____ are portfolios of observations and data summarizing health priorities needs and resources and are key to establishing to establishing public health budgets
Community Health Assessments (CHA)
The National Center for Health Statistics (NCHS) is a division of the ____ and conducts ______
CDC; period surveys of representative samples of the population
National Health Interview Survey is conducted by DHHS _____ on _______ households
Every other year; 50,000
National Health and Nutrition Examination Survey (NHANES) is conducted ______ on ______. Involves ____
Every year; 5,000 individuals; full medical work up
in 2005-2006, ___% of American children's parents talked to a healthcare provider about a child's emotional or behavioral problems; __% were prescribed meds for mood disorders; __% for ADHD
15; 5; 89
Health Informatics info come from (5)
Clinical studies, standard databases, census (very detailed questions), DHHS, coroner reports.
T/F A comprehensive health information database exists
T/F Medical records are available to foreign hospitals to serve travelers
False- administrative costs are accrued when these records are gathered manually
Hospital Records contain ____(3)
Medical, family, diagnostic history
Almost all psychopharm medications prescribed to 4-17 yr olds is for ____ (more ___ than ____0
ADHD, males than females, older children than younger
For the treatment of ADHD, more children are treated with ___ than ____ and are most commonly treated in _____
meds than others; private practice or clinic, schools, general medical practice
Current treatment methods of ADHD may indicate these 3 anthropological conclusions (so what?)
Need for greater access to wider variety of mental health services, more research on non- medical/ combo treatments, community level assessments of quality and scope of school based/ other mental services (follow up studies needed for all)
Notification systems: WHO requires international reporting of ___ (3)
Yellow fever, cholera, plague
Notification Systems: Reporting is imperfect because there is no universal health care access or use, no universal reporting system, takes time
Notification Systems: CDC requires reporting of disease by ____ and _____ for more urgent conditions
mail/ internet; phone
Notification Systems: Chain of disease reporting (4)
Health care professional, local/ state public health agency, federal agency, news media
Notification Systems: : Task of Health care professional
(diagnosis),
Notification Systems: : Task of local/ state public health care agency
investigates source/ spread, communicates with CDC
Notification Systems: : Task of federal agency
disease control and public relations strategies, scientific research
Notification Systems: : Task of news media
Public notification
Commodity fetishism: Definition and relation to tomato scare
Marx- disconnect final product from its sources
Even though only canned tomatoes were affected, sales of all mexican produce went down, subtle xenophobia in news (masks accurate assessment of immigration policy and public health),
emphasizes need for political sensitivity when issuing press releases
T/F There is no reason for the lax monitoring of produce importation that exist today
False- economic incentives
Older age groups have higher rates of death by most causes except _____ (3)
injuries, suicide, homicide, HIV infection
The most common cause of death for children under 19 was _____ is ______
motor vehicle accidents (occupant or pedestrian); falls
4 important factors of interpreting public health info
Single study or meta- analysis, size of study, animal or human study, study of biological markers or actual disease
The DARC gene has been associated with ___ (2)
Decreased susceptibility to malaria, increased to HIV
___% of healthy people 2010 goals were accomplished, __% are moving in the right direction, __% moving in wrong direction
15; 44; 15
Poor perception of health status is inversely related to ____
Household income
T/F Income inequalities have increased since 1980
True
Morbidity/ Mortality from chronic disease is ____ higher in low- income citizens compared to high- income citizens
300%
Men are twice as likely to die from _____ and 4 times more likely to die from _____
unintentional injuries, fun accidents
Women have ___ as much depression as men
2x
People lacking higher education are ___ more likely to die from premature death than are people with some higher education; infant mortality rate is reduced by ___ if you graduate from college
200%
These factors are affected by race, income, education, sex (7)
morbidity/ mortality from chronic disease, life expectancy, death from unintentional injuries, gun accidents, premature death, depression, infant mortality
Total infant mortality is ___ but African American infant mortality is _____
decreasing, increasing (2x rate for white Americans)
