Civil War, the darkest days of any American presidency. President Lincoln viewed agriculture as a critically important component of his domestic policy & the Economy.

Prevention Programs: preventing infant mortality

"Back to Sleep" campaign Room for improvement: only 31% of African American Infants sleep on their backs promotes safe sleep. ***Always place baby on its back. Never put an infant in an adult bed. Never smoke around babies.*** ***SIDS rate has fallen by over 50%***

Government Nutrition Programs

"Food Assistance" during the Great Depression WIC (1960s): provides vouchers for nutritious foods for pregnant women, lactating mothers, children up to 5 School Meals Program Supplemental Nutrition Assistance Program (SNAP) formerly called Food Stamp Program ***11% of households in the U.S. are "food insecure"***

Chapter 17 Injuries Are Not Accidents

*** pg. 259***

Infant Mortality

***23,000*** infants died in the United States in 2013 (cdc.gov) ***The U.S. ranks 27th*** in the world 6.6 deaths per 1000 live births Behind Sweden, Japan, Finland, Norway, France, Germany, Israel... ***Not all countries measure the same way*** ***in 2015, 4.5 million (75% of all under-five deaths) occurred within the first year of life.*** Infant mortality steadily declining

Of the 6.4 million pregnancies in the U.S. annually, what percent of these are unintended?

***49%***

Epidemiology of Injuries

***4th leading cause of death in the U.S*** . Leading cause of death among people ages 1-44 ***Higher injury rates in groups with lower SES*** ***Males have higher injury rates than females*** ***Blacks have lower injury mortality than whites** ***Exception being higher homicide rates***

Clean Environment: Basis of Public Health

***Assessment***: what's in the environment ***Policy***: regulate environmental hazards ***Assurance***: protect communities ***Mission of public health***: "To ensure the conditions in which people can be healthy"

Causes of Infant Mortality

***Birth defects (20%)*** - leading cause overall Congenital Malformations Downs Syndrome, Tay-Sachs, hemophilia ***Prematurity & low birth weight*** 12.5% of all births are preterm Still leading cause among blacks Causes are environmental, behavior, nutritional, & social ***Sudden infant death syndrome (SIDS)*** Cause of death unknown Deaths are almost always caused by suffocation

CDC fact

***CDC estimates that each year roughly 1 in 6 Americans (or 48 million ppl) gets sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.***

Reproductive Health Education (Sex Ed)

***Comprehensive Education*** Discusses abstinence, contraception, healthy relationships, & sometimes pregnancy options ***Abstinence Only Education*** Promotes abstinence as the only safeguard against pregnancy/STIs Not effective "National Surveys of young women ages 15 to 19 found that 14% of the decline in pregnancy could be attributed to delayed initiation of sexual activity, while 86%...was due to increased use of contraceptives."

Commissioner of Food and Drugs: FDA

***Dr. Scott Gottlieb*** was sworn in as the 23rd Commissioner of Food and Drugs on May 11, 2017. Dr. Gottlieb is a physician, medical policy expert, & public health advocate who previously served as the FDA's Deputy Commissioner for Medical & Scientific Affairs & before that, as a senior advisor to the FDA Commissioner. Dr. Gottlieb was previously a Resident Fellow at the American Enterprise Institute, & a Clinical Assistant Professor at the New York University School of Medicine in Manhattan, where he also practiced medicine as a hospitalist physician. He completed a residency in internal medicine at the Mount Sinai Medical Center in New York, New York and is a graduate of the Mount Sinai School of Medicine & of Wesleyan University, in Middletown, Connecticut, where he studied Economics.

Government Oversight for Food SafetyScreening

***FDA all other foods 85% of F.B. illness*** Inspections every 3-5yrs Budget of ***$4.36 Billion*** (majority from fees)- food safety budget $914 million In 2000, inspected 1% of imported foods at port of entry The FDA has its headquarters at White Oak, Maryland.[3] 14,824 employees The agency also has 223 field offices and 13 laboratories located throughout the 50 states, the United States Virgin Islands, and Puerto Rico. In 2008, the FDA began to post employees to foreign countries, including China, India, Costa Rica, Chile, Belgium, and the United Kingdom

Child Health & Safety: pt.2

***Fluoridation*** Prevents tooth decay Only 69% of communities fluoridate their water ***Government Regulation*** U.S. Consumer Products Safety Commission regulates toys and children's furniture Safety regulations for day care centers Sex offender registries & Amber Alerts ***Policy*** Car seats, safety belts, helmet laws

Father of the Pure Food and Drugs Act

***Harvey W. Wiley*** In 1883, Harvey W. Wiley, chief chemist of the U.S Agricultural Department's Bureau of Chemistry, began experimenting with food & drug adulteration. Wiley was nicknamed the "Father of the Pure Food and Drugs Act."

Safety Measures: Food health policy

***Hazard Analysis Critical Control Point (HACCP)*** Focuses on procedures; reduces need for inspections ***Irradiation - kills bacteria, parasites, pests*** ***CDC surveillance for food-borne disease*** FoodNet Pulsenet - DNA fingerprinting of bacteria

Child Health & Safety

***Immunizations*** Vaccines for Children Program (1993): government funding for uninsured children Some required before entering school CDC tracks immunization rates Some controversial like HPV ***Asthma*** 8.5% of children in the U.S. have asthma Low birth weight, secondhand smoke, allergies, air pollution ***Health Screenings/Health Care*** Affordable Care Act increases funding for school-based healthcare & health education programs Diagnostic, treatment, and rehabilitative services for children with special needs (Medicaid)

Food production chain

***production, processing, distribution, preparation (restaurant/ retail)***

History of Food Safety: PT 2

***In 1927, U.S Food, Drug and Insecticide Administration (shortened to Food and Drug Administration) or FDA was created to enforce the Pure Food and Drug act.*** The Pure food Act was later superseded in 1938 by Pure Food, Drug and Cosmetics Act. This act prohibited any food or drug that is dangerous to health to be sold in interstate commerce. In 1958, concern over cancer led to the adoption of the Delaney Amendments, which expanded the FDA's regulatory powers to set limits on pesticides and additives. Manufacturers had to prove that additives and pesticides were safe before they could be used. The Fair Packaging & Labeling Act of 1966 standardized the labels of products and required that labels provide honest information. The next major act was the Food Quality Protection Act of 1996. It set new regulations requiring implementation of Hazard Analysis and Critical Control points (HACCPs) for most food processor. The Food quality Protection Act also changed the way acceptable pesticide levels are calculated. Now total exposure for all sources must be calculated.

Barriers to Prenatal Care

***Lack of knowledge, transportation, or time Experiences of rudeness/ judgment Long wait times Lack of child care for other children*** For immigrants Anti-immigrant sentiment Affordable Care Act/"Obamacare" reduces funding for 'charity' hospitals

Adults 20-49

***Motor vehicles still the major cause of injury mortality*** IMPORTANT Factors: ***# 1 ALCOHOL*** ***#2 YOUTH***

History of Child Health Programs

***New York City milk stations*** starting in 1893 After raking in a fortune as co-owner of ***Macy's, Nathan Straus*** devoted himself to making life better for New York's poor tenement dwellers. In the depression years of 1892 and 1893, he gave away food and coal to thousands, and he built homeless shelters. He also turned his sights toward what was dubbed the ***"white peril,"*** the raw, bacteria-ridden milk city children routinely drank—milk Straus and many experts believed was linked to New York's high childhood mortality rate (two of Straus' own kids had died young). "Straus was convinced that the discoveries of Louis Pasteur offered the best hope for a remedy to the milk problem," states jewishvirtuallibrary.org. So in 1893 he built his own pasteurization plant on East Third Street, then opened 18 milk stations in the city, "which sold his sterilized milk for only a few cents and made free milk available to those unable to afford even that." Milk stations popped up everywhere: City Hall Park, Mott Street, Cherry Street, Washington Street, East 66th Street, Lenox Avenue, and eventually Columbus Circle (above, circa 1930), run by William Randolph Hearst's wife. When Straus showed health officials that childhood mortality rates had been drastically cut in neighborhoods with milk stations, the city—and soon all cities—banned the sale of raw milk.

