Public Health 102 Final Review

Cure Violence Model

"Individual and community-level change in communities where it is a norm for young people to carry and use a gun to settle conflict. Attempts to stop the transmission of violence in a manner similar to that of public health interventions designed to curtail epidemics or to reduce the impact CV operates independently of, while hopefully not undermining, law enforcement. Three key elements to stop the violent behavior: The interruption of violence: preventing retaliatory shootings, mediating ongoing conflicts, and continuing to follow up to keep the conflicts "cool." Identifying and treating those at highest risk: carefully structured recruiting of high-risk youth and young adults Changing group norms: public education efforts and events with message that violence is harmful to everyone, unacceptable behavior, and can be stopped. The mix of staff members Violence interrupters form relationships with high-risk youth and monitor ongoing disputes to learn about potential acts of retaliation before they happen. The VIs try to "talk them down" or persuade them that there are other ways to negotiate the conflict Outreach workers connect to positive resources, including employment, housing, recreational activities, and education. Several studies have evaluated the CV model by monitoring implementation and outcomes. Chicago, Baltimore, Brooklyn, Phoenix, and Pittsburgh Mixed results that showed that strong adherence to CV methods and theories and buy-in from stakeholders were key to success

Social Contextual Framework

"Social Contextual Framework explains the role of the social context in health behavior change" -a set of factors and conditions with multiple levels of influence. - Social context may function as either modifying conditions or mediating mechanisms *Modifying conditions independently impact on outcomes but are not influenced by the intervention.* Mediating mechanisms are variables in the pathway between the event or intervention and the outcomes. - The model draws on mediating mechanisms from a number of social and behavioral theories that are potentially modifiable within the context of intervention in a range of channels.

Survivorship basics

*** a survivor is usually considered to be at least 2 years out of treatment (often >5)*** Over 460,000 childhood cancer survivors are alive today in the U.S.1 • Today, 83.9% of children diagnosed with any cancer go on to survive over 5 years, however, survivorship does not guarantee an end to the problem. Majority of cancer kids develop chronic illness (stroke, kidney problems,

Key stressors Prejudice events Stigma and stigma threats Concealment Internalized homophobia

**Prejudice** Antigay violence and discrimination are core stressors affecting gay and lesbian populations LGB people are disproportionately exposed to prejudice events, including discrimination and violence. LGB people were twice as likely as heterosexual people to have experienced a life event related to prejudice, such as being fired from a job LGB youth are even more likely than adults to be victimized by antigay prejudice events, and the psychological consequences of their victimization may be more severe. **STigma** Like other minority group members, LGB people learn to anticipate negative regard from members of the dominant culture. The greater one's perceived stigma, the greater the need for vigilance By definition such vigilance is chronic the "need to be constantly 'on guard' . . . alert, or mindful of the possibility that the other person is prejudiced" Different threats from stigma Categorization threat: involves threat that a person will be categorized by others as a member of a group against his or her will, especially when group membership is irrelevant within the particular context Distinctiveness threat: denial of distinct group membership when it is relevant or significant Value threats: Undermining of the minority group's values, such as its competence and morality. Threat to acceptance: Negative feedback from one's in-group and the consequent threat rejection by the group. ***Concelement***Concealing stigma is often used as a coping strategy -avoiding negative consequences of stigma It can backfire and become stressful LGB people may conceal their sexual orientation in an effort to either protect themselves from real harm or out of shame and guilt Concealment is an major source of stress for gay men and lesbians ***Learning to hide is the most common coping strategy of LGB adolescents*** Internalized homophobia A form of stress that is internal and insidious Lesbians and gay men may be harmed by directing negative social values toward the self. -Even in the absence of overt negative events -Even if one's minority status is successfully concealed Gay people maintain varying degrees of residual antigay attitudes that are integrated into their self-perception that can lead to mental health problems ***Ex: Gay men trying to hide the way they talk because in society it is stigmatized and they feel ashamed of it.

Distal to proximal stressors

*Distal minority stressors*: objective stressors in that they do not depend on an individual's perceptions or appraisals Can be seen as independent of personal identification with minority status Ex: a woman may have a romantic relationship with another woman but not identify as a lesbian, but if she is perceived as a lesbian by others, she may suffer from stressors associated with prejudice toward LGB people *Identity is proximal*, and minority identity is linked to a variety of stress processes Vigilant in interactions with others (expectations of rejection) Hide their identity for fear of harm (concealment) Or internalize stigma (internalized homophobia).

Work and school effects

-Employed adults in the U.S. spend about one-quarter of all of their time at work. -Worksites often provide easy access to unhealthy foods in vending machines and limited access to healthier options, such as fruits and vegetables. -Studies have shown that making changes to the workplace food environment, such as offering more healthy foods in company cafeterias, results in improved diet quality. -Work environments can also increase the risk of obesity arising from job stress and work-related fatigue, linked to poor diets and reduced physical activity. -Shift workers and employees working longer- than usual hours every week have a higher risk of obesity.

