CVB Health and Society Flashcards
1
Q
How does polycystic ovary syndrome affect a woman’s risk of heart disease?
A
Polycystic ovary syndrome exposes women to many risk factors of coronary disease
- Increased testosterone
- Low HDL
- Decreased insulin sensitivity
- Possible hypertension
These women often present with fertility problems
2
Q
When do the origins of heart disease begin?
A
In utero
3
Q
Raising taxes on tobacco products by 10% decreases tobacco sales by ____%
A
Raising taxes on tobacco products by 10% decreases tobacco sales by 5 %
4
Q
Give some examples of individual surface constructs of culture.
What are the limitations of these surface constructs?
A
- Race/ethnicity
- Immagrant status
- Years in the US
- General behaviors
- Food preferences
- Friend preferences
These surface constructs do not capture how culture might intersect with factors that lead to variability the way culture affects health (gender, religion, education, income, immigrant generation)
5
Q
What is the systolic blood pressure threshold at which risk for stroke mortality increases?
A
Risk of stroke mortality increases in a log-linear fashion for blood pressures above 115
(May be even lower; in class they talked about how there is no threshold, increased blood pressure will always mean increased stroke mortality)
6
Q
Rank the managed care plans from most affordable to least affordable
A
- HMO (Health maintenence organization = most affordable
- POS (Point of service)
- EPO (Exclusive provider organization)
- PPO (Preferred provider organization) = least affordable
7
Q
In order for something to be considered a “fundamental cause,” it must…
- 4.
A
In order for something to be considered a “fundamental cause,” it must…
- Influence multiple disease outcomes
- Affect these disease outcomes through multiple risk factors
- Involve access to resources that can be used to avoid risks or minimize the consequences of disease
- Have an association that is reproduced over time via the replacement of intervening mechanisms
8
Q
What was the objective of the SPRINT trial?
A
To compare the benefit of treatment of systolic blood pressure to a target of less than 120 mm Hg (intensive treatment) with treatment to a target of less than 140 mm Hg (standard treatment) in non-diabetic patients
9
Q
What are the advantages of high-deductible insurance plans?
A
- High network availability
- Lower premiums
- Cheaper option for rare insurance users
- Avoid market rates
- HSA (health savings account) elligible
10
Q
How is the WHO model list of essential medicines selected?
A
- Disease prevalence
- Public health relevance
- Evidence of clinical efficacy, safety, and relative cost-effectiveness
11
Q
How were the participants of the HOPE-3 trial different from the participants in the SPRINT trial?
A
- HOPE-3
- Intermediate risk of CVD
- Risk of a major cardiac event <1% per year
- SBP < 160
- Intermediate risk of CVD
- SPRINT
- High risk of CVD or age 75+
- 10-year CVD risk ≥15%
- SBP 130-180
- High risk of CVD or age 75+
12
Q
What was the objective of the HOPE-3 study?
A
To determine the effects of lowering blood pressure in intermediate risk individuals (SBP <160)
[Evaluate the role of therapy in persons at intermediate risk (defined as an annual risk of major cardiovascular events of approximately 1%) who do not have vascular disease and who have a systolic blood pressure of less than 160 mm Hg (who represent the majority of middle-aged and older persons)]
13
Q
What are the requirements for a POS plan?
- PCP?
- Referall to see a specialist?
- In-network benefits?
- Non-emergency out-of-network benefits?
- Emergency coverage?
A
- PCP? Yes
- Referall to see a specialist? Sometimes
- In-network benefits? Yes
- Non-emergency out-of-network benefits? Yes
- Emergency coverage? Yes
14
Q
List some biological reasons why it is difficult to quit smoking
A
- Genes
- Acute and chronic effects on the brain
- Nicotine is very addictive
15
Q
Describe the MPOWER framework for toboacco control (What does each letter stand for?)
A
- Monitor tobacco use and prevention policies
- Protect people from tobacco smoke
- Offer help to quit
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising
- Raise taxes on tobacco
16
Q
Why is enrollemnt in Illinois’ insurance marketplace declining?
A
- Strong economy => more people are insured through work
- Open enrollment is shorter than it was in 2016
- Cuts to federal funding that supported enrollment outreach
- Trump signed a tax reform bill that repealed the ACA’s individual mandate penalty (fee for not being insured)
17
Q
What is the average age of smoking initiation in the US?
A
14 years old
(90% of smokers started before age 18;
98% started before age 26)
18
Q
Plaque biology is different in women and men. What is the effect on the risk of infarction?
