Public Health Exam 3
2013 Deaths and Mortality
-# of deaths: 2,596,993 -Death rate: 821.5 deaths per 100,000 population -Life expectancy: 78.8 years -Infant mortality rate: 5.96 deaths per 1,000 live births
Missouri total potential savings by 2030 if the state reduces average BMI by 5%
-$13.3 billion -Potential cases avoided by 2030 if the state reduces average BMI by 5%: -Diabetes: 179,659 -Coronary Heart Disease & Stroke: 152,070 -Hypertension: 133,798 -Arthritis: 75,434 -Obesity-Related Cancer: 13,704
Master settlement agreement
-1997-1998 - agreed on a settlement -$206 billion to 46 states over 25 years -Industry agreed to restrictions on advertising -Disappointingly, states used very little of settlement money for tobacco control -$1.7 billion to American Legacy Foundation - "Truth Campaign" - used lessons learned from California campaign
The injury burden: mortality
-400 individuals a day -Number one killer for children, adolescents, and young adults -other half of injuries are unintentional - what we used to call accidents
All these factors effect:
-Access to health choices -nutritional choices -Physical activity -Sexual behavior -alcohol consumption -Violence
Leading actual causes of death
-Account for almost half of all deaths -Most are preventable -Most are caused by individual behavior -Trgets for public health intervention
Tobacco facts
-Accounts for 30% of all cancer deaths -Of the 480,000 deaths attributed to smoking- 35,000 were caused by second hand smoke
Mortality
-All injury deaths Number of deaths: 192,945 Deaths per 100,000 population: 60.2 -All poisoning deaths Number of deaths: 48,545 Deaths per 100,000 population: 15.4 -Drug poisoning deaths Deaths per 100,000 population: 13.9 -All firearm deaths Number of deaths: 33,636 Deaths per 100,000 population: 10.6 -Motor vehicle traffic deaths Number of deaths: 33,804 Deaths per 100,000 population: 10.7 -Source: Deaths: Final data for 2013, table18 http://www.cdc.gov/nchs/fastats/injury.htm Source: Health, United States, 2014, Table30
Obesity rates among all children in the US
-Approximately 17% (or 12.5 million) of children & adolescents aged 2—19 years are obese. -Since 1980, obesity prevalence among children & adolescents has almost tripled. -There are significant racial & ethnic disparities in obesity prevalence among U.S. children & adolescents. -In 2007—2008, Hispanic boys, aged 2 to 19 years old, were significantly more likely to be obese than non-Hispanic white boys, & non-Hispanic black girls were significantly more likely to be obese than non-Hispanic white girls. -1 of 7 low-income, preschool-aged children is obese. -County obesity rates are variable within states. Even states with the lowest prevalence of obesity have counties where many low-income children are obese & at risk for chronic disease.
Causes of obesity
-Behavior -Environment -Genetics -Diseases -Drugs
Healthy people 2020: Health related quality of life & well
-Being Patient Reported Outcomes Measurement Information System (PROMIS) -Global Health Measure , Well-Being Measures , Participation Measures
Economic Impact
-Businesses often resist public health measures because they affect profits -Those who myst pay may not be the ones who benefit -Costs may be short-term, while benefits may be long term -Costs easier to calculate than benefits
Affect of demoralizing an issue
-Can you think of some health issues with stigmas attached to them? -Victims are demoralized -Offenders are driven underground -Relief efforts are unsuccessful -unfunded -not utilized for fear of exposure or retribution -Epidemic spreads
Tobacoo: Public health enemy #1
-Cancer -Cardiovascular disease -Chronic obstructive lung disease -Infant heaths due to low birth weights -Burns
1990s Broad attack on tobacco
-Class action lawsuit by state attorneys general -FDA commissioner Kessler proposed to regulate tobacco -MR. butts leaked tobacco documents -Tobacco industry on the defensive
Health risk of obesity
-Coronary heart disease -type 2 diabetes -cancers -hypertension -dyslipidemia (high total cholesterol) -Stroke -Liver and gallbladder disease -Sleep apnea -Osteoarthritis -Gynecological problems
Who is at risk for suicide
-Depression, other mental disorders, or substance abuse disorder -A prior suicide attempt -Family history of a mental disorder or substance abuse -Family history of suicide -Family violence, including physical or sexual abuse -Having guns or other firearms in the home -Incarceration, being in prison or jail -Being exposed to others' suicidal behavior, such as that of family members, peers, or media figures.
