Community and public health final exam
Al Gore
"Magical" way to stabilize population growth (demographic transition) 1. education of girls 2. Empowerment of women to participate in their own choices (family, community, and nation) 3. Availability of fertility management of fertility ("world has reneged on its commitment") 4. Continue declines in child mortality
Population growth and climate change
"The administration is unraveling the biggest and most successful climate policy on the books, one that has also saved consumers millions of dollars in gasoline costs, cut air pollution, and helped grow the auto industry," Ken Kimmell, president of the Union of Concerned Scientists, said in a statement.
Which of the following is true about landfills?
'Sanitary' landfills use holes in the ground lined with plastic, layer with soil daily and control gases and toxins with vents and drains
The language of SUD diagnosis
*** Substance USE disorders now used based on diagnostic criteria - mild, moderate, or severe substance ABUSE is NOT used it is now substance USE SUD is a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs
Which sources drive air pollution?
1. Industry 2. Transportation 3. Consumer and commercial products 4. Agriculture 5. Other 6. Commercial and residential heating Individual choices are good but they decrease pollutants less efficiently
Sewers facts continued
16,400 treatment facilities in US discharge 32 billion gallons of wastewater per day 70% of chemicals of emerging concern in sludge overlap with those detected in humans "It turns out that we can use our wastewater treatment plants to take the chemical pulse of the nation, determine chemical inventories, and zero in on risky chemicals prone to harm people, prosperity and the planet."
Opioid deaths in the US 1999 - 2014
3 waves 1. OxyCotin 2. Heroin 3 Fentanyl (50-100 times stronger than heroin) drug overdoses kill more than cars, guns, and falling
Nalaxone
A drug that has the ability to reverse an overdose while its happening only lasts 30-60 minutes so you can re-overdose can be used by bystanders (non medical personnel)
Air pollution
A mixture of natural and human made substances in the air we breath indoor AND outdoor
Fluoropolymers
A polymer with multiple carbon-fluorine bonds. The best known is Teflonperfluorooctanoic acid (PFOA) also called C8 Similar products are Gore-Tex Stainmaster, and Scotchgard These compounds are often referred to as "perfluoroalkyl and polyfluoroalkyl substances" and denoted by the acronym PFAS.
When epidemiologists are called on to investigate an outbreak of an infectious disease, what is the first thing they must do?
Agree on a case definition
Which of the following statements about injuries is true?
Alcohol is a significant factor in over half of motor vehicle deaths
Which of the following statements about bioterrorism-related issues is true?
All of the above Emergency rooms conduct surveillance of routine and unusual illnesses to track for possible attacks Lack of health insurance has been identified by public health experts as a risk-factor in spreading pathogens and delaying recognition of an outbreak during a possible bioterrorist attack Inter-agency preparation and planning at all levels of the private and public sectors are critical components of public health
Which is an example of public health measures to control infectious diseases?
All of the above Surveillance of new cases Antibiotic treatment Quarantine
The major epidemic diseases are caused by
All of the above Viruses Parasites Bacteria
Which similarities exist between public health's 50 year+ battle to reduce cigarette consumption (tobacco) among youth, and the new battle to reduce youth use of e-cigs (vaping).
