US Health - final exam Social and Behavioral Sciences

Question 1

Leading causes of death versus leading ACTUAL causes of death

Answer 1

1990 CDC Study:
- Findings: the leading causes of death were not root causes but were diagnoses at the time of death that resulted from a combination of inborn (largely genetic) factors and external factors

• Undertook to identify the underlying causes of death from each of the leading diseases

Question 2

Leading causes of death versus leading ACTUAL causes of death

What were the leading causes of death in 1900?

How do they compare to 2006?

Answer 2

What were the leading causes of death in 1900?
- Pneumonia and influenza
- TB
- Diarrhea and intestinal ulcerations

How do they compare to 2006?
- Heart disease
- Cancer
- Cerebrovascular disease
- COPD

Question 3

If the leading causes of death are diseases

What are the actual causes of those diseases?

Answer 3

What causes the diseases?:
- Tobacco
- Poor diet and physical inactivity
- Alcohol consumption
- Microbial agents
- Toxic agents
- Motor vehicles
- Firearms
- Sexual behavior
- Illicit drug use

Question 4

Tobacco

Answer 4

Found to be the leading cause of death in the United States
Accounts for 30% of all cancer deaths and 21% of cardiovascular disease deaths
Causes chronic obstructive lung disease
A direct contributing factor in infant deaths due to low birth weight
Burns due to accidental fires
Of the 435K deaths attributed to tobacco smoking, 35K were caused by second hand smoke

Question 5

Poor diet and physical inactivity

Answer 5

Second most important actual cause of death
Overeating + inactivity = obesity
Dietary fat, sedentary behavior and obesity have all been associated with heart disease, stroke, cancer and diabetes
The number of deaths associated with this factor is increasing as the incidence of overweight and obesity increases

Question 6

Misuse of alcohol

what % of motor vehicle deaths does it cause?

what does it lead to

Answer 6

Causes 35 to 40% of motor vehicle fatalities

This leads to chronic liver disease and cirrhosis

Home Injuries

Drownings

Fire fatalities

Job injuries

3 to 5% of cancer deaths

Question 7

Excessive alcohol use definition
not tested on numbers

Answer 7

The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours.

binge drinking is associated with health problems and is enough to raise blood alcohol concentration

Question 8

Binge drinking

Answer 8

Binge drinking is associated with many health problems, including:
Unintentional injuries (car crashes, falls, burns, drowning)

Intentional injuries (firearm injuries, sexual assault, domestic violence)

Alcohol poisoning

Sexually transmitted diseases

Unintended pregnancy

Children born with Fetal Alcohol Syndrome

High blood pressure, stroke, and other cardiovascular diseases

Liver disease

Neurological damage

Sexual dysfunction

Poor control of diabetes

Question 9

Evidence-based interventions to prevent binge drinking

Answer 9

Increasing alcoholic beverage costs and excise taxes

Limiting the number of retail alcohol outlets that sell alcoholic beverages in a given area

Holding alcohol retailers responsible for the harm caused by their underage or intoxicated patrons

Restricting access to alcohol by maintaining limits on the days and hours of alcohol retail sales

Consistent enforcement of laws against underage drinking and alcohol-impaired driving

Maintaining government controls on alcohol sales

Screening and counseling for alcohol misuse

Question 10

Microbial agents

Answer 10

Encompassed the top three killers in 1900
Less significant now partly due to public health successes
Infectious disease is still significant and always a threat to public health

Question 11

Significance of the 9 actual causes of death to public health

Answer 11

The 9 actual causes of death account for about 50% of all deaths in the United States

What about the other 50%?
Genetic factors
Deaths legitimately attributed to old age
Lack of healthcare
Less clearly identifiable causes

these are preventable because it is a choice if you wash your hands, smoke, drink

Question 12

The 9 identified factors

Answer 12

Why are these public health issues?
Cause premature deaths
Lead to poor quality of life
They are preventable with effective public health measures
All but microbial agents and toxic agents are rooted in behavioral choices of individuals
Impact on the healthcare system

Question 13

Government approaches to promote healthy behavior

what does the gov’t do about promoting healthy behaviors

Answer 13

Education

Regulation:
Both have had success and failure
Both continue to be important components of public health’s mission

Question 14

Education from gov’t on public health

Answer 14

Informs the public about healthy and unhealthy behaviors so that changes to lifestyle can improve health

Question 15

Education examples from the gov’t

Answer 15

Examples:
1964 Surgeon General’s report called Smoking and Health

FDA food labeling requirements

Educational messages in the media (public service announcements)

Schools: Sex education, health classes

Social norms approach: advertising actual norms to reduce high-risk behaviors (drinking on college campuses)

Health education delivered by medical professionals during office visits (one one-on-one)

• what changes and influences of health that the public have on their own health*

Question 16

Education, Is there any level of controversy with this approach?