Sources of controversies
-Economic impact -Individual Liberty -Moral & Religious concerns
Public Health interventions
-Education -Regulation -Prohibition
Community level
-Educational programs for bartenders in gay establishments -Distribution of condoms
What are the issues?- Individual liberty
-Extent to which the government can and should restrict freedom to improve the communities health -Protect people from harming others -Protect children from harm -Protect people from harming themselves -Communal resources -Social interest versus inconvenience
Diet & nutrition
-Federal recommendations - Dietary Guidelines for Americans -More fruits and vegetables -Legumes -Whole grains -Low-fat milk and milk products -Less refined grains -Less total fats, especially cholesterol & saturated & trans fats -Less added sugar & calories
Public Policy level
-Free, confidential HIV testing
California's tobacco control program
-Funded by 1989 tax increase of 25cents per pack -Cigerette consumption immediately began to decline -Media campaign in 1990 & 1991 -1994- smokingban in all workplaces -Cigarette consumption declined by 60% since 1988 -Lessons on effective anti-tobacco messages
Weight bias
-Has serious medical & psychological consequences -reduces earning potential -affects hiring and promotion opportunities -affects academic opportunities & achievement
Intentional Death: Suicide
-In 2015, suicide was ranked as the 10th leading cause of death. -There were 41,149 suicides in 2013 in the United States—a rate of 12.6 per 100,000 is equal to 113 suicides each day or one every 13 minutes. -Suicide results in an estimated $51 billion in combined medical and work loss costs. Suicide is the second leading cause of death for young people ages 15 to 34. (CDC, 2013)
Epidemiology of injuries
-Injuries are the fifth leading cause of death in the U.S. -Injuries are the leading cause of death among people ages one to 44 -Higher injury rates in groups with lower SES -Males have higher injury rates than female -Blacks have higher injury rates than whites
Historical trends
-Intensive use began in early 20th century -Free distribution to soldiers during world war -Women began smoking during and after World War 2 -Smoking peaked in mid-1960s at over 42% of adults -Lung cancer trends followed smoking trends about 20 years later -1964 - first Surgeon General's report - Dr. Luther L. Terry Smoking rates began to decline
Ecological model of health behavior
-Intrapersonal level -Interpersonal level -Institutional level -Community level -Public policy level
Regulation
-Laws against murder and assault -Traffic regulations -Restrictions on alcohol, drugs, & tobacco -Age restrictions on many behaviors -Sexual behavior is hard to regulate
Healthy people 2020: General health status
-Life expectancy (with international comparison), Healthy life expectancy -Years of potential life lost (YPLL) (with international comparison) -Physically & mentally unhealthy days -Self-assessed health status -Limitation of activity -Chronic disease prevalence
New labels
-Michelle Obama announced that the us food and drug administration is revamping the nutrition label on 700,000 food product in spring 2014 -On the new labels, food manufacturers would have to make the calorie count more prominent with bold type, delete the "calories from fat" listing (the FDA now thinks that the type of fat is more important than the calories from fat, so calories from fat will be removed, but total fat, saturated fat and trans fat counts will stay) and list added sugars in addition to total sugars, as well as Vitamin D and potassium.
How Much Exercise?
