FMPH 110 Midterm 1 PDF

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Sarah Linke, Fall 2017, summary of lecture notes before first midterm ...

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Lecture 1  3-4-50 concept 3 health behaviors, 4 diseases, 50 percent -smoking, physical activity, diet and nutrition -heart disease/stroke, diabetes, cancer, pulmonary disease -responsible for 50% of deaths -gone down in San Diego 2000-2013  People know that things are bad for them, but do it. How do we stop this? Biggest question in medicine  Health behavior: any action performed that affects ones well being  Behavioral risk factor: behavior that influences your chances for development of a disease or condition  Health: well being, being free from injury in the mind body and social  Behavior: the manner of conducting oneself, organisms actions and response to stimulation or environment, observable activity= action, response, functioning, reaction  Social Ecological Model -relationship amongst various personal and environmental factors -ex: avoiding sickly environments, putting oneself in an environment which healthy behaviors are promoted -Individual---interpersonal---community---policy  Chronic disease: condition that develops and generally gets worse over time  Causes of death: smoking, blood pressure, obesity  Framingham Heart Study: study with 5209 men and women between 30 and 60, found that 80% of coronary heart disease may be preventable Lecture 2  Framework- used to understand the distribution and causes of health behaviors in populations in order to influence health behavior  Epidemiology= the study of the distribution and determinants of health related states or events, and the application of thus study to the control of diseases and other health problems Etiology: the cause, set of causes or manner of causation of a disease or condition  Behavioral epidemiology frameworks: PHASE I: Establish links between health behavior and chronic disease -most has been studied and established -epidemiological data, observational studies -direction: Is behavior health promoting of compromising. Ex: as obesity increases CVD increases -dose-response relationship: we know that behaviors are related, but need evidence that one causes the other -magnitude: 1 of every 2 or 3 smokers dies from smoking related diseases PHASE II: develop methods for accurately assessing health behaviors -establishing validity and reliability of measures -field testing measures PHASE III: Identify factors that influence levels of health behaviors

-non-modifiable correlates helps with targeting -modifiable correlates helps with tailoring PHASE IV: Evaluate interventions to promote health behaviors -testing of interventions, focusing on all previous phases Intervention studies are experimental PHASE V: Translate research into practice -effective interventions developed, assess public health impact  Heart Disease: conditions due to atherosclerosis- narrowing of the small blood vessels that supply blood and oxygen to the heart due to plaque -risk factors include- high blood pressure, high blood cholesterol, and diabetes Smoking: damage linings of arteries, makes your heart work harder by reducing oxygen in blood, raises blood pressure, blood clots  Cancer: cells divide uncontrollably and invade tissues and organs -smoking can cause 14 types of cancer -20 cancers caused by being overweight or obese  Diabetes: Type II is preventable -body cannot produce enough insulin, or becomes resistant to it, is insulin dependent -heart disease death rates are 2-4 times higher than for non diabetics 1 in 10 diabetics has had a stroke people with diabetes has quadrupled since 1980 smoking increases risk of diabetes by 30-40 percent  Pulmonary disease Emphysema: damage to air sacks chronic bronchitis: narrowing of large airways small airway disease: narrowing of small airways Lecture 3  Prevalence vs. incidence: incidence is new and prevalence is the total of the disease. Bathtub image  More than 1/3 of US adults are obese  TEDTALK: evaluating the bigger problem. There are people who have done everything right but still have diabetes. Must take away the idea that fat=diabetes, but actually insulin. -many researchers believe that obesity causes insulin resistance, but what if we have it backwards  Obesity- it is a risk factor or an outcome?  Diet: food and drink regularly provided or consumed  Dietary guidelines 2015-2020: long term health eating, 10% of calories from added sugars, 10 percent of calories from saturated fats, less than 2300 mg of sodium, nutrient dense foods, no recommendation for cholesterol  Relative risk: the ratio of the risk in the exposed divided by the risk in the unexposed  Clicker-An adult can meet the 2008 PA guidelines with: Three 10 minute bouts of moderate intensity PA five days per week and 3 days strength training -Guidline is 150 minutes moderate or 75 minutes vigourous, can have bouts of 10 minutes. 3 days a week strength training

-52% of people do not meet these guidelines  Cigarette smoking has gone down in the US from 1997, now 16.8 percent  Increase in e-cigarette use Lecture 4  Health disparities: gaps in health or determinants of health between segments of the population -health differences closely linked with social, economic, environmental disadvantages  6 health disparity issues: cancer, cardiovascular disease, chemical dependency, diabetes, homicide and accidents, infant mortality  lack of trust, lack of cultural influence on health and health knowledge Social economic status is tied to many aspects. Minorities overrepresented in low SES  Why do health disparities exist; -social and cultural environment: social and cultural norms -physical environment: safety, access access and quality of service: support services (fire, police)  Hispanic females have longest life expectancy  Prevalence of obesity higher in women than men Black and Hispanic women higher than white women over 50 percent of black women are obese  Less people in poverty smoke?  2020 Goals for cardiovascular health: -smoking, BMI, PA, Diet, cholesterol, BP, Glucose  How does each level of the SEM affect ones dietary behavior: -Low SES= less access to healthy foods -men have less healthy diets -Hispanic woman have high rates obesity along with black women AI smoke the most Lecture 5  Correlates: Factors associated statistically with the behaviors (non modifiable and modifiable, tarkets, behavioral tailors  Ted talk: Social media there to provide social support. Creating online groups can create new communities to “go back to the village”  Diet and Food environment -food deserts: no grocery store within 1 mile  What would be least affective in helping people to eat more healthy foods? Banning new fast food restaurants in a place saturated with them  Fast food being 1/10 of a mile = 5.2% increase in obesity  Physical Activity and Built Environment -just because there is easy access to being active does not necessarily mean people with choose it  Smoking -initiation is 2.5 times greater in adolescents who frequently visit stores with cig advertising, twice as high is exposed to advertisements - lower access reduces smoking

