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Pub Health Final
Dr. Mittak's Public Health Final Exam
| Question | Answer |
|---|---|
| How many Americans are considered to live in a rural area? | 62 million people |
| How many people should be in a population for it to be considered rural? | < or = 3500 people |
| What are 4 issues facing rural America? | 1. Inadequate access to health care 2. Fewer educational choices 3. Few opportunities for professional advancement 4. Few cultural resources |
| What are some problems affecting rural Americans? | Lack of money/poor, Over-development/sprawl, Price of crops, Droughts/weather, Lack of opportunities, Decline of family farm, Isolated/lack of exposure, Pollution, Schools/education, Influences from the city, young moving away, Farmers selling land... |
| Rural residents tend to be _________, why? | Poorer; average income 7K lower than urban areas, more likely to live below poverty level; income disparity greater for minorities; 24% rural children live in poverty |
| What percentage of physicians practice in rural areas? | 10% practice in rural America; Over 2K health professional shortage areas |
| What is the ratio of dentists to population in urban and rural areas? | Urban: 60:100,000 Rural: 40:100,000 |
| Rural residents are less likely to have _____________ or ______________ and rural poor less likely to have what? | Employer-provided health care coverage or prescription drug coverage; coverage by medicaid |
| What is a reason so many rural hospitals closed in the past 25 years? | Medicare payments to rural hospitals and physicians are dramatically less than urban hospitals for equivalent services. |
| Why would more rural patients die following acute MI than urban patients? | Medicare patients w/ acute MI treated in rural hospitals are less likely to receive recommended Tx and significantly higher 30 day post MI death rates |
| What is more likely to be a consequence of a MVA in a rural area? | fatality |
| What are rural residents more likely to have in the injury and violence category? | 2x likely to die from unintentional injuries other than MVAs; Higher risk of death by gunshot |
| What is the average age of suicides in rural areas? | 35+ in adult men; suicide rate in women is escalating; rate is higher in rural areas |
| What makes up for 60% of total rural accidents? | Death and serious injury |
| Why is there an increased morbidity and mortality in rural areas? | Prolonged delays of EMS call and arrival, d/t increased travel distances and personnel distribution; 8 minutes longer than urban areas |
| Who is twice as likely to smoke cigarettes and what type of tobacco is more prevalent in rural areas? | 8th graders; smokeless tobacco more prevalent among adult males 18-24. |
| What substance abuse arrest is greater in non-urban counties? | DUI; 40% 12th graders report using alcohol while driving. |
| What substances are abused in Rural areas? | alcohol, drugs, prescription medications, OTC drugs and cigarettes. |
| What crimes does substance abuse result in? | buying and selling drugs, DWI, disorderly conduct; also low grades in school and other complications. |
| What are the cultural factors that contribute to overweight and obesity in rural areas? | Higher dietary fat and calorie consumption; declining frequency of exercise; increased TV watching; decrease in following diet recommendations; different amounts of exercise among residents. |
| What are structural factors contributing to obesity in rural areas? | Lack of nutrition education; dec. access to nutritionists; fewer gym classes in school and fewer exercise facilities; fewer prevention and Tx facilities and they are farther away. |
| Do young adults in rural areas have responsible sexual behavior? | No, research says that they do not have safer sex behaviors than non-rural adults such as number of sex partners and rate of unprotected sex. |
| How is mental illness perceived in rural areas? | Not enough knowledge, fear of prejudice toward those w/ mental illness, hesitancy of people w/ mental illness to get Tx gives a feeling of disgrace and shame. |
| What makes patients in rural areas not want to go to mental health providers? | Close knit society of rural areas means they will be recognized if trying to seek help from a mental health provider and lack of those providers also plays a role. |
| What is associated w/ a lower likelihood of receiving mental health care? | Poverty, age and living in rural areas and tend to wait longer to get Tx; elderly at risk too. |
| What are prioritization areas of environmental quality in rural areas? (5) | 1. Groundwater pollution 2. Surface-water pollution 3. Pesticide misuse 4. Soil erosion 5. Odors, visible and non-visible air pollution, and noise pollution |
| What harmful materials have been found in rural homes? | Elevated in-wall humidity (mold); radon; CO; insecticides and herbicides in well water. |
| What factors contribute to rural kids not getting immunized? | poverty; ethnic minority; parent w/ low level of education; large family; cost and lack of insurance coverage; late start at vaccination series; parental lack of awareness; missed opportunities in clinical visits. |
| What are the main contributors to kids in rural areas not getting immunized? | poor, less educated, lack health insurance, longer travel times to health providers. |
| How many deaths does tobacco cause per year, what is the estimated amount by 2030 and how much earlier do smokers die? | 5 million deaths per year; 8 million annually by 2030; 13-14 years earlier. |
