PUBHLTH 200 EXAM 2: LEARNING OBJECTIVES

Describe the importance of health behaviors, relative to other factors, to preventing premature deaths:

Individual health behaviors make up 1/2 of all premature deaths, while other factors (health care, social environment, geriatrics, etc.) make up <1/3). So its important to promote and prevent unhealthy behaviors,

Name reasons why people engage in UNhealthy behaviors:

Lack of knowledge. Education predicts behavior. Risk perception. Peer pressure. Economic influences. Benefits, immediate, costs deferred. Psychological environment. Feels good. Physical environment. Addiction & habit. Policy environment.

Explain reasons why people engage in UNhealthy behaviors: Lack of knowledge

Lack of consequences.

Explain reasons why people engage in UNhealthy behaviors: Risk perception

Don’t think it will apply to self.

Explain reasons why people engage in UNhealthy behaviors: Peer pressure

Fit norms.

Explain reasons why people engage in UNhealthy behaviors: Economic influences

Unhealthy, cheaper option > healthy, expensive option.

Explain reasons why people engage in UNhealthy behaviors: Physical environment

Low SES leads to higher smoking, obesity, and drug abuse rates.

Explain the ecological model to a health problem

Framework composed of 5 levels (potential targets for health promotion interventions) that examines how a social environment supports/maintains unhealthy behaviors in individuals. Allows understanding of health outcomes. Interpersonal factors. Interpersonal Relations. Community. Society.

Explain the ecological model to a health problem: Interpersonal factors

Individual determinants of health (beliefs, self-efficacy, attitudes). Public health efforts (primary prevention): Education/counseling.

Explain and apply the ecological model to a health problem: Interpersonal Relations

Social relations affect individual behavior (family, friends, coworkers).

Explain and apply the ecological model to a health problem: Organizational/Institutional factors

Social organizations (Workplaces, schools, healthcare facilities).

Explain and apply the ecological model to a health problem: Community factors

Community initiatives/characteristics and relationships b/t orgs. in relation to their norms (local economies, neighborhoods, churches, social norms).

Explain and apply the ecological model to a health problem: Public policy/Societal factors

Enforcement of laws (media, zoning, laws, taxes, bans, social norms).

Name the major health risk behaviors,that shape public and population health measures (premature mortality):

Tobacco. Alcohol. Poor diet. Physical inactivity. Illicit drug use.

Describe the major health risk behaviors, and how they shape public and population health measures: Tobacco

Was the leading cause of diability-adjusted life years and preventable cause of death (leads to cancer, cardiovascular disease, pulmonary disease).

Disability-adjusted life years:

# years lost from poor health/disability/premature death (overall disease burden).

Tobacco & Ecological Model: Intrapersonal

Belief: smoking reduces stress.

Tobacco & Ecological Model: Interpersonal

Friends smoke.

Tobacco & Ecological Model: Institutional

Workplace allows smoking.

Tobacco & Ecological Model: Community

Tobacco economy.

Tobacco & Ecological Model: Policy

Cigarette taxes & indoor smoking bans.

Describe the major health risk behaviors, and how they shape public and population health measures: Poor diet

Leading actual cause of death. Obesity is assoc. w/ higher mortality and increased risks for chronic diseases (diabetes and heart disease).

Describe the major health risk behaviors, and how they shape public and population health measures: Lack of exercise

By increasing physical activity, the ability to prevent many illnesses (stroke and obesity) will increase (wonder drug).

Describe the major health risk behaviors, and how they shape public and population health measures: Alcohol

Cause-related deaths are due to acute and chronic causes. However, heart disease is less likely in moderate consumption of alcohol, whereas the rate increases for no and heavy consumption.

Describe the major health risk behaviors, and how they shape public and population health measures: Illicit drug use

Increase in overdose deaths. Rose in economic and social changes from opioid epidemic.

Describe the major health risk behaviors, and how they shape public and population health measures:

All the major health risk behaviors are factors in preventable deaths, death rate, shorter life expectancies, and large economic costs.