-Minimum of 150 kilocalories per day, e.g., walking briskly for about 30 minutes -More is better -40 percent of Americans get no exercise -Lower SES is associated with more inactivity -Children get less exercise as they get older -Obesity in children is correlated with the amount of time spent watching television
All injuries (data are for the US)
-Morbidity: number of medically attended injury and poisoning episodes in the non institutional population: 37.4 million -Episodes per 1,000 population: 121.2 Health care use Ambulatory care Number of visits (to physician offices, hospital outpatient and emergency departments) for injuries: 80.1 million (includes visits for adverse effects of medical treatment) Number of emergency department visits for injuries: 43.0 million (includes visits for adverse effects of medical treatment) Hospital inpatient care: Number of discharges for fractures (all sites): 1.1 million Number of discharges for poisonings: 260,000 Number of discharges for certain complications of surgical and medical care: 1.0 million
Changing the environment
-More effective than trying to change individual behavior -Change focus from blaming he victim -Pioneered in injury control programs -Effective in tobacco control programs
Behavior & the social environment
-Most important predictor of health is socioeconomic status -Health gradient holds at all levels of the social scale -Health also affected by gender, martial status, race and ethnicity -In US, racial and ethic minorities have poorer health than white -Health disparities are a big concern of public health
What are the issues? -Economic
-Most public health measures have a negative economic impact of some kind on some segment of the population or an industry (tax incase, regulations, added to prices of products) -Industries resist change (automobile malfunctions, taboo industry) -Those who pay for a public health measure may not benefit (Worker safety) -Cost of public health measures are easier to calculate than the benefits
Misuse of alcohol
-Motor vehicle fatalities (35-40% involve alcohol) -Chronic liver disease & cirrhosis -Home injuries -Drownings -Fire fatalities -Job injuries -Cancer (3-5% of a ll cancer deaths)
My plate
-MyPlate is the current nutrition guide published by the United States Department of Agriculture, depicting a plate and glass divided into five food groups. -It replaced the USDA's MyPyramid guide on June 2, 2011, ending 19 years of USDA food pyramid diagrams. -MyPlate will be displayed on food packaging and used in nutrition education in the United States. -MyPlate is divided into sections of approximately 30 percent grains, 30 percent vegetables, 20 percent fruits and 20 percent protein, accompanied by a smaller circle representing dairy, such as a glass of low-fat/nonfat milk or a yogurt cup.
2014 Adult obesity rates by state
-New numbers from the Centers for Disease Control find that while adult obesity rates remain steady, they are still high around the country. -In a state-by-state analysis, Arkansas, West Virginia and Mississippi were states with the highest adult obesity rates. Hawaii, the District of Columbia and Colorado had the lowest rates. -While the Midwest had the greatest prevalence of obesity, the South was not far behind and was home to seven of the states with the highest obesity rates in the nation. -Obesity rates have been steadily rising since the 1990s. -In 2013, Mississippi and West Virginia were the first two states to ever report more than 35% of their adult population as obese.
Why the effect of SES
-Nutrition -Sanitation -Conditions of the physical environment -Higher SES leads to more healthy behavior -Access to medical care
Poor diet & physical Inactivity
-Obesity -Heart disease -Diabetes -Cancer
Behavior
-Obesity is caused by the unhealthy eating patterns combined with inadequate physical activity, each a faction that influences people's health whether or not they weigh too much. -Only 1% to 3% of Americans eat recommended number of servings from all food groups -Main vegetables are iceberg lettuce, potatoes including chips and fries, & canned tomatoes -Increased intake of sweetened beverages, less milk
Environment
-People may make decisions based on their environment or community. -For example, a person may choose not to walk to the store or to work because of a lack of sidewalks. -Communities, homes, and workplaces can all influence people's health decisions. Because of this influence, it is important to create environments in these locations that make it easier to engage in physical activity and to eat a healthy diet. -The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity 2001 identified action steps for several locations that may help prevent and decrease obesity and overweight.
Genetics
-Plays a role in obesity -Do not always predict future health -Genes and behavior may both be needed for person to be overweight -In some cases multiple genes may increase ones susceptibility for obesity and require outside facts such as abundant food supply or little physical activity
Leading cause of injuries
-Poisoning -Motor vehicle injuries -Firearms injuries -Falls -Suffocation -Drowning -Fires/burns -Cut/pierce
Determinants of health
-Policy making -social factors -Health services -Individual behavior -Biology & genetics
Stage of change: Transtheoretical Model
-Precomplation -Contemplation -Preparation -Action -Maintenance
Transtheoretical Model stages
-Precontemplation is the stage in which people are not intending to make a change in the foreseeable future (6months). People may be in this stage because they are uninformed or under-informed about the consequences of their behavior. Or they may have tried to change a number of times and become demoralized about their ability to change. -Contemplation is the stage in which people are intending to change in the next 6 months. They are more aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time. Both groups tend to avoid reading, talking or thinking about their high risk behaviors. They are often characterized in other theories as resistant or unmotivated or as not ready for health promotion programs. Preparation is the stage in which people are intending to take action in the immediate future. These individuals have a plan of action, such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book or relying on a self-change approach. These are the people that should be recruited for action- oriented smoking cessation, weight loss, or exercise programs. Action is the stage in which people have made specific overt modifications in their life-styles within the past 6 months. This is the end all be all of many behavioral modification programs Maintenance is the stage in which people are working to prevent relapse but they are not changing their behaviors as frequently as do people in action. They are less tempted to relapse & increasingly more confident that they can continue their change.