T/F African Americans are both more likely to get chronic diseases and to die from them
True- heart disease, prostate cancer, HIV/AIDS
____ have highest diabetes, depression, suicide rate in world
African- Americans
__% of Americans live in rural areas (fewer than 2,500 residents) where injury related mortality is __% higher
25; 40- less likely to have healthcare visits, use seatbelts, be insured or exercise regularly
Gay men have significantly higher rates of ___ (4)
STDs, substance abuse, major depression, suicide (2-3 times rate of suicide)
Military personnel have higher rates of (3)
substance abuse , domestic abuse, suicide (veterans are 8x more likely to commit suicide)
T/F more women than men are discharged from the hospital following treatment for cardiovascular disease
____ make routine doctors visits more regularly, varies ____ among "8 America" classifications
Females, surprisingly little
According to 8 Americas study ____ and ____ seem have worse health conditions than comparable demos
males, poor Southern blacks
___ year difference in life expectancy between America 1 and 8 (Asians, High- Risk urban blacks)
21
Since 1980, life expectancy gap between sexes has _____ by ____%
increased, 0.5%
Top 3 contributers to disease burden
Smoking, alcohol use, overweight and obesity (these affect males more than women)
8 most cost- effective PH interventions
tobacco cessation counseling in young adults, anti-tobacco messaging for adolescents, screening elderly for vision impairments, counseling adolescents on alcohol abuse, screening adults for problem drinking, screening adults for colorectal cancer, screening young women for HPV (or providing vaccine), vaccinating older adults against pneumonia.
Age adjusted rates of death due to HIV have _____ between ___ and _____
declined; 1987-2002
In 1985, ____ had highest death/ case rates due to HIV. Now ____ have highest rates. (____ and ___ have almost no deaths due to HIV)
White; Black (rates in blacks have gone up while rates in whites have gone down); Asian/ Pacific Islanders, American Indian/ Alaska Native
___% of AIDS cases are among black people though they make up __% of the population. (for whites __% of cases, __% of population)
50, 13; 30; 68
Top 3 methods of AIDS transmission for males
Male-to- male sexual contact (58%), injection drug use, high- risk hetero sex
Top 3 methods of AIDS transmission for females
High- risk hetero sex (71%), injection drug use, other (other is only 2%)
Percentage of HIV deaths that are of females has ____ by _____ from ___ to _____
increased, 200%, 1987-2003
Most females who die from AIDS from hetero contact are ____
Black (probably most in general given prevalence of this mode of transmission)
The _____ region of the U.S. has the highest rates of adults living with AIDS while the ____ region has the lowest.
South; Midwest
Proportional distribution of AIDS cases in the South have ____ between 1987 and 2003 while rates in the West, Northeast have ______. Cases in the Midwest have more or less stayed the same for that time period.
Increased; decreased
Most adolescents with AIDS are ____. The proportion of this group has ____ since 1981
Black, Increased from 50-64% (only 15% of population)
African American household income is ___% of white's, ___% of blacks live in poverty while ___% of whites do
62; 26, 9
__ of Extremely poor Americans are ____ with ____
women with no high school diploma
Trio of social suffering
Gender, Poverty, Biology
STDS acquisition is ____ more likely in male to female vaginal intercourse
2-5
STD coinfection increases risk of HIV contraction by ___ times
50x
NIMH Prevention trial (2)
Best study regarding STD programs in U.S., study of 37 STD clinics with "high- risk" African- American and Hispanic men and women
Procedures of NIMH Prevention Trial (3)
study of 37 STD clinics with "high- risk" African- American and Hispanic men and women; participants shows 1 hr video or seven weekly 90 minute risk reduction training sessions; focused on behavioral interventin and risk reduction through education, self- esteem building and situational negotiation skills
Results of NIMH Study
No change in unprotected sex acts/ month (reduction on low- end, slight increase on high- end of intervention group), increased condom use, slightly lower reduction in gonorrhea rates
____ are least likely to be insured, ____ most likely
Mexicans, those slightly above poverty line; whites, 200% or more of poverty line
T/F Uninsured are more likely to have undiagnosed high cholesterol/ blood pressure
Modes of Transportation
Modes of transmission (4)
Direct (airborne), Indirect (bloodborne, waterborne, airborne), transcutaneous, vertical (mother to child)
Transmission cycle (4)
Agent--> vector--> host--> environment
Three possible steps from vector to human host
Vector--> intermediary host--> human host
Insect transmission accounts for___ of all vector- borne disease transmission.