Name and explain major public health successes related to changing health behaviors: Successes

Prohibition (in the middle). Motor vehicle injuries. AIDs.

Name major public health failures related to changing health behaviors: Failures

Firearm safety. Youth Vaping. Obesity epidemic.

Explain major public health successes related to changing health behaviors: Prohibition

Improved health (reduced liver disease), but failed in social consequences (increase in murder/bootlegging). Overturned b/c health effects didn’t justify risks. Similar trend today in drug use.

Explain major public health successes related to changing health behaviors: Motor vehicle injuries

Targets to vehicle safety efforts, improving roads, and campaigns against drunk driving.

Explain major public health successes related to changing health behaviors: AIDs epidemic

Despite prevalence of unprotected anal intercourse increasing, rate of HIV cases continue to fall. Due to new treatments, closing high-risk behavior sites, and informing pop.

Explain major public health failures related to changing health behaviors: Firearm safety

No change in behavior.

Public health challenges to improving health behaviors (thus improving population health):

Must have significant influence on health of Americans. Need targeted, coordinated public health efforts. Belief in individual choices and individual consequences. However, in the end, everyone pays the cost. Political, ethical, philosophical, legal, and economic barriers.

Name the three major categories of strategies used to shift health behaviors, including their utility to achieve behavior change:

Education. Financial Incentives. Laws & Policies (Regulatory Approach).

Explain the three major categories of strategies used to shift health behaviors, including their utility to achieve behavior change: Education

Informs public about health behaviors. Works well when offered by informed educators in well-resourced settings, boosting progress. Used at intrapersonal level (PSA, food labeling (FDA), required sexed (dependent on local government), social norms approach (perception vs. actual norms through survey and advertising results).

Explain the three major categories of strategies used to shift health behaviors, including their utility to achieve behavior change: Financial Incentives

Increase in taxes on unhealthy habits, insurance (due to condition), and job benefits.

Explain the three major categories of strategies used to shift health behaviors, including their utility to achieve behavior change: Laws and Policies (Regulatory Approach)

Most accepted b/c it keeps kids safe and for the common good. However, debated due to ethics, paternalism, and challenge of one’s self to protect from others’ actions( prohibition).

Describe the public health consequences of smoking in the United States

Smoking kills more people annually than the other top 5 health risk behavior deaths (premature deaths) combined. Persistent use of tobacco products expose users to severe toxins (not just nicotine) from inhaling/burning smoke. Non-biodegradable cigarette butts.

Describe the economic consequences of smoking in the United States

Healthcare spending (Government-financed programs burden). Lost productivity (illnesses/poor health). Lost productivity (premature deaths). Lost productivity (secondhand smoke).

Major causes of tobacco related deaths:

Lung cancer. Cardiovascular disease. Pulmonary diseases.

Smoking increases health risks of:

Strokes. Asthma. Low birth weight + premature birth. Diabetes. Sight problems. Cancer.

Explain trends in smoking behavior over time: Early 20th Century → 1960s

Smoking was glamorized and on the rise w/ marketing campaigns. Mass distribution to soldiers.

Explain trends in smoking behavior over time: 1960s

Surgeon General’s report on it’s negative health consequences, cigarette consumption has been steadily decreasing. Frowned upon for women. Original general report didn’t include statistic for women, they continued to smoke until given evidence directed towards them.

Explain trends in smoking behavior over time: 1970s-1990s: Social Norm Shift

Indoor clean-air laws, advertising restrictions and taxation led to steady decline.

Explain trends in smoking behavior over time: Today

Youth smoking nearly eradicated.

Name current inequities in smoking:

Race/ethnicity, sex orientation, disability status, mental health status. Age. Socioeconomic status.

Explain current inequities in smoking: By race + ethnicity

NA have highest rates, followed by BA and WA. Hispanics/Asians have the lowest rates. Historically higher in black men with high lung cancer mortality.