Education
-Provide information -Smoking is bad -Recommended dietary allowances -Health education in schools -Sex education is controversial -Physicians recommendation can be effective
Promoting physical activity
-Remove environmental barriers & provide places to exercise -Suburban lifestyle - must drive everywhere --Build sidewalks, walking trails, bike paths --Mall walking in shopping malls -Police surveillance & neighborhood watches in high-crime neighborhoods -Develop habits of exercise in children -Physical education classes should focus on activities that can be practiced throughout one's lifetime
Public Health Controversies
-Smoking bans -Vaccinations -Drinking age limits -Abortion -Birth control/ Family planning
Promoting healthy living
-Social environment promotes overeating -very difficult to change eating patterns -5-a Day campagin to increase consumption of fruits & vegetables -Advertising by food industry, including ads aimed at children -food labeling -best hope is to focus on children, starting with breast-feeding
Disease and drugs
-Some illnesses may lead to obesity or weight gain, These may include Cushing disease, and polycystic ovary syndrome -Drugs such as steroids, and some antidepressants may also cause weight gain -A doctor is the best source to tell you whether illnesses, medications, psychological factors are contributing to weight gain or making wight loss hard
Intrapersonal level
-Target different levels of influence -I am susceptible to infection -There is something i can do that will lessen the treat of infection -I am capable of making these changes
Taxes on smoking
-Teenagers especially are sensitive to price -California raised cigarette taxes to fund tobacco control programs -Many states have raised cigarette taxes to close budget shortfalls -The highest state and local tax rate is Chicago at $6.16. -Nationally smoking related health cost and lost productivity totals $19.16 per pack -Missouri's cigarette tax of 17 cents per pack is the nation's lowest well below the national average of $1.49.
Emphasis on Youth
-Tobacco companies must recruit 2 million smokers a year to replace those who die or quit -Most smokers begin smoking in their teens -Ads focus on young people -Ads focus on women - claim that smoking helps them lose weight -Laws prohibit sale of tobacco to minors, but ineffective
Psychological & sociologic Models used to explain behavior & behavior change
-Transtheoretical model of change -stage of change -health belief model (HBM) -Locus of control -The ecological model
Physical activity & health
-Weight control works best when healthy eating is combined with physical activity -Exercise promotes health independent of weight control -Exercise helps to prevent heart disease, high blood pressure, improves cholesterol, diabetes, some forms of cancer
Deaths caused by smoking
-cardiovascular disease -Lung disease -Respiratory disease- pneumonia, influence, brochitis, emphysema, chronic airway obstruction -Others cancers- laryngeal, oral, esophageal, pancratic, urinary -burns
BMI
-is a measure of relative size based on the mass and height of an individual -The index was devised by adolphe jacques quetelet during the course of developing what he called social physics between 1830 and 1850 -does not directly measure body fat -some people such as athletes have a vmi that identifies them as overweight even though they do not have excess body fat
Prohibition
18th amendment- prohibited alcohol in 1919. Repealed 14 years later by 21st amendment -was effective in reducing disease caused by alcohol. However, organized crime flourished -Prohibition against drugs such as heroin, marajuana, and cocaine is generally accepted -However the war on drugs may not be working, it is expensive empowers criminals t home and terrorist abroad, and sends thousands of people to prison for minor offenses
Regulatory Restrictions
1965 Warning Labels - Congress passed the Federal Cigarette Labeling and Advertising Act (FCLAA). 1967 Federal Communications Commission - Fairness Doctrine - counter-advertising 1971 - negotiated total ban on advertising 1992 - EPA -- environmental tobacco smoke is carcinogenic 1990s - nonsmokers rights movement 1997 President Clinton announces an Executive Order making federal workplaces smoke-free. The 2009 Tobacco Control Act requires that new cigarettes be reviewed by the FDA before being allowed on the market. Effective July 22, 2010, the law prohibits the tobacco industry from distributing or introducing into the U.S. market any tobacco products for which the labeling or advertising contains the descriptors "light," "low," "mild," or any similar descriptor, irrespective of the date of manufacture
