ph 101 NOTES
ph 101 NOTES Public health 101
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Public health 101
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This 8 page Bundle was uploaded by Shuntynia Notetaker on Thursday October 1, 2015. The Bundle belongs to Public health 101 at University of Rochester taught by Chin in Fall 2015. Since its upload, it has received 54 views. For similar materials see Intro to public health in Public Health at University of Rochester.
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Date Created: 10/01/15
PH101 Article Notes Class 3: Principles of Community Engagement: Chapter 2, pages 45- 53 Community Engagement is difficult to have and maintain 9 Principles on Making Community Engagement Successful o 1) Before starting a community engagement effort, you must be clear about the purposes of the engagement effort, and the communities you want to engage express why it is important that alone is not enough for engagement though emphasize how economics will be impacted ask community members their health-related concerns are, and have them help plan and develop programs o 2) Learn about the community’s culture, economic conditions, politics, social networks, norms, values, history, etc. and their perceptions of community engagement important o learn as much about community as possible be aware of what community perceives as costs and benefits of certain decisions, and leaders who are initiating change important to build genuine partnerships o 3) It’s necessary to establish relationships and trust in a community in order for engagement to occur this way positive change is more likely to occur o 4) Self-determination is key – let the members decide what they want and be responsibility for what they want, don’t just jump into a community and make changes or try to control things without their approval more likely to participate if it is an open and supportive environment o 5) Partnering with the community is necessary to create change and improve health must be mutually beneficial o 6) All aspects of the community engagement must respect and recognize diversity, and should be taken into consideration for planning and designing approaches for engagement health status, education, economic status, employment related to a person’s language, culture, race, age, gender, etc. must be respectful of a cultural traditions o 7) Community engagement can only be sustained by identifying and mobilizing community assets and strengths use existing resources, and use new resources when possible o 8) Organization’s should be flexible in meeting a community’s changing needs o 9) Community collaboration consists of long-term commitment have greatest chance of making a difference Class 4: Glantz. Social and Behavioral Theories Health interventions that are based on theory are more effective than those not based in theory Health behavior theories come from social and behavioral science theory Theory: set of interrelated concepts, definitions, and propositions that explains or predicts events or situations by specifying relations among variables o Can apply broadly Theory is important because it can o Understand why people do/do not practice health promoting behaviors o Help identify what info is needed to design effective interventions o Provide insight on how to design a successful program 2 Broad Types of Theory o explanatory theory o change theory theories rooted in understanding the social determinants of health and health behavior should have upstream, ecological-effect approaches o interventions should targeted at the individual, interpersonal level, organizational level, and environmental factors 4 Most Widely-used Theoretical Models of Health Behavior o Health Belief Model (HBM) Developed to understand why people did/did not use preventive services Theorizes people’s beliefs about being at risk for diseases, perceptions of the benefits of avoiding the disease, and what influences a person’s readiness to take action Core constructs Perceived susceptibility / perceived severity Perceived benefits / barriers Cues to action Self-efficacy o The Transtheoretical Model/Stages of Change (TTM) For understanding people’s readiness for long term changes in health behavior Helpful for explaining and predicting changes for many behaviors, like smoking, exercise, eating habits 5 Stages precontemplation o person has no recognition of a need to change contemplation o person is thinking about changing (in next 6 months) preparation o planning for change (usually within next month) action o adopting new habits (for at least 6 months) maintenance o ongoing practice of new, healthier behaviors people can go backwards or repeat stages too o Social Cognitive Theory (SCT) Explains behavior in terms a 3-way reciprocal model of factors that influence each other Key constructs Observational learning Reinforcement Self-control Self-efficacy o The Social Ecological Model Helps us to understand factors affecting behavior Emphasizes the multiple levels of influence on behaviors Important to create an environment conducive to change Interventions to Change Health Behavior o Should include goal setting, behavioral contracting, health communication How Theory is Used o Informed by theory theoretical framework exist, but there was limited/no application o Applied theory