A
In women, plaques are more likely to erode
In men, plaques are more likely to rupture
Both can lead to infarction
19
Q
What is the strongest predictor of a child’s cardiovascular health?
A
The parent’s cardiovascular health
20
Q
Who were the participants of the HOPE-3 trial?
A
Intermediate risk participants, as defined by teh INTERHEART risk score
(Risk of a major cardiac event <1% per year)
21
Q
The SAHELI study revealed that __________, __________, and __________ factors contributed most to the explanatory models of heart disease in the South-Asian immigrants who were interviewed.
A
The SAHELI study revealed that physchological**, **behavioral** , and **physical factors contributed most to the explanatory models of heart disease in the South-Asian immigrants who were interviewed.
- Psychological: worry and stress cause heart disease
- Behavioral: Heating unhealthy food causes heart disease
- Physical: Increased cholosterol causes heart disease
22
Q
____ years after quitting smoking, a person’s risk of coronary artery disease is similar to that of a non-smoker
A
15 years after quitting smoking, a person’s risk of coronary artery disease is similar to that of a non-smoker
23
Q
List some of the societal burdens of tobacco use
A
- $$$: lost productivity, healthcare costs
- Absenteeism
- Excessive utilization of healthcare services
- Secondhand smoke
- Social stigma
24
Q
According to the results of the MESA study, Blacks living in more segregated neighborhoods were % more likely to develop atherosclerosis
A
According to the results of the MESA study, Blacks living in more segregated neighborhoods were 20% more likely to develop atherosclerosis
25
Who bears the risk in a fully-insured, individual (non-group) insurance plan?
How do these plans work?
The insurance company bears the risk
Indivduals buy health insurance directly from the insurer or on the health insurance marketplace
The individual is responsible for 100% of the premium
Coverage must follow the essential health benefits standard
26
What percentage of adults meet the "moderate to vigorous physical activity" requirements?
~50%
27
What are the early (childhood) risk factors for CV disease?
* Mild increases in, LDL-C, TG
* Mild decreases in HDL-C
* High carbohydrate diet
* Increases TG by enhancing hepatic VLDL synthesis
* High VLDL, TG (associated with low HDL-C)
28
South Asians with stronger traditional cultural beliefs had _____ physical activity levels
South Asians with stronger traditional cultural beliefs had **_lower_** physical activity levels than South Asians with less strong cultural beliefs
29
Why is the Trump adiministration encouraging states to redesign their medicaid programs
(What are the goals? Potential disadvantages?)
* Let states...
* Transition to **premium support models**
* Access **looser regulatory requirements**
* Impose **work requirements** to enrollees
* But democrats believe...
* These changes would weaken the ACA's coverage expansions
30
What would allow a patint to enroll in a health insurance marketplace plan outside of open enrollment?
A qualifying event
* Birth of a child
* Marriage
* Employment change
31
How does sitting affect skeletal muscle LPL?
Prolonged sitting leads to suppression of skeletal muscle LPL
This results in reduced TG uptake, and reduced HDL cholesterol production
32
What is more beneficial:
accumulating physical activity in short bursts throughout the day,
or
condensing it all into one sustained bout?
Neither! Both are equally beneficial (2018 guidelines)
33
What are the 7 building blocks included in the WHO's health-systems framework?
**SWIM-FL** (**SWIM** **F**or your **L**ife)
* **S**ervice Delivery
* Health **W**orkforce
* Health **I**nformation Systems
* Access to Essential **M**edicines
* **F**inancing
* **L**eadership/Governance
34
What was the South Asians Active Together (SAATH) intervention?
An Exercise Intervention for South Asian Mothers at Risk for Diabetes
* Excercise programs and opportunities designed specifically for South Asian women
35
Is this an example of structural or cultural competency?
Recognizing that a patient is eating fried foods because there aren't any healthy food options in his neighborhood
Structural
36
What was the intervetion in the HOPE-3 trial?
Candesartan
37
One in ____ women die from heart disease
One in **_3_** women die from heart disease
38
Why was the SPRINT trial stopped early?
People in the intervention arm (target BP \<120) were dying less than the standard care arm (target BP \<140)
39
According to the 2017 Blood Pressure Guidelines, initiation of drug therapy is recommended when blood pressure is \_\_\_\_\_\_\_\__mmHg_ in the setting of **\>10% predicted 10-year ASCVD risk**
According to the 2017 Blood Pressure Guidelines, initiation of drug therapy is recommended when blood pressure is **_\>130/\>80_** in the setting of **\>10% predicted 10-year ASCVD risk**
40
What are the requirements for a PPO plan?
