Final Exam Flashcards
(141 cards)
1
Q
What is the public health approach to addressing a health problem?
A
- Define the health problem
- Identify risk factors associated with the problem
- Develop, test, and implement interventions to control and prevent the problem
- Monitor those interventions to assess their effectiveness
2
Q
What are the major features of public health? (7)
A
- Social justice philosophy: accessibility for all
- Inherently political: where should limited funds go?
- Expanding agenda: shifts with shifting health problems in a society
- Link with government: only the government can enforce laws
- Grounded in science: biostats, epidemiology, behavioral sciences, etc
- Prevention: reduce the probability of the health outcome
- Uncommon culture: majority of people in public health come to PH from a not-PH background
3
Q
What factors affect the health of a population? (4)
A
- Physical factors
- Social/cultural factors like traditions and beliefs
- Community organizing
- Individual behavior
4
Q
Edward Jenner
A
Small pox vaccine
5
Q
John Snow
A
Cholera; father of epidemiology
6
Q
Lemuel Shattuck
A
Blue print for modern public health
7
Q
Edwin Chadwick
A
Sanitation movement
8
Q
Robert Koch
A
Figured out that microbes caused infectious diseases
9
Q
Louis Pasteur
A
Germ theory
10
Q
Public Health in U.S. Prior to 1900
A
Acceptance of and avoidance of epidemics
11
Q
1900 to 1960
A
Health resources development, like sanitation reform
12
Q
1960-73
A
Social engineering, like Medicare and Medicaid
13
Q
1973-Present
A
Health promotion
14
Q
Communicable diseases
A
Infections diseases caused by biological agents; transmittable. Example: HIV
15
Q
Non-communicable disease
A
Cannot be transmitted. Example: Cancer
16
Q
Acute disease
A
Peak severity less than three months and complete recovery
17
Q
Chronic disease
A
Peak severity longer than three months and recovery is slow and often incomplete
18
Q
Top Three Causes for Morbidity
A
- Heart disease 2. Cancer 3. Chronic lower respiratory diesease
19
Q
Top Three Causes of Mortality
A
- tobacco 2. Diet/Exercise 3. Alcohol
20
Q
Crude mortality rate
A
total # of deaths/total population
21
Q
Age-specific mortatlity
A
of deaths among persons 15-24 in 2012/# of people age 15-24 in 2012
22
Q
Years of Potential Life Lost
A
threshold age-age of death
23
Q
Common sources of public health data (4)
A
- US census
- Monthly vital statistics report
- Morbidity and Mortality Weekly Report
- Nation health surveys (National health interview survey; national health and nutrition examination survey; Youth Risk Behavior Survey; National health care survey)
24
Q
Incidence Rate
A
of cases for a given time period/population age group
25
Prevalence rate:
of cases/population age group
26
Descriptive epidemiological studies
observe person, place, and time
27
Ecological study
observe occurrences of diseases within a population to determine association. (descriptive study)
28
Case report
profile of an individual patient (descriptive study)
29
Case series
Characteristics of a number of patients with a given health outcome (descriptive study)
30
Cross-sectional survey
Assessment of status of individuals with respect to presence or absence of both exposure and health outcome at the same point (descriptive study)
31
Analytical studies
Testing the hypothesis formulated from descriptive studies
32
Case-control study
identification of factors that are more common or pronounced in people with a health outcome compared to a similar group without the health outcome (analytical study)
33
How are the results of a case-control study presented?
Results presented as odds ratio; probability
| odds ratio: (odds of outcome/no outcome exposure)/(odds of outcome/unexposed)
34
Cohort study
Group o people who share important characteristics classified based on the presence/absence of exposure to a particular factor and followed for a specific period of time
35
How are the results of a cohort study presented
Presented as a relative risk; RR= incidence rate among exposed/incidence rate among unexposed
36
Intervention study
Exposure status of each participant through randomization to eliminate biases; also presented as relative risk; ethical issues arise
37
Types of insurance (3)
1. Private: employer based (>90%) or individual (expensive)
2. Medicare: federal entitlement program for people over 65 or for disabled people under 65 or people diagnosed with end-stage renal disease.
