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Pub Health Final

Dr. Mittak's Public Health Final Exam

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
Created by: kabrown