85%
Worldwide resurgence of vector borne diseases since ___ because of ___(2)
1970's; major environmental changes, low surveillance in tropics and subtropics
Factors influencing spread of vector- borne diseases (4)
Size of host population, density of agents in host population, environmental conditions such as temperature and humidity, levels of human resistance
Immunity vs. Resistance
Immunity: Resistance to infection from presence of antibodies or cells that act on a specific microorganism; Resistance- resistance to transmission or development of disease
Primary: sanitation, vaccine, protective workplace equipment, surveillance; Secondary; Isolation, chlorination of clothing, PEP (antibiotics); Tertiary: Isolation of corpses, sIte containment and cleanup
Scalp Ringworm: Affects __-__% of children in the U.S., mostly ______. Primary mode of transmission is in _____. ___% of all positive cases are asymptomatic.
Primary: school programs. Secondary: Anti- fungal meds and therapies. Tertiary: monitoring of anti- fungal medication side effects
____ disease pathogens account for nearly all airborne disease in the U.S.
20
T/F Smaller sneeze droplets (in microns) are more dangerous as more remain in air for longer.
True
Rank the following (from shortest to longest) in terms of persistence on air: Bacteria, spores, viruses
Bacteria, viruses, spores
Rank the following (from most to least) in terms of efficacy of removing spore levels from environment.
A/C, mechanical ventilation (fans), natural ventilation (open windows), outdoor air
Indirect modes of transmission
Bloodborne (HIV, Hep B, Hep C); Food and Waterborne (cholera, salmonella, typhoid, botulism. hep A, polio)
_____ and _____ have the highest incidences of foodborne illness. _____ (2) Have the lowest
restaurants and homes; cafeterias, resorts
Hepatitis B: ___% of all humans are HBV+, __-__% have chronic, symptomatic HPV. ___ annual deaths/ 100,000 in U.S./ Worldwide
30; 2-8; 2
Hepatitis B: Main transmission methods (4)
IV drug use, unprotected sex, blood transfusion, perinatal transmission (HBV+ mothers have a 20% chance of transmitting to child. CHild has 5% chance of clearing infection)
Prim: Vaccination, sex and drug education, blood transfusion screening, anti- viral prophylactics for pregnant women; Secondary: at- risk screening, early antiviral treatment, co- morbidity treatment; Tert: viral load testing, anti- viral treatments, substance abuse control and liver health management
Hepatitis C: ____ cases worldwide, ___ new cases/ year worldwide, ___ cases in U.S.
200 million, 3-4 million, 4 million
Hepatitis C: Leading cause of _____ and ____
liver cancer and liver transplants
Hepatitis C: ____ co-infection with HIV, ____ of prisoners are positive, ___ of cases in U.S. have been incarcerated
35, 35, 84
Hepatitis C: Sources of infection (top 3)
IDU (60%), sexual (15%), Transfusion (before screening) (10%)
Prim: Vaccination, Sex and drug education, screening of blood transfusions, anti- viral prophylactics for pregnant women; Secondary: at- risk screening, early antiviral treatment, co- morbidity treatment; Tertiary: viral load testing, anti- viral treatments, substance abuse control and liver health management
Methods of Indirect (transcutaneous) Transmission (4)
Insects, Animal bite, Latrogenic (in hospital), self- injeced
Rabies: _____ annual human deaths, __ in Asia, __ in Africa
55,000; 31,000; 24,00
Rabies: Global epidemic in ____, ____ discovered vaccine, which is now ____. Lack of ___ in East Asia has led to increased incidence, led to development of ___ policy
1800s; Louis Pasteur; routine for children and animals in developed countries; animal control; one dog policy (2006)
Ebola: Mission Hospital founded by ___ in ____, served ____ including ____
Belgians; 1935; primary source of medical care for 60,000 people; travelers from outlying areas- active prenatal care unit
Ebola: Sequence of events
Health ministry dispatch epidemiologists and microbiologists to region; 11/17 of hospital staff have died, entire Bumba Zone is quarantined; liver specimens reveal unknown virus, international commission is formed- 500 possible cases identified, link found between exposure to Yambuku Hospital and hemorrhagic fever
Ebola: Most effects people in ____ age
middle (15-49)
Ebola: Identified cause
Non- sterile injection conditions at Mission hospital
Prim: UV inspection of aerosolized water; Secon: antibiotics; Tert: treatment of comorbidity and immune system compromise
Malaria: ____ cases world wide, most (a little over half) are ____ and in ____.