All of the options Changing public perception of harm Control and regulation of marketing to youth Easy access
A program that is effective in getting people to change their health-related behavior must use evidence-based theory that targets:
All of the options Infrastructure in the environment that supports the behavior change A person's sense of self-efficacy that they have the ability to change behavior Perceptions of risk and perceptions of barriers to change
Particulate Matter (PM)
An amalgamation of solid and liquid particles suspended in the air Most are microscopic and inhalable (mold spores, dust, smoke, pollen, soot, dirt) Sources: construction sites, mining activities, paving, unpaved road dust, natural dust, vehicle emissions, wildfires, slash-and-burn agricultural , other fuel-burning activities Health impacts: irritate nose, throat, allergies, respiratory disease, reduced immune response, congenital disabilities, diabetes, reduced brain white matter, stroke high blood pressure and heat attack, increased risk of lung cancer, reduced lung development, bronchitis, premature death various sizes
What determines "treatment" - hitting particular targets in effluent testing
Biochemical Oxygen Demand (BOD) Total Suspended Solids (TSS) - that which is a retained by a filter Oil and Grease Settleable Matter (material settling out of suspension - floating) pH > 6.0 < 9.0 Fecal Coliform Total Chlorine Residual (helps measure the effectiveness of disinfection)
US cause of infant mortality
Birth defects - screening and prevention of parental exposure Low birth weight - poverty, lack or limited pre-natal care, high tech interventions, C-sections multiples Sudden infant death syndrome - accidental suffocation, smoking, sleeping on stomach, cultural influences, unknown
Normal birth weight
Birth weights greater than or equal to 2500 grams (5.5 lbs)
Very low birth weight
Birth weights less than 1500 grams (3.3 lbs)
Low birth weight
Birth weights less than 5.5 lbs
COVID-19, health disparities and air pollution
Black Americans represent only about 13% of the population in the states reporting racial/ethnic information, they account for about 34% of total Covid-19 deaths in those states." "These health disparities are preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health that are experienced by socially disadvantaged populations"
Unintentional injuries
Bodily harm that can be caused by fires, car crashes, drowning, sharp objects, guns, poisoning, being struck by something, hot liquids like boiling water, tripping on the sidewalk, falling down the stairs, bike crashes, etc
What is the primary source of outdoor air pollution in urban areas?
Cars
The Long Island Breast Cancer Study tested the hypothesis that environmental pollution was causing the relatively high rates of breast cancer among residents of Suffolk and Nassau counties of New York. Epidemiologists identified a group of 1,420 women who were diagnosed with breast cancer between 1984 and 1986 and compared their residential histories over a 20 year period prior to their diagnosis with those of a matched group of healthy women. What kind of epidemiologic study was this?
Case-control
Which of the following is not true of chronic diseases?
Chronic diseases are easier targets than infectious diseases for public health interventions because the causes (of chronic disease) are straightforward
The landmark 'Tuskegee Study' changed the way studies were conducted by requiring the following strict, federal ethical guidelines except:
Clinical trials must be halted if the patients in the control group requests to be placed in the treatment group
A sample of 6,098 children are followed through elementary school by researchers who survey their dietary habits annually. Which type of study design is being employed?
Cohort
A study that observes a group of people overtime to look for disease development
Cohort study
John Snow, the 'father of modern epidemiology', determined the source of contaminated water in London in 1853 and 1854 by:
Comparing death rates of residents who lived in homes supplied by one water company with that of residents who lived in homes supplied by another water company
Sewage sludge
Concentrations as high as 990,000 ppt of PFOS and 240,000 ppt for PFOA have been found in processed sewage sludge. 60% of the initially applied PFAS in sludge persisted in the soil over a period of three years, showing the possibility of the accumulation of PFAS with cumulative applications of sludge. Where does sludge go once it leaves the WWTP? depends 1. back to landfills 2. "land applied" on farms 3. "composted" and distributed to landscapers, households and farms
Which study design outcome does notstrengthen the cause and effect relationship?
Confounding variable
National Combined Sewer Overflow (CSO) Policy of 1994
Coordinates CSO management, with long-term plans required to meet CWA
Why should we care about opiods
Dead addicts don't recover Medical model of disorder (brain disease) Opportunities for recovery Individuals have value Equity between health problems (heart disease vs SUD) Overdoes can be reversed and prevented Lowers cost to society to treat and prevent SUD related consequences Harm reduction reduces negative health outcomes they are not just junkies, those are out fathers and sons in there
Causes of overpopulation
Decline in birth rate, particularly infant mortality, advanced medicine, fertility treatment technology, exploitation of natural resources of poorer countries, "lack" of family planning (funding politics, oppositions from cultural and religious norms), inequitable distribution of resources
What global resources become depleted due to overpopulation?
