Public Health Final

Public health researchers and policy makers strive to use the most reliable data when drawing conclusions and making decisions. What two things from the list below are important for researchers and policy makers to consider when looking at data:

- Our understanding of a health outcome may change as researchers learn more about that health outcome. - Data used should be representative of the population at risk.

Probabilities are used to describe the variety and frequency of past outcomes under similar conditions to predict what should happen in the future. Statisticians use different values to convey probability. The p value is one such value which is used to express the probability that the observed result could have occurred by chance alone. Scientists agree a p value of ______ or less is the criterion for a test/study result to be considered statistically significant.

0.05

One a statute is passed, it often goes through a series of steps before it becomes law. Put the steps of this process in order:

1. a legislative passes a statute 2. the statute may be challenged 3. a state court may overturn 4. a federal court may overturn

Earth Day was first celebrated in the United States on April 22, _____________. It marked the beginning of the modern environmental movement in the country.

1970

What year and under which administration was the Environmental Protection Agency established?

1970 Nixon administration

The Affordable Care Act was passed by Congress in 2010. It has significantly reduced the number of uninsured Americans. What year did it go into FULL effect?

2015

Go to https://data.census.gov (Links to an external site.) and use the Explore Census Data tool to look at the profile for Denton County, Texas. Under the Families and Living Arrangements section, the estimated number of households is listed. How many households does the Census Bureau estimate are located in Denton County in 2017?

275,164

Guinea worm is considered a Neglected Tropical Disease by the WHO and other health organizations. In 1986, there were more than 3.5 million cases in over 21 countries in Africa and Asia. Efforts by a number of public health organizations, including the Carter Center and UNICEF, have greatly reduced the number of people infected. These efforts had an impact, with the number of cases being reduced from around 3.5 million cases to how many cases in 2018?

28

What percentage of Medicaid beneficiaries are children, their parents, and pregnant women?

85%

There are many ways to define heath. How does the World Health Organization define health?

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

The World Health Organization defines a health care system as:

A system that encompasses all activities to promote, restore, and maintain health.

What agency was established to develop guidelines for treatments, then became controversial among many in the medical community when it began to implement guidelines and had to shift its focus to quality of care and patient safety?

Agency for Health Care Policy and Research

There are vast differences in the health risks people experience across the world, but we all share some similar threats. Choose from the list below:

All listed

Researchers acknowledge social factors impact infant mortality, including socioeconomic status (SES), which is measured based on income, education, and occupation. Which of the following explains how low SES increases risk:

All of the Above

Delhi and many surrounding states in India have been dealing with a thick hazardous smog for weeks now caused by a number of factors. Choose from below:

All of the above

Public health is the science of protecting and improving the health and safety of people and their communities. Choose the work public health professionals carry out to do this from the list below:

All of the above

Why are many environmental laws and regulations controversial?

All of the above

The three core functions of public health include assessment of health issues, development of policies to address health issues, and assurance the programs and policies are addressing those health issues. The ten essential services of public health are services which fall under one of the three core functions. Match each of the ten services with the core public health function under which it falls.

Assessment: Monitor health status... Policy Development: Inform, educate... Assurance: Enforce laws...

Public health first applied the idea of education, enforcement, and engineering to injury prevention where?

Auto Industry

Diseases are caused by three main agents. Match the description with the agent:

Bacteria: Single celled organisms that can survive and reproduce without a host Virus: Organisms without a cellular structure and cannot survive or reproduce without an animal or plant cell Parasite: Organisms that live on or in a host and gets its food from or at the expense of its host

Human behavior can be difficult to study and understand. Even with a structured and reliable study, errors can occur and impact findings. This can lead researchers to incorrect conclusions. Epidemiologists must factor errors into their research. What type of error can occur when there is systematic error in a study that results in an incorrect estimate of the association between exposure and risk of disease because of a concentration on an interest in one area or subject leading to blind spots in the research?

Bias

In which state does the law allow health care institutions to withdraw life support when further treatment is judged futile, even against the wishes of the patient as expressed in an advance directive?

California

Health behaviors and health outcomes are influenced by many different factors, such as genetics, behavior, and environment. Researchers need tools to systematically review these factors to determine what impact each can have on health. The government collects basic information about households across the country that is very useful to public health researchers because it helps put health data into perspective by giving them a reliable way to calculate a population at risk. What is this body of data?

Census data

Which agency recommends pregnant women be tested for common infections to decrease the chances of having a miscarriage, a baby with a birth defect, or other reproductive problems?