515 million, non- symptomatic; Africa
Malaria essentially only effects the ____ hemisphere and the ___
Southern, poor
Malaria: Pathogenesis
1) Hepatic infection- microorganisms migrate to liver and multiply for 6-15 days (up to 1 yr) 2) red blood cell infection (adhesive proteins stick to blood vessel walls to avoid immune system cycling)
Prim: Insecticide, bed nets, sheets, protective clothing, prophylactic drugs in high risk groups, genetic modification of mosquitoes Secon: Anti- Malarial drugs, hospitalization; Tertiary; primary care, symptom monitoring
2 Phases of Mosquito Net Distribution
1) populations learn how to use and treat nets (nets cost 15 cents- distr for free) 2) retreatment (wash resistant insecticide in fibers lasts 2-3 years, cheaper chems last 6-12 months)
Bagamoyo Tanzania Bed Net Project
Nets given to 3 villages (different ethic groups) at 6 mo intervals; 91% had no previous experience with nets or insecticide treatments
Mixed Cultural Views of Mosquito Nets in Bagamoyo Tanzania Bed Net Project
Dawa: word meaning both a substance used in agr or pest control, often regarded as dangeous and linked to colonial history but also used in traditional healing to refer to an herbal treatment- views motivate non-adherence
Downfalls of Mosquito Nets (4)
Insecticide wears off even if nets are not actively used, insecticide might be weakened even if other insects are dying, mosquitoes are dangerous even out of season and in small numbers, insecticide has noticeable side effects
Effects of Fees of Mosquito Net Use
Fees deter adherence, if nearby village gets for free, fees deter even more (low adherence associated with alcoholism)
Evidence Based Recommendations to Promote ITN Use
CHW undergo special training and edu, community level education programs, alcohol abuse programs, financial resources, transportation to and from clinic, multiple distribution days
Yellow Fever: Caused by same mosquitoes as ____ and _____; major epidemics in ____ (yrs- 2)and _____ (notable places-2), prevented French from building _____
Dengue, Chikungunya; 1700-1800s; New Orleans, Memphis; Panama Canal
Yellow Fever: Currently Endemic in ___ and ____
Northern South American (Brazil, Bolivia, Paraguay), Central Africa
Case identification, vaccination; Secon: Hospitalization, complex antibiotic and med regimes; Tertiary: isolation, DOTS, other kinds of social and ambulatory care
Predictors of Poor Drug Adherence (6)
Mental illness, drug use, youth, gender, unstable housing, socioeconomic status
MDRTB makes up _-_% of all cases, __% of recovery chances (__% of all forms of TB), ___% of all MDRTB cases in the developing world.
0-54, 56, 95
DOTS typically leads to a ___ drug compliance rate and a ___% survival rate
Without ART: median progression from HIV infection to AIDS is ____, median survival time after developing AIDS is ____
9-10 years; 9-10 months
With ARTs mortality, AIDS and hospitalizations decreased __-__%, average life expectancy increased ___ years
60-80; 15
Requirements for Successful ARV Therapies (3)
HIV counseling and psychosocial support, treatment adherence (95% adherence required), $$ (300-1500 in low income countries; $10,000 in U.S.)
