Final study guide Flashcards
Harm reduction
a type of intervention aimed at people who are unable or unwilling to stop their current, harmful behavior completely, and therefore we encourage them to reduce or limit the harmful behavior
2 examples of harm reduction
- Needle exchange for intravenous drug users.
2. Cutting back on the number of cigarettes consumed per day, rather than complete smoking cessation.
Name three reasons that the poor may find it difficult to practice habitual behaviors
- Habitual behaviors require stable contexts in order to form. However, those who are poor may not have the resources to secure a stable environment (ie, always able to secure water/electricity, ect).
- Habitual behaviors are formed through repetition, and poor individuals may not have time to repeat the behavior as their time is consumed with securing basic necessities.
- Habitual behaviors, like all behaviors, are influenced by societal norms and pressures that could adversely impact the practice of the behavior.
Habitual behavior can be more difficult for the poor, bc unable to ensure a stable context:
● electricity blackouts
● irregular employment
Gasoline is inexpensive in the United States. Behavioral economists argue that this sends a signal to people that encourages gasoline consumption. (a) What are three costs not included in the price of gasoline that people pay at the pump? (b) What concept from the course applies to this situation?
A.
- The cost of releasing greenhouse gasses into the environment.
- The environmental cost of extracting oil to produce gasoline.
- The cost of oil spills in the transport of oil to make gasoline.
- The political cost of conflicts resulting from oil-motivated agendas
- Economic cost of perpetuating an industry that will not be sustainable in the long term
B. Externalities. (In particular, negative externalities.)
Tragedy of the commons
Term used for a situation where each person acts independently and rationally according to her or his self-interest, while at the same time depleting or damaging a common resource that the whole group depends on
Example of tragedy of the commons
- Overuse of groundwater by homeowners leading to limited water supply in California.
- Overuse of electricity leading to environmental issues from coal
- Overconsumption of meat leading to environmental, economic and public health issues related to meat containing antibiotics, large waste production, unsafe breeding habits, etc
If you ask people on a questionnaire about a behavior they practice every day such as taking a shower or brushing teeth, they may overestimate how much they practice the behavior. Epidemiologists often attribute this situation to “courtesy bias” or “social desirability bias”. What is a reason that people find it difficult to report accurately how much they practice the behavior, specific to this kind of behavior?
One reason that people find it difficult to accurately report how often they practice a habitual behavior like this one is because habitual behaviors are performed with a high degree of automaticity. In other words, as the behavior is repeated over and over again, it becomes highly automatic and no longer requires a lot of cognitive engagement. As such, even though the behavior is performed, an individual may not be able to recall doing so and therefore it is hard for him or her to accurately report how often they practice the behavior.
In the Community Led Total Sanitation intervention methodology, how are people made aware of the extent of the problem of open defecation? What is this stage of the process called?
In CLTS people are made aware of the problem of OD through transect walks where the facilitator and community members walk through community identifying areas of OD and moving towards the realization that so long as OD persists, community members will continue to ingest one another’s feces as it spreads through the environment. The transect walks are aimed at developing collective disgust that will mobilize action.
This stage of the process is called “triggering.”
Tobacco control researchers have found that effective tobacco prevention in teenagers requires a combination of taxes on cigarettes and prohibition on tobacco sales to minors, creation of no-smoking areas both inside and around secondary schools, discouraging parents from purchasing cigarettes for their teenagers, and building the confidence of teenagers to refuse cigarettes when offered to them by peers. What model summarizes this package of interventions? Explain briefly.
McLeroy Social Ecological model o Intrapersonal – building confidence o Interpersonal – discouraging parents o Community – non-smoking areas o Public policy – taxes and regulations
Briefly describe one component of the Thai 100% Condom Program that is at the Structural Level in the Sweat/ Denison Social Ecological Model
Implement and enforce policy making condom use mandatory during all sex acts in all commercial sex work establishments
Define Young’s concepts of internalizing and externalizing disease etiologies. Provide an example of each.
Externalizing systems = making etiologic explanations for serious sicknesses, looking for religious or magical agents or elements and what events brought victims to misfortune, responsibility beyond patient control
Internalizing systems = biomedical explanations for etiology, interpret symptoms and make a subsequent diagnosis, responsibility lies with patient
What features of childhood drowning in Bangladesh might lead people to ascribe it to externalizing or personalistic causes?
- Traditional rescue practices were largely non-beneficial
- externalizing causes: drowning is difficult to prevent… harder to put fences around lakes or shallow bodies of water.