Centers for Disease Control and Prevention

A Supreme Court decision allowed states to opt out of the Medicaid expansion under the ACA. Who would be left without care if a state decided not to participate?

Childless Adults

Which of the following is America's most important public health issue?

Cigarette smoking

There are diseases which cannot be prevented with a vaccine and for which there no cure. Some of these diseases can be avoided by modifying human behavior. Who in the public health community can often have the most success in influencing change in behavior?

Community health workers

Choose two of the chronic degenerative diseases that are leading causes of death in America today:

Diabetes Heart disease

Application of which model at the interpersonal level would lead to different strategies in a teen drug prevention program, depending on the nature of the teens' social relationships?

Ecological model

Which of the following influences people's diet and activity patterns, which are the second most important factor in American's poor health?

Environmental Factors

The Department of Health and Human Services (HHS) is the main federal agency that handles public health activities. Which one of the following agencies is NOT under the authority of HHS?

Environmental Protection Agency

Injury is not a leading cause of death for people ages 1-44.

False

Public health and clinical care both require knowledge of medicine and health, but they both focus on different aspects of ensuring the health and safety of populations. Public health professionals focus on the bio-science of health and work to heal the individual. Clinical professionals, on the other hand, work at the community level to prevent health problems from happening or recurring.

False

Self-efficacy is the sense of having control over one's life, but it is not an important factor in an individual's efforts to change behavior.

False

The impact humans are having on the atmosphere, hydrosphere, biosphere, and other earth systems is so great many scientists are now in agreement we are in a new geological era that many refer to as the Anthropocene. Scientists generally agree the impact humans are having can be reversed.

False

The worst pandemic in recent history was:

Flu of 1918

In the TED Radio Hour clip played in class, Dr. Dixon Chibanda discusses a public health intervention he developed to reduce the treatment gap for common mental disorders in Zimbabwe. To address this gap, he trained and supervised grandmothers to sit at public benches and deliver problem-solving therapy to community members. What was the name of the program?

Friendship Bench

Healthy People 2020 agreed to address five key social determinants of health. Choose two:

Health care Neighborhood and built environment

Which of the following has documented extensive evidence that the delivery of medical care is inequitable and that ethnic and racial minorities may receive poorer quality care than white Americans? Outcomes research

Health services research

The Tuskegee Syphilis study was carried out starting in 1932 in Macon County, Alabama. The study was designed to study the long-term impacts of syphilis on males. Researchers recruited black men to participate without giving them details about what the study entailed. Over the next forty years, participants were monitored as their health deteriorated. Eight years into the study, in 1940, penicillin was discovered and was known to be a successful treatment for syphilis. None of the study participants were given this treatment. The study continued into the 1970s and was only stopped when the study became public. The injustice of the study spurred the creation of ethical limitations on research involving humans. Choose three of those limitations from the list below.

If the treatment group is clearly showing better or worse results than the control group, the study will be stopped. Participants must freely consent to participating. Each study must be approved in advance by an institutional review board to assure the study meets ethical standards, among other requirements.

Disease frequency is a measure epidemiologists use to study the distribution and determinants of disease. It is calculated by comparing the number of cases of a specific health outcome to the size of the population at risk. This frequency can be expressed through two different rates, incidence and prevalence rates. Incidence rate is the proportion of the population with new cases during specified time interval. A prevalence rate is the proportion of the population with new and preexisting cases at a point in time. Which rate is most useful in identifying a disease outbreak?

Incidence Rate

Behavioral science deals primarily with human action and often seeks to generalize about human behavior in society. It tends to focus on:

Individual behaviors, beliefs, attitudes, and values

A report discussed in the textbook from what agency states, "It is paradoxical that obesity is increasing in the United States while more people are dieting than ever before"?

Institute of Medicine

Schneider discussed three types of epidemiologic studies. Match the type of study with its description.

Intervention Studies: Subjects are assigned to a test group (people who receive the treatment) or the control group (people who do not receive the treatment). Cohort Studies: Healthy subjects are questioned about their exposures at the beginning of a study and then observed over a period of time to see if those with a specific exposure were more likely to develop a specific health outcome. Case-Control Studies: Subjects with a specific health outcome are compared to subjects who do not have that health outcome to see if there are differences in exposure.

To confirm that they provide high-quality care, health care institutions may seek accreditation by which private organization?

Joint Commission

What are some examples of efforts humans have made before modern times to maintain a healthy environment?