Five guiding concepts of SE 1.population perspective 2.social and economic context of behavior 3.Contextual multilevel analysis 4.developmental and lifecourse perspective 5.resistance and susceptibility to disease

1. An individual's risk of illness cannot be considered in isolation from the disease risk of the population to which s/he belongs. We must incorporate the social context into explanations about why some people stay healthy while others get sick. Some prevention activities should target whole populations regardless of the variation in individuals' risk status (Using a bird eye view of the whole population) 2. Behaviors are not randomly distributed in the population. They are socially and economically patterned and often cluster with one another..The social environment influences behavior ~ shapes norms ~ enforces patterns of social control ~ provides (or not) opportunities to engage in certain behaviors ~ reduces or produces stress for which certain behaviors may be an effective coping strategy, at least in the short term. 3. Ecologic-level exposures in environmental and infectious disease epidemiology are well established. Also valid ecologic-level exposures related to the social environment. Lead to an understanding of social determinants of health that is more than the sum of individual-level measures. 4. Identification of periods of causation is central to improving population health. Three main life course trajectories: ~Early development and childhood: the importance of early life exposures in shaping cognition and brain ~Most adult disease is not likely the result of early childhood or prenatal exposure but rather the result of a lifetime of accumulated exposures ~ Social trajectory model of health and disease: early life exposures do not directly affect adult health. They influence adult social conditions, which, in turn, affect adult health. 5. The general susceptibility hypothesis: ~whether individuals developed one disease or another depended on their behavioral or environmental exposures as well as their biological or genetic makeup. ~whether they became ill or died at earlier ages or whether specific socially defined groups had greater rates of disease depended on socially stressful conditions. ~Social epidemiology has become more integrated neuroscience: clear biological mechanisms have been defined.

Key pathways

1. Through direct physiological effects on the development of disease or maintenance of health via biological alterations as a result either of cumulative effects of repeated emotion experiences or of an extreme and acute emotion episode. 2. By motivating (or demotivating) health relevant behaviors such as cigarette smoking or risky sex.

Theoretical model of influence of social networks on health

A "cascading causal process" (SE, 243) of dynamically linked processes, from the macro- social to the psycho-biological

Lifecourse perspective on emotions and health

A lifecourse perspective can help to clarify how and why emotions might influence later health outcomes And how effective emotional functioning is influenced the social and family environments Emotions are fundamental to adaptation -Providing impetus and mechanisms for adaptive behavior. -A major task of early childhood is developing emotional regulation -The ability to control frustration, delay gratification, or self soothe contributes to or undermines the growth of new skills in young children -This in turn matters for learning to evaluate risk and make decisions and for navigating social challenges. -Dysregulation in childhood emotional functioning has been demonstrated to persist into adulthood -Conversely, appropriate regulation may lead to developing resilient emotions and behaviors

Prostrate cancer disparities

African-American men have the highest incidence rate for prostate cancer in the United States and are more than twice as likely as White men to die of the disease. Lowest death rates for prostate cancer are found in Asian/Pacific Islander men. Hypothesis that genetic factors might partly account for the observed differences. Variants—in human DNA that are associated with the risk of developing prostate cancer. Nearly all of the variants were found most often in African American/Black men Also: Social context very important Barriers to screening and diagnosis: low SES, lack of health insurance coverage, unequal access to health care services, and absence of ties to a primary care physician African-American men less likely to receive regular physical examinations and screening for prostate cancer

Antecedent and response strategies

Antecedent-focused strategies are employed before an emotion occurs -When stressed, we can reappraise the situation, changing our cognitive appraisals to prevent or reduce the intensity of negative emotions. Response-focused strategies are employed after an emotion has occurred -modifying the behavioral manifestations of the emotion (e.g., suppression) -such efforts may be taxing and may not mitigate the negative emotional experience The appropriateness of any given strategy is context-dependent A greater reliance on antecedent-oriented regulation may be more adaptive

Work-family conflict

Beginning in the 1950s and 1960s, women in many countries around the world joined the paid labor force in unprecedented numbers -In some countries women struggled to balance work and family demands - in other countries public policies and workplace practices enable working families to maintain labor force participation and family life simultaneously. Work-family conflict based on role theories -Conflicting roles, expectations, and demands shape strains. Conflict can move from work to family, or family to work. -The model links job demands, job control, and social support to a broad range of outcomes for working families Women are especially affected, but men increasingly suffer from many of the same work-family demands. -Health effects among mothers may spill over directly to their children during in utero experiences and may play out over childhood via related behavioral and environmental interactions -Work-family conflict was thought to take its greatest toll on organizational outcomes such as turnover, absenteeism, and job dissatisfaction. -Mental disorders are often significantly associated with work-family conflict among both men and women.

Indirect behavioral pathways

Behavioral risk factors mediate relationships between trait negative emotions like anger or depression and cardiovascular morbidity and mortality Ex: smoking, alcohol consumption, physical activity State emotions may also indirectly affect health through associations with behavioral and other risk factors. Positive emotions such as pleasure and joy are routinely targeted in advertisements for cigarettes to lowering consumers' judgments about the risks associated with their use. Negative emotions activate dopamine reward centers of the brain among smokers, making it more likely they will reach for another cigarette Emotions also influence social processes, social relationships, and cognitive processes concerning health-related decision-making, which in turn influence health

Cultural capital

Cultural capital: The acquisition of certain habits (e.g., going to museums and concerts), preferences, or styles of speech and dress as "which individuals use to express their symbolic status in society."

