PUBHLTH 200 EXAM 2

Why do people engage in unhealthy behaviors?

lack of knowledge, psychological environment, risk perception, peer pressure and role modeling, physical environment, community norms, benefits immediate + costs deferred, economic influences, addiction and habit, and policy environment.

Ecological Model

looks at how the social environment, including interpersonal, organizational, community, and public policy factors, supports and maintains unhealthy behaviors. The model proposes that changes in these factors will produce changes in individual behavior.

What is an example of a public health success?

reduced motor vehicle injuries targeted safety efforts: - roadway improvements (divided highways) - campaigns against drunk driving - vehicle safety improvements

Dietary Pattern

the combination of foods and beverages that constitutes an individual's complete dietary intake over time.

Nutrient-dense foods and beverages

those that provide vitamins, minerals, and other health-promoting components and have little added sugars, saturated fat, and sodium. Ex: fruit and vegetables, whole grains, seafoods, and lentils.

Opioids and Health Disparities

●Non-Hispanic (N-H) Black individuals were more likely than non-Hispanic white individuals to die from any-cause overdose, opioids, cocaine, and synthetic opioids. ● N-H American Indian/Alaska Native were even more likely than N-H white and N-H Black to die from a drug overdose. - There is a landscape of decreased substance use treatment initiation and engagement and poor access to addiction specialists, especially from underrepresented minority backgrounds. - Additional drivers of overdose: gaps in education, employment, and access to medical care.

Providing Mental Health Services

- Embedding counselors in units and departments across campuses - Expanding screening and treatment through Stepped Care and triage models - Harnessing tech and mobile options

New Directions in Tobacco Control Policy

- Establishing and expanding smoke-free areas to work environments, shared housing, outdoor public environments (beaches), cars with children. - Increase minimum purchase age from 18 to 21. - Graphic warning labels - Plain packaging (remove cigarette companies' ability to advertise directly on the product).

What is the Prohibition?

(18th amendment) a ban on alcohol manufacture, sale, and use passed by a constitutional amendment in 1919 only to be repealed 14 years later by the 21st amendment. Reduced the rate of cirrhosis in the liver.

Barriers to Accessing Mental Health Care

*especially in members of diverse ethnic/racial groups. - Lack of insurance/underinsurance - Mental illness stigma (esp. in minority groups) - Lack of diversity among mental health care providers - Lack of culturally competent providers - Language barriers - Distrust in the health care system - Inadequate support for mental health service in safety net settings (uninsured, Medicaid, Health Insurance Coverage other vulnerable patients). *barriers can occur at any level of socioecological model.

Smoking Statistics

- 15% of preventable deaths - 480,000 deaths annually - 10 years shorter lives expectancy - $3,000,000,000 total economic cost

Health Consequences of Smoking

- 500,000 Americans lose their lives each year due to smoking. - 15 million people are ill or disabled due to smoking - 6 Million/8 Million Globally - Vast majority from low/middle income countries - 90% of lung cancer deaths are attributable to smoking as well as Chronic Obstructive Pulmonary Disease (COPD) such as emphysema or chronic bronchitis and cardiovascular disease.

Selected Chemicals in Cigarette Smoke

- Arsenic (potent ant poison) - Carbon Monoxide (poison gas in auto exhaust) - Formaldehyde (preservative for dead bodies)

Mental Health and Academics

- Being depressed in college is associated with 2x more likely to depart without graduating. - Untreated mental disorders are associated with lower GPA, enrollment discontinuity, and drop-out.

Physical Activity and Weight Data

- Children and adults are not meeting the physical activity guidelines. - 24% of adults overall are meeting guidelines (less than 1 in 4) - Obesity has fairly steadily increased over time in recent decades. - Obesity is more prevalent amongst Black and Latino communities. This could be due to: - food insecurity disproportionately affects Blacks and Latinos. - targeted advertising towards B + L for fast food or sugar sweetened beverages. - Access to greenspace due to neighborhood safety. - BMI has racist origins as it was developed by white European men and doesn't account for body composition or bone density --> could misclassify rates of obesity in marginalized groups.