OSHA

***OSHA*** is a small agency; with our state partners we have approximately 2,200 inspectors responsible for the health and safety of 130 million workers, employed at more than 8 million worksites around the nation - which translates to about one compliance officer for every 59,000 workers. OSHA has 10 regional offices and 90 local area offices. OSHA at 40 In four decades, OSHA has made a dramatic difference in workplace safety. Since 1970, workplace fatalities have been reduced by more than 65 percent and occupational injury and illness rates have declined by 67 percent. At the same time, U.S. employment has almost doubled. OSHA budget FY 2016: $552,787,000 FY 2017: $551,736,000 FY 2018: $543,257,000 (requested)

Occupational Injuries

***Occupational Safety & Health Administration (OSHA)- regulatory agency*** ***National Institute of Occupational Safety & Health (NIOSH) - research agency***

Preventing Birth Defects

***Prenatal Care Initiatives*** Genetic & newborn screening Dietary supplementation with folic acid ***Policy Initiatives*** FDA regulation of teratogenic drugs Warnings against alcohol for pregnant women Immunization of all children against rubella protects infants

Preventing Low Birth Weight

***Prenatal care*** Smoking Cessation Drug & Alcohol Screening ***Prevention Programs*** Reducing adolescent pregnancy Spacing births through contraceptive use ***Research*** Causes of low birth weight are not well understood

CDC

***PulseNet***, a sophisticated outbreak detection system, is a national surveillance network of CDC, state, and local public health laboratories and federal food regulatory agency laboratories. PulseNet performs pulsed-field gel electrophoresis ("DNA fingerprinting") on disease-causing bacteria that may be foodborne to find clusters of cases that might be related. National Outbreak Reporting System (NORS). Foodborne Outbreak Online Database (FOOD) is an annual listing of foodborne disease outbreaks in the United States (1998-2009) which has been designed to allow the public direct access to information on foodborne outbreaks reported to CDC.

Women's health stats

***Slide 26 chptr 18***

Foodborne illness graphic

***Slide 3 chptr 24***

Best emergency contraceptive graphic:

***Slide 40 and 41 chptr 18***

Graphic food policy

***Slides 18-20 Chapter 24***

Contraceptives

***Sterilization***: Tubal $0 & $6,000/Vasectomy 0-$1000 ***IUDs & Implants*** (hormonal or non-hormonal) Costs between $0 and $1,000 up front, but lasts up to 12 years ***Injections/Shots*** $0-$100 per injection, plus any exam fees ***Oral contraceptives*** (combination or progestin-only) Most insurance plans offer the lowest copays on generic medication -- usually $5 to $15 -- and higher copays of $30 to $40 for non-preferred brands. Often used inconsistently & unreliably ***Barrier methods*** (condoms 0-$1, diaphragm 0-$75, cervical cap 0-$75) Prevents sexually transmitted disease Often used inconsistently & unreliably A CDC Report shows that 99.1 percent of sexually experienced women ages 15 to 44 who were surveyed between 2006 and 2010 have used some form of contraception, up from 98.2 percent in 2002. Ninety-three percent of sexually experienced women have used condoms at some point in their lives, and roughly four out of every five women have used birth control pills.

Preventing Infant Mortality:Public Health Initiatives

***Sudden Unexpected Infant Deaths (SUID)*** ***Sudden Infant Death Syndrome (SIDS)*** ***The SIDS rate for American Indians & African Americans is 2 to 3 times that of Whites***. Each year in the United States, there are about ***3,500*** Sudden Unexpected Infant Deaths (SUID). These deaths occur among infants less than 1 year old and have no immediately obvious cause. The three commonly reported types of SUID are About ***1,500*** infants died of SIDS in 2014. Unknown cause. Accidental suffocation and strangulation in bed. About half of these Sudden Unexpected Infant Deaths (SUID) are due to Sudden Infant Death Syndrome (SIDS), the leading cause of SUID and of all deaths among infants aged 1-12 months. http://www.cdc.gov/sids/data.htm ***Graphic slide 24 chptr 18***

History of Food Safety:THE JUNGLE

***The Jungle is a 1906 novel written by journalist Upton Sinclair.*** Sinclair wrote the novel with the intention of portraying the life of the immigrant in the United States, but readers were more concerned with the large portion of the book pertaining to the corruption of the American meatpacking industry The book is famous for exposing of the poor health conditions in the meatpacking industry. People began complaining to Congress and to President Theodore Roosevelt. Pressure was also mounting from foreign governments that wanted some assures that food imported from US was pure & wholesome. ***Two acts were passed in 1906, the Pure Food & Drug Act and the Beef Inspection Act, to improve food safety conditions.***

Irrationality of System: USDA and FDA

***USDA has bigger budget, more authority Regulates 20% of food*** Detailed laws on regulation of meat ***FDA has smaller budget, less authority Regulates 80% of food*** Inspects only 1% of imported food 80% of seafood is imported 60% of fresh fruits & vegetables are imported

Causes of Food-Borne Illness

- ***Bacteria*** Salmonella -- eggs, poultry, meat E. coli O157:H7 - ground beef, alfalfa sprouts, unpasteurized apple juice, raw milk, lettuce - ***Viruses*** Hepatitis A - green onions from Mexico, shellfish Norwalk virus -- shellfish - ***Parasites*** Cyclospora - raspberries from Guatemala Parasites in sushi, sashimi, ceviche

Importance of Infant & Child Health

- Foundation of health throughout life - Children are most vulnerable group in society - Infant mortality rate (IMR) is an indicator of health status of population - U.S. ranks 27th internationally - IMR higher for blacks than whites - indicator of health disparity

Chapter 16 Summary

1. Americans are overweight, over nourished, and they exercise too little. All three factors independently increase health risks, especially for cardiovascular disease, cancer, and diabetes. 2. According to CDC surveys, approximately two-thirds of Americans are overweight or obese, and the percentage has been increasing. The prevalence of overweight and obesity is higher among low SES groups than among those of higher SES. Black women are more likely than white women to be overweight or obese, but among men, black men have about the same prevalence of overweight and obesity than white men. 3. Americans eat too much protein and fat and too few fruits and vegetables. The federal government recommends that people eat more fruits, vegetables, legumes, whole grains, and low-fat milk products. The food guide pyramid has been revised in an attempt to make it more understandable. 4. It is difficult for people to change their eating habits. Public health campaigns must compete with well-financed advertisements for non-nutritious foods. Most people's efforts to reduce body weight are unsuccessful in the long term.