Depletion of global resources - deforestation for fuel and housing, soil depletion destroys farming, lack of fresh, clean water, disputes over water rights causes war and violence, food from sea 70% depleted, technology to improve agribusiness damages environment Urban migration - most of world lives crammed into cities, 'shantytowns', sanitation, electricity, poverty, infectious disease, pollution Climate change - severe weather events, flooding, property damage, mass death and displacement
Safe injection facilities
Do not increase drug use Crime and public nuisance decrease Take better care of themselves Gain access to medical and social services Have not been a single overdose in this program
The relationship between the 'amount' of exposure to a disease or injury and the 'amount' of risk for the disease or injury
Does-response
The model that describes five levels of influence on health behavior (intrapersonal, interpersonal, institutional, community, and public policy) is called which of the following:
Ecological model
Four Es
Education Enforcement Engineering Economic incentives/penalties
Socioeconomic status (SES) is determined by a formula that includes these 4 components (that were specifically listed in class as the formula):
Education, income, occupation and wealth
Motor vehicle injuries
Engineering To make cars safer (headrests, dashboards, steering columns, air bags, turn signals, break lights, annual inspections brakes & tires) To make highways safer (divided hwy, raised lane dividers embedded in road, rumble strips at edges and 'wrong-way' signs at off ramps helps minimize driver mistakes)
Clean Water Act (CWA) 1972
Establishes the National Pollution Discharge Elimination System (NPDES), a permitting program based on technological minimum standards
Who is exposed?
Everybody Sources - air, water, soil, food, indoor dust Routes - ingestion (main), inhalation Long-term continuous exposure is a main concern PFAS accumulate in the liver, kidneys, and blood where they bind to albumin It takes 5.4 years for a person's body to get rid of PFOS and 8 years to be rid of PFOA. Childbirth can speed the process but transfers them to the foetus and nursing baby. (ATSDR)
According to the 2 specific public health strategies in your textbook readings this week, the two primary approaches the government has traditionally taken to promote healthy behavior are enforcement and evaluation
False
All chronic diseases have single causes and can be proven with well designed studies.
False
All of the identified 'Superfund' sites (areas of mass contamination) have been cleaned
False
All people, regardless of skin color, are at equal risk of contracting and/or dying from COVID-19
False
An example of a public health intervention at the institutional level using the ecological model would be one-on-one, refusal skills training for underage youth who have been caught using drugs and alcohol
False
Because of occupational exposure, workers historically were better protected than the general population from exposure to larger amounts of toxic substances.
False
Fortunately, most of the rescue workers on 9/11 wore respirators to protect themselves from the 5,000 tons of asbestos released into the air.
False
If you want to compare death rates in two cities with populations that are different from one another with respect to age, you should compare crude death rates.
False
Injury rates are lower in groups with lower socioeconomic status
False
People with less education and lower incomes are more likely to be physically active than those of higher socioeconomic status.
False
Public Health Surveillance of infectious disease cannot be applied to bioterrorism
False
Race, ethnicity and gender are not predictors of health outcomes
False
Randomized double-blind control trials are the least rigorous (least ideal) of all designs for epidemiological studies.
False
Smallpox, polio, measles and malaria have all been eradicated from the earth
False
States with laws restricting tanning beds based on age most likely have higher rates of skin cancer than those states without such restrictive laws
False
Teaching an individual to choose healthy foods and to exercise improves health outcomes more than changing food policy or the built environment
False
The 3 E's of injury prevention are emergency, electronics, and evaluation
False
The Food and Drug Administration (FDA) has regulated tobacco for over 50 years
False
The Tuskegee syphilis study was ethical because the men were probably not harmed by withholding antibiotic treatment.
False
The United States has the lowest infant and maternal mortality rate in the world due to years of public health investment and progress
False
The beginning of the HIV epidemic was an example of political and religious interests partnering with public health interests to pass new laws without much debate
False
The cause and effect of smoking and lung cancer continues to be unclear in epidemiological studies.
False
The death rate from poisoning has dramatically increased primarily due to access to toxic household cleaning products
False
The flu vaccine contains the same strain of influenza each year.