National estimated cost of obesity
2009 study by the Centers for Disease Control and Prevention, along with RTI International (a nonprofit research group), found that the direct and indirect cost of obesity "is as high as $147 billion annually." The study was based on figures collected in 2006. The study found that in 2006, obese patients spent an average of $1,429 more for their medical care than did people within a normal weight range. That is a 42 percent higher cost for people who are obese According to the MO Dept of Health and Senior Services, regardless of health status, Missouri taxpayers pay $191 per person each year for medical expenses directly attributed to obesity related health costs.
Obesity +Tobacco + alcohol=
432 billion per year in health care cost
Missouri smoking facts
Adult Current Cigarette/Smokeless Tobacco Use In Missouri, the percentage of adults (ages 18+) who currently smoke cigarettes was 25.0% in 2011. Across all states and D.C., the prevalence of cigarette smoking among adults ranged from 11.8% to 29.0%. Missouri ranked 43rd among the states. The percentage of adults who currently use smokeless tobacco was 5.3% in 2011. Across all states and D.C., the prevalence ranged from 1.4% to 9.8%. Missouri ranked 37th among the states.
Unintentional injuries
All unintentional injury deaths Number of deaths: 120,859 Deaths per 100,000 population: 39.1 Unintentional Injuries are the leading cause of death among people ages 1 to 24
Many in the united states continue to be exposed to secondhand smoke
An estimated 88 million nonsmokers in the United States were exposed to secondhand smoke in 2007-2008. Children are at particular risk for exposure to secondhand smoke: 53.6% of young children (aged 3-11 years) were exposed to secondhand smoke in 2007-2008. While only 5.4% of adult nonsmokers in the United States lived with someone who smoked inside their home, 18.2% of children (aged 3-11 years) lived with someone who smoked inside their home in 2007-2008.
Injunctive Norms:
Approval of a certain actions (ex: drinking after 21 yr is approved in society or donating organs)
Dangers of second hand smoke- children
Ear infections More frequent and severe asthma attacks Respiratory symptoms (e.g., coughing, sneezing, shortness of breath) Respiratory infections (i.e., bronchitis, pneumonia) A greater risk for sudden infant death syndrome (SIDS) In children aged 18 months or younger, secondhand smoke exposure is responsible for— approximately 7,500-15,000 hospitalizations annually in the United States.4
Locus of control theory (self -Efficacy)
External Locus Everything happens by chance or due to others manipulation of my life. Internal Locus I can have an impact on my own health by the choices I make. Perceived self efficacy People's beliefs about their capabilities to produce effects. Self-efficacy is increased by previous successful performance Self-efficacy is increased by seeing others successfully perform, especially if model is a peer.
Dangers of second hand smoke- adults
Heart Disease: Increase their heart disease risk by 25-30%. Immediate harmful effects on the cardiovascular system that can increase the risk for heart attack. People who already have heart disease are at especially high risk.3,5 Secondhand smoke exposure causes an estimated 46,000 heart disease deaths annually among adult nonsmokers in the United States.6 Lung Cancer: Increase their lung cancer risk by 20-30%. Secondhand smoke exposure causes an estimated 3,400 lung cancer deaths annually among adult nonsmokers in the United States.6
Intentional Death: Homicide
Homicide Number of deaths: 16,121 Deaths per 100,000 population: 5.1 Firearm homicides Number of deaths:11,208 Deaths per 100,000 population:3.5
Obesity rates in 2030
If states' obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020—and double again by 2030. Medical costs associated with treating preventable obesity-related diseases could increase by up to $66 billion per year by 2030, and the loss in economic productivity could be as high as $580 billion annually.