Possible Unintended Consequences of Recommendations

- Disordered eating/eating disorders - Overexercise - Healthcare Avoidance - Stereotype Threat (people feel at risk of conforming to stereotypes specifically of obese people such as being lazy and eating unhealthy).

Why are there not better smoking cessation therapies?

- E-cigarette companies, for example, could go through the formal FDA process but it is a lot harder and more costly than just getting FDA authorization for a tobacco product. - Sales will also be higher this way because won't have to rely on a prescription or be something covered by Medicaid/Medicare.

What are some stand-alone harms of vaping?

- E-cigarette use is not risk-free. - Vaping nicotine affects heart rate and lung function but level of seriousness is not on the same magnitude as cigarettes.

Has vaping been used to wean off of cigarettes?

- E-cigarettes have overtaken nicotine replacement therapy as a self-reported cessation method. Some research suggests that it is more effective. - Completely switching from smoking to vaping exclusively, that does improve health outcomes and it does facilitate quitting.

What is the relationship between injury and health equity?

- Everyone, regardless of race, gender, or SES, is at risk for injury. - However, everyone is not at the same risk of injury. - Race, gender, SES, etc. can affect how a person recovers from injury, whether an injured person has access to treatment, or whether they have the proper knowledge about injury recovery and care.

FDA Tobacco Regulatory Authority

- FDA was granted authority to regulate tobacco products by the Family Smoking Prevention and Tobacco Control Act of 2009. Barriers: - Opposition from Tobacco industry and Congressional leaders - Legal action against regulations (gives industries 5+ years to sell more cigarettes) - Emergence of black markets (if regulation is too stringent) - Philosophical objectives (is it fair to reduce nicotine by this much to make it non-addictive) - Bureaucratic hurdles of implementing regulations - Perception that smoking is no longer a public health challenge.

What is a public health failure?

- Firearm deaths - Around 30,000 people lose their lives annually due to gun deaths.

Challenges Facing Smokers

- Heavily addicted - Low socioeconomic status and low education - Up to 50% of smokers have mental illness or substance abuse co-morbidities - Percentage of remaining smokers do not want to quit

Behavioral and Cultural Change in Smoking

- Higher educated people smoked less. CYCLE: Policies --> Reduced Smoking--> Norm Changes--> More Policies--> Reduced Smoking--> Policies

Why are MH concerns rising among college students?

- Increase in social media usage. - Socio-political events such as during the 2016 campaign and election of Donald Trump where he advanced a travel ban prohibiting travel to the US from some predominantly Muslim countries. - Used a difference in difference study design (type of quasi experimental research). Compared Muslim student MH before and after election to non-Muslim students MH before and after election. - Higher MH rates for both groups, but rise was LARGER for Muslims.

Is it difficult to measure the long term effects of vaping and e-cigarettes as it's relatively new? Could this be considered another controversy to vaping as a treatment preventative prevention of combustible smoking?

- It is difficult. - People are studying exposure to e-cig emissions in mice and looking at biomarkers (blood pressure, lung function or other short term evaluations of health) to see if vaping is linked to cancer and later diseases. Tradeoff: we don't know how to help people quit vaping either. Are we okay with all the uncertainties around e-cig compared to the certainties of smoking?

Why are people in the South smoking more?

- Made up of rural populations who smoke more. - Have weaker public health policy - weaker infrastructure for providing social services (lower Medicaid coverage) - historical targeting by the industry - there are not enough no-smoking policies in many areas (only like hospitals)

Dietary Plate Implementation Strategy

- Make half your plate fruits and veggies (focus on whole fruit instead of fruit juices and vary your veggies). - Choose low-fat or fat-free dairy milk or yogurt (or lactose-free dairy or fortified soy versions). - Make half your grains whole grains - Vary your protein routine

Women between the ages of 35-64 are being diagnosed with lung cancer at higher rates than men at that age group. Why?

- Men have always had higher smoking rates than women. Any underlying biological differences were masked by these differences in smoking rates. - Men always had higher lung cancer rates because they smoked more. But now that women have caught up, the biological differences are more seen. - Lung cancer incidence and rates are dropping. Lung cancer screening is required, and it will become less useful as the years go by-should hospitals invest technology?

