BBH 302 Exam 2

Asian Paradox

- Leading cause of death is cancer, but when compared to other groups, it has the lowest rates -good birthing outcomes, but low levels of prenatal care

TB Trends

- between US born and foreign born Asians, foreign born asians have overall highest rates - In US born --> Blacks have the highest, then whites are number 2

AI/AN Census Data

- indian health services are federal! which means if the government shuts down, they get no services!!! -22% live on a reservation -20% spoke another language -26% live in poverty

Select all of the public health interventions covered in this paper that reduced opioid addictions in the 19th century.

- revolutions in bacteriology and public health - the development of alternative analgesics such as aspirin - stricter prescription laws - admonitions about morphine in the lay and professional literature

Which of the following are the leading causes of DEATH in Hispanic populations?

-Cancer -Heart Disease -Unintentional Injuries

Relationship between breast cancer and childbearing

-Childbearing is a protective factor - decreased birth rates indicate higher risk for cancer

Suicide Trends for YOUTH

-Highest in AI+AN

Suicide Trends for ADULTS

-Highest in Whites (specifically white men) - 2nd Highest is AI+AN

Which of the following was reported to be disparity (poorer outcomes) in both AI/AN men AND women, compared to Non-Hispanic White men and women?

-SMOKING -falling in the last 3 months -diabetes -obesity -leisure time physical activity

Hawaiin and Pacific Islanders Unique Disparities

-TB -Asthma -Personal care-=proxy

Which of the following were the 4 main barriers to participation in clinical research among African Americans?

-Trust -logisitics of the research process -communication -experimentation

Weathering (Incidence vs. Prevalence)

-age, when we reach 65 the life expectancy gap narrows -see major differences because blacks are developing diseases earlier in life, even if it is the same period of time

AI/AN Unique Disparities

-diabetes -infant mortality -alcoholism

Black Paradox

-prostate cancer: high screening -Breast cancer: high screening, but at later stage

Problem with Asians being the "model minority"

-they will get ignored. -underrepresentation in programs because they wont be included. -Many are still poor!

The authors state that there are 3 areas that need greater attention in order to achieve health equity. Which of the following are the 3 areas highlighted?

-working with multiple health and non- health sectors for health improvement of all populations, with a focus on at-risk communities -developing targeted strategies that address structural determinants related to health inequities that are rooted in social position, racism and discrimination, and access to social and health resources -developing targeted interventions for addressing disparities through increased awareness, education, and behavioral change targeting all perspectives and stakeholder groups

Highest rates of Heart Disease in which 2 groups?

1. Blacks 2. Non-Hispanic Whites

Drug Overdose

1st: 2nd: AI/AN

Health in all policies approach

A collaborative approach that health and health promotion are impacted by policies that are managed by non-health government and non-government entities

1st and 2nd highest asthma rates in what 2 populations?

Adults : - 1St: NH+OPI Children: -1st: Blacks -2nd: NH+OPI

In the movie, Drs. Collins and David described a research study that they conducted which showed that unfavorable birth outcomes in African American women were not due to genetics. What finding led them to this conclusion?

African women had birth outcomes similar to white americans Differences in living experiences and stressors is what is thought to cause this

Unique leading cause of death in Asians

Alzheimers

Indian Health Services (IHS)

An agency in the Department of Health and Human Services that provides comprehensive health care and services to native populations from federally recognized tribes

TB rates in NON-US BORN persons

Asians (1) --> Hispanics (2) --> Blacks (3)

Septicimia

Associated with: -longer hospital stays - long term illness such as infant mortality, cancer, HIV

What is the the HIGHEST in NH/OPI populations?

Asthma

Major health disparities in NH/OPI

Asthma (highest, blacks are second) High use of illicit drug disorder Low rates of cancer (despite low rates of screening) High rates of mental illness

Amenable Deaths

Avoidable deaths that could be prevented if individuals received adequate and timely health care

Why is it that blacks have a high rate of cancer screening, yet high incidence rates and even higher (the highest) mortality rates for cancer?

Because black women are getting screenings too late. Later than white women, thus white women have higher rates of Incidence but lower rates of Mortality than black women. (breast cancer) Black men have higher rates of incidence and mortality. Could be a result of the resource disparity between blacks and whites.

What population has the highest rates of cancer mortality rates in all sites?

Black men and women Whites men and women are second highest in mortality

Nurse Eunice Rivers

Black nurse that recruited for the Tuskeegee Study

Infant mortality rates

Blacks (1) --> AI/AN (2)

HIV/AIDs rates

Blacks (1) --> Hispanics/Latinos (2)

TB rates in US BORN persons

Blacks (1) --> Whites (2) --> Hispanics (3)

Non-Hispanic Black

Blacks who are not of Hispanic/Latino origin

What are the major cancer disparities for white men and women?