* PCP?
* Referall to see a specialist?
* In-network benefits?
* Non-emergency out-of-network benefits?
* Emergency coverage?
* PCP? **No**
* Referall to see a specialist? **No**
* In-network benefits? **Yes**
* Non-emergency out-of-network benefits? **Yes**
* Emergency coverage? **Yes**
41
What is driving the rising **number** of global CVD deaths, despite declining rates of death due to CVD?
Population growth and aging
42
How does the tobacco industry try to undermine tobaco control efforts?
Many states make huge revenues on tobacco - there is not a lot of incentive to fund tobacco cessation programs
Tobacco companies make up their revenue in countries where advertising bans are less strict
43
What are the ACA's Cost-Sharing Reduction Programs (CSRs)?
How have they changed under the Trump administration?
Cost Sharing Reduction Programs
* Allocated money to subsidize insurance for Americans with incomes 100-250% of the poverty level
* This money must be allocated every year, but **Trump has not done so**
44
In the Multi-Ethnic Study of Atherosclerosis (MESA), what did the Z score of a neighborhood represent?
Z-score \>1.96 = high segregation
Z-score 0-1.96 = medium segregation
Z-score \<0 = low segregation
45
What were the results of the London Transport Workers study (Morris et al., 1953)?
More active people (ex: ticket checkers) had less incidence of CV events and less death at follow up if they did have a CV event than less active people (ex: conductors, bus drivers)
46
What were the objectives of the CARDIA study?
* Study link between neighborhood environment (food environment) and development of subclinical atherosclerosis
* Measure food environment
* Measure Coronary Artery Calcification (CAC)
47
What is the United Nations Sustainable Development Goal that relates to cardiovascular disease?
Under Good Health and Well Being,
## Footnote
**Reduce premature death from chronic diseases
(including CVD) by 1/3 by 2030**
48
According to the 2017 Blood Pressure Guidelines, initiation of drug therapy is recommended when blood pressure is \_\_\_\_\_\_\_\__mmHg_ in the setting of **\<****10% predicted 10-year ASCVD risk**
According to the 2017 Blood Pressure Guidelines, initiation of drug therapy is recommended when blood pressure is **_\>140 systolic or \>90 mmHg diastolic mmHg_** in the setting of **\<****10% predicted 10-year ASCVD risk**
49
What are the requirements for a EPO plan?
* PCP?
* Referall to see a specialist?
* In-network benefits?
* Non-emergency out-of-network benefits?
* Emergency coverage?
* PCP? **Sometimes**
* Referall to see a specialist? **No**
* In-network benefits? **Yes**
* Non-emergency out-of-network benefits? **No**
* Emergency coverage? **Yes**
50
Who is covered by medicaid?
**Eligivility varies by state with federal guidelines**
* Low income people
* Especially children, pregnant women, seniors, and people with disabilities
* People with disabilities
* No need to have worked in the past
* Medically needy
* High medical expenses but not low income
* Immmigrants
* Legal: waiting periods amy be relaxed at state's option
* Undocumented: State's option
51
What is cardiovascular syndrome X?
**Women are more likely to have a normal coronary angiogram despite an abnormal stress test**
Women get more small vessel disease of the coronary arteries (rather than large vessel). Both types of disease cause infarction, but occlusion of the small vessels is easily missed in a coronary angiogram
52
Why did people of color experience large gains in coverage from 2014-2015?
Why did these gains stall in 2016-2017?
The Affordable Care Act was established
Federal policy changes (ex: Trump) contributed to the stalling of coverage gains in 2016-2017
53
Give some examples of deep structures of culture
The things included in the anthropological definition of culture
* Beliefs, Attitudes, Values, Norms
* Explanatory models
* Meanings
* Behaviors
54
How is the distribution of CAD different in men and women?
How does this affect outcomes
Men get more **large vessel disease**
Women get more **small vessel disease**
Both cause infarction, but this means women are more likely to have a **normal coronary angiogram despite an abnormal stress test** (Cardiovascular syndrome X)
55
What is the single most strategic cardiometabolic prefentraion strategy?
Diet
56
What pecentage of the global population smokes?
20%
57
Who is covered by medicare?
People who have worked and turned 65 or become disabled
People with end stage kidney disease
**Eligibility is uniform throughout the US**
58
What is the difference between Medicare parts A, B, C and D?