False
The general public and public health experts usually agree on the perception of risk for activities and technologies that may cause harm or injury
False
The major chronic diseases usually have multiple causes, usually develop over a long period of time, and affect only old people.
False
The primary goal/mission of Public Health is to treat disease and promote health
False
The research shows an unclear relationship between population growth and climate change
False
What is true about motor vehicle accidents?
Federal regulation of traffic safety has resulted in decreased fatality trends for the previous 4 decades (excluding the previous few years)
Causes of substance use disorder
Genetics - includes impact of environment on genes expression, accounts for about 40% to 60% of a person's risk of SUD Environment - community/family attitudes and social norms, local, state and federal laws and policy that regulate access and use, influence of beverage and tobacco industry Mental health - teens and those with mental health disorders at increased risk than other populations. ACES increases risk
PFAS (polyfluoroalkyl substances)
Human made 4,000 and counting Widely used since the 1950s Adverse health effects in the single digit parts per trillion (PPT)
A program that is effective in getting people to change their health-related behavior must convey all of the following messages except:
I am not strong enough to make these changes
Which of the following is not a public health function in responding to a disaster?
Identifying who is responsible for a terrorist attack
Which of the following is not part of the chain of infection?
Immunization
Scientists believe that all of the following are responsible for the emergence of new infections except:
Immunization campaigns and Directly observed therapy (DOT)
Breastfeeding
Improves health outcomes Total medical care costs for nation are lower for fully breastfed infants than never breastfed infants Breastfeeding contributes to a more productive workforce - breastfeeding mothers miss less work Breastfeeding is better for our environment - less trash and waste Not all newborns are breastfed due to cultural norms, formula marketing, stigma and public shaming, and hostile work environment
What is one reason that some strains of bacteria have become drug resistant?
Inappropriate use of antibiotics
An epidemiologist investigating an outbreak of COVID-19 in Boston, MA reports that there have been 175 new cases this week. Which of the following terms best describes the number she reports?
Incidence of COVID-19
An epidemiologist investigating an outbreak of Giardia in Boston reports that there have been 21 new cases this week. Which of the following terms best describes the number she reports?
Incidence of Giardia
In communities where many children are not vaccinated, the lack of herd immunity:
Increases risk of exposure to preventable infectious diseases
Which of the following statements is true:
Individual and environmental changes are needed to reduce the obesity epidemic
Poverty predicts infant mortality rate
Infant mortality has been called a social problem rather than a medical problem - strongest risk factor is poverty Poverty increases many other risks including poor environment, poor nutrition, unhealthy maternal behavior, lack of access to medical care, and lack of social support
Which of the following statements about infectious diseases is true?
Infectious diseases had been dramatically controlled by the 1960's
The availability of fresh fruits and vegetables in the NU cafeteria is an example of a strategy to change individual behavior at what level of the Ecological Model of Health Behavior?
Institutional
Of the following strategies to control air pollution, which one is not true?
Laws that ban new factory construction
The earth has a limited supply of fresh water (suitable for cooking, bathing farming and other human needs), as a result, which measures have been put in place in some places?
Low-volume toilets/showerheads and limits on car washing and lawn watering
Death disparities
Lower SES groups have higher injury rates 'Diseases of Dispair' Opioid overdose, mass shootings, suicide Poisonings Whites & Hispanics leading cause Blacks leading cause firearms Firearms - Males are more likely to die than females, black males more likely to die than white males
Studies have shown that air pollution in the form of small particulate matter is:
MORE of a health risk than large particulate matter
Air pollution health risks
Major environmental risk to health - by reducing air pollution levels, can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma the lower the levels of air pollution the better the cardiovascular and respiratory health of the population 2016 91% of the world were living in places where WHO air quality guidelines were not met Ambient (outdoor air pollution) in cities and rural areas cause 4.2 million premature deaths worldwide 91% of those premature deaths occurred in low and middle income countries (mainly south-east asia and western pacific regions) Policies and investments supporting cleaner transport, energy-efficient homes, power generation, industry and better municipal waste management would reduce key sources of outdoor air pollution indoor smoke is a serious health risk for people who heat their homes with biomass, kerosene fuels and coal
Injuries are not accidents, many are preventable
Major public health problem Can apply epidemiological methods similarly to acute/chronic disease Injuries follow predictable patterns and are often preventable Cost-effective interventions are usually those that modify the product or the environment(rather than trying to change behavior) Dramatic reduction in death from research and policy change Like everything else, SES matters!