Bladder, Oral/pharynx, Lukemia/Lymphoma (mortality and incidence are highest) And melanoma (because of skin tone)

#1 leading cause of death in Asians

Cancer

#1 leading cause of death in hispanics/latino

Cancer

Major Barriers to Optimal health in Blacks

Centuries of Institutionalized racism Genetic Fatalism Urbanization and poverty Distrust of the medical system (Tuskegee study - the reason for informed consent)

The Asian sub population - Vietnamese and Cambodian Women have what cancer?

Cervical Cancer

Think back to the reading and lesson on levels of racism. The authors state that "Commodity food assistance programs, common on reservations, have provided high-calorie, high-fat foods that often replace a more healthy menu for low-income populations." Is this an act of omission or commission?

Commission

Latino Health Paradox or Hispanic Mortality Paradox

Despite generally being lower income and having lower education, Hispanics/Latinos in the U.S. tend to be healthier (in general) than other ethnic groups.

Unique leading cases of death in Hispanics/Latino

Diabetes Chronic liver disease (despite low alcohol use) Cirrhosis

Major Health Disparities in AI/AN

Diabetes Second highest in infant mortality (after blacks)

In NH/PI what is personal care Proxy to?

Disability

Disempowerment

Efforts to derive of power, authority, or influence: make weak, ineffectual or unimportant. Similar to marginalization

Which of the following health behaviors did the authors suggest may account for high rates of motor vehicle accidents in AI/AN populations?

Excessive alcohol use

Research has shown that African-Americans are more likely to participate in research studies that involve injections and medications than surveys and blood/urine samples.

FALSE

Health care coverage was high in survey respondents who lived in Indian Health Service Contract Health Service Delivery Areas, compared to Non-Hispanic Whites in those areas.

FALSE Approximately 23% of AI/AN persons reported that they had "no health plan" and ~28% that they had "no personal doctor." This compares to rates of approximately 12% and 19% for Whites in these areas.

Asian Paradox

Good outcomes in breast cancer, despite low rates of mammograms Good birth outcomes, despite low levels of prenatal care

Major Health disparities in Asians

H. Pylori Infection (associated with stomach cancer) High rates of Hep B (associated with liver cancer) Highest rates of TB in NON-US BORN PERSONS

Who is largest emerging population in the US?

HISPANICS/LATINOS 2nd = Africans

#1 Leading cause of death for AI/AN

Heart Disease

#1 cause of death in NH/OPI

Heart disease

#1 leading cause of death in blacks

Heart disease

Which of the following describes the Latina Birth Outcomes Paradox?

Hispanic women experience lower rates of low birth weight and mortality, despite lower socioeconomic status and inadequate health care

Latina Birth Outcomes Paradox

Hispanic/Latina women have similar birth outcomes as women of higher socioeconomic status and those with better healthcare access.

Obesity rates

Hispanics (1) --> Blacks (2)

Major Health Disparities for Hispanics/Latino

Hispanics/Latinos are the second highest in HIV/AIDS (after blacks)

Unique causes of death in Blacks

Homicide Septicemia Stroke HIV (US Born blacks have the highest rates of TB - then whites - then hispanics)

Major Health Disparities in Blacks

Infant mortality (highest compared to other populations) Maternal Mortality Hypertension Asthma (second highest rates after NHPI)

Major Barriers to Optimal Health in Asians

Language and cultural barriers Traditional vs. conventional medicine Dietary practices (fruit and vegetable intake, low dairy intake, Nitrates from processed foods) Limited access in the working poor - Poor working conditions - Crowding - Uninsured and underinsured - Fear of public charge

Major Barriers to Optimal Health for Hispanics/Latinos

Large proportion of the immigrant population Cultural and language barriers Disconnect with conventional medicine and traditional beleifs Urbanization and poverty

The Asian sub population - Vietnamese Men have what cancer?

Liver Cancer

Despite lower rates of alcohol uses, which of the following was higher in Hispanic/Latino populations?

Liver Disease - Hep B might explain these rates

Septicemia in blacks is caused by

Long term hospital stays, infants being in the hospital longer,

Asian are low in what cancer?

Low breast cancer and low rates of screening

What is the Alcohol Paradox for AI/AN populations?

Lower rates of alcohol use, but higher rates of alcohol misuse/overdose

Breast cancer rates were lower in Hispanic/Latina woemen, despite:

Lower rates of mammography use

Unique leading cause of death for AI/AN

Motor Vehicle Accidents Suicide (second highest after whites) Chronic Liver disease (low alcohol use) Cirrhosis

More careful prescribing of opioids for acute and chronic pain is an example of which level of opioid drug misuse prevention?

Primary

What condition is highly associated with the homelessness rates in blacks?

Schizophrenia

Urine toxicology is an example of which level of opioid drug misuse prevention?

Secondary

Factors such as macroeconomics, cultural values, socioeconomic status, and social support are known as:

Social Determinants of Health

Which of the 6 approaches applied in the integrative population health equity framework applies to the conditions in which people live, work and play, include things like housing, transportation, and racism?