Why is vaping so controversial in the public health community?

- People thought vaping led to smoking. However, research has shown that those people would have likely smoked anyway. Also, smoking rates have been declining in youth and young adults and more so with the addition of e-cigs, which wouldn't match up. - controversy arises because as a society, we're very concerned about the welfare of youth and young people and how little of society cares about current smokers (usually older, single, unmarried MEN who are homeless, imprisoned, or have mental illness. - Young people who vape are disproportionately white. So opponents came from politically powerful WHITE families. Contributed to degree of media coverage.

Tobacco Use Disparities

- People with a college degree generally do not smoke. - people whose parents have a college degree don't smoke. - people with psychiatric illnesses make up an increasing share of the remaining smoker population. - low socioeconomic status/rural populations smoke more. - multiple substance disorders/alcohol smoke more. - people with LGBTQ tend to smoke more. - disabled individuals smoke more. *tobacco rates are decreasing and so are the percentage of mental illness individuals who smoke. but a majority of the smokers are still vulnerable.

FDA Nicotine Product Continuum of Risk Plan

- Reduce nicotine in cigarettes to non-addicting levels. - Encourage innovation in non-combusted nicotine-delivery products and extend timelines for new product review.

What is the leading cause of death for people ages 1-24 in the US?

- Since the year 2000, there has been a decrease in motor vehicle crashes and deaths. - Firearm deaths within that age group has now eclipsed motor vehicle accidents as a leading cause of injury related death.

Cigarettes compared to more Intense Drugs

- Smoking is extremely dangerous compared to illicit drugs--> but kills you in 30 years. - Drugs are worse for short-term health outcomes.

Surgeon General Report Impact

- Smoking prevalence has decreased from 42% to 16%. - Rate of smoking amongst kids has dropped much more rapidly. High school students smoking is extremely rare. - Adult per capita cigarette consumption: total cigarettes over 18+ population. Also decreased after report. Now levels are back to that of the 1930s.

Proposals to Meet Guidelines

- Tax benefits for healthier foods - Adding more grocery stores in food desert areas - Mobile food access - Restructuring of grocery stores - Keeping work, home, and school within a walking radius.

How does public health want to address the ease of vaping, such as students being able to do it in class?

- Technically, most e-cigarettes on the market right now have not received authorization from the FDA to market at all (ILLEGAL). - FDA has not taken action because they don't have the capacity to take enforcement actions all the time everywhere (must be selective) - E-cigs are easy for people to access and young people to carry around. Lots of PH campiagns are geared towards dissuading young people from vaping.

How have occupational injury deaths changed over time and why?

- The US population increased from 97 million to 326 million people, but the number of work-related deaths decreased significantly. Occurred due to: - changes in policy/law, enforcement of policy/law, and a shift in the nature of work. Ex: - Basic laws on child labor, workplace exposures (chemicals and equipment) - Regulation/Enforcement (federal OSHA and state equivalents, MIOSHA) - Legal Liability (Worker's Compensation) - Nature of Work (less physical--> more service or technology based)

Which students experience higher rates of concern? Which are least likely to receive treatment?

- Treatment rates have been increasing since 2013. Gender Minorities (compared to cisgender), Sexual Minorities (lesbian, gay, bisexual, and queer). International students (Asian), Students of color (Latinx, African Americans, and Asian). *Proportion of students receiving services has increased but the disparities still stay the same.

Importance of injuries?

- Unintentional injuries are THE leading cause of death in Americans ages 1-44. - Intentional injuries are not far behind. - We care about injury a lot because it has a disproportionate impact on younger age groups leading to a large number of years of potential life lost (YPLL), years lived with disability (YLD) and disability-adjusted life years (DALY). - YPLL = difference between a person's expected age of death and the actual age of death. - YLD = years of life lived with disability. - DALY = YPLL + YLD

Limitations of BMI

- Was developed based on data primarily from non-Hispanic white populations - Was intended to be used at the population level, not the individual level - Does not take into account muscle mass, bone density, or overall body composition. Example: Athletes who have a high muscle mass may be classified as obese when they in fact have a very low body fat percentage.