* A = Hospital insurance (Original medicare)
* Helps pay for hospital stays, skilled nursing facility, hospice
* B = Medical insurance (Original medicare)
* Mostly outpatient services
* Medications administered by physician are covered
* Home health/equipment
* C = Medicare Advantage (Optional)
* Offered by private insurance companies that ahve contracted with medicare
* Includes A, B, sometimes D
* D = Rx
* Private plans that cover prescription costs
59
What are some aspects of the cardioprotective dietary pattern?
The **2015 US dietary guidelines, DASH diet, and Mediterranean-type diets**
* Unsaturated fatty acids
* Fiber-rich fruits, vegetables, whole grains
* Unsalted nuts
* Fish and vegetable protein sources
60
List some social/environmental/cultural reasons why it is difficult to quit smoking
* Family and peers who smoke
* Permissive environments
* Ex: people are allowed to take smoke breaks but not other breaks at work
61
What were the results of the Jackson Heart Study?
People living in areas of **high disadvantage, high violence, high disorder are more likely to develop cardiovascular disease**
* Statistically significant for women in every category except social cohesion
* Not statistically significant for men, but trending in that direction?
62
What is the barker hypothesis?
**Poor maternal nutritional environment** resulted in intrauterine growth retardation (IGR) and the delivery of **low birth weight infants**
This led to **chronic diseases later in life**
* Coronary heart disease
* Diabetes TII
* Hypertension
* Stroke
63
What is the anthropologic definition of culture?
A **shared** set of...
* Beliefs, Attitudes, Values, Norms
* Explanatory models
* Meanings
* Behaviors
64
Why is the shape of this curve different from the PSC data and figure (that showed increasing risk of stroke as BP increased above 115 mmHg)?
Note: the figure pictured shows achieved SBP on medications
Patients may have underlying reasons (confounding factors) for blood pressure that low (ex: heart failure)
65
Who bears the risk in employer-sponsored group health insurance?
How do these plans work?
The insurance company bears the risk
The company pays the premiums of its employees to an insurance company
These plans are subject to state requirements (Small companies must cover essential benefits, medium companies must cover 60% of essential benefits)
66
What are Association Health Plans (AHPs)?
Cheaper "gimmicky" health plans that Trump expanded access to
However...
* Substandard coverage
* Many hospitals will not accept AHPs
* The 10 basic things that healthcare plans must cover **do not apply to AHPs**
67
What were the results of the CARDIA study?
Those with **higher exposure to convenience stores were 34% more likely to develop CAC** (these people had no CAC at baseline)
68
Name 3 all-inclusive government health care systems in the United States
Veterans Health Administration
Indian Health System
TRICARE
69
What percentage of drugs are substandard or falsified?
10%
70
Who administers...
Medicare?
Medicaid?
CHIP?
* Medicare
* Federal government through CMS (Center for Medicare and Medicaid services)
* Medicaid
* State with federal CMS oversite
* CHIP
* State with federal CMS oversite
71
Who is at a higher risk for developing CV disease?
A) Joe: Walks 4-5 times per week, BMI = 32
B) Louie: Sedentary lifestyle, BMI 23
B) Louie: Sedentary lifestyle, BMI 23
People who are "fit but fat" have a lower CVD risk than people who are "unfit but thin"
72
Which cardiovascular diseases are more common in women than in men?
* **Microvascular coronary disease** (CV Syndrome X
* Takatsubo's cardiomyopathy
* **Peripartum cardiomyopathy**
* Fibromuscular dysplasia
* **HFpEF**
* **Atrial fibrillation**
* ****As well as thromboembolic risk in A-fib
73
What is the purpose of health insurance?
To share risk (of high healthcare costs) among a group of people
74
How long after quitting smoking does it take for ciruculation, blood oxygen levels, and risk of heart attack to improve?
2 weeks - 3 months
75
Why have Trump's efforts to "repeal and replace" ObamaCare stalled?
* Congressional republicans cannot agree on a single plan
* There is no clear direction from Trump regarding what he wants to keep and improve vs. get rid of
76
Describe the evidence that residential segregation is a **fundamental cause** of health disparities
1. **Many diseases** have increased prevalence on the South and West sides of Chicago
2. **Many risk factors** have increased prevalence on the South and West sides of Chicago
3. **Fewer hospitals and health clinics** on the South and West sides of Chicago
4. **New interventions/treatments** consistently fail to reach the South and West sides, resulting in similar patterns of increasing disease prevalence in these areas while they fall in wealthier neighborhoods
77
Which female-specific conditions cause increases in cholesterol?