AIDS therapies require an average of ____ pills to be taken each day; patients can only miss __/week
3-5 pills, 5
DOTS in Boston: Positive effects on these medical factors (6)
total inpatient days (decrease), length of hospital stays, medical costs, effectiveness, drug adherence, long- term decrease in CD4 counts
Responsibilities of CHWs
Monitor treatment/ deliver drugs, give counsel, provide moral support, educate about prevention, monitor co- morbidity and symptoms
DOTS in Haiti: Positive Effects
decreased mortality, decreased co- infections, weight gain, decreased days in hospital, increased ability to manage life, job creation (CHWs, Non- medical personnel, others)
Perinatal Disease Prevention in HIV: __% transmission rate, most HIV+ mothers have ___ and ___
7; prenatal care; effective use of prenatal anti-retroviral therapies
Reasons for opening (1), closure (1997) of Windham Needle Exchange (5)
115 residents diagnosed with HIV (59% were drug users- 39% white, 43% hispanic); state sponsorship of illegal activity, visible location, strong personalities on staff, advocacy for drug users, sensational reporting on needle problem
Effects of Windham Needle Exchange Closure (3)
Major increase in users exposed to unreliable needles and drugs, major increase in needle sharing, no decrease in bio- waste
Texarcana Measles Outbreak (1971-1971): Attack rate in Texaswas ___, attack rate in Arkansas was ____
48.2; 4.2
Vaccine types (5)
Live organisms (measles, yellow fever, plague), Inactivated or killed organisms (influenza, rabies), cellular fraction (meningitis), recombinant DNC engineering (influenza, hep B), toxoids (tetanus, diptheria, botulism)
Exposure to antigen, 3-14 day lag, Development of antibodies
Vaccines: Secondary Response
Booster response, subsequent exposure to antigen, shorter lag period
Vaccines: Immunologic Memory
Long- term immune response to specific disease
Diseases whose incidences were greatly reduced by vaccines (4)
Diphtheria, polio, measles, pertussis
Smallpox eradication required __% worldwide coverage but herd immunity for measles requires __% coverage. __% of U.S. children recieve all vaccines by recommended age
80; 95; 75
Diptheria: infectious disease in ____ temperatures. ____ experienced epidemics in _____, which led dosages to go from __ to ___ with ____ and ____ coverage.
Cold; USSR; 1980's; 3; 4; boosters; higher (93%)
Foundations of Expanded Programme of Immunizations (EPI)
1970: fewer than 10% of children have basic immunizations; 1980's: WHO and UNICEF launch EPI, 1990's 80% of children receive basic immuns, preventing 3 million deaths annually
Diseases eradicated because of EPI
tetanus in pregnant women, polio, measles deaths reduced by 95%
Global Alliance for Vaccines and Immunizations (GAVI) goals (3)
66% reduction in child mortality in 36 designated countries by 2015, into of under- used vaccines (hepatitis, yellow fever) in developing countries, establish effective and comprehensive immunization programs to be integrated into primary health care systems
Pertussis (Whooping Cough) ___ disease of the ____ that causes ____ with possible development of _____
bacterial, respiratory tract, cold- like symptoms/ crowing sounds, pneuemonia
Limitations of pertussis vaccine (4)
Lasts only a few years, allergic reactions (seizures) common, high risk of disease in elderly, cases of permanent brain damage
Pertussis prevalence has ____ since ____, especially since ____
increased; 1980; 2001
Wheel of vaccine related lawsuits
Tort litigations--> increased price of vaccine/ malpractice insurance--> National Childhood Vaccine Injury Act (1986)
The National Childhood Vaccine Injury Act (1986)
Reduced risk of tort litigation related to vaccine related injuries by establishing a claim procedure involving the United States Court of Federal Claims
Common claims against vaccinations (5)
Side effects (studies limit these), vaccines weaken natural immune response (not proven), risk for diseases (influenza vaccine may increase risk of acquiring Guillain- Barre syndrome), Dangerous chemicals used (some evidence at clinical leve, non at population level), individual freedom (lack of herd immunity requirements puts everyone at risk)
