NS 1600 Classes 2-18 and Research Papers

What is Public Health?

Organized community effort aimed at the prevention of disease and the promotion of health

What report defined the three core functions of public health?

The Future of Public Health, published in 1988 by the Institute of Medicine

What are the three core functions of public health?

Assessment, Policy Development, and Assurance

What is Assessment in public health?

The diagnostic function, in which a public health agency collects, assembles, analyzes, and makes available information on the health of the population

What is Policy Development in public health?

The use of scientific knowledge to develop a strategic approach to improving the community's health

What is Assurance in public health?

Assuring that the services needed for the protection of public health in the community are available and accessible to everyone, including environmental, educational, and basic medical services

How many Essential Public Health Services are there?

Ten Essential Public Health Services

What are the two Assessment services in the Ten Essential Public Health Services?

1) Monitor health status to identify community health problems,

2) Diagnose and investigate health problems and health hazards in the community

What are the three Policy Development services in the Ten Essential Public Health Services?

3) Inform, educate, and empower people about health issues,

4) Mobilize community partnerships to identify and solve health problems,

5) Develop policies and plans that support individual and community health efforts

What are the four Assurance services in the Ten Essential Public Health Services?

6) Enforce laws and regulations that protect health and ensure safety,

7) Link people to needed personal health services and assure provision of health care when otherwise unavailable,

8) Assure a competent public health and personal healthcare workforce,

9) Evaluate effectiveness, accessibility, and quality of personal and population-based health services

What is the 10th Essential Public Health Service and what function does it serve?

10) Research for new insights and innovative solutions to health problems (serves all functions)

Differences between Public Health and Medicine?

• Public Health focuses on population health while Medicine focuses on individual health

• Public Health emphasizes disease prevention while Medicine emphasizes disease treatment

• Public Health interventions may involve medical care, but also environment, social and behavioral factors; Medicine interventions primarily involve medical care

What are the five sciences of public health?

1. Epidemiology

2. Statistics

3. Biomedical sciences

4. Environmental health sciences

5. Social and behavioral sciences

What is Epidemiology?

The study of populations to seek the causes of health and disease

What is Statistics in public health?

A way of gathering and analyzing data to extract information, seek causation, and calculate probabilities

What is Biomedical Science?

The study of the biological basis of human health and disease, including genetics, immunology, infectious diseases, chronic diseases, and molecular approaches to treatment

What is Environmental Health?

Those aspects of human health, diseases, and injury that are determined or influenced by factors in the environment

What is Social and Behavioral Science in public health?

How human behavior, social structures, and cultural norms influence health outcomes and designing interventions to improve population health; used to predict, prevent, and manage diseases in individuals and populations

What is Primary Prevention?

Intervening before the onset of disease

• example: legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)

What is Secondary Prevention?

Screening to identify a disease at early onset

• example: daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes

What is Tertiary Prevention?

Managing a disease, including treatment and rehabilitation

• example: cardiac or stroke rehabilitation programs, chronic disease management 

What economic considerations are involved in public health interventions?

Who pays and who gains (i.e. loss of jobs, increase in price of products, increase in taxes, deciding if interventions are worth the cost)

What is Paternalism?

Restriction of people's individual freedom with the aim of protecting their health and safety

• e.g. mandatory seatbelt laws

What is Libertarianism?

A belief system that holds that an individual's rights can only be restricted in order to prevent harm to others

• e.g. supporting the legalization of drugs

What is the Tragedy of the Commons?

A situation where individuals acting independently in their own self-interest deplete or spoil shared resources, even when it's clear that it's not in anyone's long-term interest

Solutions to the tragedy of the commons include government regulation, privatization of resources, and community-based management

What is Justice in public health ethics?

Fairness in the distribution of benefits and burdens in society

What is Fairness in public health?

Equal and equitable treatment of individuals and groups, ensuring that resources and opportunities are distributed justly

What are examples of moral and religious opposition in public health?

Sex education in schools, needle exchange programs, physician assisted suicides, etc.

What are the two main categories of literature in scientific journals?

Primary Literature and Secondary Literature

What types of articles are considered Primary Literature?

Original research articles, Protocols, Case report/case series, Conference proceedings, Editorial, Correspondence/letters to editor

What types of articles are considered Secondary Literature?

Narrative reviews, Systematic reviews, Reports, Book reviews, Guidelines, Commentary

What is the standard structure of a scientific paper?