Reasons: Menthol aggressively market to BA communities.

Explain current inequities in smoking: By sexual orientation

Bisexuals have highest rates, followed by LGB then straight individuals. Attributed to bar culture in LGBT+ community.

Explain current inequities in smoking: By disability status

Disabled have higher rates of smoking than abled.

Explain current inequities in smoking: By mental health status

Those w/ severe depression and anxiety tend to smoke > other categories, decreasing as the condition decreases. This Attributed to those w/ mental illness using cigarettes as a coping/calming mechanism.

Explain current inequities in smoking: By Socioeconomic status

<High school have the highest rates compared to college graduates. Social privilege is a big contributor to smoking inequities.

Explain current inequities in smoking: By Age

Older adults show slower decline and higher disease risk than young adults.

Explain effective and ineffective strategies to reduce smoking: Education

Effective: (surgeon general reports, media campaigns, clinical treatment (rarely done properly). Media campaign limitation: Costly/ harder to saturate media market. Why media campaigns have been effective: Ambitious, explicit, and hard-hitting. Ineffective (School health education, warning labels). Way to make warning labels effective: Include graphic images/ plain packaging.

Explain effective and ineffective strategies to reduce smoking: Education - Quitting Diffusion

More educated population reduce their smoking resulting in other populations to follow (fit norms).

Explain effective and ineffective strategies to reduce smoking: Financial Incentives

Effective (cigarette tax increase and lower insurance for nonsmokers). Taxes/Prices limitation: Limit on increase in taxes and regulations on minimum cigarette price. Need political will. Ineffective (Nicotine replacement therapies bought over counter). Nicotine Replacement Therapies (Cessation assistance) limitation: Needs better tools.

Explain effective and ineffective strategies to reduce smoking: Laws/Regulations

Effective (advertising bans (ex. For youth), smoke-free laws). Smoke-free law limitation: Only 1/2 of states have laws. Expanding Smoke-free Law: To work environments/institutions/shared housing/outdoor public environments/cars w/ children. Ineffective Ex: no sales to minors. Way to make no sales to minors effective: Eliminate harsh repercussions and increase minimum age from 18 to 21. Social norm change from desirable to undesirable behaviors. The Master Settlement Agreement.

Explain effective and ineffective strategies to reduce smoking: Laws/Regulations - Master Settlement Aggrement

Class-action lawsuit against tobacco industry. Resulted in industry compensating states for treating smoking related illnesses and restricting advertisements. Tobacco regulation changed from Congress to FDA. Policy changes support cultural and behavioral changes.

Warner’s strategies to reduce tobacco-related deaths:

Significantly raise taxes on combustible tobacco products, while moderately raising taxes on e-cigarettes to isolate youth buyers and create an incentive for adults. No marketing permitted for youth/young adults and adults should be advised on using e-cigarettes and quit smoking.

Explain why further reductions in smoking may be challenging:

Heavily addicted. Current mental illness/substance abuse co-morbidities. Having multiple marginalized identities and other substance abuse disorders will increase smoking disorder. Low SES and education. Rest don’t want to quit. Comes in new forms.

Contrast the known health risks of combustible cigarettes v. e-cigarettes: Cigs

Proven to cause: Lung cancer. Heart disease. Stroke. Pregnancy complications. Contains Tar (carcinogenic). Arsenic and carbon monoxide.

Contrast the known health risks of combustible cigarettes v. e-cigarettes: E-cigs

Lower health risks (less carcinogens; not enough evidence on long-term disease). Cessation assistance, helping smokers quit/reduce consumption. Labeled an epidemic b/c unlike cigs smoking many highly educated youth from affluent families tried it.

Similarities of the known health risks of combustible cigarettes v. e-cigarettes

Promotes dual use. Could potentially cause children to be addicted and promote to cigarettes. Former smokers relapse with a vape and continue smoking. Emit second-hand smoke/vape.