Keeping water sources clean Ensuring proper storm and wastewater drainage

Chronic diseases are now the leading causes of death in America. There are no specific pathogens that cause someone to develop these types of diseases. They have multiple causes. Scientists know several factors can increase someone's chances of developing chronic diseases. Choose two from the options below

Lack of exercise Overconsumption of alcohol

Epidemiologic studies cannot prove cause and effect, but the relationship between cause and effect can be solidified by the reliability of the findings. There are several factors that can increase reliability. Choose two of those factors from the list below:

Large study population Known biological explanation for an association

Scientists know exposure to even low levels of _____________________ can have a negative impact on a child's development and can cause learning and behavior problems.

Lead

We have discussed the Flint water crisis in class. In 2014, the city of Flint, Michigan changed its water source and did not take proper steps to treat the new water safely. This resulted in water with dangerous contaminants being delivered to city customers. One of the contaminants tested at high levels in the drinking water was lead. New evidence is coming to light revealing the City of Flint also knew of another contaminant in the water that caused some people to develop a potentially fatal disease. The state has acknowledged twelve people have died after developing this disease as a result of exposure to contaminated drinking water. What is the name of the disease?

Legionnaire's disease

Public health is primarily the responsibility of the government. Each of the three branches of government play specific roles in public health policy. Match the branch of the government with the role it plays:

Legislative: Public health activities must... Judicial: Public Health law... Executive: Decisions at legislative...

There are three main levels of public health in America, local, state, and federal. Each carries out different tasks to ensure the health of all people is protected. Match the tasks below to the level of government which carries them out.

Local Level: This level of government provides vaccines for the general population, infants to older adults. It conducts restaurant inspection programs. This level of government is responsible for collecting and analyzing health statistics for their area of service. It also delivers maternal and child health services. State Level: This level of government has the primary constitutional responsibility and authority for the health, safety, and general welfare of their population. This level of public health is often responsible for carrying out licensing and certification of medical personnel, facilities, and services. This level of government also coordinates the work done at smaller locations, including collecting and analyzing data from those locations. Federal Level:This level of government is responsible for putting laws into practice, it also funds many of the public health efforts in the US. This level of government has surveillance systems in place to collect and analyze data on a large scale. It also funds medical and public health research. This level of government is responsible for ensuring the safety and effectiveness of medicine, the safety of our food supply and other commonly used products.

Notifiable diseases are infectious and non-infectious diseases required by law to be reported to government authorities. Where are notifiable diseases usually reported first?

Local health departments

Global health professionals work to achieve optimal health for everyone around the globe. They have accomplished many things in the last 100 years. Choose any listed below: All listed

Malaria prevention and access to safe water

What is one way the U.S. health care system can reduce costs?

More competition

The ____________________ is the most dangerous animal in the world. This animal transmits deadly diseases like malaria, dengue fever, and encephalitis to humans.

Mosquito

There are sources of data available to analyze the health of people across the country. As we have discussed, there are different levels of quality in data gathered. Self-reported data about health behavior is less reliable than data gathered from measurements taken by a medical professional (example: weight, blood pressure, neurological exam). Which of the following ongoing surveys uses medical professionals to collect data from participants ?

National Health and Nutrition Examination Survey

Epidemiology is the study of the distribution and determinants of disease frequency in the human population. Studying the distribution and determinants of infectious disease requires a different approach compared to the approach taken to study the distributions and determinants of chronic disease. Scientists know chronic diseases develop in humans over time and must therefore be studied over long periods of time. Schneider mentions two major cohort studies of chronic disease in America that have been continuously gathering data on participants for more than four decades. Choose those two studies from list below:

Nurses' Health Study - This study has included more than 275,000 participants over its duration and continues to recruit more. It was designed to look at factors that may be related to the development of various chronic diseases. Framingham Study - This study began with a study population of more than 5,000 men and women. It and was designed to investigate the possible risk factors for developing heart disease. The study has now gathered data from 14,000 participants from three generations.

In the 1960s and 1970s, governments at all levels were setting new standards for air, water, waster disposal, and human safety. Which government organization was established in 1970 to ensure safe and healthful working conditions for people?