Long-term disability

1.7 Million traumatic brain injuries each year- of these 52,000 die and 275,000 are hospitalized and survive. TBI is a contributing factor to a third (30.5%) of all injury-related deaths in the United States.1 About 75% of TBIs that occur each year are concussions or other forms of mild TBI.2 TBIs may lead to changes in thinking, sensation or language and may increase risk later in life for Alzheimer's or Parkinson. Ex: Mohammed Ali In 2009, an estimated 248,418 children (age 19 or younger) were treated in U.S. EDs for sports and recreation-related injuries that included a diagnosis of concussion or TBI.3 Annual Costs of Brain Injury in the United States Every year Americans spend close to $50 billion on traumatic brain injuries. The majority of this money—close to $32 billion—goes toward hospitalization, while the remaining costs are associated with brain injury-related deaths

WISQARS™ — Your source for U.S. Injury Statistics

CDC's WISQARS™ (Web-based Injury Statistics Query and Reporting System) is an interactive, online database that provides fatal and nonfatal injury, violent death, and cost of injury data from a variety of trusted sources. http://www.cdc.gov/injury/wisqars/index.html

The injury burden: mortality

400 individuals a day Number one killer for children, adolescents & young adults Over half of the injuries are unintentional - what we used to call accidents Ellen MacKenzie, Epidemiology Reviews, 2000

Teens & Adolescents

46% of teens in high school report having had sex Only 61% of sexually active teens reported using condoms. (The National Campaign) In 2006, 750,000 women younger than 20 became pregnant. (Guttmacher Institute) Pregnant teens: less likely to seek prenatal care less likely to gain adequate weight more likely to smoke ***Teen pregnancy graphics: Slide 36 chptr 18***

Chapter 16 Summary

5. Physical activity promotes a healthier distribution of weight, can contribute to weight loss when combined with dieting, and independently protects against cardiovascular disease, diabetes, and some kinds of cancer. People who are physically active live longer. 6. Most Americans get very little exercise. While more exercise is better, the minimum standard is an expenditure of 150 kilocalories per day of light to moderate activity for the average adult. 7. More research is needed to learn what public health measures could be effective in increasing people's physical activity. One approach that might help is to remove common environmental barriers that discourage activity. 8. Because the problems of obesity, overnutrition, and lack of exercise are increasingly common in children, raising the risk that adults will be even less healthy in the future than they are today, public health efforts should concentrate especially on encouraging children to develop healthier habits of eating and exercising.

Injuries to children

< 1 Unintentional suffocation For kids 1-3 (deaths) # 1 Motor Vehicles #2 Drowning Non-fatal injuries Falls Blunt trauma/shaking leading cause of head injury among infants and young children

***Possible essay: Why do we believe injuries aren't accidents and whats a better term?***

Accidents are unavoidable random occurrences and that is where the belief of injuries not being accidents comes into play. Recently, it has become recognized by public health practitioners that injuries should be treated as public health problems that can ensue preventive interventions that can stop or lessen injuries from occurring. Injuries are caused by individual behavior, but they are also influenced by the social and physical environment the said individual is surrounded by. Injuries should instead be called incidents, because they should require a chain of causation leading to how the injury actually happened.

Politics of the FDA

FDA subject to intense political pressures Complaints it is too slow in approving drugs Drug companies pay a fee to speed up review process Now complaints that the FDA is too cozy with industry

Intentional Death: Homicide

All homicides Number of deaths: 17,793 Deaths per 100,000 population: 5.5 Firearm homicides Number of deaths: 12,979 Deaths per 100,000 population: 4.0 https://www.cdc.gov/nchs/fastats/homicide.htm

Mortality

All unintentional injury deaths Number of deaths: 146,571 Deaths per 100,000 population: 45.6 Cause of death rank: 4 Unintentional fall deaths Number of deaths: 33,381 Deaths per 100,000 population: 10.4 Motor vehicle traffic deaths Number of deaths: 37,757 Deaths per 100,000 population: 11.7 Unintentional poisoning deaths Number of deaths: 47,478 Deaths per 100,000 population: 14.8 Source: Deaths: Final Data for 2015, tables 6, 7

Accidents or Unintentional Injuries(Data are for the U.S.) http://www.cdc.gov/nchs/fastats/acc-inj.htm

All unintentional injury deaths Number of deaths: 120,859 Deaths per 100,000 population: 39.1 Cause of death rank: 5 Unintentional fall deaths Number of deaths: 26,009 Deaths per 100,000 population: 8.4 Motor vehicle traffic deaths Number of deaths: 33,687 Deaths per 100,000 population: 10.9 Source: Deaths: Final Data for 2010, tables 9, 18 [PDF - 3.1 MB]

E-cigs

Battery operated devices that turn liquid nicotine into a "vapor" that the user inhales SLides 25-28 on powerpoint and page *233** in book

History of food safety

Before manufacturing traditionally, farming practices & preserving techniques were used to ensure safe food. During industrial revolution, food began to be processed & packaged. Lacking regulation, manufacturers were free to add whatever they liked to their products. ***Sweepings from the floor were included in pepper, lead salts were added to candy and cheese, textile inks were used as coloring agents, bricks dust was added to cocoa, and copper salts were added to peas and pickles. Chemicals like borax were common in foods from bacon to margarine.*** In the 1880s, women started organizing groups to protest the conditions at slaughterhouses in New York City & adulterated foods in other parts of the country.

Causes of Obesity

Behavior Environment Genetics Diseases Drugs

Weight Bias in Education

Bias by teachers ■ Teachers say overweight students are untidy, more emotional, less likely to succeed at work, and more likely to have family problems. ■ Forty-three percent of teachers agree that "most people feel uncomfortable when they associate with obese people." ■ Teachers have lower expectations for overweight students (compared to thinner students) across

Weight Bias in Employment

Bias examples ■ not being hired because of weight; ■ becoming the target of derogatory comments and jokes by employers and coworkers; ■ being fired for failure to lose weight; ■ being penalized for weight, through company benefits programs.

Deaths caused by smoking

Cardiovascular disease Lung cancer Respiratory diseases - pneumonia, influenza, bronchitis, emphysema, chronic airway obstruction Other cancers - laryngeal, oral, esophageal, pancreatic, urinary Diseases among infants Burns

CDC

Centers for Disease Control and Prevention ***United States Food and Drug Administration (FDA), the United States Department of Agriculture - Food Safety and Inspection Service (USDA/FSIS) , and the Environmental Protection Agency.*** ***During a multi-state foodborne disease outbreak, CDC serves as lead coordinator between public health partners to detect the outbreak, define its size and extent, and to identify the source***.

Child Safety Seats

Child safety seats reduce the risk of death in passenger cars by 71% for infants, and by 54% for toddlers ages 1 to 4 years. According to researchers at the Children's Hospital of Philadelphia, for children 4 to 7 years, booster seats reduce injury risk by 59% compared to seat belts alone. Child passengers should never be seated in front of an airbag. Airbags can injure or kill children in a crash that might otherwise have been survivable ***Have all children under age 13 sit in the back seat***. Place children in the ***middle of the back seat*** when possible, because it is the safest spot in the vehicle.