Describe the debate around e-cigarettes within the public health community: Public Health Establishment (CDC, health depts., NGOs) View

Concerned w/ exponential growth in e-cigarette use by children and addiction. Highly marked.

Describe the debate around e-cigarettes within the public health community: Harm Reductionists View

Believe e-cigarettes will help smokers quit. Emphasized risks too much to kids and downplayed benefits for adult smoker attempting to quit. Less harmful.

Describe person first language in health and healthcare:

Language choice that emphasizes the person as a whole and views the disorder, disease, condition, or disability as only one part of the person.

Purpose of first language in health and healthcare:

Reduces stigma. Reduces provider bias. Improves patient–provider relationships. Prevents labeling someone as their illness.

Provide examples of person first language in health care:

Instead of: person is obese....Use: that person has obesity. However, some in the neurodivergent community prefer identity 1st language as form of pride and self-definition.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: 1800s - 1900s

Daily recommendations for nutrients were developed to prevent/treat infectious diseases focused on children.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: 1940s

Shift from preventing infectious diseases to preventing chronic disease, because of wars focus on rationing foods, with current guidelines enacted.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: 1950s

Development of food groups.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: 1970s

Relate guidelines to health outcomes.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: 1990s - Today

Steady decline of youth activity. Currently minority of adults meet activity guidelines.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: Rise of obesity Definition

Complex/recurring state of excess adipose tissue that may affect health and impede on critical organs, resulting from a variety of factors such as genetics, diet, and physical inactivity.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: Obesity and Public Health

Highly prevalent. Associated with serious health/economic consequences. Preventable/treatable.

Explain trends in chronic disease in the U.S. in connection to changes in dietary and physical activity trends: Contributions to overweight and obesity prevalence in U.S.

Dietary intake/Nutrition (Type of accessible foods). Physical inactivity. Genetics. Sleep. Environmental Exposures.

Role of food companies:

Push larger portions on consumers. Argue that diet is a matter of individual choice. Uses science to sow confusion about the harm products can do.

Possible regulations on food companies:

Prohibit ability to make misleading health claims. Implement a sin tax (Tax that raises the price of a product that is harmful, discouraging the consumption).

Principles for sugar sweetened beverage taxes

Focus on minimizing harmful effects and less on minimizing consumption. The goal is not to deprive people but to limit them to a level that balances pleasure against harm. Target the policies that incur the most harm. Tax grams of sugar not ounces of liquid. Implement taxes over as wide of a geographic area as possible.

The Diabetes Prevention Program (DPP) - Nationwide Randomized Trial

Using adults who were overweight/obese with prediabetes. It was found that the incidence of diabetes was reduced the most in the lifestyle intervention group compared to the groups that had a brief education and either took a placebo or a pill.

Type 2 Diabetes Recommendations:

Carbohydrates do not cause diabetes - Instead there is an underlying etiology that disrupts insulin signal. A well-rounded diet - follow Dietary Guidelines for Americans.

A well-rounded diet - follow Dietary Guidelines for Americans

Spacing of meals. Portion sizes (high risk diet: excess alcohol leads to stroke and liver disease). High fiber (high risk diet: added sugars, sodium, and saturated/trans fats lead to stoke, hypertension and obesity). Focus on Calories for weight loss (if needed).

Follow American Guidelines for Physical Activity depending on age:

Controls blood glucose levels by stimulating glucose uptake without an insulin response.

Describe the nutrient and diet recommendations in the U.S.:

Guidance: Consuming too many macronutrients can lead to excess energy being stored as fat. However, too little can lead to body dysregulation.

DRI Composed of:

Average amount of energy/nutrients individuals should consume/day to stay healthy. Has accommodations for age (life-stages), conditions (pregnancy, lactation), and sex (female/male). Uses the Recommended Dietary Allowance (RDA).

DRI Overall purpose is to stay healthy by:

Reducing risk of chronic disease. Prevention of deficiencies and excess malnutrition. Supporting health when nutritional needs are altered.

