Public Health Exam 1

Clinical care

Prevention, treatment, management of illness and preservation of mental and physical well-being through services offered by medical/allied health professions; aka health care

Determinant

Factor that contributes to generation of a trait

Epidemic/outbreak

Occurrence in community/region of cases of an illness, specific health-related behaviors, or other health-related events clearly in excess of normal expectancy

Health outcome

Result of medical condition that directly affects length/quality of patient’s life

Core functions of public health

Assessment, policy development, assurance

Partners in public health system

Community, clinical care delivery system, employers/businesses, media, academia, government PH infrastructure

Public health approach

Surveillance, risk factor identification, intervention evaluation, implementation

John Snow

Father of modern epidemiology, traced source of cholera outbreak

Health determinants

Genes/biology, behavior, social/societal characteristics, health services

Public health core sciences

Prevention effectiveness, epidemiology, laboratory, informatics, surveillance

CDC’s most important public health concerns

Alcohol, food safety, nosocomial infections, heart disease and stroke, HIV, motor vehicle accidents, nutrition, physical activity, obesity, prescription drug overdose, teen pregnancy, tobacco use

Top 10 public health challenges 2023

Health systems, mental health crisis, reproductive health, malnutrition and food safety, diabetes, cancer, environmental pollution, substance abuse, infectious disease, climate change

Epidemiology

Diagnostic discipline of public health, major part of public health assessment function, investigates cause of disease, identifies trends in occurrence, evaluates effectiveness of medical and public health interventions; observational science

Epidemic surveillance

Major line of defense in protecting the public against disease, control spread of known disease and aid in recognizing new disease, importance increased with threat of bioterrorism

Outbreak investigation

Verify diagnosis, construct working case definition, find cases systemically through active surveillance, consider incubation period, look for common source of exposure

Chronic diseases

Identify risk factors, observe long-term trends, studies more complicated and difficult than for infectious disease or toxic contamination

Framingham heart study

Longitudinal cohort study, 10 years, cigarette smoking risk factor identified in 1960, hypertension risk factor identified in 2001, obesity risk factor identified in 2002

NHLBI genome-wide association study with Boston University SHARe project

Psychosocial

Pertaining to influence of social factors on individual’s mind and behavior and to interrelation of behavioral and social factors (norms, politics, culture, economy)

Social determinants of health

Non-medical conditions in which people live, work, play, pray; affects wide array of health functioning, well-being, quality of life outcomes and risks

Measles

Most cases in 2019 since 1992, 73% linked to NY, serious complications- 128 hospitalized and 61 with pneumonia or encephalitis out of 1,282 total cases, 5% had complications, NY low vaccination rate, all cases caused by wild-type D8 or B3

Smallpox

Contagious, disfiguring, deadly, eradicated worldwide by 1980, no cure/treatment, vaccine has high risk of side effects

Chain of infection

Pathogen, reservoir, mode of transmission, susceptible host

Public health measures to control spread of disease

Aim to interrupt most vulnerable link of chain of infection- kill pathogen, eliminate reservoir, prevent transmission (hand washing, condoms, quarantine), increase resistance of host by immunization

Epidemiological surveillance

Ongoing systematic collection, analysis, and interpretation of health data that are essential to the planning, implementation, and evaluation of public health practice

Eradication

Possible if there is no nonhuman reservoir and if vaccine exists (smallpox, polio in western hemisphere, measles is next target- no longer endemic in US)

Fear of vaccines

No MMR vaccine-autism link in Large Study, some vaccines have side effects, herd immunity is lost if many people don’t get vaccinated, pharmaceutical companies are reluctant to develop vaccines due to low profits and risk of lawsuits

Tuberculosis

Leading cause of infectious disease deaths worldwide, 1/3 world population infected, resurgence in US in early 1990s, people with HIV are at higher risk, aerosol transmission, untreated fatality rate 50%, antibiotics for several months, directly observed therapy prevents antibiotic resistance

Factors that lead to emergence of new infectious disease

Human activities that cause ecological damage or close contact with wildlife, modern agricultural practices, international travel, international distribution of food and exotic animals, breakdown of social restraints on sexual behavior or IV drug use

RNA viruses

Influenza and HIV

Legionnair’s disease/legionellosis

Atypical pneumonia, spread through mist containing bacteria, many people exposed are asymptomatic, treated with antibiotics

Public Health response to emerging infections

Global surveillance, improved public health capacity, veterinary surveillance, reduce inappropriate use of antibiotics

Institute of Medicine recommends new vaccines and antimicrobial drugs and measures against vector-borne diseases

Bioterrorism

Deliberate release of germs to cause illness/death, often found in nature, approach is same as that for natural disease outbreaks, first recognized by surveillance in hospital ER