Pregnancy
Polycystic ovary syndrome
Early menopause
78
What are Short-Term Plans (STPs)?
"Joke" short-term insurance plans allowed under the Trump adinistration
* Limited to 3 months in duration, renewable for only 36 months
* May bar people with preexisting conditions
* Limited coverage - Many hospitals do not accept
* Annual and lifetime cap on benefits
* Few prescription drugs required
* 10 basic benefits are not required to be covered
* Many exclude maternity care, preventative care, mental health care, and substance abuse treatment
79
How much physical activity is recommended?
* Substantial health benefits
* 150 min/week of moderate intensity
* *or**
* 75 min/week of vigorous intesnsity
* Even better health benefits
* 300 min/week of moderate intensity
* *or**
* 150 min/week of vigorous intensity
80
What is the difference between a "difference" and a "disparity?"
Difference = differences between groups that may be due to clinical appropriateness, need, and patient preferences
Disparity = differences that are not physiologic and may be related to systemic differences in the operation of health care systems, legal regulatory environment, or discrimination
81
How does tobacco use contribute to coronary heart disease?
* Exacerbation of ischemia
* Cigarette smoking reduces circulation
* Nicotine makes the heart work harder
* CO also has negative effects on the endothelium
* Injury and dysfunction
* Atherosclerosis progression
* Increase coagulability
* Inflammation
82
What is a conceptual/explanatory model?
A person's beliefs about phenomena (ex: Heart disease)
Can include biological, psychological, spiritual, physical, etc. factors
Influenced by culture, past experiences, etc.
83
What is reverse causality?
When the true cause and effect relationship is reversed
Ex: looking at this graph and assuming that lower blood pressure causes an increased risk of CVD
(In reality, the patients with lower achieved blood pressure typically have heart failure, or another CVD that causes lower blood pressure)
84
What is a potential problem with the expansion of medicaid public option?
Expansion of medicaid public option may cause problems **if there are not enough patients with private insurance to offset losses from treating patients covered under medicare or medicaid**
(Medicaid pays $0.66/1.00, Medicare $0.88/1.00)
85
Who were the participants of the SPRINT trial?
* Age 50+
* SBP 130-180
* ↑ risk for CVD (10-year CVD risk ≥15% or age 75+)
* No stroke or active CHF
86
What are the requirements for a HMO plan?
* PCP?
* Referall to see a specialist?
* In-network benefits?
* Non-emergency out-of-network benefits?
* Emergency coverage?
* PCP? **Yes**
* Referall to see a specialist? **Yes**
* In-network benefits? **Yes**
* Non-emergency out-of-network benefits? **No**
* Emergency coverage? **Yes**
87
What is the leading cause of death in American Women?
Heart disease
(Also the leading cause of death of American Men)
88
What were the blood pressure requirements for patients starting the SPRINT trial?
SBP 130-180 mmHg
89
What is the leading cause of death worldwide?
Ischemic heart disease
90
What were the results of the South Asians Active Together (SAATH) intervention?
Participants weight decreased
Increased physical activity, excercise-related confidence
Participants were happier!
91
What is the most effective strategy for decreasing rates of tobacco use?
Raising taxes on cigarettes
92
What is the current rate of cigarette smoking in the US?
13.7%
93
What are the different types of private insurance based on funder and plan structure?
* By funder
* Self-funded/self-insured
* Group health insurance
* Individual/non-group
* Medicare/medicaid
* By plan structure
* Indemnity (unmanaged care)
* Managed care
* High Deductible Health Plan (HDHP)
94
What kind fo study was the SPRINT trial?
Randomized control trial
95
The results of the CARDIA study showed that:
Moving to less segregated neighborhood was associated wtih a _**\_ \_mmHg**_ reduction in systolic blood pressure
If we only include people who moved to a lower segregation neighborhood and stayed there, there was a **_mmHg_** reduction in systolic BP
The results of the CARDIA study showed that:
Moving to less segregated neighborhood was associated wtih a **_1_** **_mmHg_** reduction in systolic blood pressure
If we only include people who moved to a lower segregation neighborhood and stayed there, there was a **_5_** **_mmHg_** reduction in systolic BP
96
Why is carotid intima media thickness (cIMT) significant?
cIMT is a measure of subclinical atherosclerosis
Increased cIMT is associated with incidence of CVD
97
In which groups is increased BMI **not** a significant predictor of mortality?
In groups that have **high physical fitness**, increased BMI does not predict increased mortality
98
When is ACA open enrollemnt?