| How much does smoking cost in the U.S. and how much does second-hand smoke cost? | 97 billion in lost productivity + 96 billion in health care expenditures = 193 billion; 10 billion in health care expenditures for second-hand. |
| How much in smoking prevention was available to states in 2008, how much did they use and what % would have funded tobacco control programs? | $24.4 billion; less than 3%; 15% would've funded every state tobacco control program. |
| How much does the cigarette industry spend in advertisements per year, per day? | $12.5 billion in 2006; $34 million per day |
| What are hookahs? | Water pipes; used to smoke specially made tobacco available in a variety of flavors; hookah smoking is typically a group event; in recent years a resurgence of hookah use has been noted. |
| Is hookah smoking as bad as cigarettes? | Yes; mode of smoking increases the amount of concentration of toxins found in cigarette smoke; also the length of time increases the amount of smoke inhaled. |
| What are the 3 types of chewing tobacco? | 1. loose leaf: cured tobacco strips sweetened and packed in foil pouches 2. Plug: cured tobacco leaves pressed together into a cake and wrapped in a tobacco leaf 3. Twist (roll): cured tobacco leaves twisted to resemble rope. |
| How is each type of chewing tobacco used? | Piece taken from pouch (or cut off from twist) and place b/w cheek and gums. |
| What is snuff? | Finely ground tobacco that can be dry, moist or packaged in sachets; cured and fermented tobacco processed into fine particles and packed in round cans; b/w cheek or lip and gums or inhaled through nostrils. |
| How much is spent on smokeless tobacco advertising? | 250.79 million in 2005; 354.12 million in 2006 |
| What are the 2 leading smokeless tobacco brands for users 12 and older? | 1. Skoal 2. Copenhagen |
| What states have the highest smoking prevalence in adults, men and women? | Adults: WV, IN, KY Men: IN, MO, TN Women: WV, KY, IN |
| What states have the lowest smoking rates in adults, men and women? | Adults: UT, CA, NJ Men: UT, MD, MA Women: UT, CA, NJ |
| Who uses tobacco products more? | Males:Females 35.8%:23.4% cigarettes: 27.4%:22.5% cigars: 9.6%:1.8% smokeless tobacco: 6.1%:0.4% |
| What gender and race have the higher rates for smoking? | White females followed by Hispanic females and African Americans females have the lowest rate. |
| What age group has a higher rate of smoking while pregnant? | 15-17 y/o |
| What race has the highest prevalence of smoking, the lowest? | American Indians/Alaskan Natives 12+y/o highest; Asian Americans lowest |
| What does education status have to do w/ the likelihood of smoking? | Adults who hadn't completed high school more likely to smoke, next was high school grads, some college, college grads; full time college students less likely than part time |
| What does income have to do w/ the likelihood of smoking? | Adults in families that are poor more likely to be current smokers and less likely to have quit than their affluent counterparts. |
| What is the most important contaminant of indoor air and what are the 2 types? | Environmental tobacco smoke; sidestream (smoldering cigarette) and mainstream (exhaled) |
| Which of the 2 types of environmental tobacco smoke is more harmful? | Side stream: has a higher concentration of tar, nicotine and CO and contains 5 human carcinogens, 9 probable carcinogens and 3 animal carcinogens. |
| What populations are at greater risk for adverse health affects d/t environmental tobacco smoke? | Women, in utero infants, children, adolescents |
| Why are adolescents at a greater risk to start smoking? | Process of separating from the home environment; Gaining independence; Acquiring adult skills; influence of peer groups. |
| What is different in females for falling ill to the effects of smoking? | similar chances of falling ill w/ the same diseases as males but at an earlier age and w/ more acute illness |
| What is the physiological damage of smoking to coronary heart Dz, cerebrovascular insult, cancer and COPD? | Coronary Heart Dz: Athero- and arteriosclerosis Cerebrovascular insult: stroke and subarachnoid hemorrhage Cancer: small cell and squamous cell carcinomas COPD: Emphysema and chronic bronchitis |
| What diseases are linked to smoking (non-pulmonary)? | Grave's; autoimmune thyroiditis; insulin resistance/glucose intolerance; risk of diabetes; osteoporosis; fertility problems; premature menopause; vitamin and mineral deficiencies. |
| What is the most common form of chemical dependence in the U.S., how many attempts at quitting can it take and what are withdrawal Sx? | Nicotine; at least 12 attempts to be successful; irritability, anxiety, difficulty concentrating, increased appetite |
| What is the most effective way to quit smoking? | combination of medicine and counseling. |
| What is primary prevention? | Prevention of disease onset or injury before the disease process begins via removal of the causative agent; bans on smoking in restaurants, public places following clean air guidelines. |
| What is secondary prevention? | The early diagnosis of disease or injury by screening followed by appropriate Tx to limit disability or prevent more severe manifestations. |
| What is tertiary prevention? | Applied to patients w/ disabilities, aims to reduce the impact of the disease and promote quality of life through active rehabilitation and physical therapy. |
| What are the Healthy People 2010 targets in reference to responsible sexual behavior? | increase amount of adolescents who abstain from sex or use condoms if sexually active; increase the number of sexually active persons who use condoms. |
