Chapter 18 Health Inequities in Populations

1. An underserved population is a subgroup of the population that has a higher risk of developing health problems due to marginalization in which areas? (Select all that apply.)

A) Age

B) Gender

C) Sociocultural status

D) Political affiliation

E) Religion

Ans: A, B, C

Feedback: An underserved population is a subgroup of the population that has a higher risk of developing health problems due to marginalization in sociocultural status, access to economic resources, age, or gender. Marginalization in religion and political affiliation are not typically associated with underserved populations.

2. In the Healthy People 2020 federal initiatives in the United States, which group is identified as needing special attention and creative solutions to live a healthy life in the face of sobering health disparities and social injustices?

A) Older adults

B) People with acute infectious diseases

C) People recovering from traumatic accidents

D) Mentally ill people

Ans: D

Feedback: In the Healthy People 2020 federal initiatives in the United States, the following groups are identified as needing special attention and creative solutions to live a healthy life in the face of sobering health disparities and social injustices: (1) high-risk mothers, (2) chronically ill and disabled people, (3) people living with HIV/AIDS, (4) mentally ill people, (5) substance abusers, (6) homeless people, and (7) immigrants and refugees.

3. Definitions of rural areas are based on which concepts? (Select all that apply.)

A) Administrative

B) Religious

C) Land-use

D) Political

E) Economic

Ans: A, C, E

Feedback: Definitions of rural areas can be based on administrative, land use, or economic concepts, including variations of these three themes. Religious and political concepts are not among the themes on which the definitions of rural areas are based.

4. Which most accurately defines a medically underserved area?

A) A geographic area, population group, or medical facility with shortages of healthcare professionals to the degree that a full complement of healthcare services is not possible

B) An area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older

C) A U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services

D) A subgroup of the population that has a higher risk of developing health problems because of marginalization

Ans: B

Feedback: A medically underserved area (MUA) is an area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population aged 65 or older. A health professional shortage area (HPSA) is a geographic area, population group, or medical facility with shortages of healthcare professionals to a degree that a full complement of healthcare services is not possible. A medically underserved population (MUP) is a U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services. An underserved population is a subgroup of the population that has a higher risk of developing health problems because of marginalization in sociocultural status, access to economic resources, age, or gender.

5. The nurse visits a community health clinic in a remote rural area, at which emergency care is not provided because the facility lacks the medical staff necessary to offer such services. Based on this information, which is the most accurate description of this situation?

A) Health professional shortage area

B) Medically underserved area

C) Medically underserved population

D) Undeserved population

Ans: A

Feedback: A health professional shortage area (HPSA) is a geographic area, population group, or medical facility with shortages of healthcare professionals to a degree that a full complement of healthcare services is not possible. A medically underserved area (MUA) is an area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older. A medically underserved population (MUP) is a U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services. An underserved population is a subgroup of the population that has a higher risk of developing health problems because of marginalization in sociocultural status, access to economic resources, age, or gender.

6. Which is an accurate health factor or effect of living in rural geopolitical areas?

A) Only about 5% of physicians practice in rural America despite that nearly one fourth of the population lives in these areas.

B) Although only one third of all motor vehicle accidents occur in rural areas, two thirds of the deaths attributed to these accidents occur on rural roads.

C) Rural residents are nearly three times as likely to die from unintentional injuries other than motor vehicle accidents than are urban residents.

D) Abuse of alcohol and use of smokeless tobacco is a significant problem among rural older adults.

Ans: B

Feedback: Although only one third of all motor vehicle accidents occur in rural areas, two thirds of the deaths attributed to these accidents occur on rural roads. Only about 10% (not 5%) of physicians practice in rural America despite that nearly one fourth of the population lives in these areas. Rural residents are nearly twice (not three times) as likely to die from unintentional injuries other than motor vehicle accidents than are urban residents. Abuse of alcohol and use of smokeless tobacco are a significant problem among rural youth (not older adults).

7. Which correctly ranks the top four rural health priorities according to the Healthy People goals?

A) (1) Access to quality healthcare, (2) mental health and mental disorders, (3) diabetes, (4) heart disease

B) (1) Mental health and mental disorders, (2) access to quality healthcare, (3) heart disease, (4) diabetes

C) (1) Diabetes, (2) heart disease, (3) mental health and mental disorders, (4) access to quality healthcare

D) (1) Access to quality healthcare, (2) heart disease, (3) diabetes, (4) mental health and mental disorders

Ans: D

Feedback: The correct ranking of rural health priorities is (1) access to quality healthcare, (2) heart disease, (3) diabetes, and (4) mental health and mental disorders.