Motor Vehicles: Leading Cause of Death for the following age groups

Children 1-3 In 2003, 1/3 of children <4 who died in MV crashes were unrestrained Children 4-11 Only 37% of kids 4-7 ride in booster seats Almost ¼ of kids 5-9 killed in traffic crashes were pedestrians Adolescents 12-19 Risk is higher for 16-19 year olds than any other age group

Key Birth Statistics

Data for United States in 2015 Number of births: 3,978,497 Birth rate: 12.4 per 1,000 population Fertility rate: 62.5 births per 1000 women aged 15-44 years Percent born low birthweight: 8.1% Percent unmarried: 40.3% https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf

Public Health in the News related to injury

Death by Selfie or "Kilfie" What are the leading causes of death? Drowning Transport accidents Falling Electrocution Death by animals, Fire firearms Why are so many people dying needlessly?

Maternal & Infant Mortality

Definitions ***Maternal Mortality - the death of a woman during pregnancy or childbirth*** ***Infant Mortality - the death of a child before 1 year*** Perinatal - 0 (stillborn) to 6 days Neonatal - 6 days to 28 days (4 weeks) Postneonatal - 4 weeks to 1 year

Occupational injury prevention

Determine that a hazard or potential hazard exists Where feasible, prevent hazards by effective designs of job site If hazard cannot be eliminated, use control measures Eliminate or control hazards in a timely manner http://video.google.com/videoplay?docid=3769887066320478465#docid=1404303103035803393

Chapter 13

Do people chose their own health?

On the left, a lethal dose of heroin; on the right, a lethal dose of fentanyl.

Drugs users generally don't know when their heroin is laced with fentanyl, so when they inject their usual quantity of heroin, they can inadvertently take a deadly dose of the substance.

Traumatic Injury

Each day, U.S. workers suffer injury, disability, and death from workplace incidents. On average, 15 workers die each day from traumatic injuries. Overall, 5,400 workers died in 2007 from an occupational injury and more than 4 million workers had a nonfatal injury or illness. In the private-sector alone every day, we see 11,500 nonfatal work-related injuries/illnesses with more than half of these injuries/illnesses requiring a job transfer, work restrictions, or time away from the jobs as a result. Among all workers, not just the private sector, 9,000 workers are treated in emergency departments each day, and approximately 200 of these workers are hospitalized http://wwwn.cdc.gov/niosh-survapps/Gateway/Default.aspx?c=TRI&s=HSA

Motor Vehicle Injuries, ctd.

Education & enforcement Speed limits Seat belts Alcohol plays a major role in fatal crashes Second leading factor - youth & inexperience Graduated driver's licenses Zero tolerance for blood alcohol Distracted driving contributes to crashes - cell phone use, especially text messaging Motor vehicle fatalities decreased by more than 20% since 1968 despite more cars & more miles driven

Community Level

Educational programs for bartenders in gay establishments Distribution of condoms

Why is Occupational Health Important?

Eliminates possible dangers Safeguards employee productivity Means to promote workplace process Protects employees rights Maintains worker health

The National Breastfeeding Campaign

Encourages women to breastfeed Destigmatize breastfeeding in public Help store owner create "nurse-friendly" policies Help create workplace policies to allow time to pump. Why? Because breastfeeding... Promotes brain/cognitive development Reduces the risk for infectious diseases, respiratory & ear infections, obesity, asthma & allergies.

Analyzing Injuries

Example: Car Crash ***Primary Prevention***: Conditions prevailing before event Host- was person intoxicated? Agent- were the breaks defective? Environment-was it a dark & rainy night? ***Secondary Prevention*** -conditions prevailing during event Host: wearing a seat belt Agent: car equipped with airbag/anti-lock breaks Environment: driving on divided highway ***Tertiary Prevention***: availability & quality or emergency care/trauma centers/rehabilitation centers/helicopters

Drugs: food and safety

FDA must approve after studies by pharmaceutical company New Drug Application Three phases of trial I. Small number of subjects, measure absorption, distribution, metabolism, excretion; look for side effects and toxicities II. Signs of effectiveness III. Clinical trial Post-marketing surveillance

Food & Drug Labeling & Advertising

FDA regulates labeling of foods with information on specified nutrients, recommended daily intakes FDA regulates labeling of drugs Labeling of over-the-counter drugs is by Federal Trade Commission

Additives & Contaminants: Food health policy

FDA sets tolerance levels for pesticide residues Hormones Estrogen banned in chickens Bovine growth hormone allowed for cows (does not get into milk) Antibiotics - causes antibiotic resistance Organic foods - USDA set standards in 2004 Additives To prevent deficiency diseases Preservatives or to improve color, flavor or texture Must be approved by FDA, or ***GRAS*** The concept of food additives being ***"generally recognized as safe"*** was first described in the Food Additives Amendment of 1958, and all additives introduced after this time had to be evaluated by new standards.

OSHA inspections

FY 2017 total federal inspections: 32,396 FY 2017 total State Plan inspections: 43,551 Worker injuries, illnesses and fatalities 5,190 workers were killed on the job in 2016 [https://www.bls.gov/news.release/cfoi.nr0.htm] (3.6 per 100,000 full-time equivalent workers) — on average, more than 99 a week or more than 14 deaths every day.

Obesity: Key facts pt. 2

Facing a double burden of disease Many low- and middle-income countries are now facing a "double burden" of disease. While these countries continue to deal with the problems of infectious diseases and undernutrition, they are also experiencing a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight, particularly in urban settings. It is not uncommon to find undernutrition and obesity co-existing within the same country, the same community and the same household. Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, these children are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.

Prevalence of Smoking and Cancer

Fallacy of women's immunity: -Women started smoking later than men, -women's lung cancer rates began rising later, -and lung cancer among women surpassed breast cancer in the 1980s Black men had higher rates but have declined ***High rates in American Indians and Alaska Natives*** Strong association with lack of education ***Now in U.S., about 20% of adults smoke***

Fatal injury rate computation

Fatal injury rates depict the risk of incurring a fatal occupational injury and can be used to compare risk among worker groups with varying employment levels. Since employment data are not collected by CFOI, fatal injury rates are calculated using CPS data. Each state rate in the table above represents the number of fatal occupational injuries per 100,000 full-time equivalent workers and was calculated as: Fatality rate = (NS/EHS) x 200,000,000 where  NS = number of fatal work injuries in the state  EHS = total hours worked by all employees in the state during the calendar year  200,000,000 = base for 100,000 equivalent full-time workers (working 40 hours per week, 50 weeks per year)

Obesity Rates

First- United States Last- Japan Slide 7

California's Tobacco Control Program

Funded by 1989 tax increase of 25 cents per pack Cigarette consumption immediately began to decline Media campaign in 1990 & 1991 1994 - smoking ban in all workplaces Cigarette consumption declined by 60% since 1988 Lessons on effective anti-tobacco messages

HEALTHCARE WORKERS

Healthcare is the fastest-growing sector of the U.S. economy, employing over 18 million workers. Women represent nearly 80% of the healthcare work force. Health care workers face a wide range of hazards on the job, including needle stick injuries, back injuries, latex allergy, violence, and stress. Cases of nonfatal occupational injury and illness among to healthcare workers are among the highest of any industry sector. By contrast, two of the most hazardous industries, agriculture and construction, are safer today than they were a decade ago.