Relationship between Weight and Health

- Weight cycling (i.e., repeated bouts of weight loss and regain) is linked with adverse metabolic outcomes - Weight stigma is linked with adverse metabolic outcomes andgreater mortality rates after accounting for BMI

Mental Health Stats

- are common, consequential, and largely untreated worldwide - 1/2 will experience a mental health disorder in their lifetime. - leading cause of disability, morbidity, and mortality for young adults. - cause and consequence of physical health problems. - most disorders emerge by age 25.

Impact of COVID-19

- created unprecedented stressors, isolation, and disruption. - increased academic impairment and distress. - inequitably increased MH risk factors and barriers to care, particularly taxing low-income students and students of color.

What novel approaches will we need to try to tackle with this kind of intractable issue among these communities?

- current treatment therapies for smoking cessation are terrible (everyone already has access to these- they just suck). - giving everyone access to smoking cessation treatments improves things but not by much. - Smoking cessation rates are really low. Still low for mental illness/disadvantaged groups. - Newer therapies needed (nicotine inhaler for example)

Mental Health Needs Public Health

- demand for services > availability - clinical services/counseling alone are insufficient - inequities are large and persistent - shortage of clinicians in the country. - need population-level approaches that address root causes and focus on prevention are needed.

Basic Needs: Food and Housing Insecurity

- experienced by about 60% (not having nutritious food or homelessness) - undermines educational experiences, associated with poor physical health, depression symptoms, higher stress. Colleges: opening food pantries, providing transportation passes, offering emergency housing.

Promote Social Networks

- important protective factor - students turn to each other in distress - peer outreach reduces stigma, enhances knowledge, improves MH campus climates and help-seeking Colleges: Wolverine support, cultural centers, experience-based support resources (programming for first-gen students).

How have poisoning deaths changed over time and why?

- opioids, alcohol, carbon monoxide. - Number of poisoning-related deaths have increased substantially (68% increase from 2014 to 2020). - Numbers of opioid-related deaths have likely increased through the COVID-19 pandemic ○ Concurrent with the continued increase of synthetic opioids - Males more likely to die from opioid use than women, though there have been steeper increases in female opioid overdose deaths. Rise of opioid use and death can be tied to two related trends 1. Increased overdose deaths from prescription opioid pain relievers. 2. Recent surge in illicit opioid deaths. *Past misuse of prescription opioids is the strongest risk factor for heroin initiation. - Misinformation about opioids was common and doctors were incentivized to prescribe them. Ex: Sackler Family of Purdue Pharma infamy convinced regulators that because OxyContin was a longer-lasting opioid, it had lower potential for abuse/was less addictive than most commonly prescribed painkillers at the time.

What has changed about smoking over the years?

- people who smoke are smoking fewer cigarettes each day.

MH Data Sources

- population data - annual web-based surveys - hundreds of schools and hundreds of thousands of students - random or full sample of students at each participating institution. Colleges present as OPPORTUNITIES to exacerbate or to mitigate existing problems and to prevent problems where they haven't yet developed.

Advertising Campaigns of Cigarettes

- put "filters" on cigarettes after fears of its association with lung cancer spread. However, the Kent micronite filters was made of asbestos. - targeted women and said smoking would make them skinny, less likely to eat fat sweet foods, etc. - low tar nicotine cigarettes (1970s)- made people believe it had less negative effects. People puffed more so still had same lung effects.

Dietary Guidelines for Americans 2020-2025

1. Follow a healthy dietary pattern at every life stage. 2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. 3. Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. 4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

Epidemiologic Triangle

1. Host: usually a person 2. Environment: physical or social environment ( social norms or policies and laws that might influence injury risk) 3. Agent: thing that can cause the injury. changes when using for injuries. Ex: car for motor vehicle accidents, gun for firearm violence, or opioids for poisoning.