Most dangerous: anthrax, hanta virus (50% mortality rate), botulinum (aerosol, contaminated food/water)

Chronic disease

Conditions lasting longer than 1 year and require ongoing medical attention or limit ADLs, leading cause of death and disability, not deadly short term but have severe impacts on quality of life, risk factors less recognizable, possible secondary prevention, importance of animal models, ethical concerns limiting experiments on humans

10 leading causes of death

Heart disease, cancer, unintentional injuries, chronic lower respiratory disease, stroke and cerebrovascular disease, Alzheimer’s, diabetes, influenza and pneumonia, kidney disease, suicide

Cardiovascular disease

Well established through epidemiologic studies (Framington), atherosclerosis development, American diet increases risk, hypertension, diabetes, smoking injure artery walls

Encompasses 2 leading causes of death in the US: heart disease and stroke

Cholesterol

Want low LDL and high HDL and low total cholesterol, exercise lowers total and increases HDL, smoking lowers HDL, alcohol increases HDL, stations used for secondary prevention, genetics major factor

Good levels: total <200, LDL <130, HDL >50, triglycerides <200

Cancer

Mutations in DNA caused by radiation, virus, or chemicals; diet and hormones play a role, Hep B vaccine prevents liver cancer, 1/3 deaths associated with tobacco

Diabetes

30.3 million Americans/9.4% of the population, 1.25 million type 1

Alzheimer’s/dementia

5.8 million Americans, 10% of people age 65+/5.6 million

Arthritis

22.7%/54.4 million adults, 23.5% women, 18.1% men

Mental illness

>44 million Americans/18.07%, 2.4 million/1.1% schizophrenia, 6.1 million/2.6% bipolar

Mental health

State of well-being in which the individual realizes their own abilities, can cope with normal stresses of life, work productively and fruitfully, able to make contribution to community (WHO)

Suicide risk factors

46% of people had known mental health condition; family history of suicide, substance use/intoxication (1/5 people who die by suicide have alcohol in system at time of death), access to firearms, chronic/serious medical illness, more women attempt than men but men are 4x more likely to die, history of trauma/abuse, prolonged stress, recent tragedy/loss

Mental illness

Accounts for more disability in developed countries than any other illnesses, 50% Americans associated with chronic diseases, injuries (1.59x greater risk of injuries, 1.71x higher probability of recurrent injuries), substance abuse, depression increases risk of CVD

Lifetime prevalence of common mental illness

Anxiety 31%

Mood disorder 21%

Impulse control disorder 25%

Substance use disorder 35%

Epidemiology of mental illness

Females- anxiety and mood disorder

Males- impulse control disorder and substance abuse

>60 years old, southeastern states

Causes of mental illness

Products of interaction between biological, social, and psychological factors; genetic factors important in schizophrenia, bipolar, autism, and ADHD; identifying and targeting risk factors involving individual, family, and community factors

Social media

25% teens say social media has negative effect, spending >3hrs/day increases risk for mental health problems

Ages 12-17: 13% depression, 32% anxiety

Ages 18-25: 25% mental illness

Children and mental health

Emphasis on biological and psychosocial experiences, common disorders: autism, ADHD, mood disorder; concerns about active boys being over diagnosed with ADHD, ADHD kids often have disruptive disorders

Autism spectrum disorder

1 in 59 kids, 4x more common in boys than girls, prevalence 1-2%, 1 in 6 kids in US had developmental disability in 2006-2008

Eating disorders

1.1-4.2% women have bulimia in their lifetime, lifetime prevalence of binge eating disorder 3.5% women and 2% men

Anorexia nervosa

10x risk of dying, 1/5 deaths by suicide, 50-80% risk is genetic

Serious health risks: cardiac implications, heart/kidney/liver disease, osteoporosis, anemia, electrolyte imbalances, hypoglycemia, GI issues, amenorrhea, fertility challenges, decreased testosterone levels, suicide

Adults and mental health

Anxiety most prevalent mental illness, PTSD gets emphasis on treatment strategies, 1% people schizophrenia (treatment: medication, psychotherapy, family intervention)

Older adults and mental health

Increased rates of suicide, usually associated with depression, risk factors for mental illness: medications, medical conditions, living conditions, psychosocial stressors; treatment similar to that of younger patients with emphasis on medication side effects

Mental illness treatment

Most don’t seek treatment, fear stigma, inpatient units used for crisis care only, housing is often a problem for people with severe mental illness

Cost of mental health disorders

Lancet commission reports say mental disorders will cost global economy $16 trillion by 2030, 12 billion working days lost due to mental illness every year

LGBTQ and mental illness

Adults: 2x more likely to experience mental health condition, 40% experience rejection from family, trans adults are 4x more likely to experience mental health condition, 2x more likely to experience substance use disorder