Biomedical Basis of Smoking's Harmful Effects
Nicotine is an addictive drug -Raises blood pressure and heart rate -May cause spasms in blood vessels of heart Tars-provide flavor -Damage cilia & irritate respiratory tract Carbon monoxide -Interfere with oxygen carrying capacity of blood Other ingredients -Arsenic, benzene, are also carcinogenic -Alter clotting properties of blood -Raise blood cholesterol and reduce HDL
Epidemiology of obesity
Obesity has become a major health concern. 1 in every 3 adults is obese3 and almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th percentile of the CDC growth chart).4 -More than one-third (34.9% or 78.6 million) of U.S. adults are obese. [Read abstract Journal of American Medicine (JAMA) -Prevalence of overweight & obesity have been increasing since 1960s in males & females of all ages -Higher SES is associated with lower rates of overweight & obesity, especially among women -Among men, 73% are overweight & 33% are obese -Among women, 63.9% are overweight & 35% are obese -Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%) -Black women (80.3%) are more likely than white women (60.2%) to be overweight or obese -Black men and white men have approximately the same prevalence of overweight & obesity
Consequences of medical bias
Overweight patients ■ are reluctant to seek medical care; ■ cancel or delay medical appointments; ■ put off important preventative health care services Doctors seeing overweight patients ■ spend less time with the patient; ■ engage in less discussion; ■ are reluctant to perform preventive health screenings such as pelvic exams, cancer screenings, and mammograms; ■ do less intervention
Weight bias in employment
Overweight people: ■ earn 1 to 6 percent less than non overweight people in comparable positions, & obese females suffer more than obese males ■ get fewer promotions;13 ■ are viewed as lazy, less competent, and lacking in self-discipline by their employers & co-workers; more than half (54%) of overweight participants in a study reported they had been stigmatized by co-workers; ■ can be fired or suspended because of their weight, despite demonstrating good job performance & even though weight is unrelated to their job responsibilities
Descriptive Norms
Popularity of a certain action (ex: most youth use cell phone)
Overweight among children
Prevalence of oversight among 6 to 19 years old increased from 5% to 15% between 1960s and 2000s -High prevalence among mexican american boys and african american girls -type 2 diabetes is being diagnosed in children
Weight bias: a social justice issue
Science has documented clear, consistent evidence that overweight people face discrimination in employment, education, and health care. In a country where two out of three adults and one out of two children are overweight or obese, weight bias affects millions, at a steadily increasing rate. In 1995-96, weight discrimination was reported by 7% of US adults. In 2004-2006, that percentage rose to 12% of adults.
Smoking facts
Smoking is the leading preventable cause of death in the United States. Cigarette smoking causes more than 480,000 deaths each year in the United States. This is about one in five deaths. Smoking causes more deaths each year than all of these combined: Human immunodeficiency virus (HIV) Illegal drug use Alcohol use Motor vehicle injuries Firearm-related incidents More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history. Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths in men and women. More women die from lung cancer each year than from breast cancer. About 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD) are caused by smoking. Cigarette smoking increases risk for death from all causes in men and women. The risk of dying from cigarette smoking has increased over the last 50 years in men and women in the United States.
Others social factors influencing behaviors & health
Social Support _Alameda study found that an individuals health status and risk of dying strongly associated with social network -Social support can buffer stress Stress -Mortality is increased after death of a spouse, loss of a job, divorce, etc -Stress increases risk of heart disease, common cold -Daily hassles Demographic Factors -race/ethnicity, age, gender, marital statusCommunity Norms
FDA regulates new tobacco products
The U.S. Food and Drug Administration recently finalized a rule that extends its regulatory authority to all tobacco products, including e-cigarettes, cigars, and hookah and pipe tobacco, as part of its goal to improve public health. It extends the FDA's regulatory authority to all tobacco products, including e-cigarettes It requires health warnings on roll-your-own tobacco, cigarette tobacco, and certain newly regulated tobacco products and also bans free samples. It restricts youth access to newly regulated tobacco products by: 1) not allowing products to be sold to those younger than 18 and requiring age verification via photo ID; and 2) not allowing tobacco products to be sold in vending machines (unless in an adult-only facility).