Early detection disparities

Disparities in early detection of cancer Differential of rates of use screening tests Ex: 72.1% of non-Hispanic white women over 40 had a mammogram in the last two years African-American 68.2%, Hispanic 62%, AsianAmerican 57%, Native American 52% Lack of screening is the primary blame for the greater burden of cervical cancer among Hispanic and African American women the higher death rate from breast cancer among African-American women. Also disparities in later stage diagnoses of many cancers.

Individually oriented interventions: Motivational Interviewing

During the 1980s and 1990s, most interventions were individually targeted ~typically relied heavily on health education and advice giving ~grounded in theories emphasizing the need to strengthen psychosocial precursors for behavior change ~knowledge and attitudes such as self-efficacy and outcome expectations Interventions were typically small-scale, long in duration, and complex. ~developed in clinical or laboratory settings, with change expected to occur in a linear and rational sequence ~many of them were costly, and the external validity of some has been questioned Motivational Interviewing ~ involves the use of counselors in nonjudgmental and nonconfrontational encounters to help individuals work through their ambivalence to behavior change ~ effectiveness of motivational interviewing is highly dependent on the training of counselors Telephone-Based Interventions ~ Good evidence for initiation of behavior change. ~ Scalability is questioned because of training. eHealth technologies ~ deliver interventions through one or a combination of mobile websites, text messages, or e-mails. ~ Little evidence the interventions have worked well, but it's believed they will improve as technology does

Differences between standard epidemiology and social epidemiology (SE)

EPI: the study of what is upon the people; study of distribution and determinants of health across populations. Social EPI: The branch of epidemiology that studies the social distribution and social determinants of health

Straits and traits

Emotions are either 1.Transitory states brought on by specific situations 2. Traits that are stable and general dispositions to experience particular emotions Certain personality types may be more vulnerable to disease because they are predisposed to particular emotions -Individuals high in trait anger experience the transitory state of anger more frequently and intensely -Hostility predisposes individuals to experience more episodes of anger, suspicion, and cynicism -Hostile individuals may create hostile environments, creating more opportunities to experience anger. The broaden and build model Positive emotions produce optimal functioning. Joy, interest, contentment, and love lead to a broader range of thought and action tendencies. Broadening these tendencies over time serves to build personal resources.

Direct biological pathways

Emotions are hypothesized to influence health directly because they evoke physiological processes -As multiple biological pathways are almost certainly involved -Activation of the hypothalamic-pituitary-adrenal [HPA] axis and the sympathetic nervous system [SNS] --Ex: Elevations in serum norepinephrine levels are associated with negative emotions and may increase blood lipids, free fatty acids, blood pressure, and heart rate, and lead to constriction of peripheral blood vessels. -Over time, recurring activation of these systems may set disease-related physiological processes in motion. -Growing evidence linking depression and anxiety to chronically elevated levels of inflammation

Basic emotional theory

Emotions have cognitive, neurobiological, and behavioral components biologically based a product of the interaction between the person and the environment mediating between continually changing situations and the individual's behavior. An emotion serves as signal that the person is faced with a particular challenge or threat, and this motivates a response. Fear causes us to fight or flee Each emotion depends on an individual's appraisal of events their importance the demands they place on the individual the options and prospects for coping Emotions serve to communicate a person's emotional state and likely behaviors to others Action tendencies: Emotions are associated with urges to act in particular ways to help the individual to cope with environmental demands

Etiology of childhood cancers

Etiology: (Cause or origin of disease) Different for childhood cancer compared to adult cancer - No lifestyle/behavior component - No random time effect where cells develop cancerous mutations over time - Very little is understood about cause of most childhood cancers. Believed to be mostly caused by random acquired (in utero) genetic mutations.

Emotions influencing CHD

Extensive research on effects on emotion on coronary heart disease (CHD) In the 1950s: a new risk factor for CHD called the Type A behavioral (TAB) pattern. An action-emotion complex that requires an environmental challenge to serve as the trigger for expression. The overt manifestations of the behavior include a freefloating but well-rationalized hostility, hyperaggressiveness, and a sense of time urgency. Large-scale epidemiological studies in 1960s and 1970s appeared to corroborate the Type A hypothesis NIH, 1981: TAB was an independent risk factor for CHD Enthusiasm waned after a series of cohort studies that failed to find a relationship with CHD. Given the similarities between certain emotional states, investigators hypothesized that a number of negative emotions may be risk factors for CHD

Family Ecological Model

Family ecological factors shape family social and emotional environments Parents' experiences of social disparities and chronic stress influence -parents' food and physical activity and parenting practices - in turn, children's diet and physical activity behaviors and, subsequently, their obesity risk. -Successful family interventions for obesity prevention and control will require a holistic approach ~addressing family ecological factors and parents' experiences of social disparities and chronic stress ~in conjunction with more traditional features of obesity interventions, including knowledge and skill development in healthy lifestyles.