Maternal and child health
Maternal and Child health is the highest priority of public health Infant Mortality Rate (IMR) and the Maternal Mortality Rate (MMR) is seen as an indicator of health for the whole society Although IMR is in decline in the US, rates still higher than many other countries
Sewers - what is happening in the treatment plant?
Mechanical treatment: screening, grit removal, and primary clarification (primary treatment) Biological treatment: uses bacteria and other microorganisms to remove some organic matter and suspended solids (secondary treatment) Sludge treatment: mesophillic digestion, lime application to increase pH and temperature, dewatered sometimes heated, composted, made into pellets
Medicated Assisted Treatment (stigma)
Medicated-Assisted Treatment (MAT) is the use of FDA- approved medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders for opioids, alcohol and smoking. "Medicated Assisted Treatment can cut mortality in half"
What is driving public concern? - drinking water contamination
Merrimack, NH: PFOA was first discovered at faucets at Saint-Gobain Performance Plastics three years ago Levels of contamination as high as 140 ppt have since been discovered in public wells owned by the Merrimack Village District, which provides water to about 25,000 residents.
Do achievements in Public Health really 'cause' overcrowding, explosive population growth, environmental degradation, climate change?
Not really. inadequate distribution of resources is driver Public Health is the solution
Infant mortality rate
Number of deaths among infants under 1 year per 1,000 live births in a given year Death of an infant during first year of life
Intentional injuries
Occur on purpose such as homicide or suicide (overdose depends)
Deer Island - Boston's Wastewater Treatment Plant
Over 2 million people in 43 communities send sewage to MWRA's treatment plant in Boston Harbor Over 5,000 businesses and industries contribute wastewater as well
Human overpopulation definition
Overpopulation or overabundance occurs when a species' population exceeds becomes so excessive that people deem it must be managed. It can result from an increase in births, a decline in the mortality rate, an increase in immigration, or a depletion of resources. When overpopulation occurs the available resources become too limited for the entire population to survive comfortably.
Injuries as a major public health problem
PWTF (prevention and wellness trust fund) - appears to be a very sound investment from the point of view of improving outcomes and controlling costs." PWTF falls prevention interventions were cost effective and projected to prevent3,000 falls among older adults over five years
6 criteria air pollutants
Particulate matter Sulfure dioxide Carbon monoxide Nitrogen oxide Ozone Lead Example of health impact of particulate matter successes - research shows 10% reduction in PM2.5 could prevent: 400+ deaths/yr in LA, 1500+ deaths yr in CA, 1300+ deaths in US several more proposed (CO2, methane, nitrous oxide, hydrofluorocarbons, perfluorocarbons, sulfur hexafluoride, etc
Clean Air Act
Passed in 1970 (updated in 1977 and 1990) Established strict air quality standards Sets limits and does research Requires monitoring and regulation of 6 major 'criteria air pollutants' (all from combustion - burning fossil fuels) 1990 added 1870+ Mandated reduction of car and factory emission s (chemical plants, oil refineries, aerospace manufacturers, steel mills dry cleaners, etc) Trump rescinded some elements of the Clean Air Act
All 4 links in the Chain of Infection are:
Pathogen, Reservoir, Method of transmission, and Susceptible host
Unsustainable growth - population biology
Patterns of population growth S curve = population expands rapidly, then hovers around carrying capacity J curve = population expands rapidly, then crashes when carrying capacity is exceeded
Prevention is the vaccine for the disease of injury
Perhaps a better definition for "accident" is that it results because of a risk that is poorly managed. Accidents or, rather, injuries, don't just When viewed in this light, injury is preventable, diagnosable, treatable, survivable, and ultimately, controllable.