Chapter 14

How psychosocial factors affect health behavior: begins pg. ***205***

Public Health in the News: Hurricane Michael

Hurricane Michael: A terrifyingly powerful Category 4 Hurricane Michael was poised to become the strongest hurricane to hit the Florida Panhandle in recorded history Wednesday, its rapid strengthening catching some by surprise and leaving anxious officials telling those who didn't evacuate: It's time to hunker down. Expected Storm 14 feet, wind speeds of 145 mph." This is the worst storm that our Florida Panhandle has seen in a century," Gov. Rick Scott said Wednesday morning. "Hurricane Michael is upon us, and now is the time to seek refuge." Climate Change Report: The report, issued on Monday by the Intergovernmental Panel on Climate Change, a group of scientists convened by the United Nations to guide world leaders, describes a world of worsening food shortages and wildfires, and a mass die-off of coral reefs as soon as 2040. Temperature projected to rise 2.7 degrees Fahrenheit /1.5 degrees (Celcius). The UN report, which is based on more than 6,000 scientific references from 91 authors across 40 countries. US response: President Trump suggested that the state of the world's climate may actually be "fabulous," and that he's seen reports expressing that position.

Family Plannaing & Unintended Pregnancy

In 2006, ***49%*** of pregnancies were unintended—a slight increase from 48% in 2001. Among women aged 19 years and younger, more than 4 out of 5 pregnancies were unintended. The proportion of pregnancies that were unintended was highest among teens younger than age 15 years, at ***98%***. Between 2001 and 2006, the proportion of pregnancies that were unintended— Declined from 89% to 79% among teens aged 15-17 years. Increased from 79% to 83% among women aged 18 and 19 years and from 59% to 64% among women aged 20-24 years. Large increases in unintended pregnancy rates were found among women with lower education, low income, and cohabiting women. Source: Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception. 2011;84(5):478-485.

Family Planning & Unintended Pregnancy

In 2013, ***664,435*** legal induced abortions were reported to CDC from 49 reporting areas. The abortion rate for 2013 was ***12.5 abortions per 1,000 women*** aged 15-44 years, and the abortion ratio was ***200 abortions per 1,000 live births***. In 2012, ***699,202 legal induced abortions*** were reported to CDC from 49 reporting areas (Source: CDCs Abortion Surveillance System) Given the large decreases in the total number, rate, and ratio of reported abortions from 2011 to 2014, in combination with decreases that occurred during 2008-2011, all three measures reached historic lows.

TBIs

In 2013, about 2.8 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States. TBI contributed to the deaths of nearly 50,000 people. TBI was a diagnosis in more than 282,000 hospitalizations and 2.5 million ED visits. These consisted of TBI alone or TBI in combination with other injuries. Over the span of six years (2007-2013), while rates of TBI-related ED visits increased by 47%, hospitalization rates decreased by 2.5% and death rates decreased by 5%. In 2012, an estimated 329,290 children (age 19 or younger) were treated in U.S. EDs for sports and recreation-related injuries that included a diagnosis of concussion or TBI. From 2001 to 2012, the rate of ED visits for sports and recreation-related injuries with a diagnosis of concussion or TBI, alone or in combination with other injuries, more than doubled among children (age 19 or younger).

Motor Vehicle Injuries

Leading cause of injury death - over 35,000 deaths per year ***Ralph Nader - Unsafe at Any Speed, the Designed-In Dangers of the American Automobile, published 1966*** Engineering changes to make cars safer laminated windshields installation of seat belts collapsible steering assemblies dashboard padding Engineering changes to make highways safer NHTSA empowered to set standards for auto safety Crash testing

Preterm Birth

In the United States, most of the efforts have been focused on tertiary prevention, aimed at improving the outcomes for infants born prematurely, and requiring expensive use of neonatal intensive care. Secondary prevention is aimed at identifying women at risk of giving birth too early and reducing their risk. For example, maternal ***smoking causes a 25 percent increased*** risk of preterm birth; the CDC monitors the prevalence of smoking among pregnant women, which has declined significantly since 1990 but is still over 10 percent. A state-by-state survey found in 2010 that 30.5 percent of pregnant women in West Virginia smoked during the last three months of pregnancy. Other risk factors include previous preterm births, carrying more than one fetus, obesity, diabetes, and bacterial infections of the genital tract. Recent evidence suggests that gum disease is associated with preterm births, & that periodontal treatment may reduce the risk.

Irrationality of System: USDA and FDA... More

Increasing % of American food imported ***USDA can ban imported meat or poultry, but NOT fruits, vegetables, grains, or fish*** Can not detain imports while testing Overseas diseases...are now here

Infant Mortality

Infant mortality is the death of an infant before his or her first birthday. The infant mortality rate is the number of infant deaths for every 1,000 live births. In addition to giving us key information about maternal & infant health, the infant mortality rate is an important marker of the overall health of a society. In 2015, the infant mortality rate in the United States was ***5.9 deaths per 1,000 live births***. Over 23,000 infants died in the United States in 2015. The five leading causes of infant death in 2015 were: 1. Birth defects. 2. Preterm birth and low birth weight. 3. Sudden infant death syndrome. 4.Maternal pregnancy complications. 5. Injuries (e.g., suffocation).

Emergency Contraception

Large dose of estrogen & progestin contraceptive Most effective between 0-72 hours after unprotected sex Non-abortive- (some religious groups disagree) Available without a prescription for women ages 17+ Cost between $30-$65 ***Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.***

Vintage Smoking Ads

Made smoking look good

Pedestrians, Motorcyclists, & Bicyclists pt. 2

Motorcyclists- more than 4,668 deaths Head injuries leading cause of death 21 states & DC require helmets 28 states require helmets for younger riders Bicyclists - about 743 deaths per year Head injuries account for 60% of deaths 15 percent are under 16 21 states & DC require helmets for children

Criticism of OSHA

Much of the debate about OSHA regulations and enforcement policies revolves around the cost of regulations and enforcement, versus the actual benefit in reduced worker injury, illness & death. It is a job killer? OSHA has come under considerable criticism for the ineffectiveness of its penalties, particularly its criminal penalties. The maximum penalty is a misdemeanor with a maximum of 6-months in jail During its more than 40 years of existence, OSHA has secured only 12 criminal convictions. OSHA has been accused of being more devoted to the numbers of inspections than to actual safety.

Certain groups are more likely to abuse or overdose on prescription painkillers:

Many more men than women die of overdoses from prescription painkillers. Middle-aged adults have the highest prescription painkiller overdose rates. People in rural counties are about two times as likely to overdose on prescription painkillers as people in big cities. Whites and American Indian or Alaska Natives are more likely to overdose on prescription painkillers. About 1 in 10 American Indian or Alaska Natives age 12 or older used prescription painkillers for nonmedical reasons in the past year, compared to 1 in 20 whites and 1 in 30 blacks. http://www.cdc.gov/Features/VitalSigns/PainkillerOverdoses/

Chapter 18

Maternal & Child Health as a Social Problem

Question: What are some of the vaccinations required before starting school?

Measles, Mumps, Rubella, (some) flu,

interpersonal level

My peers support new behavior

Missouri Statistics in infant mortality

Missouri Birth Data 2015 State Rank* U.S.** Percent of Births to Unmarried Mothers 40.4 24th (tie) 40.3¹ Cesarean Delivery Rate 30.3 28th 32.0 Preterm Birth Rate 10.0 16th (tie) 9.6 Teen Birth Rate ‡ 25.0 21st 22.3 Low Birthweight Rate 8.3 20th (tie) 8.1 Infant Mortality Rate (Deaths per 1,000 live births) 6.5 ***(488 deaths)*** 5.9 ¹ Excludes data from U.S. territories ‡Number of live births per 1,000 females aged 15-19

Summary: Healthy People 2020

Nations roadmap for better health Sets national objectives based on data & expert opinion Sets targets to be reached in 10yrs Base funding decisions on applicability to HP goals Continually monitors objectives and target Encourage collaborations across sectors. Guide individuals toward making informed health decisions. Measure the impact of prevention activities https://youtu.be/5Lul6KNIw_8 Four foundation health measures will serve as an indicator of progress towards achieving these goals: General Health Status Health-Related Quality of Life & Well-Being Determinants of Health Disparities

Why the Effect of SES?