Policy Interventions for Smoking

1. Information and Education: publishing Surgeon General's report, warning labels, school health education, media anti-smoking, 2. Incentives: tax increases (raise price of cigarettes- impact is greater amongst kids), lower insurance premiums for nonsmokers. 3. Laws and Regulations: banning advertising, smoke free workplace laws, restricting sales to minors. Effective: Tax, smoke-free laws, counter-advertising and media campaigns, advertising ban, and clinical treatment (if done properly). Ineffective: School health education (teachers are not interested, not the proper resources provided), obscure warning labels on cigarette packaging (vivid labels with pictures do have an impact), sales against minors possession and use (most people are not aware of laws and are also not enforced that strongly), and nicotine replacement therapies bought OTC (not used properly).

What three categories do strategies for health behavior change fall into?

1. Laws and policies 2. Incentives 3. Education

Mental Health Disparities Fun Facts

1. Rates of depression are lower in Blacks and Hispanics but are more persistent. 2. People who identify as two or more races are more likely to report mental illness than any other race/ethnicity group. 3. American Indians/Alaskan Natives report higher rates of PTSD and alcohol dependence. 4. Lack of cultural understanding might contribute to underdiagnosis or misdiagnosis in racially/ethnically diverse populations. 5. There are differences in types of services (outpatient, prescription, inpatient) used by people of different ethnic/racial groups. 6. Racial/ethnic minority youth with behavioral health issues are often referred to the juvenile justice system than to specialty primary care compared to white youth.

Limitations on Successful Tobacco Control Policies

1. Taxes and Prices: limit on increases in taxes and regulations on minimum price of cigarettes. 2. Smoke Free Requirements: only half of states in the US can become smoke-free. 3. Media Campaigns: campaigns are effective but very costly. 4. Cessation Assistance: needs better tools

Alcohol Use

55%- Acute Causes - Motor Vehicle crashes - Poisoning - Suicides - Fall injuries 45%- Chronic Causes - Alcoholic Liver Disease - Liver Cirrhosis - Stroke - Hypertension - Acute pancreatitis *health impact of alcohol use is U-shaped *alcohol use is highest among young adults aged 18-25.

What is Mental Health?

A state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. An integral component of health and well-being that underpins our individual and collective ability to make decisions, build relationships and shape the world we live in.

Inequities across Instituitions

At community colleges compared to 4-year colleges: - Higher prevalence of MH among 18-22 - Fewer counseling and psychiatry services on campus. - Fewer providers - Less likely to offer crisis services and suicide prevention

Trying to Quit Smoking

Being off of cigarettes for 24 hours with the intention of quitting smoking

Individual/Intrapersonal Level

Biological factors, beliefs, knowledge, personal finances, skills, attitudes, preferences, and self-efficacy.

What are "Mental Health Disparities"

CDC Definition Three Categories: 1. disparities between the attention given mental health and that given other public health issues of comparable magnitude. 2. disparities between the health of persons with mental illness as compared with that of those without. 3. disparities between populations with respect to mental health and the accessibility, quality, and outcomes of mental health care.

U.S. Preventative Services Task Force Recommendations for Weight

Children and Adolescents (6+ years): - Clinicians should screen children and adolescents for obesity and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. Adults (18+ years): - All adults should be screened for obesity - Clinicians should offer or refer patients with obesity to intensive, multicomponent behavioral interventions

Physical Activity Guidelines for Americans

Children and Adolescents (6-17 years): - At least 60 minutes/day of moderate-to-vigorous physical activity. Adults (18+ years): Aerobic Physical Activity: At least 150-300 minutes/week at moderate intensity or 75-150 minutes/week at vigorous intensity. Muscle-Strengthening Activities: At least 2 days/week working all major muscle groups.

Tobacco Use and Mental Health

Common misconception: Smoking helps alleviate mental illness. - Research shows that smoking cessation improves mental health. - Nicotine withdrawal symptoms overlap with anxiety/depression symptoms and so people confuse them when they are facing withdrawal and feed the craving. - Depression worsens smoking outcomes (makes it harder to quit) and smoking increases depression.

Community Level

Community initiatives, neighborhood characteristics, relationships between organizations, community norms

What is the most common kind of injury-related death in the US currently?

