Public Health Quiz 1

Health equity

Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.

Health Disparities

Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations

Social determinants of health

The conditions in which we are born, we grow and age, and in which we live and work. The factors below impact on our health and wellbeing

Childhood experiences, housing, education, social support, family income, employment, our communities, access to health services

Redlining

the illegal, discriminatory practice of banks and insurers denying or limiting financial services—such as mortgages or insurance—to residents of specific neighborhoods, usually based on the race or national origin of the people living there.

Social Ecological Model

• Organizing multiple determinants of health

  • Society, community, relationships, individual 

• Individual factors 

  • Genetics, gender identity, racial identity, ethnicity, age, SES (socioeconomic status), education, occupation, behaviors (exercise, eating habits, etc.)

• Relationship factors

  • Family, peers, friends, classmates, intimate partners, social groups, religious groups

• Community factors

  • Neighborhood, schools, workplace, urban v. rural vs. suburban, stores (pharmacies, food close by?), parks, local transportation

• Societal Factors

  • Economic policies

  • Institutional racism

  • Political system

  • Justice system

  • Educational policies

  • Physical environment

    • Natural and built environment

    • Healthcare system

Societal

Legislation to encourage employers to offer… (SEM)

Community and relationships

School-based programs that help students… build positive relationships (SEM)

Relationships

A peer program that teaches youth about dating norms in their circle of friends (SEM)

Community

A city establishes a business improvement… (SEM)

Societal

The national media complains… (SEM)

Community 

A neighborhood watch group (SEM)

Structural Determinants of Health

• (TERM) (formal/seen)

  • Laws, policies, institutions

• (TERM) (Informal/unseen)

  • Stereotypes, social stigmas, informal rules

These are related to social determinants

Political Determinants of Health

• Laws and national policies that impact our health

• Political DOH encompass: voting, government, and policy

• Examples

  • Housing is a SDOH, redlining practices are political DOH

  • Affordable Care Act (health insurance policy)

  • Funding to increase public transportation in a city/state is a political DOH

  • The 1967 federal law mandating helmets for motorcyclists before states could receive highway construction funds

The Life Course Model

• A way of looking at life not as disconnected stages, but as an integrated continuum 

• Suggests that a complex interplay of risk and protective factors that contributes to health outcomes across the span of a person’s life 

• Current health is the result of previous experiences 

• → From pregnancy → infancy → childhood → adulthood

  • Includes the things our mothers eat and breathe etc. while we are in utero

• Can be intergenerational 

• Risk factors and protective factors

• What is one change you could make NOW that might improve your health later in life?

  • Diet, drinking, exercise 

Mechanisms to explain Life Course Approach: Cumulative impact (accumulation of risk)

• Exposures or insults gradually accumulate through episodes of illness and injury, adverse environmental conditions, and health damaging behaviors

• Additive independent risks

Mechanisms to explain Life Course Approach: Critical period (aka sensitive periods, latent effects) - more ideal?

• Limited time window in which an exposure can have adverse or protective effects on development and subsequent disease outcome

• Outside this developmental window there is little or no excess disease risk associated with exposure 

Mechanisms to explain Life Course Approach: Gestation as a critical period

• Preterm birth (<37 weeks) and low birth weight (<5ibs 8oz) have been linked to multiple health problems in childhood and adulthood

  • School performance, behavioral problems in children

  • High blood pressure, heart disease, obesity, type 2 diabetes 

• Differences in preterm birth rates based on race

Mechanisms to explain Life Course Approach: The Life Course Model and Cancer Development

• Disease of aging (higher risk as get older)

• Disease of cumulative mutations 

Adverse Childhood Experiences (ACEs)

• Emotional abuse

• Physical abuse

• Sexual abuse

• Mother treated violently

• Substance abuse

• Household mental illness 

• Links to chronic diseases and ACEs

  • The odds of these diseases go up with increase in ACEs reports

  • Double risk for 4 or more ACEs for coronary heart disease with adults 

• We can create positive childhood experiences (PCEs) - these are protective factors 