HPV: ____ annual deaths from cervical cancer; ___% of women in US will have contracted HPV by age 50 (most will remain subclinical); ___ new cases of cervical pre- cancer ever year (Deaths result)
233,00; 80; 250,000 (3,700 deaths)
Methods to prevent HPV
Pap smear (reduces cervical cancer incidence by 50%), Gardasil, Varvarix, Combo of Gardasil and Varvarix (100%)
Suggestions for Effective Vaccination Programs (6)
Availability/ effectiveness of vaccine, widespread coverage, community education/ promotion and enrollment programs, assessment of need through surveillance, ongoing evaluation, monitoring of antigenic drift
In the epidemiological transition, deaths from ____(2) have increased while ___ has decreased
circulatory disease, cancer; infectious disease
Diseases of Civilization are characterized by (5)
Economic growth, demographic changes, relative income inequality and mental health morbidity, preventable disease, lifestyle related
Neonatal, Postneonatal and infant mortality as well as fertility ___ with epi transition
decline
4 Stages of Health Transition
Age of pestilence (infectious) and famine, age of receding pandemics (improved sanitation), age of degenerative and man- made diseases, age of delayed degenerative diseases
Age of Pestilence and famine: Life Expectancy, Changes in broad disease categories
~30, infections, nutritional deficiencies
Age of Receding Pandemics: Life Expectancy, Changes in broad disease categories
While rates of smoking have declined in __(3), they are rising sharply in __
USA, UK, Canada; Asia (developing world will account for almost 3/4 of smokers by 2030)
Diabetes is expected to see a global ___ in next 20 years, esp in ___(3)
Middle East, India, SE Asia (Most of Asia and Africa, really)
Some countries, such as India, are experiencing ____ transitions
heterogenous
HIV Rates in South Africas Major cities have __
risen but stabilized at around 25%
U.S. life expectancy is correlated with __(2)
Regions, smoking/ tobacco taxation rates
Unintentional injuries are the _____ in some countries- high frequency among _____ people
leading cause of death; young and middle- aged
Unintentional injuries are the __ largest contributor to the global disease burden/ U.S. mortality burden
5th
Prevention: Motor Vehicle Accidents
Mandatory seatbelts, speeding laws, age limits, police enforcement, air bags and safety standards
Prevention: Falls
Railings in homes/ public buildings, proper medication management
Prevention: Domestic violence
criminalization, shelters
The most common injury- related cause of death worldwide is ______, which cause ___ of all brain and spinal cord injuries worldwide.
Motor Vehicle Accidents- also the leading cause of death for ages 1-24
Recommended Public Health Approaches to Motor Vehicle Safety (7)
Mandatory seatbelts, alcohol regulations, helmets for bicyclists, speed limits of 55 mph, minimum age requirements, training requirements, vehicle and road design standards
Environmental conditions cause __ (3)
cancers, neurological disorders, chronic pain
Environmental causes cause __ of all cancers in U.S. - especially dangerous because of ____
5%; long- latency periods
William Farr
Helped environmental/ workplace safety movement, which started with British metal miners
Category 1- shown to cause cancer in humans; Category 2- causes cancer in animal tests, probably in humans; Category 3: possibly carcinogenic but inconclusive evidence supporting conclusion
Benzene
250,000 workers exposed annually, cause of acute or chronic neurological disorders, leading cause of leukemia
Non- linear dose response relationship indicates __
threshold
Workplace safety tree
Prevention--> Surveillance--> Chemical levels, Cancer rates. Prevention--> regulation--> biological wastes, agr chemicals
Exposure to both radon and cigarettes causes ____
Multiplicative risk of lung cancer (9-24 for tobacco alone, 5 for radon alone)
First mention of "passive smoking" in ____, Surgeon General's report on second hand smoke in _____- same year as causal link
Landmark paper on second hand smoke pollution found ____, second major study in ____ found that ____