several constructs of a theory were applied in a study o Tested theory more than half of the theoretical constructs were measured and explicitly tested in a study o Building/creating theory new or revised theory Class 5: The Social Determinants of Health: Coming of Age Social determinants of health: factors w/ important direct or indirect effects on health o Downstream social determinants: factors that are temporally and spatially close to health effects o Upstream social determinants: fundamental causes that set in motion causal pathways leading to health effects o Many health problems we face cannot be successful addressed by medical care alone Educational attainment and income play a huge role in health Other factors o Neighborhood conditions air and water quality, closeness to facilities, exposure to hazardous substances, access to nutritious food, safe places to exercise o Working conditions noise levels, chemical expsoures, stress, working overtime, high physical workload, risk of obesity, health care opportunities o Education increased health knowledge, better-informed decisions, affects employment opportunities, higher pay, higher social status o Income access to goods, vehicles, property, Major racial differences o Race racism linked to limited opportunities, discrimination, greater likelihood to live in disadvantaged neighborhoods o Stress trigger release of cortisol, weaker immune system, o Early childhood experiences affect cognitive, behavioral, physical development Class 6: Health Inequalities Among British Civil Servants: the Whitehall II Study Study began in 1967 Showed inverse association b/w social class and mortality o Higher social class lower mortality rate, lower social class higher mortality rate 1985 – this claim was investigated again o 10,314 participants o ages 35-55 o asked to answer questionnaire and screening findings o still an inverse association, and it works at a gradient o people of lower class reported lower perceived health o those at lower social class also had higher rates of health- risk behaviors Whitehall study looked at the causes of the social risk factors contributing to the gradient of health status --- confirmed hypotheses Class 7: “Weathering” and Age Patterns of Allostatic Load Among Blacks and Whites in the United States Question – Do US Blacks experience early health deterioration due to repeated exposure and adaptation to stressors? This is a study that looked how Black people in the US’s health compared to White’s, by surveying and looking at the allostatic load scores for adults aged 18-64 years old allostatic load is "the wear and tear on the body" which grows over time when the individual is exposed to repeated or chronic stress. o Causes physiological reactions that affect blood pressure, cholesterol levels, waisttohip ratio Black experience poorer health at earlier ages than Whites this is consistent across many health indicators Black women had highest allostatic load scores Class 8: Turning Gold to Lead ACE Study THE ACE Study (Adverse Childhood Experiences Study) looks at how childhood experiences affect adult health decades later Found that there is a powerful relationship b/w our emotional experiences, and our physical and mental health as adults It seems that time does not heal all wounds Found that sexual abuse was quite common Many patients were aware that there’s a link between abuse and obesity Tried to find 8 categories of childhood abuse, and the dysfunctions that come along with them o Recurrent physical abuse o Recurrent emotional abuse o Sexual abuse o Growing up in a household where someone was in prison o Growing up in household where mother was reated violently o Growing up with alcoholic or drug use in household o Growing up with someone chronically depressed o Growing up where at least one biological parent was lost to during hchildhood Adverse (difficult) childhood experiences are o Much more common than acknowledged o And have a powerful relation to adult health 50 years later In regards to smoking Current smoking behaviors strongly related to what happened decades ago in childhood In regards to chronic obstructive pulmonary disease -> has strong relationship to score on ACE study Also linked to more STDs, emotional disorders, heart disease, diabetes, unintended pregnancy, alcoholism Physicians should pay more attention to history of patient’s problems Class 9: Relationship of Childhood Abuse and Household Dysfunction to Many of Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study This is a study questionnaire that was used to look at the link between 7 categories of adverse childhood experiences (psychological, physical, sexual abuse, violence against mother, living with substance abuser, living with mentally ill, liven with someone imprisoned), and that person’s behavior, health status, and disease later on in life Found that there was a strong graded relationship b/w how many of these experiences people had experienced as a child, and their number of risk factors for leading causes of death as adults Strong link b/w childhood abuse and adult health risk behaviors/disease With more of the abusive childhood exposures, the prevalence and risk for smoking, severe obesity, physical inactivity, depressed mood, and suicide attempt increased
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