Treatment and survival disparities

Five-year survival rates from cancer show disparities among race, even though there's little evidence that racial and ethnic populations differ in their response to treatment. They do, however, differ in access to high-quality cancer care Some examples: Between 1988 and 1998, women with Stage I and II breast cancer were less likely to be treated with breast-conserving surgery and radiation if they resided in poorer census tracts African Americans with Stage I or II non-small cell lung cancer are less likely to receive the recommended treatment of surgery than Whites, even if they have insurance and are at the same income level. African Americans with cervical cancer are more likely than Whites to go unstaged and receive no treatment. Whites are more likely than persons of other racial/ethnic groups to receive aggressive treatment for colorectal cancer.

Community-level factors

Food deserts -Roughly 2 million U.S. households live more than a mile from a supermarket and don't have cars or access to cars. -Living in food deserts has been associated with lower quality diets and increased risk of obesity in some studies. **Also: evidence that low-income neighborhoods are less likely to have access to large supermarkets offering high-quality and low-cost food, compared to middle income neighborhoods and white neighborhoods**** Convenience Stores -Convenience stores often offer less variety, higher prices, and lower quality produce than supermarkets. -When small stores do stock healthier foods, however, people living nearby eat better. -Convenience stores and other small stores selling unhealthy snack foods are more likely to locate in poor neighborhoods and particularly near schools. Fast Food -Eating fast food has been shown to increase caloric intake and the risk of becoming obese -Not as clear that living or working closer to fast-food restaurants have the same effect; some studies found a relationship, others didn't. ***But: Fast-food restaurants are more likely to locate near schools, and their close proximity to schools has been linked to increased risk of obesity in children. ***

Functional syndromes

Functional syndromes: medically unexplained symptoms with no pathologically defined changes in tissues can be found Fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, etc. Potentially related to hyperexcitement of central neurons Emotional factors may play an important role in the development and exacerbation of these syndromes Empirical evidence lags in part because of the lack of "objective" indicators syndromes, which are largely diagnosed based on symptom reporting. Do traumatic or stressful events precede these syndromes? Findings mixed or weak Can treatment for psychological distress improve outcomes? For fibromyalgia patients identified a small but consistent effect An unmet public health challenge: emphasizing the importance of understanding the interrelationships among affect, symptoms, and health.

Gun Control Act and the Brady Act

Gun Control Act: The Federal Firearms Act of 1938 and the Gun Control Act (GCA) of 1968 Basic structure for accountability in the firearm industry by requiring federal firearm license. Required firearms to have serial numbers and imposed record-keeping. Individuals purchasing firearms from FFLs to sign a form stating that they were not convicted felons or otherwise disqualified Could be prosecuted for "lying and buying" Gun dealers had no obligation to verify that a purchaser was not proscribed from possessing firearms. Brady Act:The Brady Handgun Violence Prevention Act of 1994 Mandated background checks to determine whether individuals seeking to purchase firearms from licensed gun dealers were prohibited from possessing firearms. From 1994 through 2010, National Instant Criminal Background Check System (NICS) received more than 118 million firearm purchase applications, and 2.1 million of those requests were denied either by the FBI or by state or local law enforcement agencies

Health Decision Model

Health decision model takes social variables of experience, knowledge, and interaction into account -Along with severity, susceptibility, and evaluation Decisions about health actions are made in the context of other people Requires knowledge and appreciation of the important of social context peer attitudes influential groups

Race and ethnicity in survivorship health outcomes

Hispanic and non- Hispanic black children have significantly lower 5- year survival rates. Non-Hispanic white and non Hispanic black girls have higher survival rates than boy counterparts. No difference for Hispanic boys and girls. Controlling for other important factors, Hispanic and non-Hispanic black children have higher risks of death from ALL than white children. The poorer the neighborhood, the higher the risk of death.

Health Belief Model

How do we explain the absence of action? -HBM: a person's perception of risk is mistaken HBM model for healthy behavior change -Recognize that they are susceptible to a particular condition -Perceive that the severity of the condition is such that it is worth avoiding. -Perceive that the benefits of avoiding the condition are worth the effort of changing the behavior and the possible adverse effects of the change -Perceive that they have the self-efficacy (skills, assertiveness, etc.) to change their behavior. -Cues to action are considered important in assisting all stages of change in this model.

HIV and social capital

How social capital may affect HIV rates -health-promoting behaviors: "Condom mandate," monogamy, serosorting -access to services and amenities: Clinics, health insurance -mutual trust: Decreased stigma -greater political participation: Activism, lobbying Ex: In South Africa, civic participation was studied as a proxy for understanding community influences on HIV infection. -Participation in certain churches, sports clubs, and youth groups were protective -Membership in other social groups that encouraged high levels of social drinking increased HIV risk.