Youth: 2x more likely to experience depressive symptoms, consider and attempt suicide, 120% increased risk of homelessness

COVID impact on mental health

4x higher rates of anxiety and depression, sharpest increase among males, Asian Americans, young adults, parents with kids living at home

Anxiety- 7.4-8.6% monthly US adults reporting symptoms 2019, 28.2-37.2% submonthly US adults reporting symptoms april 2020- august 2021

Depressio: 5.9-7.5% monthly US adults reporting symptoms 2019, 20.2-31.1% submonthly US adults reporting symptoms april 2020- august 2021

Mental health statistics

¼ Americans need addiction treatment or mental health care, 2/3 of these go undiagnosed/untreated

41% mentally ill people received professional services in the past year, the longer a person waits to seek help=more difficult recovery

Someone dies by suicide every 12.3 minutes; for every suicide, 25 attempts are made

140 people die of drug overdose every day, 91 of these due to opioids

80,000 die due to alcohol use disorder

Center for counseling and student development

Mission is to enhance personal growth through developmental, preventative, therapeutic programming designed to facilitate skill development, improve functioning, and increase understanding of self and others

Diseases caused by smoking

CVD, centers (lung, oral, laryngeal, esophageal, pancreatic, urinary), respiratory conditions (pneumonia, influenza, bronchitis, emphysema, chronic airway obstruction), burns, diseases among infants

Biomedical basis of smoking’s harmful effects

Nicotine- increases bp and HR, causes spasms in blood vessels of heart

Tar residue from burning tobacco condensed in lungs, damages cilia, irritates respiratory tract, carcinogen

CO- interferes with oxygen carrying capacity of blood

Arsenic and benzene- carcinogenic, alters clotting properties of blood, increases cholesterol, decreases HDL

Historical tobacco trends

Intensive use began in early 20th century, distributed for free to soldiers in world wars, women began smoking during and after WWII, peaked in mid 1960s with >42% of adults, lung cancer trends followed 20 years later, Surgeon General’s 1st report in 1964 caused rates to decline

Prevalence of smoking and cancer

Black men at high rate but declining, high rates in Alaskan natives, strong association with lack of education, 14% of adults smoke in the US

Fallacy of women’s immunity to effects of smoking

Women started smoking later than men, lung cancer rates increased later, surpassed breast cancer in the 1980s

Regulatory restrictions on smoking

Federal trade commission- warning labels, federal communications commission- fairness doctrine for counter-advertising

1971- industry submitted total ban on advertising on radio and television

1992- EPA declared environmental tobacco smoke to be carcinogenic

2019- 27 states and DC banned/restricted smoking in public places including work sites, restaurants, and most bars

Initial emphasis on youth

Companies must recruit 1 million smokers per year ti replace those who die/quit, most start in their teens, ads focus on young people (Joe Camel) and women (suggest that smoking will help them lose weight), laws prohibit sale to minors but ineffective

Smoking- taxes

Teens sensitive to price, California increased cig taxes to fund tobacco control programs, many states increased cig taxes to close budget shortfalls (#1 strategy to damage tobacco industry, tax increase is effective at lower number of smokers

Cost of smoking

Pack of cigs $5-15, juul/nic carts $15.99 for 4, JUUL Labs reports that each 5% cart contains 40mg nicotine per pod=1 pack of cigs, studies show that amount of nicotine in liquid is 39.3-48.3mg

California tobacco control program

Funded by 1989 tax increase of 25 cents/pack, cig consumption immediately decreased, antismoking campaign 1990-1991 decreased smoking, banned in all workplaces except bars/casinos/taverns in 1994, decreased to 11% in 2017

1990s broad attack on tobacco

Class-action lawsuits by state attorneys general were filed, FDA commissioner Kessler proposed to regulate tobacco, “Mr. Butts” leaked tobacco company documents, tobacco industry was put on defensive, challenged FDA’s authority to regulate tobacco

Master settlement agreement

1997-1998 attorneys general and tobacco industry agreed on settlement: industry pays $206 billion to 46 states over 25 years and $17 billion to American Legacy Foundation (“Truth campaign”, states used very little settlement money for tobacco control)

Tips campaign

Uses approaches to address health disparities in pursuit of health equity by increasing reach, representation, receptivity, and accessibility of smoking cessation messages, increasing awareness of free resources among adults

Family smoking prevention+Tobacco Control Act

Passed by Congress in 2009, authorizes FDA to regulate tobacco products and restrict advertising/promotion, requires large graphic warning labels on cig packages, forbids tobacco companies from sponsoring sporting events, requires disclosure of ingredients in cigs