PFAS contamination
Point sources - wastewater treatment plants (WWTPs) , Landfills Non-point sources - sewage sludge aka "biosolids", atmospheric deposition
Environmental challenges
Politically, policy extremely hard to change Non-attainment for criteria pollutants in 125 areas in 37 states Thousands not regulated or tested, new toxins every year Pollutants persist even after banned Risk-benefit analysis (constant tension) Environmental justice
The second leading cause of actual death is:
Poor diet and physical inactivity
Solutions to SUD
Prevention, intervention (harm reduction), treatment, and recovery medical assisted treatment (MAT), harm reduction (for those still using)
Injury prevention strategies
Primary - conditions before event Secondary - conditions during event Tertiary - availability and quality of emergency care after event
Public health and population growth the good news
Public Health has reduced death rates, especially among children, in developing countries Since 1950, 60% reduction in children deaths before age 5! Primarily due to improvements in sanitation, advances in treating diarrheal diseases in children and small advances in women's rights
Environmental health policy
Public policy
Which of the following statements is true?
Purification of public water supplies significantly controlled infectious diseases
Which of the following statements is true about rabies?
Rabies surveillance is an example of controlling an infectious disease
Which of the following interventions has proven most successful in reducing the prevalence of smoking among young people?
Raising cigarette taxes
Which of the following interventions has proven the most successful in reducing the prevalence of smoking among young people?
Raising cigarette taxes
When study results show an association between an exposure and a disease which may have occurred by chance
Random variation
40 CFR Part 503 (Sewage Sludge Regulations)
Regulates the use and disposal of sewage sludge. Limits are put on metals, pathogen content, and vector attraction
All of these strategies are important to reduce underage drinking. Which strategy will have the biggest population impact using the ecological model approach?
Regulation of alcohol outlet density (number of alcohol stores in one area)
Which of the following statements is not true?
Research demonstrates that rates of Coronary heart disease and stroke are about the same between African Americans, Hispanics and Whites.
90% of substance use disorders (SUDs) begin in adolescence
SUD is pediatric brain disease Goal of prevention is 'delay first use' Adolescent brain not fully developed until age 25 Exposing a teen brain to substances is different than when an adults' fully developed brain is exposed to those same substances
When there is a systematic difference in participants chosen and not chosen for a study
Selection bias
Personal stigma
Self-disgust, shame and self-hate, feeling unworthy
Public health reduced deaths
Since 1900 infant mortality decreased due to improved SES, housing, nutrition, immunization, clean water, ect.
The actual cause of the greatest number of deaths annually in the United States is:
Smoking-related diseases (Tobacco)
Spike in overdose due to covid-19
Social isolation - no bystanders to administer Nalaxone Barriers to treatment Increase in behavioral health disorders due to stress and axiety Stigma Crisis of unemployment, housing, domestic violence, education
Stigmas (in general)
Stigmas can create physical and mental barriers for people with addiction to seeking treatment
Water Quality Act of 1987 (Amendment of CWA)
Strengthens regs by adding penalties. Amends solids control program
Which of the following statements is true?
Studies show households with guns are more likely to injure the gun owner, household member or a family friend than an intruder
HIV allowed the re-introduction of which bacteria that was once thought conquered?
TB (tuberculosis)
Which of the following is not an example of using regulation as a way of changing people's behavior?
Teaching college students how often their peers are binge drinking
Which of the following statements reflects a highly effective (and true) example of education immediately changing people's behavior (to reduce their risk)?
The 1964 surgeon general's report on smoking and health
Which environmental health concern is not true?
The awareness that leaded gasoline, which is currently allowed, should be banned in the future.
Which is the accurate definition of the Social Determinants of Health according to the WHO (World Health Organization)?
The conditions in which people are born, grow, play, work, pray and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.
