Kines 501 Exam 1

Ecological perspective

the interaction between, and interdependence of, factors within and across all levels of a health problem. It highlights people's interactions with their physical and sociocultural environments. The relationship between living things and their environment

Social ecological model update

health promotion should focus not only on intrapersonal behavioral factors but also on the multiple-level factors that influence the specific behavior in question. (individual, interpersonal, organizational, community, public policy)

Health equity

The state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance

Attainment of the highest level of health for all people

Health disparities

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.

Example: racial or ethnic group, religion, SES, gender, age, mental health, etc

Health inequities

are differences in health outcomes of a population or group that are systemic, avoidable, unfair or unjust. (not just the difference in health outcome, its based on the systemic difference)

Social determinants of health

The conditions in which people are born, grow, live, work, and age, are shaped by the distribution of money, power, and resources at global, national, and local levels

Examples: Healthcare access and quality• Education access and quality• Social and community context• Economic stability• Neighborhood and built environment

Healthy People 2030

US program that sets health goals and measures changes in health

Goals: eliminate health disparities, attain healthy lives

Priorities: SDoH, mental health, health inequities,

Epidemiology

Definition: the study of distribution and determinants of health-related states among specified populations and the application of that study to the control of health problems

Purpose: study past or current trends in health status or level of disease• Identify causes of death• Define risk factors and determinants of disease• Determine need for health services• Identify feasible disease-prevention and health promotion strategies• Predict future disease outbreaks

Prevalence

number of new and old cases in a given period of time, divided by the total number in that population

•Useful in the study of chronic disease - diseases that usually last three months or longer

Incidence

number of new health-related events or cases of a disease, divided by population at risk

•Important in the study of acute diseases - diseases in which the peak severity of symptoms occurs and subsides within days or weeks

Mortality

the state of being subject to death

Morbidity

illness or disease

Life expectancy

average number of years a person is expected to live based on current mortality rates

Cross-Sectional Study (prevalence study)

A one-time data collection effort that often uses a self-report format. Using this type of study, you can find a correlation between two statistics; however, you cannot assume causation.

Time is fixed; assessments made at single time point

Longitudinal study design (Cohort study)

A cohort of healthy people is followed through time to see if they develop a specific disease of interest.

Assess cohort over time, assessment made at multiple points

Primary Data Source

The active process of collecting specific information through research. Primary data provides accurate, community-specific data about the problem and potential solutions.

Examples: Observational study designs• Cross-sectional studies• Cohort studies• Case-control studies• Experimental designs

Secondary Data Source

Using information that has already been collected by national, state, orlocal sources.• Secondary data helps you determine how your community compares to other communities who face similar issues.

Examples: • Disease registries• Population surveys• Census• Vital statistics

Food desert

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 traveling distance.

Food insecurity

when people don't have enough to eat and don't know where their next meal will come from

4 key steps to achieve health equity

1. Identify important health disparities

2. Change and implement policies, laws, systems, environments, and practices to reduce inequities in the opportunities and resources needed to be as healthy as possible

3. Evaluate and monitor efforts using short- and long-term measures

4. Reassess strategies in light of process and outcomes and plan next steps

Predisposing factors

the conditions and activities that can lead to the development of disease within a living organism

Ex: genetics, life events, or temperament

Reinforcing factors

the positive or negative influences or feedback from others that encourage or discourage health-related behaviour change

Ex: social influences from family, peers, teachers or employers.

Enabling factors

forces that facilitate or impede individual, collective, or environmental change based on their level of availability

Ex: income, insurance coverage, access to services, and community characteristics such as availability of resources and region of the country

Womb to tomb

prebirth to death relating to health outcomes and risk factors

Key principles of the Belmont Report

Respect for Persons, Beneficence, and Justice—and their specific applications (Informed Consent, Assessment of Risks and Benefits, and Selection of Subjects)

Community capacity

the interaction of human, organizational, and social capital existing within a given community that can be leveraged to solve collective problems and improve or maintain the well-being of a given community.