Poisoning such as opioid deaths, eclipsing motor vehicle crashes as the leading cause for UNINTENTIONAL injuries.

Intervention Approaches

Effective: - skill training with supervised practice (teach students social, emotional, and coping skills) and a key part is the supervision. Mindfulness programs and Cognitive behavioral and relaxation interventions. - Screening (health center check-ins) but services must be readily available. - Means restriction (install barriers on bridges, prevent access to medications that result in suicide). Ineffective: - psychoeducation (telling students info and hoping they do something about it). can be a part of the intervention but does not work solely on its own. - gatekeeper training (a type of program where people reach out to people who are not MH professionals and work to increase their knowledge of disorders and enhance their ability to identify folks who need services). Training faculty members or peer advisors.

Key Recommendations for Infants

First 6 months of life: Exclusively feed infants human milk (or iron-fortified formula when human milk is unavailable). Provide supplemental vitamin D beginning soon after birth. Starting at about 6 months: Introduce nutrient-dense complementary foods. Introduce potentially allergenic foods. Introduce a variety of foods from all food groups. Include foods rich in iron and zinc.

Key Recommendations for 12 Months through Older Adulthood

Healthy Dietary Pattern: - Vegetables of all types - Fruits, especially whole fruit - Grains, at least half of which are whole grain - Dairy, particularly fat-free or low-fat options (or lactose-free/fortified soy versions) - Protein foods including lean meats, poultry, eggs, seafood, legumes, nuts, seeds, soy products - Oils, including vegetable oils and oils in food, such as seafood and nuts Unhealthy Diet: - Added sugars (avoid before 2 years; limit to < 10% of calories for age 2+) - Saturated fat (limit to < 10% of calories for age 2+) - Sodium (< 2,300 mg per day, and even less for children < 14 years) - Alcohol (adults 21+ limit to ≤ 2 drinks/day for men and ≤ 1 drink/day for women)

Diet Data

Healthy Eating Index: a measure that assesses how well a diet meets the recommendations of the Dietary Guidelines for Americans. - U.S. is around the 55-60 range where the best is 100. - Age ranges of 2-4 and 5-8 are good, starts decreasing in teen years, and then increases again at adulthood until it reaches its peak of 63 at the 60+ range. Based on food group for ages 19-30: - Males and females are typically below the recommended amount. - Males are above for protein. And males and females are above for refined grain. - Males and females are also both above the recommended amount of unhealthy food groups.

Socioecological Model for Injury Prevention

INDIVIDUAL: Individual firearm safety practices RELATIONSHIP: Friends, family, clinicians, and others supporting at-risk individuals. INSTITUTION AND COMMUNITY: Organizations, groups and places promoting safety from suicide. SOCIETAL: Policies, laws, and cultural norms supporting suicide prevention.

Weight-Related Behaviors Applied to Ecological Model Framework

Intrapersonal/Individual: - attitude towards eating well and exercising - motivation - self-efficacy - intention Interpersonal: - Parental support - Parents' knowledge of nutrition - Role modeling of parents - Support from friends. Institutional/Organizational: - Eating habits at office - School cafeteria lunch options - Employee discounts for gym memberships Community: - Safe neighborhoods for exercising - Farmers markets - Limited fast food restaurants in community. Societal/Public Policy: - Soda taxes - Systemic poverty - Nutritional information at restaurants - Societal stigma *intervening at the higher levels such as societal affects the health of more people.

Analyze Brenda and Anais and their mental health problems using the Socioecological model.