- In Bangladesh, drownings do not happen in pools, but instead of uncontrolled bodies of water. So, there is a lack of perceived control
- Attributing drowning to supernatural events reduces blame to put on mother
- takes the problem out of her control
- evident by the fact that most near-death experiences were not attributed to spirits (because they were less susceptible to damaging blame)
Explain briefly three critiques an anthropologist might make of the Health Belief Model.
- Missing household and community aspects
- Lacking emic illness terminology
- Perceived benefits might be affected by pre-existing notions people have about treatments
- Focuses primarily on individual rather than superstructural or multi-layered environmental influences
- Could put blame disproportionately on individual if behavior not practiced; puts burden on individual
Explain briefly three ways you might increase a teenager’s self-efficacy to refuse a cigarette when offered by a peer
- Modeling of desired behavior by others to get vicarious experience in going against social norm (observational learning)
- Encouragement or mentoring by others to carry out the behavior
- Practice and experience in carrying out the behavior to become more confident in self-control (self-efficacy)
- Education on the potential benefits
- Removing perceived barriers (?); finding effective, culturally appropriate ways to decline cigarette smoking when offered
Explain briefly why educated, upper-income parents might be more likely to refuse vaccination for their children, using one or more concepts/constructs from the course
In the example discussed in class with upper-income parents of children at the Waldorf school vaccine decision making was a highly social process. The social norm was not to vaccinate children. This exerted pressure on parents to refuse vaccination. Also descriptive norms → they saw that the people around them would refuse vaccination, so they did not.
Additionally, the Waldorf school parents perceived little benefit of the vaccine (since the population at large was vaccinated, the risk to their child of catching an infectious disease was small) but significant risk (side-effects, introducing chemicals into their children). These perceptions (aligned with value and threat expectations of the Health Belief Model) made it less likely that parents would vaccinate.
ANOTHER OPTION:
High Income Settings - consequences to not taking action might be lower because greater health care system and access to treatment. People have increased agency to opt out of vaccination.
■ places most affected by negative externalities from actions in high income settings are located far away from the high income settings.
○ Low/Middle Income Settings - no matter what you believe, you have less agency to control whether or not you can act on your beliefs. Facing consequences of decisions to participate/not participate in preventative more immediately.
■ example from Waldorf school: a women said, well if we lived in Kenya, we would get the vaccine.
○ Interdependent societies - more likely to participate in mass preventative
In country X, there is one local term that applies to the consequences of bites by rabid dogs and the bites by non-rabid dogs. A well-known local healer reports that his treatments are almost always effective, whereas people taken to the hospital usually die. Explain why the healer might have this view, drawing on one or more concepts from the course.
- Nosological fusion – one emic term includes both severe and mild dog bites. A distinction between the two is not being made in local terminology
- Healer might mostly be getting cases of non-rabid dog bites (not difficult to treat), while hospital might be mostly getting cases of rabid dog bites (considerably more dangerous)
A teenager knows that his parents want him to brush and floss his teeth every day, but he sees no reason to go along with what his parents say. What concept, construct or model describes this situation? Explain briefly.
This situation can be viewed through the lens of the Health Belief Model (HBM). HBM states that individual-level behaviors, like flossing, are largely motivated by perceived expectations (such as perceived benefits) and threats (such as risk, or severity of resulting health condition). In this example, the son may not see the benefit to flossing and the risk (eg, of gum disease) that is increased by not flossing.
How does the Theory of Reasoned Action differ from the Theory of Planned Behavior?
The theory of planned behavior includes the entire theory of reasoned action (attitude towards behavior, subjective norm, behavioral intention) along with the addition of perceived behavioral control, which results from control beliefs and perceived power
What individual model of health behavior do you think provides the best explanation for why people do or do not get their annual vaccination for influenza? Why?
HBM
Why do Katabarwa et al. contend that their system of distribution of Ivermectin for onchocerciasis control in rural Uganda is more sustainable than a conventional system based on community health workers?
- Key change was to define zones based on traditional kinship and support groups, rather than government administrative boundaries
- Thought that importance of kinship duties would lead to easier distribution of labour, higher trust in medications received from clan, seriousness of refusing kinship duties
What explanation might you provide for why sex workers may insist on condoms with a new client, but stop insisting on condom use once the person becomes a regular client?
- Relationship intimacy – less intimacy with individuals in the public domain (new clients) but as they become closer, they perceive not using condoms as a sign of security and closeness
- Perceived risk of HIV or STIs decreases as perceived intimacy increases
Describe two major dimensions of ‘patient-centered counseling’.