Title and authors, Abstract, Introduction, Methods, Results, Discussion, References

(pretty much a lab report but w/ Methods section instead of Experimental section)

What does the Abstract section provide?

Brief overview of the article summarizing study findings

What does the Introduction section contain?

Background information citing relevant literature, research gaps, and hypothesis statement

What does the Methods section describe?

Study description and detailed procedures

What does the Results section present?

Description of results obtained, which may be presented in the form of text, datasets, tables, figures, graphs, diagrams, photographs; additional supporting data may be included as a supplement

What does the Discussion section include?

An analysis and interpretation of the results, which includes relevant findings from past work, implications of the study, and conclusion

What 6 things should you identify in an Abstract?

• Objectives/Hypothesis/Research question

• Research gap

• Study design

• Methods

• Results

• Conclusion

Where is the research question/purpose typically stated in a paper?

At the end of the introduction/background section (last paragraph or so)

Where are strengths and limitations typically found in Discussion?

Towards the end of the Discussion section

What was the objective of the Strong Hearts, Healthy Communities (SHHC) study?

To examine

(1) whether the SHHC intervention improved social network members' (SNMs') weight, exercise, and diet and

(2) whether SNMs' weight and behavioral changes were modified by their relationship closeness and/or spatial closeness with trial participants

What was the study design of the SHHC study?

Eight towns received the SHHC intervention (focused on building individual healthy behaviors and creating supportive social and built environments for exercise and healthy eating); eight towns received an education-only control intervention; SNMs (n=487) completed questionnaires at baseline and at 6 months

What did the SHHC study measure?

Demographics, weight, height, exercise, and eating habits

What were the key results of the SHHC study?

SHHC's effect on SNMs differed depending on their relationship closeness with trial participants; among SNMs who had a very close relationship with trial participants, those associated with the intervention group lost more weight and decreased BMI more than those associated with the control group

Did spatial closeness affect the SHHC intervention outcomes?

No, spatial closeness did not modify any of SHHC's ripple effects

What was the conclusion of the SHHC study?

Relationship closeness, rather than spatial closeness, played an important role in influencing a rural community-based intervention's ripple effects

What is epidemiology defined as?

The study of the distribution and determinants of disease frequency in human populations; the study of patterns of disease occurrence and factors influencing these patterns

What is frequency in epidemiology?

The number, proportion, or percentage of items in a particular category in a set of data

What is prevalence?

The number or proportion of existing cases, events, or conditions in a population at a specific time

Prevalence = (# of people in a population with given condition) / (Total # of people in population)

What is incidence?

The number of new cases that develop in a population during a defined time period

Incidence = (# of new cases occurring) / (# of people at risk) during a time period

How is prevalence expressed for less common diseases?

As # of cases per 1,000 or 10,000 or 100,000

What is the denominator for incidence?

People who did not have the disease at baseline and were at risk

What is the numerator for incidence?

New cases at follow-up

What three factors affect prevalence changes over time?

1. Incidence

2. The number of people cured

3. The number of people that die

What are disease determinants?

Factors that are associated with the development of a disease

• i.e. pathogens (bacteria and viruses)

• behavior (diet and physical activity)

• genetics

• social and structural determinants (policies, racism, socioeconomic position)

What is an exposure in epidemiology?

Any characteristic that may explain or predict the presence or absence of a study outcome; can be positive or negative

What is an association in epidemiology?

The relationship between two or more events or variables; events are said to be associated when they occur more frequently together than one would expect by chance. Does NOT imply causation.

What is a risk factor?

A characteristic, behavior, or exposure that increases the likelihood of developing a disease or experiencing a negative outcome

What are examples of COVID-19 risk factors?

Being 65 years of age or older, living in a nursing home or long-term care facility, being pregnant or recently pregnant, being a smoker, having high-risk conditions (cancer, chronic kidney disease, HIV infection, substance use disorders)

What is an outcome in epidemiology?

Can refer to disease, infection, illness, disability, condition, death, or survival

How is exposure-outcome relationship structured?

Exposure (Exposed/Unexposed) and Outcome (Has disease/Does not have disease)

What is a confounder?

A variable that affects both the exposure and the outcome, making it hard to tell if the exposure really caused the outcome.

Can be handled during study design by using randomization, restriction, or matching to control for variables that might distort the true relationship between exposure and outcome.