Basics of HIV/AIDS treatment and prevention

Human Immunodeficiency Virus - Retrovirus: Uses reverse transcriptase transcribe RNA into DNA inside infected cell -Attacks the immune system, particularly the CD4 cells, or T cells. -After a latency period of up to 10 years, depleted immune system allows for opportunistic infections Acquired Immune Deficiency Syndrome -CD4 cells falls below 200 cells per cubic millimeter of blood -Or, one or more opportunistic infections along with HIV, including Kaposi's sarcoma, TB, and Pneumocystis carinii pneumonia -Without treatment, average life expectancy is 3 years

Human capital theory

Human capital: "the stock of knowledge, competencies, or other personal attributes that an individual has and that contribute to his or her 'productivity'" (SE, 183) Health is a form of human capital, and it complements other forms of human capital. -Job loss may lead to a loss of human capital by eroding skills and earnings, which may in turn lead to poor health in the long run. - Staying in labor market reduces the human capital loss, providing health gains for mothers and children. The Grossman model: -rational actor theory of the demand for health -Health is capital, a stock determined by investments and speding. -A consumption good providing utility and an investment good Predicts various effects on the labor market: - Health status determines the total time an individual spends in sickness, and therefore determines the total time available for market and nonmarket activities. However: ~Increased labor supply decreases the time available for producing better health through exercise, better cooking, etc. and increases likelihood of experiencing poor working conditions

Breast cancer disparities

In the United States, White women have the highest incidence rate for breast cancer African American women are most likely to die from the disease. Breast cancer incidence and death rates are lower for women from other racial and ethnic groups than for White and African American/Black women. Lack of medical coverage, barriers to early detection and screening, and unequal access to improvements in cancer treatment may contribute to observed differences in survival between African American/Black and White women. Aggressive breast tumors are more common in younger African American and Hispanic women living in low SES areas. This form of breast cancer is less responsive to standard cancer treatments and is associated with poorer survival

Direct versus Indirect

Indirect: Compare health outcomes of subordinated and dominant groups without direct data on exposure to discrimination. - If outcomes differ, researchers determine whether disparities can be explained by "known risk factors." -Interpret findings in light of how discrimination may shape distribution of the relevant "risk factors." -If a residual difference persists, even after controlling for these other risk factors, additional aspects of discrimination may be inferred as a possible explanation for the remaining disparities. Weakness in making causal inferences based on omitted variables, but -better than leaving the question unasked and the inequities unanalyzed. -utility for analyzing outcomes where individual knowing about not only her or his own experience but also that of others Nevertheless: Extensive evidence indicates that racial/ethnic inequities in income contribute significantly to explaining racial/ethnic inequities in disease occurrence, survival, and mortality. DIRECT: Devising valid and reliable instruments to measure individuals' exposure to discrimination -across the lifecourse -direct target or as a witness -behaviorally, psychologically, and physiologically responses Many of these instruments measured mental health -depression, anxiety, other psychological stressors Other focuses have been hypertension or blood pressure Two of the early studies reported that blood pressure and heart rate among African Americans increased more quickly upon viewing movie scenes involving racist, as compared to nonracist but angry, or neutral, encounters. EX: For Places in the Heart: neutral was a man consoling a child after the child's father's death; anger was a banker harassing a young woman over house repossession; racist was a Ku Klux Klan attack.

Reserve capacity model

Individuals of low SES achieve and maintain a smaller reserve of resources that promote effective management of stressful circumstances and reduce likelihood of experiencing significant distress. These resources may include social resources (e.g., social support, neighborhood social capital) and intrapersonal resources (e.g., sense of control, self-esteem). "Willpower" or the capacity to self-regulate as a form of reserve capacity Self-regulation - such as the ability to resist temptation and to delay gratification - tends to become drained under duress. Bandwidth tax: The ability to develop such reserves among low SES individuals may be limited because individuals in disadvantaged circumstances are exposed to more situations that require use of their resources, thereby depleting their reserves

Informal social control

Informal social control: the ability of adults in a community to maintain social order From criminology: A cohesive community is one in which residents can rely on its adults to step in when they witness unlawful behavior not just parents or formal law enforcement The likelihood rises when there is network closure When adults in a community are socially connected to each other. Applicable and relevant to the prevention of many health behaviors including underage smoking, drinking, or drug abuse. Whenever a parent relies on her neighbors to police the behaviors of their children when they are not looking, she is benefiting from the network to which she belongs. Informal control is a collective characteristic of the group.

Emotional regulation

Involves monitoring and managing one's emotional experience and response Negative and positive emotions and the interplay between them are products of emotional regulations Learned through socialization and experience over time, heavily influenced by the social environment. A dynamic process involving both up- and down-regulation of positive and negative emotions. An aspect of "self-regulation," along with the ability to focus attention, resist impulses, and delay gratification

HIV and law and policy ~Direct and indirect effects

Laws underlie many key social determinants of HIV/AIDS -housing, poverty and income inequality, racism, and community social organization DIRECT effect: a pathway through which social determinants affect health -legal restrictions on access to sterile injection equipment, which have been associated with higher HIV incidence INDIRECT effects: contribute to social conditions associated with health outcomes -tax laws on income inequality, which may foster social conditions that increase HIV vulnerability. Policies guide allocation of resources - Importance to HIV/AIDS include macroeconomic policy, health policy, social policy, and illicit drug control policy. Structural-level health policies governing prevention, treatment, and care can contribute to dramatic changes -Ex: Ryan White Care Act provides healthcare and medications to every HIV-positive person in need in US -Ex: Eliminating assistance to people with substance use disorders in San Francisco in 1990s led to increased risk behavior and fewer people in treatment for addiction.