OSHA

Infectious diseases began to decline at the beginning of the 20th century. There were many medical and public health advances during this time that were key to this decline. Choose three:

Pasteurization of milk Improved nutrition Introduction of antibiotics

The chain of infection is used to describe a pattern by which an infectious disease is transmitted from person to person. Match the following details with the correct link in the chain:

Pathogen: Bacteria, viruses, and parasites Reservoir: People, water, soil, animals Point of Exit: Bodily fluids including blood, urine, semen, saliva Method of Transmission: Direct or indirect contact with an infected person, ingestion, and inhalation Point of Entry: Respiratory tract, mucous membranes (nose, eyes, mouth), and broken skin Susceptible Host: Anyone is at risk but people with weakened immune systems are especially vulnerable

Epidemiology studies the ___________________ occurrence in human populations and the factors that influence those patterns.

Patterns of Disease

Prevalence of overweight and obesity have been increasing since the 1960s in which groups:

People of all ages and all genders

The health of a population can be driven by the balance between politics and science. Which of the following is NOT true:

Policy makers always use the most reliable scientific evidence when deciding how to make laws.

According to the Transtheoretical Model of health behavior, health change is a process a person goes through in series of steps:

Precontemplation, contemplation, preparation, action, maintenance

Which of the following are leading causes of infant mortality in the United States:

Prematurity, SIDS, birth defects

The main task of prevention is to develop interventions designed to prevent health issues identified in the assessment process. One approach to developing an intervention is addressing the health issue at three levels of prevention. Match the focus of an intervention with the level of prevention below:

Primary Prevention: Prevents Exposure to risk factor Secondary Prevention: Minimize severity of impact Tertiary Prevention: provides medical care

Public health works to prevent death and disability related to specific health threats at three levels, primary, secondary, and tertiary. Match the public health efforts to the corresponding level of prevention.

Primary Prevention: Public health works to educate medical professionals and the public about the benefits of eating a healthy diet, getting regular exercise, avoiding alcohol, not smoking, and managing stress Secondary Prevention: Early detection of a chronic disease and early intervention of many chronic diseases can lessen the negative impact on a person's life Tertiary Prevention: Educating medical professionals, community heath workers, and the public about the benefits of actively managing chronic health issues including tracking progression of a disease in an individual and ensuring access to medication

Most health care systems have:

Reliable sources for medical information, a robust financial system, patients, policies in place to ensure quality care, providers

According to Dr. Leonard Saltz in the Radiolab clip played in class, what is one of the reasons drug costs are so high?

Research

What type of analysis is a useful tool to understand why medical treatments and outcomes vary?

Small-area analysis

Scientists know certain factors determine a person's state of health. Which of the health determinants has the biggest impact on a person's health?

Social Determinants

The science of public health requires input from six disciplines to successfully carry out efforts to ensure the health and safety of a population. Which two disciplines are missing from the following list? Epidemiology Biostatistics Health management and policy Environmental health

Social and Behavioral Health Biosciences

Which area of the United States generally has the highest prevalence of depression, serious psychological distress, and mean number of mentally unhealthy days?

Southeastern

Public health professionals address health problems in a systematic way. This process involves five steps. The steps are listed below. Put them in order from the first step to the last step.

Step 1: Define the Health Problem Step 2: Identify the Risk Factors Step 3: Develop and Test Step 4: Implement Intervention Step 5: Monitor those interventions

What ingredient in tobacco smoke provides the flavor in cigarette smoke, collects as residue in the lungs, and is also a major source of its carcinogenicity?

Tars

Global health can be defined as:

The collaborative actions taken to identify and address transnational concerns about the exposures and diseases that adversely affect human populations.

The government works with nongovernmental agencies to improve the public's health. These types of organizations can include professional membership organizations (American Public Health Association), nonprofit organizations (American Heart Association), philanthropic foundations (Robert Wood Johnson Foundation), and consumers groups (Center for Science in the Public Interest). These groups can optimize government efforts because:

They can help tailor public health efforts based on the unique needs of individual communities. They have connections with communities and understand their unique situations.

A confidence interval is another range of values researchers use to gauge the chance the observed result could have occurred by chance alone. If the confidence interval, or margin of error, is smaller it means there is a lower likelihood of the observed result occurring because of random error.

True

Availability of services leads to more use of these services.

True

Damage to the respiratory tract lining from contaminants in smoke increase susceptibility to infectious diseases.

True

Information on mortality patterns is key to understanding changes in the health and well-being of the US population. Differences in death rates among various demographic subpopulations, including race and ethnicity groups, may reflect subpopulation differences in factors such as socioeconomic status, access to medical care, and the prevalence of specific risk factors in a particular subpopulation

True

Mental illnesses account for more disability in developed countries than any other group of illnesses, according to the World Health Organization?

True

Public health can often spur controversy, especially when economics, individual liberty, and morality come into play.