- Psychosocial regard – eliciting and understanding the patient’s perspective, concerns, needs, feelings (this relates to notion of “emic” [local] terms). And understanding the patient within his/her unique psychosocial context. Involves respect, active listening.
- Shared power – reaching shared understanding of problem and its treatment with patient that aligns with their values and helping the patient to share power and responsibility by involving them in choices to the degree that they wish. Involves patient participation and informed choice.
(a) What are three key strengths of interpersonal channels of communication? (b) Describe a situation where you would expect interpersonal channels of communication to be more effective.
Examples of interpersonal channels of communication:
-counseling, peer education, diffusion through social networks, community groups/participatory processes
Strengths:
- may be more convincing
- better for more complex, multi-part messages or transfer of skills
- can be adapted to individual needs
- can reach isolated or marginalized populations
- Interpersonal channel of communication can be targeted towards either intrapersonal or interpersonal level of McLeroy’s SEM
Examples of situations where interpersonal channel of communication may be more effective:
one-on-one counseling for domestic violence: highly contextual, situation is unique to the individual, the patient’s needs will be different from person to person. Gives a more intimate, personalized setting for the counselor to be more convincing to the patient, and respond to the patient’s needs.
A community is hit by severe floods. As a result of the flooding, the community comes together behind its leaders and rebuilds. (a) What term might you apply to this feeling of togetherness and solidarity the community experiences in the wake of the floods? (b) Why might this togetherness and solidarity not last very long?
A) Communitas (in contrast to hierarchy): is a temporary state when members of a group have relations of quality; hierarchy is temporarily suspended. Communitas is a state of being not a geographic location or a group of people. Communitas involves a sense of community spirit, solidarity, togetherness. Examples of circumstances under which communitas can come into being:
- Events affecting entire group (natural disaster, war, terrorist attack)
- Revolutions
- Rites of passage (weddings, funerals, coming of age rituals)
- Holidays
- Pilgrimages
B) Often people do not want to give up their position in the hierarchy for long. Also, a sense of hierarchy may feel natural. Hierarchy is common, even if informally, among groups of people or in particular contexts (e.g., in a school, a family/household, a village structure). So, people normally easily revert back to that sense of order; order/hierarchy provides rules and a basis for decision-making. People are more willing to suspend normal rules while a threat is present. When the threat dissipates, people tend to revert to the rules.
- Also, if people purposefully try to sustain communitas, then they may inadvertently end up institutionalizing it or adding some order that creates a hierarchy.
- Application to public health interventions: community-based interventions that attempt to mobilize a community are inherently unsustainable (can’t expect a community to stay mobilized)
What are three typical components of cognitive social capital that researchers measure?
- Perceived reciprocity and social support
- Example: Measures if you or “a neighbor” would contribute to a community project if you/the neighbor did not directly benefit - Perceived solidarity in a crisis
- Example: if your house burned down, would the community support you? Could you stay with someone or borrow money/clothes? - Participation in collective action
- Degree to which individuals participate in a community meeting/event/march/gathering
What is the difference between bonding and bridging social capital?
These terms come from the Communitarian construction of social capital, which promotes the idea that connections and linkages with each other promote prosocial behaviors and attitudes.
There are two types of “ties:”
-Bonding social capital: Dense network of close ties among socially homogenous group
-Bridging social capital: Looser ties between socially heterogeneous groups
Why are interventions at the community level critical for the effectiveness of the smoke-free household intervention in Indonesia?
- “Women expressed a low sense of self efficacy in individually getting their husbands to quit smoking in their homes, but a strong sense of collective efficacy that husbands might agree to a well-publicized and agreed-upon community household smoking ban.”
- individually, the women couldn’t convince their husbands to quit smoking, but if a community wide initiative, husbands expressed enough interest/motivation to stop
- Men and women expressed concern about the social risk of asking guests not to smoke in their homes without a community-wide ban and visible displays communicating their participation in this movement. → by having a community wide ban, could reduce social pressure to ask people not to smoke, relieve burden on individual to enforce ban
How did the SASA! intervention in Uganda address social norms and power imbalances to reduce gender-based violence? Explain briefly.