respirable suspended particles at 250-1000 times legal limit in many workplaces; Japan; SHS increased risk of disease in non- smoking wives in accordance to smoke habits of husband
Causal relationship between smoking and ___ (2) found in over 40 studies
Lung cancer, heart disease
Nonsmokers in households and workplaces with smoke are ___ more likely to get smoking related disease. Related to __ and ___
2-30, depending on smoke concentration; lower respiratory infections in infants; asthma
Industry responses to SHS (4)
promote more vague critiques of indoor air pollution; emphasize "accommodations" (AC fans, etc..) create a bigger monster, fund convenience store and restaurant trade groups
Love Canal and Radiation
54% of children born in 1970's in Love Canal had at least minor birth defects
Asbestos is related to ___; Regulations against were initiated in ___
lung cancer, other cancers; 1980's
Lead effects ___ children 1-5, compounds ___ and is most often found in
310,000; effects of hypertension, diabetes nervous system effects, African Americans
T/F Chronic diseases have more complex causations than infectious disease
True
Rarely does a ____ cause chronic illness
Single Cause
Chronic Disease: "Normal" replaced by "_____"
Optimal
4 Ways to Prevent Oral Cancer
Diet rich in fruits and vegetables, safe sex, oral hygiene and dental care, substance abuse control
Which cancer kills the most U.S. citizens?
Lung (including throat)
_____ people are expected to die from cigarette use by 2100 if consumption stays constant
Tobacco companies new cigarettes were dangerous by _____
1961
Risk factors for cardiovascular disease combine in ___ ways
Factors causing reduction in number of heart attack deaths (5)
Heart disease disparities: heart attacks are more fatal for men or women? higher attack rates in which race? higher risk of stroke in which race?
women; african- americans, african- americans
3 social risk factors for heart disease and stroke
Being male, African- American, under educated
Most common chronic disease in American children
Asthma
65% of asthmatic children live in areas where ___
pollution exceeds recommended levels
___ increase in asthma mortality since _____
40%, 1980's
African- American children have __ times more mortality from asthma
5
What is chronic obstructive pulmonary disorder(COPD)?
Occurs in advanced stages of chronic disease and obstructs airflow due to chronic bronchitis
COPD affects ___% of males in U.S. and causes _____ deaths/ year
30; 100,000
_____ Americans will have a cancer in their lifetimes; __% more risk of cancer in African- Americans; ___ more risk of cancer death in African- Americans
1 in 3; 10; 30 (50% in men)
_____ has highest levels of heart disease
South
Testing home for radon is a means of primary prevention for the following cancers (3)
lung, skin, gastrointestinal
Elimination of chemical and toxin exposure is a means of primary prevention for the following cancers (3)
Lung, leukemia, lymphoma
Eating a low- fat diet reduced risk of the following cancers (3)
breast, colorectal
____ is the main cause of gender disparities in cancer; it accounts for __% of all cancers
Smoking; 15-30%
6 main causes of cancer
Smoking, diet, obesity and lack of exercise, alcohol, HPV, environmental and occupational hazards
Reasons why PH might have ignored mental health in the past (3)
Preoccupation with prevention, emphasis on sanitation and environmental health, difficulties measuring mental health morbidity and preventing complex causal chains
Tools to measure mental health
General Health Questionnaire (GHQ 12), Hospital Anxiety and Depression Scale (HAD)
Sensitivity and specificity for HAD
96% sensitivity, 57% specificity for depression
What is the National Comorbidity Survey
Study of 12- month mental disease prevalence in U.S. population
Findings of the National Comorbidity Survey (4)
50% report 1 disorder in lifetime, 30% report illness in past 12 month, over half with 1 disorder have 2 or 3 (14% of total population). fewer than 40% of those with at least 1 disorder receive treatment (over 60% untreated)
Mental and neurological disorders account for ___% of global DALYs