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Individual and interpersonal correlates: -demographics: health disparities increase risk for engaging in unhealthy behavior -psychological: attitudes, preferences, knowledge, mood -interpersonal: social support, family, modeling the behavior, social norms and attitudes Lecture 6:  Theory= set of contructs, systematic view, specify relationships, explain and predict phenomena , guide intervention development  Constructs= tool to fascilitate understanding of human behavior  Theoretical constructs= exist as concepts but not as tangible entities (intelligence, happiness)  If construct isn’t a concrete thing that can be measured, split it up into different variables  Individual theories: focus on individual thought process, consider context in which they occur -Health Belief model, theory of planned behavior, stages of change  HBM: developed to understand why people weren’t using free health screenings perceived susceptibility, perceived benefits, perceived barriers, perceived self efficacy--perceived threat- individual behaviors, cues to action -critiques: focus is on individual decisions, does not consider social and environmental factors. Not sure how they all always work together  Theory of Planned Behavior: behavioral intention leads to behavior  critiques: assumes behavior is rational time between intent and action is not considered  The two HBM rely on thoughts and knowledge but aren’t enough to change behavior  Transtheoretical Model/Stages of Change model: people vary in their level of motivation to change. Target to an individual level of motivation 1. Pre contemplation. 2 Contemplation. 3. Preparation 4. Action 5. Maintenance -focus is on changing motivation -Critique: people don’t always go through a fixed set of changes in a straight line  Interpersonal Theories: Social cognitive theory/social learning theory: behavior afftected by personal/individual factors, environmental influences, attributes of the behavior. Includes social environment reciprocal determinism: environment, individual, behavior critiques: complex- a grab bag of constructs Lecture 7  Self Monitoring: important plus intention formation, goal setting, goal review, performance feedback  Self monitoring: tracking target behavior, provide feedback, recall bias  Intention formation: increase motiviation to change -change beliefs and attitudes to have positive outcome expectations -make a commitment to change  Goal Setting: specific plan with long term goals  Goal Review: periodic review and reconsideration of set goals

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Performance feedback: action, information, reaction -information about actions gives people opportunity to change actions, keep people accountable  Ehealth apps are more common amongst younger than older population  People don’t use wearables because of: cost, complication, privacy  Wearable devices: fascilitators of health behavior, not drivers -people w/o wearbale devices lost more weight in a study -devices must be designed to work with human behavior  Delivery channel: mode through which the intervention components are administered to the target person/population/community -face to face ie clinic based, web based, mail, texting and apps  Diabetes Prevention Program -randomized trial for diabetes prevention in pre-d patients -calorie restriction of 500-1000 calories, 150 minutes per week of MVPA, 7% weight loss at 6 months -first sessions focused on self monitoring, last ones focused on psychological factors -metformin lowered risk by 31 percent, change in lifestyle lowered risk by 58 percent Lecture 8:  

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Community level approaches: considers the social/environmental context and way it interacts with individuals Community mobilization: collective action by community members/groups to create change -Model: community based participatory research 9 Key principles of CBPR -Promote collaborative and equitable partnerships involves empowering/power sharing process, all parties participate in and share control over all phases of the process researchers recognize inequalities that exist between themselves and community participants -Community is the unit of identity sense of emotional connection and identification with others, shared norms and values, goals and interests, desire to meet shared needs -build on strengths and resources within the community -facilitate co-learning and capacity building among all partners -focusing on problems relevant to the local community -balances research and action for the mutual benefit of all partners -disseminates findings and knowledge gained to the broader community and involces all partners in the process -promotes a long-term process and commitment to sustainability -involves using a cyclical and iterative process Advantages of community models; Increases trust and builds cultural gaps between partners provides resources to communities involved

translate findings into policy change diverse expertise to address complex public health problems  Disadvantages; -lack of trust between community workers and who represents the community -inequitable distribution of power -conflict over funding -differences in perspective -differences in research needs and community needs  *Diffusion of innovation: process by which a behavior or technology makes its way into a population and is adopted ie. Social media -innovation development -dissemination -adoption -implementation: focus on self efficacy -maintenance  Innovators, early adopters, early majority, late majority, laggards innovators and early adopters should be the leaders  Diffusions of innovation: Relative advantage compatability complexity trialability observability  DOI example- DPP program -YMCA received funds through the Centers for Medicare and Medicaid Services to deliver DPP through the YMCA  Social Marketing -Specific kind of approach to health communication and behavior change that incorporates marketing  Market segmentation  Assessing the exposure to a campaign may be difficult, degree to which attitudes or campaigns have changed is hard to measure Lecture 9:  Community intervention- For the entire community Intervention in a community  tend to result in larger changes but over a smaller number of people  Types: Universal- target general population Selected- target groups that are at a high risk for a particular health problem Indicated: combine multiple types of activities and treatments to address multiple factors that occur together, such as poverty, diabetes, poor diet -YMCA DPP was selected because it targeted multiple risk factors  Minnesota Heart Health study: universal, little change. Social Learning Theory and Diffusion of innovations

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COMMIT: selected, larger change. high quit rate for light to moderate smokers DPP: For people with high risk of diabetes- indicated Sustainability- how can you help a program continue after the research and the research funds are gone -train and hire community members, bring in community stakeholders who want the program to continue...