Intrapersonal: - Social determinants of experience with racism/discrimination or the neighborhood/physical environment could influence them. - Struggles of self image, shame, and isolation, feeling responsible for others, and mixed immigration status of family (first gen immigrant). - Disparities are differences in accessibility to MH care and attention given to MH needs. Interpersonal: Social determinants: economic instability (unsure of parents employment due to immigration status), cultural assimilation and language barriers Experience: isolated family (unclear of what social support resources there are), social media use (peers), incarceration of a parent (missing role experience of shared family drama), and disconnection from extended family in Mexico. Health Inequities: between populations with respect of MH accessibility and outcomes and between attention given to MH. Institutional: Social Determinants: healthcare system and limited access to resources, unclear if schools have MH resources, unclear support systems for Latinx community members. Experience: must have official diagnosis to receive care, access to resources is >1 hour away, and POSITIVE SEEDS Program developed to meet teen specific needs. Health Inequities: between attention given to MH needs, between populations with access and quality of MH care. Community: Social Determinants: discrimination and stigmatization of Latinx communities, limited culturally competent care and access to it. Experience: Newer/growing Latinx community could be positive or just more discrimination, cultural values and stigma around MH. Health Inequities: attention given (stigmatized) and between populations and mental health outcomes. Societal: Social Determinants: stigma and discrimination, social integration, racism/discrimination is embedded within economic sys

Does what a person smoke influence their health outcomes? (Cigars, cigarettes, and vaping)

It depends. - Any use of combustible tobacco (you have to light it up) does not really improve health outcomes. - Dual use of cigars and cigarettes mortality risk will always be there as long as they continue to smoke. - Can reduce amount smoking but benefit of that is quite small relative to just not stopping. - Mortality risk is still there for little cigars.

Societal/Public Policy Level

Media, zoning, social norms, laws, enforcement of laws

Types of Exercise

Moderate: equivalent in effort to brisk walking. Vigorous: equivalent in effort to running or jogging.

What substance flooded the streets of Boston in 1919, leading to stricter implementation of building codes to prevent similar injuries and deaths in the future?

Molasses. - A century ago the Boston waterfront was a hub of shipping and commercial industry, including the processing of sugar and the production of molasses. - A 2.3-million-gallon molasses tank had been leaking for years. - Giant molasses tank exploded --> unleashed a 15-foot wave of molasses into the Boston North End streets.

E-cigarettes

Potential: - Lower risk than cigarettes (50-95%) - Appear to help smokers quit or significantly reduce cigarette consumption SUPPORTED BY: Subset of academia and activists *researchers and members of the vaping community Concerns: - Promote dual use - Cause children to get addicted and graduate to cigarettes - Former smokers relapsing - Vaping secondhand smoke OPPOSED BY: CDC, state and local health departments, and major NGOs Solutions: e-cigarette manufacturers cannot make health claims about them, certain toxins could be prohibited, and could be put in child-proof packaging. Policy Recommendation by Dr. Warner: - Significantly raise excise taxes on cigarettes and other combusted tobacco products while also modestly raising tax on e-cigarettes. - No marketing should be permitted to adolescents or young adults and message to adults should be restricted to using e-cigarettes to quit smoking only. *The American public's understanding of the risks of vaping has gotten worse (they think it is just as dangerous as cigarettes).

Transtheoretical Model

Precontemplation: have no intention to change their behavior so first step is spreading awareness about why their unhealthy behavior such as smoking is bad. Contemplation: person is aware of benefits of change but is also aware of difficulties or barriers to change and is not ready to take action. Preparation: person has decided to make change and has planned concrete action steps such as signing up for a class Action: requires that individuals modify behavior such as abstaining from smoking Maintenance: person has achieved healthier stage but must strive to avoid relapse.

Rising Prevalence of MH issues

Prevalence of MH problems is INCREASING among students. - Rise in past year suicidal ideation from 6% in 2007 to 14% in 2022 (more than doubling).

Levels of Prevention

Primary Prevention: preventing illness or injury before it ever occurs. - Reduce risk factors and promote protective factors - In the case of injury, primary prevention occurs pre-injury. Secondary Prevention: detecting illness at its earliest stage to prevent progression to serious disease. - When injury occurs, preventing the worsening of the injury - In the case of injury, secondary prevention occurs during a potential injury event. EX: Mammograms (breast cancer screening) Tertiary prevention - when an illness or injury is already present, avoiding death or further disability - When injury has occurred, tertiary prevention occurs in the aftermath of the injury (ex. rehabilitation care)

What were the lasting effects of the Molasses flood?