  • Strengthen families’ financial stability

  • Promote social norms that protect against violence

  • Help kids have a good start

  • Teach healthy relationship skills

  • Connect youth with activities and caring adults

  • Intervene to lessen immediate and long-term harms 

• Things like reading to child, health service, appropriate discipline, pre-school can help children increase their readiness to learn as they grow (measured as meeting developmental milestones) 

Pros of Preschool

• Child health

  • Education for kids and parents

  • Links to health services

  • Nutrition

• Cognitive development

  • Math and literacy skills

  • Future educational attainment

• Research has shown:

  • Decreased premature mortality

  • Decreased chronic disease (diabetes, obesity, heart disease)

  • Increased health behaviors (eat breakfast, vaccinations, exercise, seatbelt use)

  • Decreased negative coping mechanisms: smoking, drinking 

Food insecurity

• The USDA defines this term as a lack of consistent access to enough good for every person in a household to live an active, healthy life 

• National problem

• Significant social determinant of health 

• If we don’t have the data we can't help fix it 

• Very dependent on region 

How does food insecurity affect children? 

• Impacts things like children’s growth, academics, energy, social life

• Could develop eating disorders and poor relationship with food later on

• Stunted growth due to lack of vitamins, calcium, etc.

• Obesity due to cheap, high calorie foods

• Depression, bullying

• Disordered eating

• Lack of focus → poor academic achievement 

Beyond income, what are upstream challenges to healthy food access? 

• Transportation 

• Access to cooking facilities (stove etc.)

• Time to cook

• Layout/displays of stores

  • Junk food is always placed at front and near checkout

• Food industry

• Food marketing

Food Deserts

• Food deserts can be described as geographic areas where residents’ access to affordable, healthy food options (especially fresh fruits and vegetables) is restricted or nonexistent due to the absence of grocery stores within convenient travelling distance

  • How close is grocery store or big supermarket

Food Assistance

• SNAP - Supplemental Nutrition Assistance Program 

• CalFresh - California’s version and food assistance program 

• Federal state money to help provide food for families 

Food Insecurity and College Students

• Food insecurity among college students is growing health issue

• Students motivated to attend college even though they might not be facing food insecurity if they were not in school

• 450 campus food pantries established between 2007-2017

  • Bronco Pantry: gift cards to local stores; regularly stocks non-perishable food items and fresh produce in partnership with the ForgeGarden

  • Just proof of being an SCU student, no documentation of need necessary 

Two examples of interventions aimed at increasing food security

• Baltimore tax breaks

  • 25% of residents live in food deserts

  • 80% reduction in property taxes for new grocery stores in underserved neighborhoods 

• PhatBeets, Oakland

  • Farmers markets (SNAP matching)

  • Vegetable prescriptions

  • Community gardens, youth education

  • Youth empowerment internships

  • Kitchen incubator, microloans 

Frameworks explaining why and how human actions change, integrating personal, environmental, and behavioral factors

• Health Belief Model

• Stages of Change/Transtheoretical

• Social Cognitive Theory 

• Health Belief Model

• Perceived susceptibility - Beliefs about the chances of getting a condition

• Perceived severity - Beliefs about the seriousness of a condition and its consequences

• Perceived benefits - Beliefs about the effectiveness of taking action to reduce risk or seriousness

• Perceived barriers - Beliefs about the material and psychological costs of taking action

• Cues to action - Factors that activate “readiness to change”

• Confidence in one’s ability to take action

Stages of Change/Transtheoretical

• Precontemplation - Has no intention of taking action within the next six months

• Contemplation - Intends to take action in the next six months

• Preparation - Intends to take action within the next thirty days and has taken some behavioral steps in this direction

• Action - Has changed behavior for less than six months

• Maintenance - Has changed behavior for more than six months

The model’s basic premise is that behavior change is a process not an event, that requires moving through distinct stages.