Nutrition Sanitation Conditions of the physical environment Higher SES leads to more healthy behavior Access to medical care

Leading Causes of Injuries

Poisoning Motor vehicle injuries Firearms injuries Falls Suffocation Drowning Fires/burns Cut/pierce

Federal Agencies often criticism of food policy

Politics often play a role in the US

Prescription Drug Abuse

Overdoses involving prescription painkillers (especially opioid based)—a class of drugs that includes hydrocodone, methadone, oxycodone, and oxymorphone—are a public health epidemic. According to Drug Enforcement Administration figures, nearly seven million Americans abused prescription drugs in 2009. Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs. This is more than 3 times the 4,000 people killed by these drugs in 1999. The estimated number of ED visits involving nonmedical use of benzodiazepines increased 89% during 2004--2008 (from 143,500 to 271,700 visits) and 24% during 2007--2008. http://www.cdc.gov/Features/VitalSigns/PainkillerOverdoses/ Just because they're legal doesn't mean that pharmaceutical drugs are any less dangerous than illicit drugs. They are potentially deadly when taken in large doses or when combined with alcohol or other drugs. Sometimes it takes high-profile cases to remind us of the dangers. ***One in 20 people*** in the United States, ages 12 and older, used prescription painkillers non-medically (without a prescription or just for the "high" they cause) in 2010. Nearly half a million emergency department visits in 2009 were due to people misusing or abusing prescription painkillers.

Consequences of Medical Bias

Overweight patients ■ are reluctant to seek medical care; ■ cancel or delay medical appointments; ■ put off important preventative health care services Doctors seeing overweight patients ■ spend less time with the patient; ■ engage in less discussion; ■ are reluctant to perform preventive health screenings such as pelvic exams, cancer screenings, and mammograms; ■ do less intervention

Weight Bias in Employment

Overweight people: ■ earn 1 to 6 percent less than non overweight people in comparable positions, & obese females suffer more than obese males ■ get fewer promotions;13 ■ are viewed as lazy, less competent, and lacking in self-discipline by their employers & co-workers; more than half (54%) of overweight participants in a study reported they had been stigmatized by co-workers; ■ can be fired or suspended because of their weight, despite demonstrating good job performance & even though weight is unrelated to their job responsibilities

Key Birth Statistics

PRAMS, the Pregnancy Risk Assessment Monitoring System, is a surveillance project of the Centers for Disease Control & Prevention (CDC) & state health departments. Developed in 1987, PRAMS collects state-specific, population-based data on maternal attitudes & experiences before, during, & shortly after pregnancy. PRAMS surveillance currently covers about 83% of all U.S. births.

Safe Sex PSA

PSA Safe Sex For Seniors! https://www.youtube.com/watch?v=6R-GEwUW0Eg

Pedestrians, Motorcyclists, & Bicyclists

Pedestrians - about 5,000 deaths per year 16 percent are over 70 Why are the elderly at risk? Elderly take about 52 seconds to cross Street & most walk signs only allow 35 seconds Vision loss-many elderly cannot read the walk/don't walk signs

Preventing Infant Mortality: prenatal care

Prenatal Care Provides women with information Diagnose problems early Can often link poor women with social services Most states try to remove financial barriers Affordable Care Act will require maternity coverage in all health plans in 2014-maternity coverage now considered a essential health benefit. *** Graphic Slide 20 chptr 18***

Occupational Health: still have work to do

Prolonged work hours Exposure to heat, light, noise, & vibration Work-life balance High stress Enforcing safety protocol http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=NEWS_RELEASES&p_toc_level=0&p_keyvalue

Chapter 15

Public health enemy number one: Tobacco starts on page: ***220***

Types of Child Restraints

Rear facing car Seat Birth to age 2 Forward facing 2 to 4 years Booster 40 pounds Backless Booster- until 8 years old or 4'9"/80 pounds

Chill: Refrigerate promptly

Refrigerate perishable foods within two hours Cold temperatures slow the growth of illness causing bacteria. So it's important to chill food promptly & properly. Here's how: Make sure your fridge and freezer are cooled to the right temperature. Your fridge should be between 40 ˚F and 32 ˚F, and your freezer should be 0 ˚F or below. Pack your refrigerator with care. To properly chill food (and slow bacteria growth), cold air must be allowed to circulate in your fridge. For this reason, it's important not to over-stuff your fridge. Get perishable foods into the fridge or freezer within two hours. In the summer months, cut this time down to one hour. Remember to store leftovers within two hours as well. By dividing leftovers into several clean, shallow containers, you'll allow them to chill faster. Never thaw or marinate foods on the counter Many people are surprised at this tip. But since bacteria can multiply rapidly at room temperature, thawing or marinating foods on the counter is one of the riskiest things you can do when preparing food for your family.

Government Food Safety Activities

Responsibility is divided among many agencies - ***Department of Agriculture (USDA)*** - meat, poultry, processed eggs - ***Food and Drug Administration (FDA)*** - all other foods - ***States regulate shellfish*** - ***State and local governments*** regulate stores, restaurants, institutions (schools, nursing homes)

Disparities in Maternal & Infant Mortality

Risk Factors Poverty/Socioeconomic Status (SES) Reasons why low SES increases risk Environmental hazards Poor nutrition Maternal risk behaviors - smoking, alcohol, illegal drugs Social factors - young maternal age, violence, stress, lack of social support Lack of access to prenatal care Stress

CHAPTER 24

Safe Food & Drugs: An Ongoing Regulatory Battle ***Page 381***

Locus of control theory (self-efficacy)

Self-efficacy is increased by previous successful performance Self-efficacy is increased by seeing others successfully perform, especially if model is a peer ***External Locus*** Everything happens by chance or due to others manipulation of my life. ***Internal Locus*** I can have an impact on my own health by the choices I make. ***Perceived Self-Efficacy*** People's beliefs about their capabilities to produce effects. ***Page 210***

Selfie Death Statistics

Selfie Death Statistics The largest number of such deaths was reported in India, followed by Russia, the United States & Pakistan. In addition, the vast majority of the victims - about 72.5 per cent - were male, while 27.5 per cent were female.

Infant Mortality Rates by Race & Ethnicity, 2015

Slide 13 chapter 18

Most Dangerous Jobs in 2016

Slides 38-40 on chapter 17

Intentional Death: Suicide

Suicide ranks as the 10th leading cause of death in the United States. Globally, an estimated 700,000 people take their own lives annually. In certain populations, such as adolescents and young adults, suicide constitutes 1 of the top 3 causes of death.