Social Determinants of Health

H. Pylori infection increases the risk of _________ cancer, and Hep B increases the risk of ___________ cancer.

Stomach Liver

The Asian sub population - Korean Men have what cancer?

Stomach Cancer

In what ways does chronic stress impact pregnancy and birth outcomes?

Stress hormones might trigger labor Stress can constrict blood flow to the placenta, which can stunt the babies growth Inflammation inside the uterus which can trigger premature labor

Rates of mental health problems and psychological distress are high in Native populations. In AI/AN, for which mental health problem is the morality rate the second highest?

Suicide

Hispanics are more likely than Non-Hispanic Whites to live near the most polluted, hazardous waste sites that are potential threats to human health and the environment. What is the term for these sites?

Superfund sites

Apart for AI/AN men in the Southwest, AI/AN men and women were more likely to be tested for HIV than Whites.

TRUE

Opioid overdose prevention is one of the Centers for Disease Control and Prevention's top 5 public health challenges.

TRUE

Population health interventions are mostly tested on middle-class, White populations.

TRUE

Underrepresentation of African Americans in clinical research may lead to the inability to recognize factors related to disease prevalence, treatment, and health care that may be different in this population.

TRUE

Cancer Incidence is higher in whites, but mortality is higher in Blacks

TRUE - It's not because they dont get screened, it is because blacks get screened too late - also a tumor specific to black population that is very aggressive when untreated

Whites are often used as default?

TRUE - Lowest growth rate as well

Which of the following historical events played a major role in the lack of trust in the research process in African-Americans?

The Tuskeegee Study

Indian Health Service (IHS)

The agency responsible for providing healthcare services to American Indians and Alaska Natives is:

Genetic fatalism

The idea that there is nothing you can do to intervene in terms of health fate People not wanting do something because their family members died of one event so they think they will too

Asian Enigma

The paradox of low rates of gastric (stomach) cancer in certain parts of Asia, despite high rates of H. pylori infection, which increases risk of gastric cancer

Foreign born Asians fair far worse in terms of TB than US born Asians

True

True or False: Cancer is the #1 leading cause of death in Asian populations, yet they have the lowest Cancer incidence rates

True

Rates of what infectious disease was second highest in Hispanic/Latino Populations?

Tuberculosis

Which race is the most residentially segregated?

WHITES

What population has the highest rates of cancer incidence rates in all sites?

White women

Lung cancer trends

White women (1) --> Black women (2) Black men (1) --> White men (2)

Which three populations are high in suicide rates?

Whites (1) --> American Indians/Alaskan Natives (2) --> Asians (3)

Which age group was most highly impacted by heroin addiction treatment admissions between 2001 and 2011?

Whites ages 20-34

Non-Hispanic White

Whites who are not of Hispanic/Latino origin

Helicobacter Pylori (H. pylori) Infection

bacteria that infects the stomach. Most infected people are asymptomatic. Can be passed from person to person via saliva, feces or vomit.

Genetic Fatalism

belief that an individual is destined to develop a disease due to a family history of the disease. There is also a belief that no intervention (lifestyle or medical) is likely to change this destiny

genetic fatalism

everyone around you dies (Mom) = you will get it too regardless of what you do -wont adhere to what they are supposed to do

Hispanic/Latino Paradox

have better health outcomes than average population despite higher poverty rates

African women had birth outcomes similar to white americans

if not genetics, environment and stressors such as discrimination

Which of the following was considered the most prominent facilitator to clinical research participation among African-Americans?

involving the community in the research process, research planning and implementation

NA/AI Alcohol Paradox

low use of alcohol, but greater burden for those that do use it.

Asians and Screening

lowest rates

Incidence

number of new cases of disease during a specified time interval

Prevalence

number of total cases (new and preexisting) at a specific point in time. Usually expressed as a percentage during a specific year.

Asian Enigma

paradox in low rates of gastric (stomach) cancer in certain parts of Asia, despite high rates of Helicobacter Pylori infection, which increases the risk of gastric cancer

Model Minority

perception that Asian/Pacific Islander populations are the healthiest and wealthiest of all racial/ethnic minorities

Hopelessness and cultural loss

plays a role in health disparities Disempowerment AI and Hawaiins Structural racism

Safety Net Program

secondary prevention approach to providing goods or services (e.g., health care, food, education, etc., often for free) to individuals or communities who may have limited access to these goods and services.

Model Minority

the perception that Asian/Pacific Islander populations are the healthiest and wealthiest of all racial/ethnic minorities

Community-based participatory research

the process of engaging communities in the research process in order to improve the development of relevant interventions

Life course perspective

the study of the effects that risk and cumulative exposures have on health over the lifespan

Disempowerment

to deprive of power, authority, or influence: make weak, ineffectual, or unimportant

Social marketing approach

well suited for translating complex educational messages and behavior change techniques into concepts for a specific target audience

Peter Buxton

white whistleblower on Tuskeegee