3. Medicaid: publicly funded health coverage program offered to low income americans
38
HRSA
Health Resources and Services Administration; Federal agency that helps increase access and quality of health resources for medically under-served populations
39
IHS
Indian Health Services
40
CDC
Center for Disease Control and Prevention
41
NHI
National Health Institute
42
FDA
Food and Drug Administration
43
SAMHSA
Substance Abuse and Mental Health Services Administration
44
ATSDR
Agency for Toxic Substance and Drug Registry
45
AHRQ
Agency for Healthcare Research and Quality
46
ACF
Administration for Children and Families
47
AOA
Administration on Aging
48
CMS
Center for Medicare and Medicaid Services; This federal agency is responsible for the Medicare and Medicaid programs.
49
Major sources of funding for public health at each level of government
Federal: relies heavily on income tax
State: income tax (varies from state-to-state)
Local: property and sales tax
50
What are the marketing principles to influence individual health behaviors?
1. Product: desired behavior
2. Price: cost (financial, time, emotions)
3. Place: where behavior will be performed
4. Promotion: messages, materials, channels, activities
5. Policy: laws and regulations
51
Keys to providing public health information.
1. Description should be scientific
2. What public health officials are doing (policies/programs and keeping the public informed)
3. Provide what individuals can do (provides self-efficacy)
52
Service Needs
Needs health professionals believe the target population must meet to resolve a problem
53
Service demands
Needs target population believes they must have to resolve a problem
54
Reasons for doing needs assessments
1. Prevent bad interventions
2. Create community trust and buy-in
3. Avoid wasting resources
55
Needs assessment steps
1. Identify target population
2. Gather information from published sources and experts about the health problems
3. Talk with the community about their service demands.
4. Act on what you learn from community members
56
Recommended organization of a questionnaire
Introduction; Respondent selection/eligibility criteria; Substantive questions; Background questions
57
Essential Public Health Services (Assessment 2)
1. Monitor health status to identify community health problems, ex: vital statistics
2. Diagnose and investigate health problems and hazards in the community, ex: lead exposure
58
Essential Public Health Services (Policy Development 3)
1. Inform, educate, and empower people about health issues, ex: anti-smoking campaigns
2. Mobilize community partnerships to identify and solve health problems, ex: healthy homes by design
3. Develop policies and plans that support individual and community health efforts
59
Essential Public Health Services (Assurance 5)
1. Enforce laws and regulations that protect health and ensure safety, ex: seat belts
2. Link people to needed personal health services and assure the provision of healthcare when otherwise unavailable, ex: HIV testing sites
3. Assure a competent public health and personal healthcare workforce, ex: board of medical licensure
4. Evaluate effectiveness, accessibility and quality of personal and population based health services, ex: evaluation of drinking water
5. Research for new insights and innovative solutions to healthcare, ex: pregnancy risk assessment data
60
Primary prevention
Measures that forestall the onset of illness/injury before the disease process begins
61
Secondary prevention
early diagnosis and treatment of diseases before the disease becomes advanced and before disability becomes severe
62
Tertiary prevention
Measures aimed at rehabilitation after significant pathogenesis
63
Downstream intervention
individual level interventions with the intent of altering personal behaviors
64
Midstream intervention
interventions with groups and individuals
65
Upstream intervention
population-wide interventions, ex: policy, media, economic incentives, legislation, environmental changes
66
Steps for public health program development
1. Identify the problem (s) and risk factor(s)
2. Set goals and objectives
3. Develop an intervention
4. Implement the intervention
5. Evaluate the results
67
Causal pathway
Indirect factor--> direct factor--> determinate--> health problems
68
Outcome objective
level to which a health problem should be reduced in a specified time period
69
Impact objectivie
level to which a direct determinate is expected to be reduced or maintained within a time period
70
Global health epidemiological transition stage 1
malnutrition and infectious disease are the leading causes of death
71
Global health epidemiological transition stage 2
Improved nutrition and public health leads to increase in Chronic non-communicable diseases
72
Global health epidemiological transition stage 3
increased fat and caloric intake; widespread, chronic non-communicable diseases
73
Global health epidemiological transition stage 4
CVD and cancer are the leading causes of death; stage 3 efforts lead to decline in age-adjusted
74
Top diseases worldwide
1. CVD
2. Cancer
3. Chronic respiratory diseases
4. Type 2 Diabetes
5. Obesity
6. Mental health and psychiatric conditions
75
Classifications of environmental exposures (3)
1. Chemical, physical, or biological
2. Man-made or natural
3. Essential or non-essential
76
Effects of lead poisoning
1. Loss of IQ
2. 2x increase in rate of behavioral disorders
3. 27% increase in rate of criminal arrests
4. Reduction in grey matter
77
Biological hazards
Living organisms and viruses or their products that increase the risk of disease or death in humans (water, food and vector borne)
78
Chemical hazards
Hazards causes by the mismanagement of chemicals
79
Physical hazards
Radon and UV radiation
80
What did the Clean Water Act and Safe Drinking Water Act deem that all water ways must be?