Social Cognitive Theory 

• Reciprocal determinism - The dynamic interaction of the person, behavior, and the environment in which the behavior is performed

• Behavioral capability - knowledge and skill to perform a given behavior

• Expectations - Anticipated outcomes of a behavior

• Self-efficacy - Confidence in one’s ability to take action and overcome barriers

• Observational learning (modeling) - BEhavioral acquisition that occurs by watching the actions and outcomes of others’ behavior

• Reinforcements - Responses to a person’s behavior that increase or decrease the likelihood of reoccurrence

SCT described a dynamic, ongoing process in which personal factors, environmental factors, and human behavior exert influence upon each other 

Sexual health

a state of physical, emotional, mental, and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination, and violence. 

Sexual health problems

1. Unintended teen pregnancies are on the decline; economic and health effects for both mother and child

2. Sex education, access to contraception, and family planning services are not universal

   1. Teens in poor neighborhoods/schools tend to have least access

   2. Political and religious objections often limit sex education in schools, and availability of contraception

3. STIs (STDs) are on the rise and can lead to infertility, transmission to infants during delivery, cancer (HPV), etc. 

4. More than 200,000 sexual assaults occur annually in the U.S. 

5. Reproductive rights and abortion services are becoming more limited 

What is a sexually transmitted infection (STI/STD)?

• STIs are infections or conditions that you can get from any kind of sexual activity involving your mouth, anus, vagina or penis

• Common symptoms: burning, itching or discharge in your genital area; some are asymptomatic 

• Highly contagious! If you’re sexually active, you can have (and pass on) an STI without even knowing it

• STIs are serious illnesses that need treatment

  • Treated easily with antibiotics

  • Tested by peeing in cup usually 

Special Populations to Consider for sexual health issues

• Young people

  • Not married

  • Access 

  • Knowledge 

  • Young women’s bodies are biologically more prone to STIs

  • Many young people are hesitant to talk honestly with a doctor about their sex lives

  • Not having insurance or transportation can make it more difficult to access testing

  • Young people tend to have more partners

• Gay, Bisexual, and Men Who Have Sex with Men (MSM)

  • Behaviors – not using condoms regularly and having anal sex – increase STI risk

  • Homophobia, stigma and discrimination negatively impacts access to care

Unintended Pregnancy

• Nearly half of all pregnancies in the United States are unintended

  • 27% were mistimed or wanted later; 18% were unwanted 

• The unintended pregnancy rate in the US is much higher than other developed countries

• Unintended pregnancy is higher in low-income women 

The State of Sex Ed in the US (Public Schools Only) 

• 30 states and the District of Columbia require sex education, either explicitly by law or by proxy via enforced state standards

  • 17% of these only teach abstinence

• Only 10 states have politics that include affirming sexual orientation instruction on LGBTQ identities or discussion of sexual health for LGBTQ youth

• 5 states have laws requiring comprehensive sex education (CSE). of these:

  • Like seeing condom on a banana 

Interventions to improve sexual health

• Individual

  • Condoms

  • Diagnosis and treatment

  • HPV vaccine

• Relationship

  • Partner communication 

  • Partner notification (telling your partner about results) 

  • Prenatal screening

• Community/societal? 

  • Education

  • Population screening → free or really cheap screening

  • Vaccination program  

HPV Vaccine

• Recommended for adolescents 11-12 years of age, before sexually active

• 2 dose regimen, 6 months apart (CDC saying 1 shot - 95% effective)

• Recommended for everyone thru 26 years of age

• Gardasil 9 prevents against 9 HPV types and cervical cancer

NYC Condom (Community level intervention)

• Managed by New York City Department of Health

• Organizations can order:

  • Free male condoms

  • Free female condoms

  • Free lubricant

  • Free dental damn

  • Free finger cots

• It’s got to be accessible!