8. When speaking with an older man in a rural community about his lifelong smoking habit, the nurse is alarmed to learn that he has never heard that cigarette smoking is the major cause of lung cancer. This situation exemplifies which of the seven A's of challenges to elders in rural areas?

A) Availability

B) Accessibility

C) Affordability

D) Awareness

Ans: D

Feedback: Awareness refers to the level of information dissemination and degree of literacy. Availability refers to the number and diversity of formal services and providers, number of acceptable services, and amount of human service infrastructure. Accessibility refers to the amount of adequate, appropriate, and affordable transportation as well as the degree of cultural and geographic isolation. Affordability refers to the ability to pay for services.

9. While visiting the home of an 89-year-old woman out in the country, the nurse learns that her primary care provider's office is one hour's drive away. The client states, "I've just stopped going in for appointments in the past few years. It's just too far for me to drive by myself." This situation exemplifies which of the seven A's of challenges to elders in rural areas?

A) Availability

B) Accessibility

C) Affordability

D) Awareness

Ans: B

Feedback: Accessibility refers to amount of adequate, appropriate, and affordable transportation as well as the degree of cultural and geographic isolation. Availability refers to the number and diversity of formal services and providers, number of acceptable services, and amount of human service infrastructure. Affordability refers to the ability to pay for services. Awareness refers to the level of information dissemination and degree of literacy.

10. The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which exemplifies a strategy at the family level?

A) Mentor a child in a READ program.

B) Volunteer with children who are homeless or in foster care.

C) Create daily homework routines and limit television viewing.

D) Vote in every election and advocate for children.

Ans: C

Feedback: Individual strategies include mentoring a child in a READ program, volunteering with children who are homeless or in foster care, and voting in every election and advocating for children. A family strategy is to create daily homework routines and limit television viewing.

11. The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Encouraging families to spend quality time together by hosting a movie or game night at a local church is an example of a strategy at which level?

A) Family

B) Community

C) Organizational

D) Government

Ans: B

Feedback: Encouraging families to spend quality time together by hosting a movie or game night at a local church is an example of a strategy at the community level and not at the family, organizational, or government levels.

12. The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which strategies are at the government level? (Select all that apply.)

A) Provide free tax filing assistance to low-income working families.

B) Educate families about how they can apply for food stamps, Head Start, federal nutrition programs, and other similar benefits.

C) Ensure children in foster care and detention receive quality treatment to address their mental, behavioral, and emotional needs.

D) Promote high-quality children's television programming and access to other quality electronic media.

E) Start a halfway house and counseling program for youth who have run away.

Ans: C, D

Feedback: Government strategies include ensuring that children in foster care and detention receive quality treatment to address their mental, behavioral, and emotional needs and promoting high-quality children's television programming and access to other quality electronic media. Organization strategies include providing free tax filing assistance to low-income working families and educating families about how they can apply for food stamps, Head Start, federal nutrition programs, and other similar benefits. Community strategies include starting a halfway house and counseling program for youth who have run away.

13. In the United States, detention centers, jails, and prisons are places that provide safety to the public by incarcerating people who have committed crimes and who are deemed a threat to society. Which demographics are true of the majority of inmates? (Select all that apply.)

A) Incarcerated for violent crimes

B) Latino or African-American

C) Average age of 37 years

D) Serving sentences of more than 10 years

E) Male gender

Ans: B, C, E

Feedback: Most inmates are males who are African-American or Latino. The average age of inmates is 37. Seventy-five percent of all prisoners are nonviolent and have been incarcerated for drug possession and trafficking, bribery, and extortion, and 40% are serving sentences of more than 10 years.

14. A nurse is assessing a client who was recently released from prison. Based on knowledge of the incidence rates of various types of crimes that lead to incarceration, the nurse suspects that the client may have committed which crime?

A) Murder

B) Rape

C) Assault

D) Drug possession and trafficking

Ans: D

Feedback: Seventy-five percent of all prisoners are nonviolent and have become incarcerated for drug possession and trafficking, bribery, and extortion.