Poisoning

Surpassed firearms as a cause of injury death in 1994 The death rate from poisoning rose by almost 80% between 1999-2005. In 2005 unintentional poisoning caused more deaths than motor vehicle crashes among people 35-54 years old Most deaths due to misuse of prescription drugs, especially painkillers By 2004, at least 20,000 unintentional drug poisoning deaths occurred annually in the United States. By comparison, just over 17,000 homicides occurred that year (US Health & Human Services).

intrapersonal level

Target different levels of influence I am susceptible to infection There is something I can do that will lessen the treat of infection I am capable of making these changes

Preventing Infant Mortality

Technological Advances Even very premature babies are surviving. Rumaisa Rahman, 25 weeks gestation, 8 inches (20 cm) long & weighed 9.2 ounces. Spent 6 months in NICU before going home. (2004) In spite of all the advances in care for premature infants, the facts are this: when babies are born at 23 to 24 weeks, they have about a 50 to 60 percent chance of survival, but also a 50 to 60 percent chance of having a devastating handicap. Disadvantages Disrupts bonding between parent & child Leaves children with long-term disabilities Extremely costly

Taxes

Teenagers especially are sensitive to price California raised cigarette taxes to fund tobacco control programs Many states have raised cigarette taxes to close budget shortfalls The highest state and local tax rate is Chicago at $6.16. Nationally smoking related health cost and lost productivity totals ***$19.16 per pack*** ***Missouri's cigarette tax of 17*** cents per pack is the nation's lowest well below the national average of ***$1.49***.

To thaw food safely, choose one of these options:

Thaw in the refrigerator. This is the safest way to thaw meat, poultry, and seafood. Simply take the food out of the freezer and place it on a plate or pan that can catch any juices that may leak. Normally, it should be ready to use the next day. Thaw in cold water. For faster thawing, you can put the frozen package in a watertight plastic bag and submerge it in cold water. Be sure to change the water every 30 minutes. Note: If you thaw this way, be sure to cook the food immediately. Thaw in the microwave. Faster thawing can also be accomplished in the microwave. Simply follow instructions in your owner's manual for thawing. As with thawing in cold water, food thawed in the microwave should be cooked immediately. Cook without thawing. If you don't have enough time to thaw food, just remember, it is safe to cook foods from a frozen state—but your cooking time will be approximately 50% longer than fully thawed meat or poultry. Know when to throw food out. You can't tell just by looking or smelling whether harmful bacteria has started growing in your leftovers or refrigerated foods.

Polio like Illness

The Center for Disease Control (CDC) said there have been 38 confirmed cases of Acute Flaccid Myelitis (AFM) this year through the end of September. Fourteen cases have been reported in Colorado and six in Minnesota, most of them children. Flu Season-2018-2019: CDC expecting a record breaking year The CDC says that, in recent years, being vaccinated has reduced the risk by about 40 percent of being hospitalized because of the flu. Still, about 900,000 people were hospitalized because of influenza, and about 80,000 people, including 180 children (most of them unvaccinated), died during the 2017-2018 flu season, the deadliest in decades.

***Diff between USDA and FDA

The FDA and the USDA do share that the main responsibility of ensuring that foods are safe and properly labeled. The USDA was established by Abraham Lincoln and is now ran by Sonny Perdue, the 31st Secretary of Agriculture. The USDA is responsible for meat and poultry as well as processed eggs. Approximately 1 billion dollars is spent for food safety and inspection service. The FDA's current commissioner's is Dr. Scott Gottlieb. The FDA is responsible for all other foods, including seafood and produce. The food safety budget of the FDA is 914 million dollars.

USDA: more

The United States Department of Agriculture (USDA), also known as the Agriculture Department, is the U.S. federal executive department responsible for developing and executing federal government policy on farming, agriculture, forestry, and food. It aims to meet the needs of farmers and ranchers, promote agricultural trade and production, work to assure food safety, protect natural resources, foster rural communities and end hunger in the United States and abroad. USDA's Food Safety and Inspection Service (FSIS) ensures that our nation's meat, poultry and processed egg supply is wholesome, safe and properly labeled. Through prevention-based policies and practices USDA is meeting the foodborne challenges of the 21st century head on and using science to craft the best ways forward.

Body-Mass Index

The body mass index (BMI), or ***Quetelet Index of Obesity***, is a measure of relative size based on the mass and height of an individual. The index was devised by ***Adolphe Jacques Quetelet*** during the course of developing what he called "social physics," between 1830 & 1850 It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat. ***Optimal BMI for whites (23-25) while for African Americans (23 to 30).***

Injury Prevention in Public HealthThe Three Es

The first E = ***Education*** The second E =***Enforcement*** The third E = ***Engineering*** Children Can't Fly Program Fenced Swimming Pools Childproof Caps on Medications/household chemicals Smoke Detectors Flammability of Fabrics

Opioids

The impact of the opioid crisis cuts across racial/ethnic groups, age, sex, geography, and socioeconomic status. Forty-four percent of Americans say they personally know someone who has been addicted to prescription painkillers.[i] Here are some facts about the opioid crisis: ***78 Americans die every day from an opioid overdose.[ii]*** In 2014, more than 10 million people in the United States reported using prescription opioids for nonmedical reasons, and close to 2 million people older than 12 years met diagnostic criteria for a substance use disorder involving prescription opioids.[iii] The former Surgeon General's #TurnTheTide Campaign. The Surgeon General has launched an opioids campaign to raise awareness about opioid addiction and to help concerned Americans identify roles they can play in their community by: Sent a letter to 2.3M health care providers, including doctors, dentists and nurses, encouraging members of the profession to be leaders in combating this epidemic but still treating their patient's pain appropriately.

Diet, nutrition, life-style changes

The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention Federal recommendations - Dietary Guidelines for Americans More fruits and vegetables Legumes Whole grains Low-fat milk and milk products Less refined grains Less total fats, especially cholesterol & saturated & trans fats Less added sugar & calories

Identifying Common Foods & Germs

The pathogen-commodity pairs (germs and foods) responsible for the most outbreak-related illnesses, hospitalizations, & death in 2009-2010 were: Illnesses Salmonella in eggs (2231 illnesses) Salmonella in sprouts (493 illnesses) Salmonella in vine-stalk vegetables (422 illnesses) Hospitalizations Salmonella in vine-stalk vegetables (88 hospitalizations) E. coli O157 in beef (46 hospitalizations) Salmonella in sprouts (41 hospitalizations) Deaths E. coli O157 in beef (3 deaths) Salmonella in pork (2 deaths) Listeria in dairy (2 deaths) A large outbreak of Salmonella infections in 2010 caused nearly 2000 illnesses. Among the outbreaks attributed to a food vehicle composed of ingredients from only one of 17 defined food commodities, the commodities most often implicated were beef (13%), dairy (12%, nearly all unpasteurized), fish (12%), and poultry (11%).

Policy Recommendations

To improve working conditions, healthcare, and overall quality of life for millions of Americans, include weight on the list of categories that are covered in antidiscrimination laws. This can be accomplished on a federal, state, or local level. In employment Include weight in the Civil Rights Act or create separate federal anti-discrimination legislation based on weight. In health care Encourage health care organizations to include language on weight bias in their patients' rights policies, & require weight bias training for all health care professionals. In schools Protect overweight and obese children from bullying and intimidation in school by requiring states and/or school districts to adopt and enforce policies prohibiting harassment, intimidation, or bullying on school property. Include weight as a specific protected category.

Politics of the FDA, ctd.

Too many drugs found to be unsafe only after approved for marketing Fen-phen Vioxx Antidepressants for children Problems with the way clinical trials are reported Calls for a database of all clinical trials, to be registered at the beginning of the trial, with all results to be reported

Introduction to chpt. 17

Traditionally, injuries have been thought of as "accidents," unavoidable random occurrences or the result of antisocial or incautious behavior. Recently, public health practitioners have recognized that injuries can & should be treated as a public health problem, analyzable by ***epidemiological methods and amendable to preventive interventions.*** While most injuries are caused by some extent by individual behavior, they are also influenced by physical & social environment.