- addresses gender inequality
- Adapted Stages of Change theory
- encourages people to think about what power they have over others, and how they are using that power
- instead of lecturing about how to be faithful, etc, they asked men why they did the things they did (why did they commit infidelity), and whether they think those behaviors are beneficial or not. Focused on aspects of power rather than specific instructional messages
- Created an active cohort of community members who would serve as change agents with their contacts and help encourage safer power dynamics
- aimed to change the community/social norm about GBV: higher level interventions rather than targeting individual level
How does internal locus of control differ from self-efficacy? Comment on why it is important for public health interventions to take this concept into consideration.
- Self-efficacy - the belief that you are capable of successfully practicing the behavior
- Locus of control = who or what controls the ability to do practice a behavior/act in a specific situation
- eg, flying (not in control; external locus) v. driving (in control; internal locus)
- internal locus of control can lead to lower perceived risk
- This is important to consider in developing public health interventions as generating motivation to change a behavior with an internal locus will be easier as that is a behavior already considered to be under an individual’s control.
Summarize Mary Douglas’ “cultural theory of risk,” and provide two examples of ‘risky’ behaviors according to this theory.
- Cultural Theory of Risk examines structures of social organizations and how they influence concepts of risk
- Different societies prioritize different types of threats/… view different things as risks based on how much that risk threatens the structure of society
- Those who violated norms are susceptible to blame for societal issues
- High groups: emphasize collective control and interdependent self construals
- Low groups: low degree of collective control. independent self construals , self sufficiency
- High grid: stratification of society, less egalitarian
- Low grid: more egalitarian structure/distribution of power
- Example: US is a low group with a variable grid (socialized medicine)
What is meant by the strength of weak ties? Provide an example.
Strong ties are when person A has a very close connection to Person B. If it’s a weak tie, then Person A may know person B or be connected to them in some way, but not in a very personal or clearly tight connection. When thinking about social networks, some people can bridge one social group to another social group based on their ties. Strong ties generally are between people who are already within the same social group, thus they don’t tend to bridge one group with another group. Weak ties, however, tend more often to bridge one network with another network because it reflects a weak connection that two people have together. As a result, weak ties are actually the ones that can expand a network and aid in diffusion of ideas to a wider audience.
Define “opinion leaders” in the context of Diffusion of Innovations, and explain why they may be important for a public health intervention.
- Early adopters, highly integrated into local social system and respected by peers
- Important because they can spread the use of an innovation, diffusion of innovation
Which one of these statements is TRUE concerning the private domain, also called the domestic domain?
a. The private domain is controlled by private enterprise, rather than by the government.
b. The private domain refers to institutions of the state and society outside of the household.
c. Punishments in the private domain include fines and imprisonment.
d. Punishable transgressions in the private domain include disobeying the head of household, and sexual transgressions.
e. Rules and laws in the private domain have their origin in parliaments and courts.
d. Punishable transgressions in the private domain include disobeying the head of household, and sexual transgressions.
Which of the following statements is TRUE concerning the settlements and homes at Çatalhöyük in Neolithic Anatolia?
a. There were large public spaces and many, obvious public buildings at Çatalhöyük in Neolithic Anatolia
b. The proportion of the buildings and surrounding spaces that fell within the public domain was very high at Çatalhöyük in Neolithic Anatolia.
c. Ancestors were buried within the home at Çatalhöyük in Neolithic Anatolia.
d. Household structure at Çatalhöyük in Neolithic Anatolia appears remarkably similar to current household structure in USA.
c. Ancestors were buried within the home at Çatalhöyük in Neolithic Anatolia.
Which of the following is NOT true concerning relationship intimacy and condom use?
a. Higher perceived relationship intimacy is a major challenge to the promotion of consistent condom use among couples in long term relationships.
b. People may consider not using condoms as sign of closeness in the relationship.
c. Where there is greater perceived relationship intimacy, people may judge that the risk of sexually-transmitted diseases is lower.
d. People rarely consider that condom use interferes with their desire for greater connectedness in a relationship
d. People rarely consider that condom use interferes with their desire for greater connectedness in a relationship
What reason from the following list has been offered to explain why exclusive breastfeeding results in less HIV transmission from mother to child that mixed feeding where infants are given other foods and fluids along with breastmilk?
a. Infants exclusively breastfed sleep better, and this benefits their immune system
b. Foods and fluids other than breastmilk may cause injury to the infant’s gut mucosa, allowing the HIV virus to cross over into the infant’s blood
c. Infant formula has additives that bind to the HIV virus and help it avoid detection by the infant’s immune system
d. Breastmilk has naturally-occurring antibodies against the HIV virus
b. Foods and fluids other than breastmilk may cause injury to the infant’s gut mucosa, allowing the HIV virus to cross over into the infant’s blood