Social capital

the networks of relationships among people who live and work in a particular society, enabling that society to function effectively

Cultural Competence

the ability to interact effectively with people of different cultures

i.e:the ability of an individual to understand and respect values, attitudes, beliefs, and mores that differ across cultures, and to consider and respond appropriately to these differences in planning, implementing, and evaluating health education and promotion programs and interventions

Cultural Humility

involves an ongoing process of self-exploration and self-critique combined with a willingness to learn from others. It means entering a relationship with another person with the intention of honoring their beliefs, customs, and values.

Theory

Evidence based explanation that explains why or how something works

Tells us

Who: is impacted by this issue

What: you need to know before developing an intervention and how to measure it

Why: people arent folllwing this intervention

How: can we get people to follow a health intervention

Health

Lots of definitions, multidimensional, dynamic

1) absence of disease

2) able to cope with daily life

Health promotion

Health education + environmental actions to support healthy living (laws, support, organizations) 

Determinants of health

Conditions where people can be healthy

1) Biology/genes

2) SES factors

3) Environment

4) Health behaviors

5) Health care

Socioecological Model + example for each level

Shift from infectious diseases to chronic diseases (1900-1960)

1. Growth of healthcare facilities and healthcare

2. Social security 

3. Hill Burton Act 1946

4. Penicillin

5. Reform phase

Shift from infectious diseases to chronic diseases (1960-1973) Social Engineering period

Medicare and Medicaid established 

Federal government has increased role in healthcare

Shift from infectious diseases to chronic diseases (1974-Present)

1. Prevention methods

2. Healthy people project

3. Healthism - you are in charge of your own health

4. Linking premature death to lifestyle and health behaviors

Health disparities

Systemic differences in health outcomes between demographics

Stem from inequalities in the social determinants of health

Persist over time

Perventable

5 principles of ecological model 

1. Multiple levels 

2. interaction across levels 

3. Environment determines behavior 

4. Behavior-specific 

5. Multi-level intervention most effective

Ecological model definition 

An approach to study design/interventions

Ecological model strengths and weaknesses 

Strengths: affects large number of people, effective, combine with other theories 

Weaknesses: expensive, not applicable across health behaviors, lack of specificity, difficult to make, some SDoH can’t be changed

Etiology

Cause of disease

Epidemiologists

Study the determine the determinants of health in a population

Apply it to prevention, control, and treatment

Risk factor 

Something that increases the likelihood of disease, illness, health problem

Protective factor

Something that reduces the risk of disease, illness, health condition, OR REDUCES THEIR SEVERITY

Outbreak

Unusually high amount of cases

common cause

in a specific area

Health indicators

Measurement of health (DALYs, HALE, prevalence, incidence, etc.)

Crude rate vs Adjusted rate 

Crude rate= total number of cases in a population 

Adjusted rate= number of cases in a population per capita (essentially they adjust for confounding factors) 

YPLL

Years of potential life lost: the number of years lost when death occurs before one’s life expectancy

DALYs

Disability-adjusted life years: measure of disease burden,
calculated as sum of years of life lost (YPLL) and years lived with disability

HALE

Health-adjusted life expectancy - average number of years of
healthy life can expect in a specific population or region

Life expectancy

The average age a person in a given area can expect to live (at a given timeperiod)

Infant/maternal mortality

# infants/mothers in a population who die in specified timeframe per 1000 live births

Analytic study

Experimental, observational, other type of survey that seeks to establish a cause and effect

trying to find something new

Descriptive study

Characterize a health issue: severity, distribution, where, who, etc.

Exploring a current health issue

What is needed for causality

• Strong

• Temporality

• Plausibility

• Replicable

• Specific

Primary data

You are creating new data (experiments, interviews, surveys, etc.)

Secondary data

Data that has already been obtained (institution, census, publications, etc.)