What are the learning objectives for COM-B and BCW?

1. Identify behaviors that influence a public health problem

2. Use the COM-B model to identify potential barriers to achieving desired behavior changes

3. Use the Behavior Change Wheel to identify intervention functions to address barriers

What does COM-B stand for?

Capability, Opportunity, Motivation-Behavior

Why use behavior theory?

Increased understanding of health behaviors and their context; increased ability to understand and explain outcomes; increased effectiveness of interventions

How is theory used to design and test behavior change interventions?

• Identify determinants of a behavior

• Create a causal model of the problem with detailed components

• Select intervention methods to match targets

• Inform evaluation

• Identify active ingredients needed for change

What is the Behavior Change Wheel Framework?

Synthesis of 19 behavior change frameworks; incorporates common features of prior frameworks; links to a behavior change theory that can be applied to any problem; identifies concrete and distinct intervention functions; encourages consideration of full range of barriers and intervention options

What is COM-B?

A meta-framework or synthesis framework that incorporates prior behavior change theories

What is Capability in COM-B?

Psychological or physical ability to enact the behavior

What is Opportunity in COM-B?

Physical and social environment that enables the behavior

What is Motivation in COM-B?

Reflective or automatic mechanisms that activate or inhibit the behavior

How can COM-B and BCW be used?

To help you understand the behavior as you develop targeted interventions; provides a general model of the drivers of behavior; can serve as a framework theory

What is an Intervention Function?

Broad categories of means by which an intervention can change behavior (one of 9 categories)

What are the 9 intervention functions?

Education, Persuasion, Incentivization, Coercion, Training, Restriction, Environmental restructuring, Modeling, Enablement

acronym: EPICTREME

What is Education as an intervention function?

Increasing knowledge or understanding (what to do and why)

What is Persuasion as an intervention function?

Using communication to induce positive or negative feelings or stimulate action

What is Incentivization as an intervention function?

Creating an expectation of reward

What is Coercion as an intervention function?

Creating an expectation of punishment or cost

What is Training as an intervention function?

Imparting skills (how to do something)

What is Restriction as an intervention function?

Using rules to reduce opportunities to engage in the target behavior

What is Environmental Restructuring as an intervention function?

Changing the physical or social context

What is Modeling as an intervention function?

Providing an example for people to aspire to or imitate

What is Enablement as an intervention function?

Increasing means/reducing barriers to increase capability (beyond education or training) or opportunity (beyond environmental restructuring)

What is the scoring scale for selecting target behaviors?

(the lower the score the better)

• unacceptable (4 points)

• unpromising but worth considering (3 points)

• promising (2 points)

• very promising (1 point)

What is Physical capability?

Skill, strength, stamina

What is Psychological capability?

Knowledge or psychological skills, strength, or stamina to engage in the necessary mental processes

What is Physical opportunity?

Time, resources, locations/physical barriers, cues

What is Social opportunity?

Interpersonal influences, social cues, cultural norms

What is Reflective motivation?

Beliefs about capabilities, optimism, intentions, goals, beliefs about consequences

What is Automatic motivation?

Reinforcements, emotional reactions, desires, impulses/inhibitions

What intervention functions map to Physical Capability?

Training, Enablement

What intervention functions map to Psychological Capability?

Education, Training, Enablement

What intervention functions map to Physical Opportunity?

Training, Restriction, Environmental Restructuring, Enablement

What intervention functions map to Social Opportunity?

Restriction, Environmental Restructuring, Modeling, Enablement

What intervention functions map to Reflective Motivation?

Education, Persuasion, Incentivization, Coercion

What intervention functions map to Automatic Motivation?

Persuasion, Incentivization, Coercion, Training, Environmental Restructuring, Modeling, Enablement

What are examples of barriers to Physical Capability?

Physical disabilities (unable to walk, uses wheelchair), knee replacement, arthritis

What are examples of barriers to Psychological Capability?

Lack of knowledge about physical activity recommendations, dementia

What are examples of barriers to Physical Opportunity?

Perceived lack of time to engage in physical activity, no access to workout clothing and shoes, lack of access to fitness facility/parks/sidewalks/bike lanes

What are examples of barriers to Social Opportunity?

Other residents at retirement home do not engage in physical activity, adult children making discouraging remarks about engaging in physical activity