Intro to Community Health pt. 2

how we make decisions about interventions

resources, experts, media-driven priorities, history/tradition, pressure from policy makers/administrators/stakeholders

Evidence-based Public Health (EBPH)

the environmental context includes the best available evidence, population characteristics, and available resources

why is EBPH important?

science changes and we need to keep people updated with the most recent data and uncertainties

DARE

example of intervention that flopped due to lack of EBPH

this backfired because DARE exposed kids to the idea of drugs and drug use, causing an increase in drug use in kids

robot babies

increased teen pregnancy because people felt “oh that’s not so bad” —> program that was rolled out for years, lack of evidence-based

Andrew Wakefield

the guy who said vaccines caused autism

where do we go wrong in interventions that flop? (like DARE and robot babies)

bad (or no) science

failure to evaluate

lack of understanding or consideration of social determinants or socio-cultural context

incomplete or inappropriate use

why do we need EBPH?

resources are limited, so we need to focus on most effective interventions

interventions can have unintended adverse effects, so we need to evaluate them

T or F: Not all evidence is created equal

T

Hierarchy of evidence (from subjective to objective)

systemic review of evidence

thorough, structured analysis of existing research on a topic

identify patterns, gaps, and reliable evidence to guide further research or decision-making

peer-reviewed studies

at least 3 experts in the field review and criticize the study (leads to accept & publish, reject, or revise & resubmit)

types of research

quantitative and qualitative

quantitative research

test hypothesis, establish casual relationships

numerical data

statistical analysis

used when looking at prevalance (most surveys)

qualitative research

understanding meaning

non-numerical data (interviews)

thematic analysis

steps in evidence-based public health

ask, acquire, appraise, apply, asses

repeats, loops

step 1. in EBPH

ask questions

step 2. in EBPH

acquire evidence

step 3. in EBPH

appraise studies (based on credibility, generalizability, and importance)

step 4. in EBPH

apply the evidence (think about the goal of the program,, the effectiveness, potential burdens, alternatives, etc)

step 5. in EBPH

asses results (did it work? for whome? were there unintended consequences? did the benefits outweigh the costs? should this program be continued)

resources for finding evidence-based interventions

APHA Supporting Research, Campbell Collaboration, Cochrane Library, Cochrane Public Health, Compendium of Proven Community, Health Evidence, Healthy People 2020, National Institutes of Health, US Department of Health and Human Services, US Preventive Services Task Force

evidence-based practice

using the best available scientific evidence to inform and improve PH programs and policies, ensuring interventions are effective and efficient

best available evidence

component in EBPH

best available research and current data to design and implement health policies and programs

start with systemic review

randomized controlled trial

type of scientific experiment where participants are randomly assigned to differente groups to test the effectiveness of a treatment or intervention

credibility (internal generalizability)

can you believe the findings?

generalizable (external generalizability)

can the findings be applied to persons, places or settings that were not directly studied?

significance/importance

are all “significant” findings necessary? Will this have an impact on patient/population health?

T or F: The mental hygiene movement in the early 20th century emphasized ensuring access to clean environments and safe water

F

What is one major challenge in implementing population-based mental health interventions?

Workforce shortages, funding limitations, and lack of policy regulations

T or F: Most technology-based interventions to address loneliness have focused on elderly populations

T

continuum of mental health

“mental illness” to “flourishing”

mental wellbeing

Mental well-being refers to a state of positive psychological and emotional health

What are behavioral/ mental health disorders?​ How are they defined?

Behavioral/mental health disorders, or mental illnesses, are conditions that affect a person's thinking, mood, and behavior, often causing distress and difficulty in functioning. They are defined by persistent patterns of thoughts, feelings, and behaviors that deviate from the norm, cause significant distress or impairment, and are not simply normal reactions to life events. 

impact of loneliness on health

The long-term health consequences of loneliness and insufficient social connection include a 29% increased risk of heart disease, a 32% increased risk of stroke and a 50% increased risk of developing dementia in older adults, according to the surgeon general.

technology-based interventions for loneliness

remote psychotherapies

support groups through social networking sites, social media-based interventions

individual cognitive behavioral therapy (CBT) (phone, video game consoles, tablets)

robots, conversational agents, chatbox

what does a population approach to mental health entail?

A population approach to mental health focuses on improving the mental health outcomes and well-being of a defined group (e.g., community, region, or nation) by addressing the underlying social, economic, and environmental factors that impact mental health, rather than solely focusing on individual treatment

DSM

Diagnostic and Statistical Manual of Mental Disorders, a handbook used by healthcare professionals in the United States and globally as the authoritative guide for diagnosing mental disorders. 

Any Mental Illness (AMI)

mental, behavioral, or emotional disorder

vary in impact, ranging from mild, moderate, or even severe impairment

Serious Mental Illness (SMI)

mental, behavioral, or emotional disorder resulting in serious functional impairment

substantially limits or interferes with one or more major life activites

T or F: Classifications of mental illnesses change overtime

T

T or F: It is possible to have poor mental health but no mental illness—and—to have good mental health with a diagnosis of a mental illness

T

Better terminalogy for “Mental Disorders” or “Behavioral Disorders” can be…

Brain Disorders

T or F: Depression can affect brain chemistry

T

Population at higher risk for depression and anxiety

kids aged 12-17

Why are kids at higher risk for mental illness?