Acute triggering of CHD

Links between risk of incident CHD and specific emotions like anxiety, anger, and depression Anger and hostility implicated as "toxic" components in the relationship between Type A behavior pattern and CHD Hostility: a long-standing attitudinal disposition, as opposed to anger, considered an emotion and a component of hostility Anger: an unpleasant emotion in response to events that are perceived as unjust, accompanied by physiological arousal, the activation of action tendencies or impulses toward aggression. Several meta-analyses have provided evidence that chronic anger and hostility are independent risk factors for the development of CHD

Invisible and historic discrimination

Many forms of discrimination are institutional and often invisible or unnoticed. -Only determined over the long-term, through research. -Examining patterns of economic inequality. - Focusing on trends in employment, housing, education, health. This research can then be used to make visible the structures and behaviors involved in discriminatory practices. While racial prejudice has declined over time, cultural ideologies supporting discrimination are embedded in the culture. Historic: - People underreport negative social attitudes -Dominant groups typically deny discrimination exists, especially if it is no longer legal. ~For example: Pew research conducted a study to see white versus black. More whites thought that racism is gone than black people. -Friendly feelings toward individual members of subordinate groups are often combined with the denial of any responsibility for institutional discrimination.

Health effects of unemployment and recessions

Mental and physical health respond differently to economic shocks. Several measures of mental health seem worsen during economic recessions and improve during economic expansions. People behave in more healthy ways during harsh economic times, while they tend toward less healthy behavior when the economy is doing well. Recessions may lead to short-term changes in health behavior, over the long-term, exposure to recessions in key periods of the lifecourse may lead to permanent changes in health and aging Effects of economic downturns on the health of low-skilled, low-wage workers may also differ from the effect on higher-skilled workers with more stable careers. One study based on US data: Working-age adults with low educational level and the employed overall suffer increased mortality during economic contractions More highly educated, unemployed, disabled, and retired experience reduced mortality during economic downturns

MINORITY STRESS THEORY

Minority stress is a form of social stress excess stress to which individuals from stigmatized social categories are exposed as a result of their social, often a minority, position. For an member of a stigmatized minority group, the disharmony between the individual and the dominant culture can be significantly stressful To many, the connection between negative regard from others and harm to the minority person is self-evident "One's reputation, whether false or true, cannot be hammered, hammered, hammered, into one's head without doing something to one's character"

Globalism

More open global agricultural marketplace has led to cheaper food. -1994 General Agreement on Tariffs and Trade included agricultural products -Over the past four decades, the price of beef has dropped an 80% Changes in food prices have been linked to changes in how much people eat and thus their risk of obesity. -Trade liberalization gives people access to different types of food and more high-calorie processed foods. -As countries start to move up the income scale, obesity rates climb, -More people now have enough money and leisure time to watch television, buy processed foods, and eat food away from home "Nutrition transition" -Globalization helped move countries from famine to food sufficiency. -Globalization has accelerated shift from food sufficiency to Western-style feast, and to obesity and obesity-related diseases.

OBESITY

More than 78 million adults in the US were obese in 2010. -Overweight is a BMI of 25 to 29.9; obesity is ≥30. -Current: 69% of adults are overweight or obese, 35% obese -Increases in the rates of obesity appear to be slowing or leveling off. Major contributor to chronic diseases -Associated with increased risk in all-cause and cardiovascular disease mortality. -Hypertension, type 2 diabetes, stroke, gallbladder disease, osteoarthritis, respiratory problems, and some cancers. -Clinical depression, anxiety, and other mental disorders -Low quality of life: body pain and difficulty with physical functioning Hugely costly -Obese patients: 46% higher inpatient costs, 27% more physician visits and outpatient costs, and 80% increased spending on prescription drugs. -The medical care costs of obesity in the US: $147 billion

Emotion measurements

Most epidemiological studies on emotion and health have relied on self-reports of emotion, using a specific emotions approach. Scales with labels like "happiness," "sadness," and "anxiety" have been derived using this approach. Adjective checklists or lists of statements that respondents endorse in terms of the extent to which each statement applies to them. A broad array of well-validated scales for measuring anger, anxiety, and depression, but fewer for positive emotions. Self-report assessments have a number of problems Study participants must be willing to disclose what may feel like private information. Individuals may lack insight into themselves and fail to give accurate reports of the emotions they experience. Social desirability: Some participants may want to present themselves in the best light possible, and therefore fail to respond accurately to the questions Measures other than self-report are possible Peer report: Asking spouses to provide emotion ratings for study subjects Observer ratings: trained interviewers observe and rate subjects on their emotions. Difficult to define someone as "not exposed" to emotions like anxiety or anger or happiness, since almost everybody generally experiences some level of each emotion. Many epidemiologic studies are opportunistic, making use of whatever measure may be available, recognizing the tools available may not be ideal.

Lung cancer disparities

Motivation to begin and to continue smoking is strongly influenced by the social environment, although genetic factors are also known to play a role. Poor and minority communities are selectively targeted by the marketing strategies of tobacco companies Among adolescents and young adults, in particular, tobacco use is influenced by: The use of tobacco and approval of tobacco use by peers, family Accessibility of tobacco products and exposure to tobacco ads Low self-image or self-esteem Smoke-free protections, tobacco prices and taxes, and the implementation of effective tobacco prevention programs all influence tobacco use. No early screening for lung cancer, but there are disparities in diagnosis. Higher proportion of men residing in high-poverty census tracts (59.0%) were diagnosed with distant-stage lung cancer than those residing in low-poverty census tracts (54.6%).

