Knowledge check 1,2,3, 10

what are Elder's four tenets of the life course perspective?

events, timing or transitions, relationships, choices or agency

According to findings from the Health & Retirement Study (Sabbath, et al, 2015), in the United States, shown above, women who spend significant periods of their lives as single working mothers or as single non-working mothers tend to have higher mortality rates (die at younger ages) than women who spend most of their life married.

QUESTION: Use the life course concept of stress proliferation to explain why some profiles are associated with higher mortality rates.

Stress proliferation refers to combinations of stressors where one stressor causes another to occur. For example, marriage may lead to having children; having children may lead to changes in employment; employment decisions may influence decisions about marriage and children; loss of marriage may lead to initiating employment; etc. So, a woman may experience stress proliferation, and if the combination of stressors is overall negative, may suffer reduced life expectancy as a result.

In 2015, in the United States, epidemiologists estimated the following percentages of people having low back pain:

• 6.8% of adolescents or young adults (ages 10-24) had low back pain

• 29.4% of older adults (ages 70+) had low back pain

(A) Do these data show a period effect or an age effect on the occurrence of low back pain?
(B) Explain why you selected that type of effect in (A).

Answer feedback:

(A) Age effect
(B) The comparison being made is across different age groups, not across different calendar years

Some people, unfortunately, die of respiratory infections like influenza and subsequent pneumonia, in early life, before the age of 5.

For example, a boy born in 2007 had a lower risk of dying from pneumonia before age 5, than his grandfather, who was born in 1920; or his father, who was born in 1955.

(A) What explains this lower risk for the son dying of pneumonia before age 5 than his grandfather or father -- an age effect or a cohort effect?
(B) Explain why you selected that type of effect in (A).

(A) Cohort effect
(B) The different risks experienced by my grandpa, father, me and my son, before age 5, are because we were born in different years. We all had to pass through the ages from 0-5, but we passed through those ages in different settings in terms of infection risk because of being born in different years, and infection control improved over time.

TABLE: Prevalence of asthma in children

Year	Utah boys	Utah girls	Arizona boys	Arizona girls
2006	7.5%	5.5%	9.7%	10.6%
2013	7.4%	5.0%	8.4%	13.7%

Identify and briefly describe three types of patterns you see in these data:
(A) Person-related pattern (how does asthma prevalence vary across gender?)
(B) Place-related pattern (how does asthma prevalence vary across states?)
(C) Time-related pattern (how does asthma prevalence vary across years?)

(A) PERSON: In Utah, in both years, boys had more asthma than girls; OR in Arizona, in both years, girls had more asthma than boys

(B) PLACE: For both states, in both years, Arizona kids had more asthma than Utah kids (this pattern was more pronounced for girls than for boys)

(C) TIME: In Utah, both sexes, asthma went down slightly (or stayed about the same) over time; OR in Arizona, boys, asthma decreased over time; OR in Arizona, girls, asthma increased over time

What is one potential underlying reason that the asthma prevalence patterns above are the way they are? In other words, WHY might there be differences by person, place, or time. Be specific.

A good answer would need to speculate about person- place- or time-related differences in CAUSES of asthma or effective treatment of asthma. Such as biological causes, behavioral causes, social causes, or environmental causes.

Consider the maps above and answer the following questions:

(A) What geographic (place-related) pattern of cancer death vs heart disease death do you see in the 2000 map?

(B) What geographic (place-related) pattern of cancer death vs heart disease death do you see in the 2010 map?

(C) What temporal (time-related) pattern to you see when comparing the two maps?

(A) Answer should note something about the different states in 2000, such as most states are red (more heart disease death), one state is blue (more cancer death), the darkest red states tend to be in the east not the west, etc

(B) Answer should note something about the different states in 2010, such as that about half the states are blue and the other half red, some states are darker than others, etc

(C) The main thing is that the map changed from almost all red to about half blue over the course of 10 years. Answers may also highlight other differences between the two maps, such as how a specific state changed.

Using the picture as an analogy (tub being filled up with a hole draining the water at the bottom) identify explain in your own words at least two key concepts of descriptive epidemiology that we discussed in class.

INCIDENCE -- the water flowing out of the tap into the tub

PREVALENCE - the water sitting in the tub

RECOVERY/CURE or MORTALITY - the water flowing out of the tub through the drain

DURATION - how long the water stays in the tub

(A) What information is used in calculating years lived with disability (YLDs) that is not used in calculating prevalence?