Environmental racism
The disproportionate impact of environmental hazards on people of color
Environmental justice
The fair treatment of people of all races, cultures, incomes and educational levels with respect to the development and enforcement of environmental laws, regulations and policies
Demographic transition
The fall in birth rates is a rational response to parents' knowledge that their children are likely to survive into adulthood Industrialized, urban societies, children are an economic liability; expensive to feed cloth and educate Women's rights drive failing birth rates
Who is primarily responsible for identifying and regulating environmental health hazards?
The federal government
Reflecting on the documentary 'In Sickness and in Wealth', and the textbook, what does 'Gradient of Health' mean?
The higher one's SES, the better one's health will be
Carrying capacity definition
The population size the earth can support without degrading the environment
Public Health is not mentioned in the Constitution. As such, the federal government's Public Health authority is based on these constitutional rights/responsibilities except:
The precautionary principle
The definition of Epidemiology is the following:
The study of the distribution and determinants of disease in human populations
How do PFAS get in landfills?
They are in the products used everyday by households and industry Another important source of PFAS with regard to landfills is its ubiquitous presence in sewage sludge.
The main purpose of epidemiologic surveillance is
To recognize when an outbreak is occurring so that control measures may be instituted
The main purpose of epidemiologic surveillance is:
To recognize when an outbreak is occurring so that control measures may be instituted
Absence of a social network is associated with an increase in coronary heart disease, complications in pregnancy and delivery, and suicide.
True
Acid Rain and Ozone layer depletion are examples of the damage that air pollution causes, which may begin in one area but effect other areas farther away, including other countries
True
Air pollution caused by the 6 criteria air pollutants has been steadily on the decline since the 1970's.
True
American children spend more time than anything else (other than sleeping and in school) on screen time
True
Archaeological evidence shows that the earliest cities as early as 2,000 BC were designed with consideration for the health of their inhabitants by providing clean water and draining wastes
True
Aside from socioeconomic status, alcohol plays a role in a very high percentage of injuries from motor vehicles, firearms and poisonings
True
Carrying capacity is the population size that the earth can support without degrading the environment
True
Children of parents who smoke are more likely to suffer from asthma, respiratory infections and sudden infant death syndrome.
True
Children who are overweight are likely to be overweight as adults
True
Currently, it is probable that reported incidence rates, prevalence rates and mortality rates of COVID 19 are inaccurate because of inadequate testing
True
Decreased milk consumption and increased intake of sweetened beverages has contributed to the obesity epidemic among children
True
Epidemiologists study the distribution and determinants of disease frequency in a population
True
Epidemiology is based on probabilities, not certainties
True
Epidemiology is involved in the assessment function of public health.
True
Examples of 'primary prevention' to prevent fires would be to regulate and inspect newly installed electrical work in newly constructed housing.
True
Fear of vaccinations among worried parents has decreased herd immunity, which is necessary for fully effective immunizations programs
True
Inappropriate use of antibiotics is a major reason for the increased incidence of drug-resistant infections in the U.S.
True
Most of the 1,200 people who died during Hurricane Katrina in New Orleans were poor African Americans
True
One study in the 1980's suggested that coffee drinking could cause pancreatic cancer, but it was later found that smoking, not coffee, was the risk factor. This is an example of a confounding variable
True
Political controversy and economic concerns can impede the implementation of effective public health measures to control the spread of infectious diseases.
True
Prohibition of alcohol in 1919, which lasted 14 years, was similar to today's 'war on drugs' campaign
True
Psychoneuroimmunology is a new field of research that studies the impact of stress on health
True
Public Health experts predict that if trends continue, the next generation will be the first to die younger and sicker than their parents
True
Public health is controversial because it challenges the status quo, can have a negative economic impact and is resisted by people on political, moral, or ethical grounds.
True
Race and ethnicity affects chronic disease rates
True
Radon is an indoor air pollutant because it is a radioactive gas, associated with lung cancer, and enters homes by seeping up from the soil and rock below.