Describe physical activity recommendations - Regular activity, sleeping better, reducing screen time and feeling better address disease prevention and provide benefits such as:

Reduces onset of many disease states. Improves quality of sleep. Improves cognitive function: academic performance, memory, etc. Reduces depressive symptoms and acute or chronic anxiety. Maintains daily physical function. Maintains muscle and bone mass in aging adults. Allow for adequate weight gain during pregnancy, reduce postpartum depressive symptoms.

Physical Activity Guidelines for Americans by Age:

Children (3-5 yrs of age): caretakers should encourage active play. Children through adolescence (6-17 yrs of age): 60 min/day (or more) of moderate-vigorous activity. Adults (18+ yrs of age): Aerobic physical activity: 150-300 min/week of moderate intensity or 75-150 min/week of vigorous intensity. Muscle-strengthening: +2 days/week working all major muscle groups.

Example - Physical Activity Guidelines for Americans: Move Your Way Campaign

Avoid one-size-fits-all messaging. Resources to guide folks on a variety of activities to fit different lifestyles. Emphasize representation through inclusion and diversity. Leverage social and community connections. Weight loss programs have proven to be successful in adults and children when they combined diet and exercise.

Explain why there are complex relationships between diet, exercise and weight status due to the social determinants of health: Disparities in obesity, type 2 diabetes, physical activity, nutrition, etc

Higher rates of obesity and diabetes in low SES, Black, Hispanic, lower education level. Higher rates of neural tube defects in Hispanic. Lower diet quality (more deficiencies of vitamins and minerals and excesses of calories) in low SES, lower education level, non-white.

Explain why there are complex relationships between diet, exercise and weight status due to the social determinants of health: Structural racism

Safe and accessible exercise facilities. Less outdoor activity. Cheaper options: involving a whole family, mall walkers, walking trails, schools. Bicycle riders with bike lanes, and pedometers, encouraging children to play outdoors.

Explain why there are complex relationships between diet, exercise and weight status due to the social determinants of health: Types of social determinants of health that impact diet, exercise, and weight status - Food insecurity

Limited access to adequate food for healthy living. Accumulates from a variety of factors such as: SES, poverty, unemployment, and food deserts.

Attempts to use the ecological model of health behavior to create a social environment that favors healthier eating:

Important to promote self-efficacy and social support. Requires community based efforts to increase availability of healthy foods at a reasonable price. Using interpersonal and media messages to promote healthier lifestyles.

Attempts to use the ecological model of health behavior to create a social environment that favors healthier eating: Chronic Stress & Allostatic Load

Increases emotional eating. Fat storage. Diabetes risk. Hypertension.

Attempts to use the ecological model of health behavior to create a social environment that favors healthier eating: Pitfalls in using anti-smoking campaigns to healthy eating campaigns

Lacks the funding to make it successful.

Review (and reflect on) the rise of chronic disease in the U.S: Chronic conditions as public health problem characteristics

Prevalent. Serious – health and economic consequences. Poor diet and physical inactivity are the top two behavior factors identified as the leading actual causes of death in US. Preventable and treatable - lifestyle changes.

Define injury and understand what distinguishes an injury from an accident: Definition

Harm, damage, or impairment to the body that occurs through an acute (cause & effect in short time) transfer of energy exceeding physiological tolerance. Or an insufficiency of vital elements.

Define injury and understand what distinguishes an injury from an accident: Components

Transfer of energy includes mechanical (fractures in crashes), chemical (poisoning), and thermal (burns). Can be intentional (homicide/suicide)/unintentional (falls/crases/poisoning). Third leading cause of death overall in US,

Define injury and understand what distinguishes an injury from an accident: Accident

Imply something that can’t be prevented, while injuries can. Not public health problems and not influenced by an individual’s behavior, physical and social environment.

Ecological model for injuries: Individual

Individual firearms safety practices.

Ecological model for injuries: Relationship/Interpersonal

Friends, family, clinicians, and other supporting at-risk individuals.