PHP 0320 Final - 2/3 of Course

What is age-adjusted mortality rate

• Method of standardization to account for different underlying demographics of populations

• Allows for fair comparisons of death risk across populations or time periods

• Reduces confounding by age

systematic epidemiology

a data-driven, scientific approach to studying the distribution, determinants, and natural history of health-related states in populations, aimed at controlling health problems

how do you report measure of occurrences

use percentages or x per 100 

how do you report specificity, ppv + and - 

percentages

what does the Council of State and Territorial Epidemiologists do

recommends state health departments report cases of selected diseases to CDC's National Notifiable Diseases Surveillance System

• but states can decide whether they will notify the cdc

• Cases may be reportable by law, but not necessarily required to report to the CDC

Internal validity 

The program does what it is intended to do 

external validity

• Is it adopted by all students 

• Is it generalizable 

How is age-adjusted mortality interpreted

If a county has a high crude death rate, but a low age-adjusted rate, it indicates the high mortality was likely driven by an older population, not necessarily by poorer health conditions

what are the key concepts of epidemiology

systematic, population, disease, distribution, frequency

what is frequency within epidemiology

1. measure of disease occurrence

   1. Prevalence: what percent of the population has a disease at a given time (all cases of a disease)

   2. Incidence: what percentage of the population acquires the disease in a given time period (new cases of disease 

what is distribution within epidemiology

the characteristics of those with the disease - by age, geography, socioeconomic status

what is population within epidemiology

Groups of people who share common characteristics

Crude mortality rate

• number of deaths in a period of time / total population

• Measures the death rate for an entire population

Period life expectancy

Assumes that people will experience the same mortality rates in the future as they do now

Cohort life expectancy

• Actual average age of death of a group born in a specific year (historical cohort)

• Accounts for anticipated future improvements in mortality rates

Years of Potential Life Lost (YPLL)

• Used to measure relative impact of different causes of death

• Ypll = target/threshold age - age of death

Quantitative evidence

numerical data that gives us the why

issues with convenience samples vs full probability samples

• convenience samples have biases built into them, are hard to track, and can give false results

• full probability samples pick random people which allows for results to be generalized to the entire population

why is a full probability sample difficult to do for underrepresented populations

expensive

What are two ways to counter the poor representation of underrepresented populations in data?

• Oversampling underrepresented population

• Weight the samples so it matches the whole population successfully

Which group is described as the 'hardest to reach population' for data collection

undocumented immigrants

In the CDC Health Impact Pyramid, which level has the smallest population impact but requires the most individual effort?

counselling and education

In the CDC Health Impact Pyramid, which level has the largest population impact but requires the least individual effort?

socioeconomic factors - connect for health, housing and food security initiatives

What are the primary components of a community health needs assessment?

1. Reports of progress on the previous implementation plan

2. Health needs assessment

3. Implementation strategy

what does a chna require a hospital to do

to define the community it serves and assess the community’s health needs

Why did Brown hire an outside firm for the methodology of a chna, and what was the trade-off?

It became too difficult to do in-house; however, they lost the "rich data" gained when staff used to go directly to individuals' houses.

What groups are at greatest risk for maternal and child death

Black and Hispanic women and babies

What are the 5 steps of Program Development?

1. Identify the problem and risk factors

2. Set goals and objectives

3. Develop an intervention

4. Implement the intervention

5. Evaluate the intervention

Why is it necessary to conduct a Needs Assessment?

• To avoid creating "bad" interventions

• To create community trust

• To avoid wasting resources

What are the 2025 concerns for Brown health

access to care

behavioral health

chronic diseases

maternal and child health

older adult health and wellbeing

social drivers of health, especially housing

what diseases are among the top causes of death in ri

Diabetes and heart disease

What factor influences health the most

socioeconomic factors

Qualitative evidence

Used to understand how, what, when, where phenomena occur, focusing on human experiences, perceptions, and behaviors

How is a "Target Population" identified in public health?

By geography, culture, age, interest, or occupation

What is a Logic Model

A visual depiction of a program showing what will occur, what will be accomplished, and the "If-then" relationships between elements

What are the core components of a Logic Model "Process" and "Outcomes"?

Process: Inputs — Activities — Outputs

Outcomes: Short-term — Intermediate — Long-term

In a Logic Model, what is the difference between an Output and an Outcome?

Output: The direct product of activities (e.g., number of classes held, number of people trained).

Outcome: The change that occurs because of the activities (e.g., increased knowledge, behavior change, or reduced disease rates).