Swimmable and fishable
81
Sensitivity
Probability for testing positive given that one has the disease
82
Specificity
Probability for testing negative given that one does not have the disease
83
Positive predicative value
Probability of actually having the disease given that a test is positive
84
Negative predicative value
Probability of not having the disease give that a test is negative
85
Low birth weight
less than 5.5 lbs (average is 7lbs)
86
Preterm birth
Born prior to 37 weeks gestation (average is 40 weeks)
87
Leading causes of infant mortality
1. Congenital malformation
2. preterm birth
3. Sids
88
The weathering hypothesis
The initiation of health deterioration in early adulthood as a physical result of cumulative social and economic disadvantage
89
What is a general indicator of the overall health of a population?
Infant mortality
90
Births to teenage women in the United States are 2x high as that of any other industrialized nation. T/F
True
91
How can we prevent congenital anomalies?
1. Prenatal screening
2. Immunizations
3. Folic acid supplements
92
Who is the most vulnerable to death?
Infants
93
E's of prevention (6)
1. Education
2. Engineering/Environmental modification
3. Economic incentive
4. Enactment/enforcement
5. Empowerment
6. Evaluation
94
Title V of the Social Security Act
authorized the maternal and child health services problem; responsible for promoting and improving the health of mothers and children
95
Title X Funding
Provides funds for family-planning services for low-income people; restriction on abortion
96
WIC Funding
special supplemental food program for women, infants, and children
97
CHIP
State children's health insurance program
98
Family and medical leave
12 weeks of unpaid job protection
99
What percentage of adult smokers started smoking before they were 18?
90%
100
Master Settlement Agreement
Out of court settlement between largest tobacco companies and the attorney generals of 46 states; tobacco companies make annual payments in attempt to provide compensation for public expenditures for healthcare for tobacco-related incidents
101
2009 Tobacco Laws
+Raised federal excise tac to $1.01 per pack
+Granted FDA authority to ban some tobacco products with flavorings
+Required new warning labels on tobacco products
+ Strict limits on advertising in publications with significant teenage readership
+Banned all outdoor tobacco advertising within 1000 feet of schools and parks
+Ended all tobacco-brand sponsoring of sport and entertainment events
102
Where do the majority of unintentional injuries occur?
In the home
103
Injury preventions (8)
1. Education
2. Enforcement
3. Engineering
4. Environment
5. Economic incentives
6. Empowerment/engagement
7. Evaluation
8. Litigation
104
Least effective injury preventions
education and enforcement
105
Most effective injury preventions
Engineering and environment
106
Types of Intentional Injuries (3)
1. Organized violence
2. Interpersonal violence, ex: family violence, assault, intimate partner violence
3. Self-inflicted injury, ex: suicide
107
How many violent crimes are reported to the police? How many cases of rape/sexual assault are reported?
1. Around half
| 2. 40%
108
Agent
element that must be present for disease to occur (pathogen)
109
Host
any susceptible organism that is invaded by an infectious agent
110
Enviornment
outside factors that promote disease transmission, e.g. weather
111
Vector
transport mechanism for the agent, e.g. mosquito or tick
112
Chain of infection for a communicable disease
Pathogen--> reservoir--> portal of exit--> transmission--> portal of entry--> establish new disease in host
113
Measures to break the chain of infection
1. Prevention: planning for and taking action to stop the onset of disease and can happen at any stage of the chain of infection
2. Intervention: taking action during an event
3. Control: containment of the disease
4. Eradication: total elimination of the disease
114
Category A Biological Agents
High priority agents that include organism that pose a risk to national security because they can be easily disseminated, result in high mortality, cause public panic, and require special action.