(B) For public health, how might years lived with disability (YLDs) due to a given disease in a population be a more meaningful measure than prevalence of that disease in that population?

YLDs use a disability weight -- combining the concept of prevalence, a measure of how common a disease is, with a disability weight, a measure of how disabling a condition is.

YLDs could be useful for public health because they show us not only how common a disease is, but also how much burden that disease puts on a population in terms of disability. This could be especially helpful when comparing populations or comparing diseases.

Consider a social ecological model like the one diagrammed below, for organizing information about risk factors for dementia. Into which ring (physical, social, health, biological, and person who gets dementia) would you place "levels of leptin and adiponectin" in the diagram -- biological factors, health behavior, social environment, or physical environment? Why would you place it there?

Leptin and adiponectin would best be thought of as biological factors

Why? they are molecules produced by our bodies

What does the term “ecology” mean in the context of public health and studying human health? (what does the term "ecology" mean in the "socio-ecological" model?)

"Ecology" in this context means that we study human beings and human health in relation to people's relationships with each other and their physical surroundings -- their environment

Why might an SEM (SocioEcological Model) diagram be a more useful way to organize disease risk factors than just making a list of the risk factors?

Organizing risk factors into levels -- such as biological, behavioral, social, environmental -- may help us think about different types of interventions that might be necessary, and may help us see that risk factors in circles closer to the center (like behaviors) may be influenced by risk factors in circles further from the center (like social conditions).

Bircher and Kuruvilla wrote an article entitled "Defining health by addressing individual, social, and environmental determinants." They presented the following diagram (Environment, society, inidividual, demands of life) They also proposed a definition of "health." 


Using the diagram to prompt your thinking, write in one sentence what was the authors' definition of "health?"

"Health is a state of well being emergent from conducive interactions between individuals’ potentials, life’s demands, and social and environmental determinants.

They presented the following diagrams to express examples of the evolution of two types of peoples "potentials" over time.


(A) In each diagram, what type of "potential" does the solid black curve represent? According to the authors, why does this type of potential start high and decline over time?
(B) In each diagram, what type of "potential" does the dotted curve represent? According to the authors, why does this type of potential start at zero and increase over time?

(A) Biologically given potential. It starts high because it represents our genetics and physical body at birth, and declines due to disease, injury, etc., that damage our physical capacity throughout life.

(B) Personally acquired potential. It starts at zero because at birth we haven't "acquired" anything yet, but we learn and grow and develop as we go, socially, emotionally, etc.

TWO reasons that the authors say we must pay attention to social conditions?

Reason 1: Social conditions provide a CONTEXT in which behaviors occur
Reason 2: Social conditions act through fundamental pathways involving ACCESS TO RESOURCES that affect health

What are the "ideal" healthy levels of physical activity?
(A) in adults
(B) in children

Adults: >= 150 minutes of moderate (or greater) intensity activity per week
Children: >= 420 minutes of moderate (or greater) intensity activity per week

What is the "ideal" healthy level of nicotine/tobacco use?
(A) in adults
(B) in children

Adults: Zero/Never smoking

Children: Zero/Never smoking

What is the "ideal" healthy level of sleep?
(A) in adults
(B) in children

Adults: 7-<9 average hours of sleep per night

Children: Age-appropriate optimal range of average hours of sleep per night

What is the "ideal" healthy level of body weight?
(A) in adults
(B) in children

ADULTS: Normal Weight body mass index (BMI): 18.5-24.9 (less than 25) 

CHILDREN: Normal weight: 5th-<85th percentile for age

What is the "ideal" healthy level of blood lipids?
(A) in adults
(B) in children

Adults: <130 non–HDL cholesterol (mg/dL)

Children: <100 non–HDL cholesterol (mg/dL)

What is the "ideal" healthy level of blood glucose?
(A) in adults
(B) in children

Adults: No history of diabetes and FBG <100 (or HbA1c <5.7) 

Children: No history of diabetes and FBG <100 (or HbA1c <5.7)

What is the "ideal" healthy level of blood pressure?
(A) in adults
(B) in children

Adults: <120/<80 systolic and diastolic BPs (mm Hg) 

Children: Optimal (<90th percentile) systolic and diastolic BPs (mm Hg)