Categories of Injury Deaths

Unintentional Intentional Homicide Suicide

USDA

United States Department of Agriculture ***Sonny Perdue 31th Secretary of Agriculture 105, 778 employees- 10,000 (FSIS)*** ***USDA is responsible for meat and poultry*** 15% of F.B. illness Daily Inspections Budget of ***139.7 Billion- approximately $1 Billion*** for Food Safety and Inspection Service (FSIS)

History of Child Health Programs

Until the 20th century children were regarded as property of their parents (parents has the right to provide for or neglect their children, p. 304) U.S. Children's Bureau beginning in 1912 "Investigate & report all matters affecting children & child life." Child labor regulated by U.S. beginning in 1930s Children are a National Resource! Ongoing conflicts over the role of government in protecting children Child Protective Services Removal from the home Treatment of illnesses

WISQARS™ — Your source for U.S. Injury Statistics

Users can search, sort, and view the injury data and create reports, charts, and maps based on the following: Intent of injury (unintentional injury, violence-related, homicide/assault, legal intervention, suicide/intentional self-harm) Mechanism (cause) of injury (e.g., fall, fire, firearm, motor vehicle crash, poisoning, suffocation) Body region (e.g., traumatic brain injury, spinal cord, torso, upper and lower extremities) Nature (type) of injury (e.g., fracture, dislocation, internal injury, open wound, amputation, and burn) Geographic location (national, regional, state) where the injury occurred Sex, race/ethnicity, and age of the injured person

Follow these top tips to keep your family safe

Wash hands the right way—for 20 seconds with soap and running water. Washing your hands the right way can stop the spread of illness-causing bacteria. Wash surfaces & utensils after each use. Bacteria can be spread throughout the kitchen and get onto cutting boards, utensils, & counter tops Wash fruits & veggies—but not meat, poultry, or eggs! Did you know that—even if you plan to peel fruits and veggies—it's important to wash them first because bacteria can spread from the outside to the inside as you cut or peel them? http://www.foodsafety.gov

Why not wash meat, poultry, & eggs?

Washing raw meat & poultry can actually help bacteria spread, because their juices may splash onto (and contaminate!) your sink & countertops. All commercial eggs are washed before sale. Any extra handling of the eggs, such as washing, may actually increase the risk of cross-contamination, especially if the shell becomes cracked.

Assigned Readings/Videos.........

What is Healthy People? Food Safety Videos Weight Bias, A Social Justice Issue

Family Planning & Unintended Pregnancy

Why is this important? Planned pregnancy leads to healthier outcomes Adolescent pregnancy has physical and social risks for mother and child High unintended pregnancy rates in the U.S. What about it is controversial? Government provision of family planning services Title X Sex education in schools Abstinence-only or comprehensive?

Harvey Wiley's "poison squad"

Wiley's "poison squad" was made up of young, healthy, male government workers who consumed capsules of borax, formaldehyde, and other preservatives alongside their daily meals. The trials' shocking results led to the 1906 Pure Food and Drug Act & eventually to the creation of the U.S. Food and Drug Administration (FDA), transforming what the nation eats in the process.

Family Planning & Unintended Pregnancy: Abortions

Women in their twenties accounted for the majority of abortions in 2012 and throughout the period of analysis. The majority of abortions in 2012 took place early in gestation: 91.4% of abortions were performed at ≤13 weeks' gestation; 7.2% were performed at 14-20 weeks' gestation 1.3% were performed at ≥21 weeks' gestation. In 2012, 20.8% of all abortions were medical abortions. The percentage of abortions reported as early medical abortions increased 10% from 2011 to 2012. Source: MMWR. 2015;64(10). ***CHOICE Project Free contraceptives lowered abortion rate by 62-78%***

Occupational Health

Workplace issues related to the health and safety of employees, employers, and third parties ***Loren Sweatt Deputy Assistant Secretary of Labor for Occupational Safety and Health*** ***Secretary of Labor Alexander Acosta***

Food and Drug Administration (FDA or USFDA)

an agency of the United States Department of Health & Human Services, one of the United States federal executive departments. The FDA is responsible for protecting and promoting public health through the regulation and supervision of food safety, tobacco products, dietary supplements, prescription & over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices (ERED), and veterinary products. The ***FDA regulates more than $1 trillion worth of consumer goods***, about 25% of consumer expenditures in the United States. This includes $466 billion in food sales, $275 billion in drugs, $60 billion in cosmetics and $18 billion in vitamin supplements. Much of the expenditures is for goods imported into the United States; the FDA is responsible for monitoring a third of all imports

The Average Man

http://www.businessinsider.com/body-measurements-of-average-american-man-2013-9#ixzz3TL7uxWKu

CDC in Action: Foodborne Outbreaks

https://youtu.be/iIaKWNZhz74 ***When two or more people get the same illness from the same contaminated food or drink**, the event is called a foodborne outbreak. Public health officials investigates outbreak to control them, so more people do not get sick in the outbreak, & to learn how to prevent similar outbreaks from happening in the future. ***CDC and partners ensure rapid & coordinated surveillance, detection, and response to multistate foodborne outbreaks***. ***Most foodborne outbreaks are identified and investigated by local and state health departments. CDC provides consultation on some of those, as well as assistance on request for outbreaks that are particularly large, unusual, or severe.***

The Injury Pyramid

representation of the fact that, while fatal injuries are most reliably reported, many more nonfatal injuries lead to hospitalization and emergency room visits, and even more may be untreated.

Key Birth Statistics

•Non-marital births & birth rates have declined 7% & 14%, respectively, since peaking in the late 2000s. •Births to unmarried women totaled 1,605,643 in 2013. About 4 in 10 U.S. births were to unmarried women in each year from 2007 through 2013. •Non-marital birth rates fell in all age groups under 35 since 2007; rates increased for women aged 35 & over. •Birth rates were down more for unmarried black & Hispanic women than for unmarried non-Hispanic white women. •Non-marital births are increasingly likely to occur within cohabiting unions—rising from 41% of recent births in 2002 to 58% in 2006-2010.

Weight Bias in Health CareBias among medical professionals

■ In a study of 400 doctors, one of every three listed obesity as a condition to which they respond negatively. They ranked it behind only drug addiction, alcoholism, and mental illness. They associated obesity with noncompliance, hostility, dishonesty, & poor hygiene. ■ Self-report studies show that doctors view obese patients as lazy, lacking in self-control, non-compliant, unintelligent, weak-willed, & dishonest. ■ Psychologists ascribe more pathology, more negative and severe symptoms, & worse prognosis to obese patients compared to thinner patients

Weight bias

■ has serious medical & psychological consequences; ■ reduces earning potential; ■ affects hiring and promotion opportunities; ■ affects academic opportunities & achievement. Right now, no federal laws protect overweight people from discrimination.

examples OF Weight bias in Healthcare

■being the target of derogatory comments and jokes by doctors, nurses, nutritionists, and other health professionals; ■ not being provided appropriate-sized medical equipment such as blood pressure cuffs and patient gowns. In one study of nurses ■ 31 percent said they would prefer not to care for obese patients; ■ 24 percent agreed that obese patients "repulsed them"; ■ 12 percent said they would prefer not touch obese patients.