115
Category B Biological Agents
Moderate priority agents, like food-safety threats, thyphus, and ricin. They are moderately easy to disseminate, moderate mortality, moderate public panic
116
Category C
Biological agents that could be mass-engineered in the future to be Category A because they are easily available or easily produced and has potential to cause high mortality rates
117
Strategic National Stockpile
```
+Antibiotics
+Chemical antidotes
+Medical and surgical supplies
+Airway management supplies
+IV supplies
```
118
Which of the following is not a Category A bioterrorism agent?
a. Anthrax
b. Botulism
c. Small pox
d. Eastern equine encephalitis
e. Pneumonic plague
D. Eastern equine encephalitis
119
Public health achievements from 1900-99 (10)
1. Vaccinations
2. Motor vehicle safety
3. Safer work places
4. Control of infectious diseases
5. Decline in deaths from heart disease and stroke
6. Recognition of tobacco use as a health hazard
7. Healthier mothers and infants
8. Healthier and safer foods
9. Family planning
10. Fluoridation of drinking water
120
Public health achievements from 2000-2010 (10)
1. Vaccine preventable diseases
2. Motor vehicle safety
3. Occupational safety
4. Prevention and control of infectious diseases
5. Cardiovascular disease prevention
6. Tabacco control
7. Healthier mothers and infants
8. Cancer prevention
9. Childhood lead poisoning prevention
10. Public health preparedness and response
121
Categorical grant
Funding which may only be spent for very narrowly defined purposes
122
Block grant
A large sum of money granted by the national government to a regional government with only general provisions as to the way it is to be spent.
123
Project grant
federal money to states, localities, and individuals based on merit
124
Formula grant
is a United States federal grant specifying a precise formula in the legislation creating the program
125
The Framingham Heart Study
A cohort study who's purpose was to identify the risk factors associated with heart disease
126
A strength of the case-control study is the ability to calculate the incidence of a disease. T/F
False. The strength of a case-control study is the ability to calculate the odds of contracting a disease based on exposure.
127
One of the benefits of disease surveillance in the United States is the fact that the National Notifiable Disease Reporting System is an active reporting system. (T/F)
False. It is a passive reporting system.
128
HIV screening is an example of secondary prevention.
False. Primary prevention.
129
Downstream interventions are always the most effective form of public health intervention delivery because they are the most individualized types of interventions. T/F
False
130
The Clean Water Act required that waters be drinkable and without direct pollutant discharges. T/F
False. Required water to be fishable and swimmable.
131
Of all age groups, older adults (age 55 and over) have the highest rates of suicide. T/F
True.
132
DHHS
Department of Health and Human Services; Primary national health agency and one of the largest departments in the federal government.
133
The likelihood of being uninsured is greater for men than women. T/F
True.
134
To qualify for Medicare, one must be 65 or older. T/F
False. Can be under 65 and qualify if you are diagnosed with end-stage renal disease or are disabled
135
When a disproportionate share hospital receives money from the federal government to care for uninsured persons, this is an example of a formula grant. T/F
True
136
Compared to other age groups, children use the most health care services. T/F
False
137
Which of the following is NOT a part of the Affordable Care Act?
a. An expansion of the Medicare program to cover nursing and long-term care services.
b. An expansion of Medicaid to cover previously uninsured individuals.
c. The individual mandate, requiring all US citizens to purchase insurance or face a tax penalty.
d. A marketplace, where individuals can find affordable private health plans with subsidies for low-income individuals
A.
138
A relative risk of what indicates that there is no association between an exposure and disease?
0
139
Odds Ratio Interpretation
Odds of [outcome] were [#] times [higher/lower] among [exposed/+risk factor] vs. [unexposed/-risk factor]
140
Relative Risk interpretation
Risk of [outcome] were [#] times [higher/lower] among [exposed/+risk factor] vs. [unexposed/-risk factor]
141
Process objective
The steps your intervention will take to achieve the impact objective