Reactions to exploding tank: ○ A class-action lawsuit (one of Massachusetts' first!) against the company that owned the tank. ○ Policies that engineers and architects needed to approve plans and conduct inspections on buildings and commercial structures ○ Engineers needed to be certified TURNING POINT for safety regulations and construction

Economic Case for Investing Student Mental Health

Reduced depression --> increased student satisfaction---> increased reputation and alumni donations -->increased retention--> increased tuition --> increased lifetime productivity (earnings)

Interpersonal Level

Role modeling, peer pressure, social support, family, partner, friends

Institutional/Organizational Level

School, workplace, social groups, religious groups

Public Health Approach by Colleges

Schools are focusing on MH promotion, prevention, and intervention, and post-vention. - Addressing basic needs such as food or housing. - Developing life skills - Promoting social networks - Identifying students at-risk - Encouraging help-seeking - Enhancing MH services - Restricting access to potentially lethal means (medicine takebacks and barriers on bridges). - Crisis Management

Stress

Stress is due to the adverse physical and social conditions associated with lower SES. May act either directly by affecting psychological processes or indirectly by influencing individual behavior.

Is there a possibility for a scenario where governments can enforce reparations on companies that targeted tobacco use in certain populations? Is there a lack of funding for cessation therapies?

Technically, the FDA is funded by tobacco companies. - To sell cigarettes/cigars in the US, you have to pay user fees to the FDA. - User fees go to regulation, public education, other FDA priorities. - State governments can sue tobacco companies and force them to do things (have been put on trial and forced to pay states large sums of money for the harm they did to society). Are those funds used to support cessation quit lines is a separate question.

Diet Graphic

The majority of deaths at the global level attributable were due to a diet high in sodium and were mainly deaths due to cardiovascular disease.

Why do people with lower SES have higher mortality rates?

The poor are more threatened by adverse environmental conditions such as lead in paint/tap water, air pollution, and violence as well as have poorer nutrition, less access to medical care, and more psychological stress.

Ecological Model

This model provides a rationale for why public health advocates often pursue policy changes and higher levels of government involvement, rather than simple educational messages to change health behaviors. - No one factor can fully explain behavior- factors at MULTIPLE levels influence health behaviors. - Factors at different levels interact such as policies at the societal level can affect individual level factors.

Future of tobacco control policies?

Tobacco Endgame: - Addressing smoking in disadvantaged populations down the levels of the most advantaged groups. - FDA is planning to ban menthol and cigarettes. - Menthol smoking is highest among African-American men, LGBTQ, and young people. *trying to remove menthol flavor from cigarettes. - Trying to ban flavored cigarettes. Cigars and little cigars are disproportionately smoked by young African-American boys. Nicotine-Reduction Strategy: - Reduce the level of nicotine to cigarettes to non-addictive levels.

What is the SES?

a concept that includes income, education, and occupational status.

Injury

a harm, damage, or impairment to the body. - injuries can be intentional (suicide or homicide), unintentional (injury from sports or recreational activity). - not accidents bc ARE preventable. PH Issue: - because it is preventable and we can do something about them to ensure they don't happen as frequently. Also the fact that there are health equity issues. - can apply tools of PH to understand distribution and burden of injury and work to prevent disability and death from injury. - Can be done through policy development or assurance such as enforcing laws and regulations. - Injuries are influenced by a person's behavior and physical and social environment.

What is the Haddon Matrix?

a tool to conceptualize injury prevention at multiple levels at multiple intervention points.

Mental Health Conditions

characterized by symptoms that are present frequent/daily, last for substantial periods of time, cause dysfunction/disability, and are not caused by another medical condition or substance use disorder. *LEADING CAUSES OF DISABILITY *COSTLIEST HEALTH CONDITIONS FOR ADULTS AGES 18-64.

Health Behavior Model

designed to understand health behaviors and especially behavior change. Several factors that determine whether a person is likely to change behavior when faced with a health threat. Factors: the extent to which an individual feels vulnerable to the threat, the perceived severity of the threat, perceived barriers to taking action to reduce the risk, and the perceived effectiveness of taking an action to reduce or minimize the problem. Approach to changing behavior would be to convince people they are vulnerable, the threat is severe, and that certain actions are effective preventative measures.