Answer 16

Is there any level of controversy with this approach?:
- Educational messages about sexual behaviors

• Sex education in public schools
• Opposition from the tobacco industry
• Opposition from the meat industry

questions to think about
How effective is this approach?

Where do pharmacists fit into this approach?

Question 17

Regulation
who has always regulated people’s behavior by passing and enforcing laws
what is the intent of regulations

Answer 17

Government has always regulated people’s behavior by passing and enforcing laws

Intent is to pass and enforce laws to:
Restrain people from harming themselves
Restrain people from harming others

Question 18

Regulation

Answer 18

Examples of government regulations to improve public health include:
Prohibition (probably the most ambitious attempt by the U.S. Government to regulate behavior)
1919 – legally banned alcohol
Repealed 14 years later
Was it effective?

Question 19

Other examples of regulation

Answer 19

Fire arms laws
Traffic laws
Laws concerning tobacco and alcohol sales and use
Legal and illegal drug laws

Question 20

Regulation
Is there any level of controversy with this approach?:

Answer 20

Is there any level of controversy with this approach?:
Mandatory vaccinations
Premarital screening for diseases (AIDS, HIV)

questions to think about
How effective is this approach?
Where do pharmacists fit into this approach?

Question 21

Determinants of Health

what does it effect

Answer 21

Factors that influence human behaviors

Why is it important to consider changing the social environment rather than the individual?:
- If the focus is on the individual then the individual is blamed for their illness

• More efficient than changing one person at a time
• Concludes that illness may be caused by factors beyond an individual’s control

Do demographic factors (race, gender, marital status) influence health?

Question 22

Determinants of Health

What demographic factors:

Answer 22

Demographic factors: age, gender, marital status:
- Consistently found to influence health

• Some ethnic minorities have significantly higher mortality rates from most diseases than do whites in the United States
• Males have higher mortality rates than females at all ages
• Females tend to suffer from more chronic diseases than males
• Married people are generally healthier than those not married, whether single, separated, widowed, or divorced

Question 23

Socioeconomic Status (SES)
what is it important for

what does it include

Groups with the lowest SES have the highest mortality rates, why?:

Answer 23

The most important predictor of health

What does it include?:
- Income
- Education
- Occupational status

Accounts in part for health differences by race, sex, and marital status

Groups with the lowest SES have the highest mortality rates, why?:
- Adverse environmental conditions
- Poor nutrition
- Less access to healthcare
- Psychological stress

Question 24

SES
what does it account for

what are examples

Answer 24

Accounts in part for health differences by race, sex, and marital status

Example:
Variable access to healthcare is correlated to socioeconomic differences in health and SES

Question 25

Health of Minority Populations

what health disparities are still persistent

Answer 25

Health disparities among racial and ethnic groups persist despite improvements in the overall health of the U.S. population:
- Life expectancy
- Infant mortality rates
- Mortality from diabetes
- Death rates from HIV/AIDS

Question 26

Stress

what does it influence

Sometimes due to the adverse physical and social conditions associated with lower SES, what does it result in

Answer 26

A psychological factor that influences health

Sometimes due to the adverse physical and social conditions associated with lower SES:
- Acts directly by affecting physiological processes
- Acts indirectly by influencing individual behavior
- Increases risk of illness and death
- Suppresses the immune response

Question 27

Stress
Why is stress a public health issue?:

What can help people cope with life’s stresses?

Answer 27

Why is stress a public health issue?:
A contributor to heart disease and other health issues

What can help people cope with life’s stresses?
- Money
- Education
- Social support

Question 28

Social Support examples

Answer 28

Marital status

Close friends and relatives

Church membership

Affiliation with organizations

Question 29

Evidence of the influence of social support

who were interviewed

what were they surveyed on

what was the conclusion

Answer 29

Cohort study on residents of Alameda County in California

Persons aged 30 to 69 surveyed on physical, mental and social well-being and their health-related habits

Also surveyed on social networks (church memberships, number of close friends and relatives), marital status

Death certificates monitored over 9 years

Found that an individual’s health status and risk of dying were strongly associated with the extent and nature of their social network

Question 30

Psychological Models of Health Behavior

what must be understood to promote healthy behavior

what does it focus on

Answer 30

Understanding the most effective ways to promote healthier behaviors is the goal of studying the psychological and SES factors

This focus is on individual psychology

Understanding how SES, stress, social networks affect health may permit more effective interventions to promote healthier behaviors

Question 31

Psychological Models of Health Behavior

Answer 31

Theories and models attempting to explain how psychosocial factors affect health related behaviors

Some focus on individual behaviors while others focus on the effect of the social environment on individual behaviors

The goal is to utilize these analytical methods to find the most effective ways to promote healthier behaviors

HBM

trans-theoretical model

ecological model

Question 32

Health Belief Model (HBM)
on exam

what are the 4 factors

Answer 32

The four factors that determine whether a person is likely to change behavior when faced with a health threat are:

1. The extent to which the individual feels vulnerable to the threat - ex: do people feel like smoking is a threat
2. The perceived severity of the threat - what do people think about what is the result of the threat
3. Perceived barriers to taking action to reduce the threat -ex: why can they not quit smoking
4. The perceived effectiveness of taking an action to prevent or minimize the problem - ex: if we quit smoking, how effective in improving blood pressure or not getting lung cancer and improving overall health

need to look at each individual in the group

V
S o T
B
E

Question 33

HBM
what does it do and how does it do it
what are examples

Answer 33

The public health approach to changing behavior would be to convince people that:
- They are vulnerable
- The threat is severe
- Barriers to taking action are worth the risk
- Certain actions are effective preventive measures

Examples: Low-income women and mammograms, smoking cessation

Question 34

Self-efficacy
what is the definition
what is High self-efficacy
what is low self-efficacy

A sense of control is beneficial for health reduces what

what is Self-efficacy added to

Answer 34

The sense of having control over one’s life:
- High self-efficacy: People who are confident that they can control their lives
- Low self-efficacy: People who believe their lives are subject to chance or external forces

A sense of control is beneficial for health:
Reduces stress

Self-efficacy is often added as the fifth factor in the health belief model

Question 35

Self-efficacy

what can people with low self-efficacy develop?

How do you increase people’s self-efficacy?

what are examples

Answer 35

Those with low self-efficacy may develop a pattern of learned helplessness and acceptance of negative situations

How do you increase people’s self-efficacy
- Discussion on Previous successful performance of the behavior
- Seeing others successfully perform, especially if the model is a peer

Example: programs that utilize role models, mentors, such as school drug prevention programs utilizing students as mentors, alcohol anonymous

Question 36

Trans theoretical Model

what are the 5 parts?

PCPAM

Answer 36

Envisions change (smoking cessation) as a process through a series of five stages

1- Precontemplation: no intention to change the behavior. The first step is consciousness-raising to increase awareness that their behavior is unhealthy and needs to change

2- Contemplation: the person is more aware of the benefits of change but is very aware of the barriers and difficulties and still is not ready to take action

3. Preparation: when a person decides to make the change and has planned concrete action
4. Action: the individual actually modifies their behavior
5. Maintenance: people have achieved the healthier behavior and strive to prevent relapse; happens after they made the change and we monitor if they are able to improve health

Question 37

Ecological Model of Health Behavior

Answer 37

Looks at how the social environment, including interpersonal, organizational, community and public policy factors supports and maintains healthy or unhealthy behaviors

Describes five levels of influence that determine health-related behaviors, each level being a level of health promotion intervention

Question 38

The 5 Stages of the Ecological Model of Health Behavior

Answer 38

Each level is a potential target for health promotion intervention

1- Intrapersonal factors: encompasses the knowledge, attitudes, and skills of the individual; what are their knowledge and skills with health status

2- Interpersonal relations: includes family, friends, and coworkers and how they affect health behaviors such as smoking, diet, alcohol, and drug use.

3. Institutional factors: individuals spend 1/3 to 1/2 of their waking lives here. Includes school and the workplace, these influence health
4. Community: Organizations can work together in a community to jointly promote health goals; hospitals, PCP, PH departments
5. Public policy: Encompasses the regulations and limitations on behaviors.

Question 39

Health Promotion Programs

Answer 39

Utilize understanding of:
people’s behavior
levels of influence of the social environment
health belief models
the ecological model

To design more effective public health and disease prevention programs these need to be considered.

Question 40

Aids Prevention Program in San Francisco

Answer 40

Targeted at gay men in San Francisco in the mid-1980s
Goal was to prevent infection through behavior change
Campaign launched by the city health department in collaboration with community-based AIDS organizations and a research group from the University of CA

Question 41

Aids Prevention Program in San Francisco

Answer 41

Campaign’s goals were to promote the following beliefs among high-risk populations
Belief in personal threat
Belief in response efficacy
Belief in personal efficacy
Belief that new behaviors are consistent with group norms

Question 42

Aids Prevention Program in San Francisco

Answer 42

Which models or theories were utilized?:
HBM, self-efficacy, ecological model

What contributed to early success of the intervention?:
The gay community was in general well educated and politically astute, had high SES, motivation

Why has there been a resurgence of high-risk behavior and disease?:
The advent of highly effective antiretroviral therapy and drug cocktails resulted in young gay men viewing HIV infection as a less severe threat.

• so there was a rise in HIV cases because of the medicine that came out and that made them believe that HIV is less of a threat to life

Question 43

Changes in Environment

Answer 43

Environment = physical + social

Changes to the environment are often more effective and efficient than changes to individual behaviors

Includes changes to the social and the physical environment
Example: safer roads = fewer deaths from motor vehicle accidents, going to AA meetings, removing vending machines from schools and public buildings, physical activity in urban vs rural communities