Ways increased education may improve health

Numerous studies linking increased education to better health outcomes. Set of cognitive or emotional skills foster health promoting decisions throughout life. Literacy and numeracy are likely to help individuals to make healthy decisions. More abstract skills, such as the ability to think abstractly, self-regulate, delay gratification, or adhere to organizational rules, may also be important. Education may promote lifelong participation in cognitively challenging activities, which may in turn increase the chances of better health and survival. Time spent in school is also time not spent engaged in other activities, some of which may be health-damaging. May improve long-term health by increasing the chances that you will have a well-educated spouse, well-educated friends, and well educated acquaintances.

Biological causes

Obesity is caused by a chronic energy imbalance involving both dietary intake and physical activity patterns. -The same amount of energy IN and energy OUT over time = weight stays the same -More energy IN than energy OUT over time = weight gain -More energy OUT than energy IN over time = weight loss Inactivity (not enough energy out) and/or unhealthy, highly caloric food (too much energy in) Genetics -Studies of identical twins raised apart show that genes have a strong influence on a person's weight -Genes also may affect how and how much fat is stored in your body **Other medical conditions (e.g., hypothyroidism and polycystic ovary syndrome) and prescription drugs (e.g., steroids, anti-depressants) can increase the risk for obesity.**

Coping and resilience

Positive coping is common and beneficial to members of minority groups Minority status is associated not only with stress but also with important resources -group solidarity and cohesiveness that protect minority members from the adverse mental health effects of minority stress Coping can also have a stressful impact --For example, concealing one's stigma is a common way of coping with stigma and avoiding negative regard, yet it takes a heavy toll on the person

Family Causes

Pregnancy and infancy: -Mother's smoking habits, weight gain and blood sugar levels (gestational diabetes) during pregnancy -How rapidly an infant gains weight, how long breastfed, and how much sleep. Families influence children's dietary choices and risk of obesity -Children develop food preferences at home that last into adulthood. -Strong association between the availability of fruits and vegetables at home and whether children, adolescents, and adults eat these foods. -Eating meals as a family, and doing it often, has been linked with increased child and adolescent intake of fruit and vegetables and other healthy foods Poorer families have it harder -Healthy foods are more expensive than less healthful foods and may be too expensive for low-income families. -People in lower-income households often have less time for meal preparation and other household chores.

Basics of childhood cancer incidence and mortality

Race/ethnicity matters; how much of it is genetic and how much is social has yet to be determined - SES matters, beyond just income/insurance - Gender matters, most likely biological/genetic

Social capital

Social capital: Tangible resources embedded in social relationships, available for members to access.

Social contagion

Social contagion: behaviors spread more quickly through a tightly knit social network. The greater the transitivity of a network the more paths there are for members to influence the behavior of others. Transitivity: how saturated the social connections are between individuals in a network Behaviors spread through a network through the diffusion of information through the transmission of behavioral norms. Sometimes the behavior that spreads via the network can be deleterious to health Spread of obesity or drug use, through a social network The behavior can be health-promoting Spread of smoking cessation or healthy eating Christakis and Fowler's smoking data from Framingham Influenced by the behavior of people we do not even know by virtue of our membership in a network, we may still "benefit" from the rippling contagion triggered by the behavior of others in a distant part of the network. Corollary: We expect to observe faster diffusion of behaviors in networks with higher social capital that are more cohesive.

Health effects of employment protection policies

Social protection- helping rational economic actors overcome market failures in human capital formation: 1 Maternity leave policies: - Reduce gender differences in labor market trajectories, labor supply and accumulation of human capital due -Increase labor market attachment by making it easier and more likely women will return to work 2Retirement policies: -in theory, workers invest more in skills and human capital if they expect to retire later- thus increasing retiement ae may be a good idea. -Retirement policies influence human capital investment decisions concerning work and employment, in turn influencing trajectory of careers and earnings

Ecosocial theory

Started by Krieger in 2001: Ecosocial theory, the central question of which is: -Who and what is responsible for population patterns of health, disease, and wellbeing, as manifested in present, past, and changing social inequalities in health? **Ecosocial theory emphasizes accountability and agency.* The ecosocial theory of disease distribution concerns who and what drives social inequalities in health. How we literally biologically embody exposures arising from our societal and ecological context, thereby producing population rates and distributions of health. Explicit consideration of pathways of embodiment -types and levels of exposure -the period and spatial expanse involved -historical context -phenomena that affect susceptibility and resistance to exposure, ranging from micro (gut microbiome) to macro (organizing to challenge health inequities). Key issues: accountability (causal responsibility for) and agency (the power and ability to act) -not only to the magnitude of health inequities but also to how they are monitored, analyzed, and addressed. Discrimination is conceptualized as a dynamic phenomenon: simultaneously structures individual risk and population rates of disease, thereby giving rise to health inequities.