Dangers of third hand smoke
Thirdhand smoke is contamination on the surface of objects that remain after the second hand smoke has cleared Thirdhand smoke mixes and settles with dust, drifts down to carpeting and furniture surfaces, and makes its way deep into the porous material in paneling and drywall. It lingers in the hair, skin, clothing, & fingernails of smokers—so a mother who doesn't smoke in front of her kids, smokes outside, then comes inside and holds the baby is exposing that child to thirdhand smoke. The new compounds are difficult to clean up, have a long life of their own, and many may be carcinogenic. In addition to cancer, thirdhand smoke could be responsible for asthma attacks & allergic reactions
Policy recommendations
To improve working conditions, healthcare, and overall quality of life for millions of Americans, include weight on the list of categories that are covered in antidiscrimination laws. This can be accomplished on a federal, state, or local level. In employment Include weight in the Civil Rights Act or create separate federal anti-discrimination legislation based on weight. In health care Encourage health care organizations to include language on weight bias in their patients' rights policies, & require weight bias training for all health care professionals. In schools Protect overweight and obese children from bullying and intimidation in school by requiring states and/or school districts to adopt and enforce policies prohibiting harassment, intimidation, or bullying on school property. Include weight as a specific protected category.
Introduction to accidents
Traditionally, injuries have been thought of as "accidents," unavoidable random occurrences or the result of antisocial or incautious behavior. Recently, public health practitioners have recognized that injuries can & should be treated as a public health problem, analyzable by epidemiological methods and amendable to preventive interventions. While most injuries are caused by some extent by individual behavior, they are also influenced by physical & social environment.
Personal Norms:
What most people around me do or approve
Social Norms:
What society does or approves
Social Injunctive norms
individuals' belief regarding approval or disapproval of the behavior in question by society (e.g., A majority of people in the United States approve of talking with family about organ donation.)
Personal injunctive norms
individuals' belief regarding approval or disapproval of the behavior in question by those valued others (e.g., Most people who are important to me would endorse my talking with my family about organ donation.)
Social descriptive norm
individuals' beliefs regarding the popularity of the behavior in question among people in society. (e.g., A majority of people in the United States have talked with their family about organ donation)
Personal descriptive norms
individuals' beliefs regarding the popularity of the behavior in question among those who are important to the respondent or whose opinion the respondent values (e.g., Most people who are important to me have talked with their family about organ donation.)
Weight Bias in Health Care Bias among medical professionals
■ In a study of 400 doctors, one of every three listed obesity as a condition to which they respond negatively. They ranked it behind only drug addiction, alcoholism, and mental illness. They associated obesity with noncompliance, hostility, dishonesty, & poor hygiene. ■ Self-report studies show that doctors view obese patients as lazy, lacking in self-control, non-compliant, unintelligent, weak-willed, & dishonest. ■ Psychologists ascribe more pathology, more negative and severe symptoms, & worse prognosis to obese patients compared to thinner patients
Weight bias in education: Bias by teachers
■ Teachers say overweight students are untidy, more emotional, less likely to succeed at work, and more likely to have family problems. ■ Forty-three percent of teachers agree that "most people feel uncomfortable when they associate with obese people." ■ Teachers have lower expectations for overweight students (compared to thinner students) across
Weight bias in employment: Bias examples
■ not being hired because of weight; ■ becoming the target of derogatory comments and jokes by employers and coworkers; ■ being fired for failure to lose weight; ■ being penalized for weight, through company benefits programs.
Examples of weight bias in healthcare
■being the target of derogatory comments and jokes by doctors, nurses, nutritionists, and other health professionals; ■ not being provided appropriate-sized medical equipment such as blood pressure cuffs and patient gowns. In one study of nurses ■ 31 percent said they would prefer not to care for obese patients; ■ 24 percent agreed that obese patients "repulsed them"; ■ 12 percent said they would prefer not touch obese patients