Criteria used to judge importance of disease to community health

•  # of people who will die from a disease

•  # of years of potential life lost (YPLL)

• Economic costs spent at various levels ol and other drugs

Primary level of prevention

Occurs before exposure to illness

Active: Individual behavioral changes Ex: exercise, seatbelts, handwashing

Passive: Doesn’t require a behavior change Ex: water fluoridation, public smoking bans, sanitation

Secondary level of prevention

Individual: slow disease progression Ex: appointments, treatment, testing

Community: limit the spread and reduce harm Ex: surveilance, treatment, quarantining, disinfection

Tertiary level of prevention

Individuals – rehabilitation from an established condition or disease
Ex: alcohol/drug rehab, physical/occupational therapy, dentures, cardiac rehab
Communities – emergency preparedness
Ex: medical personnel availability, training, services, systems

Structural inequities

Mechanisms that organize the distribution of power and resources

Race vs ethnicity

Race- social construct, based on physical appearance

Ethnicity- self identity, historical group that shares common traditions, language, heritage, etc.

Why do we use theories?

Theories help explain why people do what they do and suggest ways to change what they do (e.g., to improve health)

Simple: theories help us understand human behavior

What is the role of knowledge in behavioral change

Knowledge is a pre-req for behavioral change

But, knowledge alone is NOT enough to change behavior

What are the 3 vital components of a theory

1. Concepts

2. Constructs

3. Variables

What is a construct in a theory

Is how we apply the concept

Theory vs Conceptual model 

A theory is more general, where a conceptual model is a lot more specific

What are the 5 steps in choosing a theory

1. Identify the health issue and the intervention population.

2. Gather information about the health issue.

3. Identify possible causes for the health issue.

4. Identify the level of interaction for the possible causes of the issue.

5. Identify the theory that best matches the level and causes.

Antecedent variable

background factors that

precede expected relationships

Mediating variable 

variables that come between predictor and outcome variables

Modifying variable

the relationship between

the predictor and outcome is influenced

by a third variable

Social networks (structure)

• How and to what extent people are connected to others

• Social support is provided through these structures

Social support (function) 

• Functions provided or perceived to be available by social relationships

• Measures: actual and perceived support, aid, resources

Major components of social networks (3)

Degree of integration in social networks

• Structural

Social interactions that are intended to be supportive

• Functional

Beliefs and perceptions of support availability held by individuals

• Functional

3 Pathways linking Social Support to Health

1. Stress prevention pathway

• Social support prevents stress

2. Stress buffering pathway

• Social support diminishes the negative health effects of stress

3. Direct effect pathway

• Health-enhancing influence of social support

Stress prevention

Part of the social support and social network theory

Social support may decrease exposure to negative life events and certain

stressors; may decrease the association between stress and health outcomes

Stress buffering

Part of the social support and social network theory

• Social support “buffers” an individual from the negative effects of stressful

experiences

• Proposes that social support decreases the association between stressful

events or perceived stress and health behaviors or physical health

outcomes

Direct effect of social support

Social support is effective regardless of stress levels

Perceived support is directly related to beneficial influences on biological health

• Relational regulation theory: accounts for direct effects of social support on

mental health outcomes

• Everyday interactions between individuals provide positive outcomes

• Higher likelihood of health promoting behaviors

Effect of social support on mortality

• Low social integration predicts higher age-adjusted mortality risk

• Individuals with greater social connections have 50% greater likelihood of survival

compared to those in low social connections (Holt-Lunstad, Smith, & Layton, 2010 )

• Perceived support appears to be a more important predictor of lower

mortality than received support

Homophily

principle of the social support and social networks theory

we tend to associate with people similar to us 

Networks with high levels of homophily tend to be more resistant to change

Structural or network properties

Transitivity

• Friends of friends become friends

• Dense pockets of interconnectedness accelerates behavior

change within clusters and slows it between clusters

Centralization

• Extent that ties are focused around one or a few nodes

• Central hubs can coordinate activities for the network; may be

less sustainable than less-centralized hubs

Density

• Number of links in the network

• Too much density can hinder network performance