Historical perspective on E cigarettes

Awareess grew to 80% 2010-2013 and use >2x among US adults, FDA originally didn’t have authority to regu;ate until March 2022 (can regulate synthetic nicotine under provisions included I the federal omnibus spending bill passed by Congress and Biden; initial concern for kids due to fun flavors, new law bans sale in stores of vape products in any flavor other than tobacco, prohibits sale of flavored nicotine pouches, lozenges, smokeless tobacco, menthol cigs, flavored small cigars; cig smoking kills >480,000 Americans each year, cig smoking cost the US >$600 billion in 2018 (>$240 billion in healthcare spending and $372 billion in lost productivity)

Obesity in adults

US prevalence 42.4% 2017-2018, 30.5% 1999-2000, severe obesity increased from 4.7% to 9.2%, estimated annual cost in US was $147 billion in 2008, medical costs for obese people was $1,429 higher than for people at healthy weight

Obesity and the heart

High LDL and triglycerides, low HDL, high bp, heart attack, 68% of people 65+ with diabetes also have heart disease, individuals with diabetes are 2-4x more likely to e at risk for heart disease, top 7 major controllable factor to prevent heart disease

Epidemiology of obesity

Increasing since the 1960s, US 74.6% men and 67.4% women overweight/obese, black>white women, white>black men, high SES associated with low rates

Obesity in children

Prevalence 19.3% or 14.4 million 2-19 year olds in 2017-2018, 13.4% 2-5 year olds, 20.3% 6-11 year olds, 21.2% 12-19 year olds, 25.6% Hispanic, 24.2% black, 16.1% white, 8.7% Asian

2019-2020: 16.2% 10-17 year olds, 23.8% black, 21.4% Hispanic, 12.1% white

Overweight children

Prevalence 1988-1994: <10%

Prevalence 2013-2016: >17.8%, increase among black and Hispanic, T2D

Federal dietary guidelines for Americans

More fruits and vegetables, whole grains, low fat dairy

Less refined grains, added sugar, salt, cholesterol, saturated and trans fats

Dietary surveys by USDA

Diet of 75% falls short of federal recommendations, vegetables most commonly omitted, intake of sweetened beverages is high and milk is low, sweetened beverages make up 7% of daily calorie intake

Physical activity and health

Epidemiologic studies demonstrate that people who are physically active live longer; exercise helps prevent heart disease, hypertension, high cholesterol, diabetes, some cancers, and CVD

Exercise requirements

Kids: need 60+ mins daily, get less as they get older, obesity correlated with time using TV, computer, video games

Adults: need 150-300 mins/week, strength training 2x/week, most Americans fail to meet guidelines, low SES associated with inactivity

Promoting physical activity

Employ ecological model, intervening at numerous levels of influence, remove environmental barriers and providing places to exercise. suburban lifestyle is to drive everywhere (add bike paths, sidewalks, walking trails), pedometers increase physical activity and decrease BMI, develop habits in kids and adolescents (physical education classes should focus on activities that can be practiced throughout lifetime)

Confronting obesity epidemic

Overweight/obesity could reverse public health improvements achieved in 20th century, life expectancy decreases, diseases account for 20.6% of US’s total medical expenditures, diet pills have less drastic effect than bariatric surgery

Weight loss drugs

Fen-phen: had to be removed from market because it caused heart valve problems and pulmonary hypertension

Belviq: activates part of brain that controls hunger

Qsymia: combination of appetite suppressant and drug used to treat epilepsy/migranes

Orlistat: inhibits absorption of dietary fats

Why physical activity is important

1 in 2 adults live with chronic disease, ½ adults get physical activity needed to decrease and prevent chronic disease, $117 billion in annual health care costs associated with inadequate physical activity, long-term military readiness is at risk because ¼ young adults are too heavy to serve, 1 in 10 premature deaths are preventable by physical activity (1 in 8 breast cancer, 1 in 8 colorectal cancer, 1 in 2 diabetes, 1 in 15 heart disease)

Benefits of physical activity- children

Lower depression, improve aerobic fitness, muscular fitness, bone health, promotes favorable body composition, improves attention and academic performance

Benefits of physical activity- adults

Decrease risk of hypertension and stroke, improves aerobic fitness, mental health, cognitive function, reduces arthritis symptoms, prevents weight gain

Benefits of physical activity- healthy aging

Improves sleep, reduces risk of falling, improves balance and joint mobility, extends years of active life, prevents weak bones and muscles loss, delays onset of cognitive decline

Benefits of physical activity- economic

Building active and walkable communities can help increase levels of retail economic activity and employment, increases property values, support neighborhood revitalization, decreases health care costs

Benefits of physical activity- safety

Walkable communities can improve safety for people who walk/ride bikes/drive

Benefits of physical activity- workforce

Physically active people tend to take less sick days