| What are the trends in sexual behavior in the past 6 years? | increase in abstinence among all youth and increase in condom use among those young people that are sexually active; most effective school based programs are ones that include a focus on abstinence and condom use. condom use has remained steady at 25%. |
| What are the facts about unintended pregnancies? | Half of all pregnancies are unwanted, not planned and not wanted, these rates have been declining. Nearly half of all unwanted pregnancies end in abortion. |
| How common are STDs in the U.S., how many are adolescents and who suffers more? | 15 million new cases per year, 4 million are adolescents; women generally suffer more serious STD complications than men. |
| What is the #1 STD in adolescents and how much do STDs cost? | Pubic lice; about $17 billion annually |
| What are STDs? | Diseases (fungal, bacterial, viral or protazoal) that are contracted by having sex - vaginal, oral or anal - w/ someone who is already infected. |
| How many Americans will be infected w/ an STD in their lifetime and who gets them? | 1 in 4 in their lifetime; 2 out of 3 occur in young people <25 y/o |
| What are strategies for preventing STDs? | Abstinence or delay Monogamy Use condoms Reduce # of sexual partners Stay sober - stay in control |
| What are the major strategies to prevention and control of STDs? | Identify persons unlikely to seek Tx, effective Dx and Tx of infected persons, eval, Tx and coeducation and counseling persons at risk, counseling of partners of persons infected, pre-exposure vaccination for those at risk. |
| What are the 5 P's in STDs? | 1. Partners 2. Prevention of pregnancy 3. Protection 4. Practices 5. Past history |
| What are questions used in terms of partners? | Do you have sex w/ men, women or both? In the past 2 months how many partners have you had? In the past year how many partners? |
| What are questions used in terms of prevention of pregnancy? | Are you or your partner trying to get pregnant? if no, what are you doing to prevent pregnancy? |
| What question is asked in terms of protection from STDs? | What do you do to protect yourself from STDs and HIV? |
| What are questions asked in terms of sexual practices? | to understand your risks for STDs I need to understand what type of sex you had recently. vaginal, condoms, oral, anal sex? How often do you use condoms? |
| What questions can be asked to identify HIV and hepatitis risk? | Have you or any of your partners ever injected drugs? Have any of your partners exchanged money for sex? Is there anything else about your sexual practices I should know? |
| What reassurances should patients receive in reference to STD Tx? | Tx will be provided regardless of individual circumstances; should also be screened for all common STDs and told what they aren't being tested for. |
| What are trends w/ chlamydia? | Expanded screening efforts resulted in more reported cases but a majority go undiagnosed since men have a low symptomatology and women are asymptmatic. It is the most common reported ID in the U.S. |
| What is chlamydia? | A bacterial infection that can easily be cured w/ antibiotics, but is usually asymptomatic and undiagnosed. Women at higher risk. |
| What states and races are high for chlamydia? | bible belt, AK, HI, NY, AZ and NM; black>american indian>hispanic>white |
| What are trends w/ gonorrhea? | Disease rate at historic low but drug resistance on the rise; 2nd most commonly reported ID in the U.S.; Drug resistance increasing in communities across U.S.; resistance is worrisome in men who have sex w/ men where resistance is 8x higher. |
| What states and races are high for chlamydia? | Males asymptomatic and women get a thick pus urethral discharge; High in bible belt, TX, IL, IN, MI, WI, OH, PA and middle NY; Black>Native American |
| What are trends w/ syphilis? | Cases increased for 4th consecutive year; rising rate driven by cases among men, CDC estimates gay males comprised 64% of syphilis cases; recent declines in African Americans reversing; urban areas bear greatest burden. |
| What states and races are high for syphilis? | Bible belt and WA, TX, FL; rural areas and gay population; Black>Hispanic |
| How many people have HIV in the U.S. and how much does Tx cost? | Nearly 700K cases of AIDS have been reported since 1980s; 800K to 900K people are currently infected; $155K or more per person |
| What age are new HIV cases and who has the leading cause of death d/t HIV? | 50% of new HIV infections in U.S. are <25 y/o; Leading cause of death in African American men aged 25-44; Presence of other STDs increases the likelihood of transmitting and acquiring HIV |
| How is HIV diagnosed? | Tests for antibodies against HIV-1, begins w/ a sensitive screening test (eliza) These must be confirmed w/ a supplemental test the Western Blot test. So eliza and western blot together gives early positive but the 2nd western blot gives the true postive. |
| Which HIV is slower and considered a chronic Dz? | HIV-1 considered chronic, majority of U.S. infections; HIV-2 found in west Africa and is endemic and persons w/ this type have about 4 years to live after Dx. |
| What are the adaptive challenges to an HIV positive result? | Accepting the possibility of a shortened lifespan, coping w/ reactions of others to a stigmatizing illness, developing and adopting strategies for maintaining physical and emotional health and initiating changes in beh. to prevent HIV transmission |
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kabrown
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