Define Efficacy in the context of program evaluation

Did the program work under ideal conditions? (e.g., high funding, highly trained staff, best possible circumstances)

Define Effectiveness in the context of program evaluation

Did the program work in real-world conditions? (e.g., after grant money runs out, integrated into normal hospital operations, facing community barriers like transportation).

What was the specific skill development intervention for the youth program?

Paid work experience in various hospital departments (Radiology, Physical Therapy, Nursing, Dietary Care, or Respiratory Care)

What does the SMART acronym stand for in program goal setting?

Specific, Measurable, Attainable, Relevant, Timely

What are the three necessary conditions for causality?

1. Temporal relationship: The exposure occurred before the outcome changed.

2. Correlation: Exposure and outcome variables co-vary.

3. Consideration of counterfactual: Ruling out alternative explanations (other factors) for the change.

evaluation design: post-test only - what is the major limitation of a "One Group: Post-test Only" design?

It lacks a comparison group

no "baseline" data from before the intervention

evaluation design: How does a "Two Group: Post-test Only" design work?

One group receives the intervention and the assessment; the other (comparison) group only receives the assessment

What is an concern regarding two-group evaluation designs?

Whether it is ethical to withhold an intervention from the comparison group (individuals who do not get the program)

Describe a Time-Series evaluation design.

It involves a participant group being tested multiple times both during and after the intervention to track changes over time.

What factors influence the selection of an evaluation design?

• The evaluation question

• Availability of resources.

• Importance of establishing causality.

• Timing of the evaluation initiation.

• Availability of archival data.

Which design is best for measuring "Satisfaction with a program"?

Post-test only

Which design is best for measuring a "Change in symptoms"?

Pre- and Post-test is required to see the difference from baseline.

What are the components of Emergency Preparedness?

Training, Medical/Public Health, Infrastructure, Communications, Transportation, Finance, and Logistics.

What are the five phases of the Emergency Management Cycle?

1. Prevention (e.g., vaccinations, fire prevention)

2. Mitigation (reducing the impact of a disaster)

3. Preparedness (personnel on standby, communication plans)

4. Response (immediate action during the event)

5. Recovery (resetting and learning from the disaster)

In the context of disaster communication, what are Interoperability and Redundancy?

Interoperability: A framework allowing different agencies (firefighters, police, etc.) to communicate and work together easily despite using different channels.

Redundancy: Ensuring there are multiple ways to do something (e.g., having backup communication methods if cell towers fail).

What is an EOC, and what is its purpose?

Emergency Operations Center

a central location where people with specific roles gather to funnel information and work on problems together as they arise

What is the sequence of response levels after an event occurs?

1. Event

2. Activation of EMS

3. Local response

4. Regional response (if a town cannot respond alone)

5. Federal response (if disaster exceeds regional resources; must be requested by the Governor and approved by the President).

What is DMAT?

Disaster Management Assistance Teams.

Federal-level contracted employees who set up medical tents, vaccination clinics, and shelters during a disaster.

Harm reduction emerged as a response to what historical factors?

Grassroots/mutual aid efforts reacting to institutional neglect and punitive drug policy, particularly during the HIV/AIDS crisis.

Name three tools used specifically for Overdose Prevention.

1. Naloxone (Narcan) distribution.

2. Fentanyl test strips.

3. Overdose Prevention Centers (safe spaces for supervised use).

what are Managed Alcohol Programs, and who are they for?

Programs where alcohol is dosed at set intervals for people with high-intensity alcohol use for whom abstinence-based programs have not been effective.

What was the primary economic driver of Flint, MI in the 1960s, and how did it change by 2010?

Flint was a prosperous manufacturing hub led by General Motors.

By 2010, employment dropped from 80,000 to 8,000 due to automation and the loss of automotive jobs.

Why did Flint switch its water source in April 2014, and what was the change?

To save costs, the city stopped purchasing water from Detroit and began drawing water from the Flint River.

What was the "critical divergence" involving General Motors in October 2014?

GM stopped using Flint water because high chlorine levels were corroding their engine parts, yet the city continued to tell residents the water was safe for human consumption

What are the three stages of the Framework for Public Health Advocacy?

1. Information Stage: Collecting/analyzing data to describe the problem.

2. Strategy Stage: Devising a plan to address the determinants or causes.

3. Action Stage: Implementing strategies, activities, and programs.

Define Environmental Justice.

The right of all people and communities to live and thrive in safe, healthy environments with equal environmental protections and meaningful involvement in decision-making.

according to the Michigan Civil Rights Commission, what were the root causes of the Flint crisis?

Deeply embedded institutional, systematic, and historical racism.

How do "Hog Farms" contribute to environmental health disparities?

Waste pits contaminate underground water sources. Communities closer to these farms often have higher poverty rates and higher non-white populations.