True

Public health professionals at the Models of Infectious Disease Agent Study (MIDAS) within the National Institute of Health use census data to predict the way infectious diseases could break out in communities across the nation.

True

The EPA defines environmental justice as the idea that everyone is entitled to the same degree of protection from environmental and health hazards, and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.

True

The United States has put many programs and agencies in place to protect children's health, including programs to ensure children have access to adequate nutrition. These programs include the Supplemental Nutrition Assistance Program (SNAP), School Meals Program, and the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Even with these programs in place today, some children still experience food insecurity.

True

Obese children are being diagnosed with what medical condition that was previously believed to occur almost exclusively in adults?

Type 2 diabetes

Which non-profit organization has a contract with the federal government to maintain a computerized network of a large number of organ recovery centers in more than 10 geographic regions of the nation?

UNOS

What were the top three leading causes of death for Americans in 2017?

Unintentional injuries Cancer Heart disease

Diseases continue to threaten humans today. They are proving to be unpredictable and new disease are a growing threat. The Institute of Medicine has conducted studies and found most of the emerging infectious disease events have been caused by pathogens spread in what way:

Zootonic - pathogens spread from animals to humans

Health policy and management is the area of public health that focuses on the delivery, quality, and costs of health care for individuals. Which of the following are areas heath policy and management knowledge can be applied?

all of the above

Health policy is the set of decisions, plans, and actions created with the intent to optimize the health of individuals, communities, and populations through specific health care objectives. What stakeholders in the health care system can be impacted by health policy?

all of the above

Notifiable conditions include which of the following:

all of the above

What areas of health care need reform?

all of the above

Why is it important to have everyone counted in the census? Choose one from the list below.

all of the above

A 1991 study found that 2% of 6-year-olds recognized Joe Camel, the same percentage that recognized the Mickey Mouse logo of the Disney Channel.

false

Epidemiologists only look at disease as a cause of illness because that is the only reason people get sick.

false

Ethical limitations on research in place today will ensure all data is gathered ethically, that all data (beneficial and harmful) collected is included in the findings, and that the findings are presented in a clear way.

false

Genetics can only affect an individual at birth.

false

In this new era, humans have full control of nature and only need to develop the right technology to ensure the health and safety of humanity for generations to come.

false

It is not important to take a community's cultural perspective into account when planning a public health program or intervention - medicine is the same everywhere.

false

It was only after modern medicine became common that humans understood the importance of taking into consideration the health of inhabitants when designing cities.

false

Most medical conditions can only be treated in one way.

false

Only some people will need health care during their lifetime.

false

The public health approach to risk reduction has historically focused on economic factors in health.

false

Uneven distribution of health tools such as vaccinations, medications, diagnostic tools, or new treatments has nothing to do with health disparities around the world.

false

What contributed to an increasing interest in the measurement of the quality and efficiency, or cost-effectiveness, of medical care?

medical errors

Once enough descriptive epidemiologic data had been gathered and a hypothesis has been developed, systematic studies can be carried out to look for associations, causative factors, and health outcomes. Studies can be classified into two types, prospective and retrospective. Which type of study starts at a certain point in time and monitors all participants for health outcomes over time?

prospective

A person's mental health can be impacted by chronic diseases, including cardiovascular disease, diabetes, asthma, and cancer.

true

According to Schneider, the U.S. medical system is the most expensive in the world.

true

Doctors offer treatments based on their knowledge and medical experience. Their decision making can also be influenced by learning about what treatments their peers offer.

true

Exposure to carcinogens can cause a person to develop cancer over time. Another dangerous group of contaminants, neurotoxins, can cause people exposed to develop health issues similar to aging.

true

In addition to the people being killed by injuries, there are almost as many survivors left with permanent disabilities, a major economic and emotional drain on families and on society in general.

true

In the past, Congress provided subsidies to tobacco growers and has been very reluctant to pass legislation opposed by the industry.

true

Racism threatens health, both "upstream" and independent of class. At every income level, African Americans, Pacific Islanders, Native Americans and other people of color often fare worse than their white counterparts.

true

Social determinants are conditions in a person's environment that affect a wide range of health, functioning, and quality of life. Social determinants can include things like access to health care, transportation, and residential segregation.

true

U.S. government policy subsidizes industrial agriculture, which produces high-calorie commodities at the expense of more nutritious produce.

true

Unhealthy behaviors may be maintained and reinforced by aspects of the social environment that are beyond the individual's control.

true

What is the simplest and most cost-effective way to prevent the spread of illness?

washing hands