HIV and stigma

Stigma, discrimination, and collective denial have played central roles in shaping responses to HIV/AIDS epidemics The effects of stigma -Individual reluctance to seek HIV testing - Lack of empowerment to enact HIV prevention. -One-third of those with HIV do not know their HIV status HIV stigma: "the prejudice, discounting, discrediting, and discrimination that are directed at people perceived to have AIDS or HIV and at the individuals, groups, and communities with which these individuals are associated"

Stress, emotion, and health

Stress has often been proposed as a way social conditions may get inside the body. External environmental demands or stressors may cause psychological or physical stress, which in turn may cause physiological changes related to disease processes. This conceptualization has its origins in physics Assumption that stress is harmful because repeated experience leads to the accumulation of damaging physiological changes. Two components as critical in determining the potential health effects of a stressor. Magnitude of the stressor, based on the assumption that stressors can be reliably characterized as ranging from "small" to "large" The capacity of the individual: individuals appraise the "same" stressor differently, with some individuals unaffected by stressors that lead others to collapse. Stress is experienced when individuals perceive (appraise) that external demands exceed their ability to cope. The interpretation of an event as stressful triggers a series of physiological changes. A negative emotion response typically occurs if demands are perceived to exceed one's ability to cope. Empirically it has proven challenging to operationalize. Defining stress can be difficult, as the term is used broadly. What does it means when an individual reports experiencing stress? What about good stress (like planning a Christmas party) versus bad stress (like death of a spouse)? What one individual considers stressful, another may not. Environmental events are considered stressors while emotions are considered responses to stressors

Food marketing

TV watching promotes obesity -displacing time for physical activity -promoting poor diets -giving more opportunities for unhealthy snacking (during TV viewing) Food and beverage marketing on television may be responsible -The effects of TV viewing on physical activity are much smaller than on diet -TV ads that children and youth see each year are primarily for high-calorie, low nutrient foods, and drinks -Food marketing influences children's food preferences and purchase requests -Branded foods, drinks, and restaurants are often featured in TV shows and movies -Product placements are overwhelmingly for unhealthy foods ***In one experiment, children who watched cartoons with food commercials ate 45% more snack food while viewing then children who watched cartoons with non-food advertising. ****

Firearm Owners Protection Act

The Firearm Owners Protection Act (FOPA), 1986. -Substantially weakened the GCA by raising the legal standard for prosecuting gun dealers who violated firearm sales laws. -Prosecutors had the burden of proving not only that a violation had occurred, but that the violation was willful. -Penalties for firearm sales laws violations were reduced -Easier for negligent gun dealers to divert or allow the diversion of large numbers of guns to criminals **Firearm-related homicide rates increased after FOPA**

Precaution-Adoption Process Model

The model focuses on process rather than particular variables. Process model suggests five stages in decision making with no particular order: -Awareness or knowledge of risk or threat -Acknowledgement of a significant risk to a group -Acknowledgement of a significant risk to oneself - Decision to take action to reduce the risk -Initiation of the behavior to reduce risk Movement through the stages can be forward or backward -Emotions, values, knowledge, intentions, actions, and social context change over time.

Ways income are associated with health

The more income and wealth are associated with better health. Higher income may enable better access to the means to produce good health, including better access to health care, as well as other forms of "healthy consumption" such as better housing, means of transportation,or clothing.

Demand-control model

This is the picture in WEEK 3 day 1 slide 4 this of this as a Punnett square Psychological demands: LOW High Decision latitude High (LS 3) (active2) (control) Low (passive 4) ( HS 1) - LS - Low strain -HS- High strain 3 and 1 have Risk of psychological strain and physical illness 4 and 1- learning motivation to develop new behavioral patterns

Homicide vs Suicide

US, 2012: 64.0% of deaths from firearm violence were suicides -11,622 homicides and 20,666 suicides (32,288 total) -Mass killings account for a very small percentage of deaths Since 2006, homicides have decreased, but suicides have increased Every day: 32.5 firearm homicides and 49.8 suicides. *A leading cause of death for teenagers and young adults.* Risk for death from firearm violence has a complex relationship with age after childhood, because of differing rates for suicide by age

Upstream vs. downstream

Up: Much social epidemiologic research is concerned with upstream determinants of population health Down: Identifying the biological mechanisms linking social exposures to health is needed to understanding causality and creating interventions

Syndemics theory

an interaction between two or more co-existing diseases and resultant excess burden of disease

Intersectionality and discrimination

multiple forms of discrimination, sometimes simultaneously, oftentimes in different ways in different contexts. Ex: White women may be subject, as women, to gender discrimination, women of color— whether black, Latina, Asian or Pacific Islander, or American Indian— may be subject to both gender and racial discrimination.

Iso-strain model

the most "toxic" jobs are those that combine high strain with social isolation Combines psychological demands and decision latitude with social support from coworkers and supervisors. Jobs that are characterized by high strain often have low levels of social interactions with other employees and hierarchical relations between supervisors and employees. Call centers, assembly lines, etc. People experiencing low social support + high psychosocial demands + low control highest relative risk for cardiovascular disease compared to the people experiencing other combinations of demand-control and social support

HIV and structural violence

~Structural violence describes institutionalized harm "...'structured' by historically given (and often economically driven) processes and forces that conspire - whether through routine, ritual, or, as is more commonly the case, the hard surfaces of life - to constrain agency" ~Manifested in patterns of discrimination based on race/ethnicity, gender, sexual orientation, and HIV status.