15. The nurse works at a clinic in Arizona that provides bilingual (English and Spanish) care to low-income immigrant workers from Mexico. Which designation most accurately describes the area or the population this nurse serves?

A) Health professional shortage area

B) Medically underserved area

C) Medically underserved population

D) Inmates

Ans: C

Feedback: A medically underserved population (MUP) is a U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services. A medically underserved area (MUA) is an area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older. A health professional shortage area (HPSA) is a geographic area, population group, or medical facility with shortages of healthcare professionals to a degree that a full complement of healthcare services is not possible. An inmate is a person who is held in a jail or prison to protect the public.

16. Which qualifies as an urbanized area according to the U.S. Census Bureau? (Select all that apply.)

A) A central city with population of 30,000 and surrounding densely settled territory with a population of 25,000 with a combined population density of 500 people per square mile

B) A central city with population of 50,000 and surrounding densely settled territory with a population of 10,000 with a combined population density of 750 people per square mile

C) A central city with population of 25,000 and surrounding densely settled territory with a population of 25,000 with a combined population density of 1,100 people per square mile

D) A central city with population of 20,000 and surrounding densely settled territory with a population of 30,000 with a combined population density of 1,250 people per square mile

E) A central city with population of 100,000 and surrounding densely settled territory with a population o

Ans: C, D, E

Feedback: The U.S. Census Bureau defines an urbanized area (UA) by population density. According to this definition, each UA includes a central city and the surrounding densely settled territory that together have a population of 50,000 or more and a population density generally exceeding 1,000 people per square mile.

17. An older woman in a rural health clinic tells the nurse that this is the first time she's been in a medical facility for more than 10 years. She shows signs of advanced diabetes, including significant necrosis in her feet. When asked why she didn't come in sooner, she says, "I don't drive, myself, and I hate asking my son to bring me—I feel like such a burden." This situation exemplifies which of the seven A's of challenges to elders in rural areas?

A) Awareness

B) Adequacy

C) Acceptability

D) Assessment

Ans: C

Feedback: Acceptability refers to the degree of reluctance to ask for help. Awareness refers to the level of information dissemination and degree of literacy. Adequacy refers to the level of service standards and evaluation and degree of evidence-based practice. Assessment refers to the amount of basic information available on what is needed using research rigor and analyses.

18. What percentage of rural children live in poverty?

A) 14%

B) 24%

C) 34%

D) 44%

Ans: B

Feedback: Nearly 24% of rural children live in poverty.

19. Which most accurately characterize Medicare clients with acute myocardial infarctions (AMIs) who are treated in rural hospitals? (Select all that apply.)

A) Less likely to experience an opportunistic infection than those in urban hospitals

B) Less likely to receive recommended treatments than those in urban hospitals

C) More likely to have a second AMI within a month of the first than those in urban hospitals

D) Have significantly higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals

E) Experience faster recovery times than those in urban hospitals

Ans: B, D

Feedback: Medicare clients with AMI who were treated in rural hospitals were less likely than those treated in urban hospitals to receive recommended treatments and had significantly higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals. The other answers are not true.

20. The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which level is represented by hosting a health fair to ensure all children who are eligible for Medicaid or state children's health insurance program are enrolled?

A) Family

B) Community

C) Organization

D) Government

Ans: C

Feedback: Organizations, not families, communities, or government, are likely host a health fair to ensure all children who are eligible for Medicaid or your state children's health insurance program are enrolled.

21. How can genomics help improve care of underserved populations? (Select all that apply.)

A) Identify increased risk in certain populations for specific diseases.

B) Boost the immune system of individuals in the community.

C) Predict how a community might metabolize medications.

D) Reduce the cost of medications.

E) Predict a community's unique vulnerability to environmental changes that can control gene expression in some diseases.

Ans: A, C, E

Feedback: Understanding the genetic predictors of disease through genomics is a determinant of how certain individuals, families, and communities may be disproportionately affected by illness, and why public health must be part of a strategy that addresses discoveries in a practical way in this developing science. We also know that different groups of people by gender or other key demographic characteristics respond to preventive treatment differently because of their genetic make-up. For example, some genotypes may metabolize medications differently. Some populations may have specific vulnerability and key environmental influences related to their health. Gomes and Pelosi (2013) discuss how the potential vulnerability to environmental changes can control gene expression in diseases of great interest in public health such as cancer, autoimmune diseases, and perhaps even the aging process.