KNES 400: Foundations of Public Health Week 3 Notes
KNES 400: Foundations of Public Health Week 3 Notes KNES 400
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This 6 page Class Notes was uploaded by Victoria Dassing on Saturday September 17, 2016. The Class Notes belongs to KNES 400 at University of Maryland taught by Shannon Jette in Fall 2016. Since its upload, it has received 41 views. For similar materials see Foundations of Public Health in Kinesiology at University of Maryland.
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Date Created: 09/17/16
Expanding Epidemiology: What are some of the issues and critiques? Monday, September 12, 2016 11:15 AM I Primary Goal of Chronic Disease Epidemiology a To identify association between exposure and outcome b The "science" of public health II Epidemiology - Infectious Disease a Germ theory i One agent --> one disease ii Agent is present in every case of disease 1 Ex. Cigarette smoking b Host --> Agent --> Environment c Why does this not work for chronic disease? i There is not only one agent 1 Ex. Cancer can be caused in many different ways II Chronic Disease Epidemiology a The term "risk factor" is used to describe these partial contributing causes i Ex. Cardiovascular disease - many factors can cause this 1 Each alone are not sufficient to cause the disease but together they contribute 2 More about probabilities opposed to possibilities II Analyzing Associations Chronic Disease Epidemiology a Relative risk: expresses how much more or less likely an exposed person is to develop an outcome relative to unexposed person b RR = incidence of outcome with exposure/incidence of outcome without exposure i RR > 1 : increased risk of outcome in exposed person ii RR = 1 : no risk of outcome iii RR < 1 reduced risk of outcome in exposed person 1 Can never have a negative RR b How do we conduct studies in chronic disease epidemiology in order to obtain measures of association? i Double blind ii Unethical to put subjects at risk II Observational Studies a Defined: Epidemiologist does not control the conditions, instead observes the associations between exposure and outcome i Cross-sectional 1 Limitation: a No temporal aspect b Did risk factor come first? Then came the outcome? ii Case-control (retrospective) 1 A bunch of people with the disease and then try to match them to physically similar people and ask questions to identify risk factors 2 Inexpensive and quick 3 Limitations: a Recall bias i The sick individual may remember their past and what RR were involved in their life ii Cohort (prospective, longitudinal) 1 Framingham - largest ongoing epidemiological cohort study in US 2 In-class videos notes: a Young couple, no money b Heart study and could receive a free physical exam c Had no idea that 60 years later she was going to be in it d Check-ups every 2 years e Children became included when they were born f Participant feels like a valuable contribution to society 2 Follow individuals along to wait until they die a Look at different exposures that could have led to death ii Overview of Study Designs 1 Past Prese Futur Design nt e Expos Cross- ure sectional outco me Expos Outco Retrospectiv ure me e/case- control Expos outco Cohort/prosp ure me ective Expos Outco Clinical ure me trials/interve ntions II Casual Claims are often inconsistent and contradictory a A few cups of coffee a day may lower risk of colon cancer -- NOT TRUE b Due to misinterpretation of findings II Critiques/Issues with Chronic Disease Epidemiology a Misinterpretation of finding, especially when translated to the public i Finding an association between presence of a risk factor (exposure) and a disease (outcome) DOES NOT PROVE CAUSATION 1 An association could be non-casual -- it could be a one-time observation due to random error or due to errors in methods/procedures used a Systematic bias b Measurement errors c Selection bias d Recall bias e Social desirability: lying f Interviewer bias g Confounders : hidden variables within the environment i Ex. Sedentary behavior --> increase in myocardial infraction ii RR include: age, smoking, iii Ex. Kids shoe size --> IQ iv RR includes: age 2 After controlling for bias/error, association seems to hold, one still should not infer causality a Best to think of exposure of interest as a risk factor for outcome i Association is statistical (not biological) ii Must work through number of principles used to infer causality iii Ex. Temporality, strength of association, consistency, dose-response, biological plausibility Expanding Epidemiology (II) : The Social Determinants of Health Wednesday, September 14, 2016 11:03 AM I Critiques/Issues with Chronic Disease Epidemiology a Misinterpretation of findings, especially when translated b Loss of attention to wider social factors that play role in development of chronic disease i Shift away from looking at the bigger picture, environment oriented ii Excessive focus on lifestyle factors and individual risk factors 1 Why? a Rise in medicine and preventive medicine b "Accomodationalist" c Socioeconomic status b Health Issue Determining Direct More Distal Factors Contributing Contributing Factors Factors Cardiovascu Obesity/overw Inactivity Low self- lar disease eight Poor Diet efficacy Lack Access Hypertension Poor Diet Lack time (high Smoking sodium) Inactivity Stress c Social/Indirect Factors Structural Factors Educational opportunities Racism/Discriminat ion Poor neighborhood conditions Macroeconomic system Lack money, poverty Working 2 jobs I Upstream and Downstream Logic a Diseases are attributable to many causes, located outside and inside the body i The social life in the realm of the distal/ upstream ii The biological, psychological belongs to the proximal/downstream iii The distal and proximal are connected by levels 1 Societal 2 Community 3 Individual b Upstream Determinants of Health: influence more remote in time or position (ex. Distal) to outcome of concern and more difficult to link together c Downstream Determinants of Health: individual lifestyle factors (health related knowledge, beliefs, behaviors) that are closer in time and distance (ex. Proximal) to health outcome making it easier to trace links between them i Influenced by upstream factors b Example: A Polluted Water Source i Children with elevated blood lead levels 1 Downstream Determinant a Drinking water 2 Upstream Determinant a Poor management and infrastructure b Globalization 2 Downstream Solutions a Don’t drink the bad water - water filter 2 Upstream Solutions a Fix the water source b In-Class Participation i What might be a downstream factor shaping physical activity 1 Obesity 2 Stress- in the middle 3 Time 4 Accessibility 5 Education/knowledge 6 Lifestyle 7 Lack of motivation 8 Injuries 9 Asthma 10 Interpersonal networks ii What might be an upstream factor shaping physical activity 1 Environment a Unsafe neighborhoods b Lack of sidewalks, bike paths, playgrounds 2 Lack of education - in the middle ii Falls in between downstream and upstream 1 Stress 2 Lack of education 3 Socioeconomic status II Ecological Framework - multiple levels of influence a Intrapersonal level: i individual characteristics such as: knowledge, attitudes, beliefs and personality traits ii Age iii Gender iv Genetics b Interpersonal level: interpersonal process and primary groups, including family, friends, and peers that provide social identity, support, and role definition c Community/Environmental level: i social environment 1 communities 2 Organizations 3 institutions ii build environment 1 living condition 2 Infrastructure 3 community design ii Natural environment 1 Weather 2 Topography b Policy level (social and economic) i Local ii State iii Federal policy iv Laws b SEM i Commonly used model or framework to understand causes of ill health ii Also used as a model to understand causes of a health-related behavior II Working Conditions and Health a Physical (material) aspects i Repetitive movements; heavy workload 1 Desk job 2 Exposure to chemical hazards ii Psychological aspects 1 Demand-control model a Very little autonomy, control 2 Effort-reward imbalance a stress ii Work-related opportunities 1 Vacation time 2 Gym membership
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