True
Socioeconomic Status is the most important predictor of health
True
Sports/football among both youth and adults, causes Traumatic Brain Injury (TBI) newly recognized (from the previous 10-15 years or so)
True
The 'Doobi-ous Results' from the '4/20 Day and fatal accidents' study (measuring the impact of drugged driving after Weed Day') demonstrated several sources of error , one of which was small sample size of 15
True
The 9/11 terrorist attacks and Hurricane Katrina had similar weaknesses in their emergency responses because of poor communication and coordination
True
The Clean Water Act set national goals that lakes and rivers should be 'fishable' and 'swimmable'
True
The Framingham Heart Study was effective at identifying smoking as a risk factor for heart disease because it followed 5,000 residents and their offspring, over decades.
True
The Master Settlement Agreement (MSA) in 1997 was a landmark deal between the tobacco companies and the states to compensate the states for costs associated with smoking
True
The easy availability of guns in the US contributes to the high death rate from firearm injuries.
True
The federal regulations of the national Safe Water Drinking Act requires drinking water be regularly monitored and tested
True
The first example of epidemiology being used for public health occurred in London in 1853 when household deaths were compared by John Snow based on the company who supplied the water to that street.
True
The infant mortality rate is defined as the number of infant deaths within the first year of life for every 1000 live births.
True
The legal requirement to use seat belts and car seats are examples of reducing mortality and morbidity by enforcement
True
The most important predictor of health is socioeconomic status (SES).
True
The prevalence of obesity decreases with increasing education.
True
Tracking cases and fatalities during this current COVID 19 global pandemic is an example of epidemiology in practice
True
Transportation can impact a person's health
True
Using swimming pool drownings as an example, lifeguards are an example of primary prevention
True
Institutional stigma
Unequal treatment in healthcare, the media, law enforcement, employers, government agencies, housing
Growing population take home points
Unlimited population growth and consumption is NOT sustainable Explosion of population over very short period of time (200 years) unprecedented in previous 10,000 years! Carrying Capacity may eventually crash from degrading the environment (damaged natural resources, scarce fresh water, fuel and land and climate change, etc) Does Public Health increase populations, causing crowding*, which risks PH progress???? NO. The opposite. Women's education and empowerment decreases birth rates (demographic transition). Less births decreases poverty
Fentanyl
Used in surgery or for sever pain (street fentanyl is different) 50-100 time more potent than heroin Even tiny amounts can kill In first quarter of 2018 Fentanyl was found in 89% of all MA fatal OD's. 57% in 2015 Illicitly produced not diverted prescriptions
Health effects associated with PFAS
Various forms of cancer, including testicular and kidney cancer Pregnancy-induced hypertension/pre-eclampsia Liver damage Increases in cholesterol levels Increased risk of thyroid disease Decreased antibody response to vaccines Increased risk of asthma diagnosis Increased risk of decreased fertility Small decreases in birth weight
Sewage treatment
What goes in (influent): household, commercial, industrial, storm water What comes out (effluent): treated wastewater, sewage sludge
The 10 essential services of public health can be summarized into these core functions:
assessment, policy development, and assurance
Primary prevention refers to:
elimination of exposure to risk factors
Social stigma
isolation and rejection from friends and family
The documentary 'Vaccine Wars' exposes which risk to the success in controlling infectious diseases?
lack of herd immunity due to unvaccinated children
Sewage treatment focused conventional pollutants
oil, grease, organics (nitrogen and phosphorous), total suspended solids, settleable matter chemical removal is incidental
Consequences of over population
problem of food, shelter, unemployment, health problem, environment degradation, fragmentation of agricultural holdings, threat to economic development, urbanization, price hike and inflation, destruction of values early spread of disease, infectious disease, water contamination, food shortages/crisis, desertification, environmental devastation, political conflict and terrorism
Public health measures that contribute most to people being healthier today than they were a century ago
sanitation, better nutrition, and occupational safety
Public health change is data driven but not without a lot of noise
social movements <--> science <--> Media <-->
The endemic rate of disease is:
the frequency of disease at the usual and expected rate