2/3 children report experiencing at least one traumatic event by 16

1 in 7 children experience abuse or neglect annually in the US

each day, 14 youth die from homicide, and more than 1,300 are treated for violence-related injuries

areas that childhood trauma can impact

cognition, physical health, emotions, relationships, mental health, behavior, brain development

consequences of an adverse childhood experience (ACES)

increased rate of depression as number of ACES increase → higher in women

T or F: mental health care is expensive

T

primary prevention for mental illness

promote and preserve mental health and well-being

secondary prevention for mental illness

screening those at high risk or in early symptoms of distress

tertiary prevention for mental illness

psychotherapy, medications, other treatments

risk factors of mental illness in children

physical and developmental impairments

attachment issues

risk factors of mental illness in parents

history of abuse

family stress

single parent households

low income and level of education

unemployment

substance use

living in high-crime areas

SDOH of mental health

adverse childhood experiences (ACEs) → abuse, neglect, household dysfunction

example of ACEs and mental health pathway

T or F: 1 in 6 individuals under the age of 18 have a diagnosable mental health disorder

F → 1 in 5

T or F: only 20% of children with feelings of depression and anxiety are receiving professional treatment

T

sdohs of mental illness

ACEs, lack of diagnosis and treatment, mental healthcare shortage areas, social media, stigma

stigma of mental illness

people with mental illness are violent (dangerousness)

people with mental illness can’t work or live independently (incompetence)

people with mental illness will not recover (permancence)

the loneliness curve

loneliness peaks in young adulthood and late life, according to Psychological Science

Loneliness decreases with age, but rises again in those in their 50s and 80 and older

Models of undestanding loneliness

social needs, cognitive discrepancy, evolutionary theory

social needs approach to understanding loneliness

objective and subjective relationships do not satisfy the desired social needs

cognitive discrepancy approach to understanding loneliness

(subjective) fulfillment of relationships

evolutionary theory approach to understanding loneliness

feeling of being lonely even in the presence of others is a biological warning system

dynamics of loneliness in young people

shirking parental control, search for meaning, individuation, identity formation, new community, college life

What does ACES stand for?

adverse childhood experiences

continuum of substance use

no use → beneificial use → non-problematic → problematic → potentially harmful use → substance use disorder

Which age group has the highest levels of depression and anxiety?

12-17 year olds

substance use disorder (SUD)

treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences

a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

underlying change in brain circuits that may persist beyond detoxification

continuum of substance use

no use → beneficial use → non-problematic → problematic → potentially harmful → substance abuse disorder

what does a clincial assessmenet for SUD assess? (behavioral addicitions)

unsuccessful efforts to quit/reduce use, use more than intended, cravings, neglect responsibilities, use in risky settings, use despite negative effects, tolerance, withdrawal, use more than intended

What behavioral addiction is recognized by the DSM-V?

gambling

What pharmaceutical industries actions helped fuel the current opioid crisis?

Purdue

goals, pros/cons of harm reduction approaches to SUDs

cons:

potential misuse to easier access: if administered wrong, it can have unintended consequences

normalizes drug use

overlooks underlying issues such as addicitons

harm reduction strategies in themselves cannot reduce addicition → must be coupled w another intervention

what do behavioral and substance use addicitions have in common?

preoccupation

avoiding feelings of discomfort

unable to control behavior

continue to engage

co-occurrence

T or F: Addiction is a chronic disease

T

how do we define a chronic disease?

preventable and treatable

changes biology

if untreated, adverse effects on biological and behavioral functioning

goal of recovery-restored functioning

relapses can occur during or after treatment

what did the war on drugs result in?

unproportionate amount of people in color incarcerated

overdose death rates

overdose tripled

overall rates of overdose deaths decline but…

they have enot declined everywhere → in some places, they have increased → not declining for everyone equally

which race/ethnicity group has the highest amount of overdose deaths?

non-hispanic american indians or alaska native

why was prevalence in drug use increasing until recently?

availability, marketing, failures of government regulation, rising stress levels assocaited with increased socioeconomic inequality, super-normal stimuli, social contagion

potential reasons for recent drug use decrease

greater naloxone availability

greater access to addiction treatment

crackdowns on illicitly manufactured fentanyl

less solitary use post-pandemic

prescription opioids

prescribed by doctors to treat moderate to severe pain but can also have serious risks and side effects

fentanyl

synthetic opioid pain reliever. It is many times more powerful than other opioids and is approved for treating severe pain

heroin

an illegal opioid. Nearly 40 people die every day from an overdose death involving this drug in the US

crime of the century: confluence of events

efforts to improve pain control (5th vital sign)

threat of litigation

aggressive marketing

structure of heathcare → incentives to increase patient volume, satisfaction

physicians not well trained

heath insurance covered opioids but not other forms of pain management

regulatory failures

sdohs of drug use

interventions to address SUD

medical assisted treatment → medical approach

needle exchange programs

over-the-counter narcan

supervised consumption sites

safer supply → offer a safer source of the substances

over the counter suboxone (controversial)

medication assisted therapy (MAT)

methadone, buprenorphine & naltrexone (suboxone), naloxone

needle exchange program

provide clean, sterile syringes to people who use injectable drugs in exchange for used ones

reduce the spread of bloodborne infections

increases to narcan (naloxone)

increase availability and legal protections for bystanders

prevent death from overdose

supervised consumption sites

locations for safe drug use with medical oversight

reduce overdose deaths, prevent infections, and provide immediate medical interventions

safer supply

offer a safer alternative to the illegal drug among people who are at high risk of overdose

reduce risk of fentanyl-related overdoses

over the counter suboxone (potential)

reduces opioid cravings and withdrawal symptoms

expand access to MAT

T or F: Smoking is the leading preventable cause of death

T → about 500k deaths per year, 16 million have smoking-related disease

T or F: Smoking can cause cancer almost anywhere in your body

T → based on data accumulated since 1950

T or F: It takes about 20 years for lung cancer to develop

T

T or F: Smoking is a public health success story

T