Nov 1 - Dec 15
99
How can NM help connect patients with coverage under the ACA?
* Community based partners are Certified Application Counselors
* Near North Health Services Corporation
* Erie Family Health Centers
* NM's financial councelling team
* Uses Change Health Care (a 3rd party medicaid enrollment provider) to help enroll eligible, uninsured patients to medicaid
100
What were the results of the HOPE-3 trial?
Compared with placebo, the fixed-dose combination of ARB + thiazide, at relatively low doses, in persons at intermediate risk without prevalent cardiovascular disease demonstrated **no significant benefit in reducing cardiovascular events**.
101
Which key ObamaCare provisions have bipartisan support?
* Pre-existing condition protections (Guaranteed issue)
* Eligibility for children up to age 26 to be covered on their parent's plan
* Also: Medicaid expansion has been successful
102
What are some interventions that are highly cost effective for CVD prevention and control?
* Nutrition pricing/policy
* Ban on trans-fatty acids
* Tobacco regulation
* Regulate advertising and labeling
* Salt regulation
* Reduce salt content in manufactured foods
* Screening for diabetes in all high-risk adults, including pregnant women
103
What factors are likely to factors lead to **variability** the way culture affects health?
* Gender
* Rlegion
* Education
* Income
* Immigrant generation
104
Which populations have higher than average smoking rates in the US?
* People with lower education levels
* LGBT
* Males
* People living below the poverty level
* People with disabilities
* People with a history of mental illness and substance use
Key: Even though smoking rates are down, these decreases have not affected all groups equally; disparities are growing
105
What are the disadvantages of high-deductible insurance plans?
* People with chronic illness
* May lead to care avoidance
* Higher out of pocket expenses for office visits, procedures, and emergencies
* Disqualified if you are covered by another non-HSA-qualified plan
106
How has the Trump administration changed the ACA?
* Reduced support for outreach and enrollment
* Elimination of the cost-sharing reduction program
* Offering AHPs and STPs
* Cheaper (cut-rate) insurance plans
* Encouraging states to redesign their medicaid programs
* No more uninsured penalty
* Texas court ruled that the ACA's penalty for no insurance is an unconstitutional use of Congress's power to tax
107
What were the results of the SAHELI clinical trial?
The SAHELI intervention (culturally-salient heart disease prevention intervention) group **lost more weight** and had greater decrease in **HbA1c** at 6 months
Physical activity and dietary outcomes did not differ between treatment groups
108
Give examples of structural determinants of health
* R**acial residential segregation**
* Education
* Occupation
* Gender
* Ethnicity
* Social class
* Income
109
What is the adverse effect of diastolic blood pressure that is too low?
The heart may not be adequately perfused; there isn't enough coronary perfusion pressure
110
What percentage of people in the US use some form of tobacco?
20%
111
When is Medicaid enrollemnt?
Anytime throughout the year
112
What is structural competency?
How is it different from culural competency?
**Structural competency:**
The ability to recognize how clinically defined symptoms, attitudes, or diseases **represent a series of upstream decisions** that influence the way our society operates. Focus on the health impacts of the **social contexts in which people live and work**
**Cultural competency** focuses more on the beliefs and behaviors of **individual patients**
113
1 year after quitting smoking, one's excess risk of coronary heart disease decreases to _____ that of a smoker
1 year after quitting smoking, one's excess risk of coronary heart disease decreases to **_half_** that of a smoker
114
List some psychological reasons why it is difficult to quit smoking
* Behaviors, thoughts, and emotions surrounding smoking
115
According to the 2017 Blood Pressure Guidelines, what is the target blood pressure for treatment?
\<130/\<80 mmHg
116
Is this an example of structural or cultural competency?
Recognizing that a patient is eating fried foods because that is what his parents usually cook at home
Cultural
117
Is this an example of structural or cultural competency?
Recognizing that the neighborhood in which a patient lives may make it difficult for her to fill her prescription for her blood pressure medication
Structural
118
What is a DALY?
Cumulative number of ears lost due to ill health, disability, or early death
Years lived with disabiliity + Years of life lost
119
The SPRINT study provided evidence that treating systolic blood pressure to a target of \<120 mmHg resulted in a \_\_\_\_% relative risk reduction, compared to treating to a target of \<140 mmHg
The SPRINT study provided evidence that treating systolic blood pressure to a target of \<120 mmHg resulted in a **_25%_** relative risk reduction, compared to treating to a target of \<140 mmHg
