CPH 440 Correctly Answered Questions 2022/2023

CPH 440 Correctly Answered Questions 2022/2023 What is the actual leading cause of death? smoking Describe the US medical spending vs. life expectancy We rank 25th in terms of life expectancy but spend 2.5 times more than the OECD average. "When we spend more on medical care, we are commonly just buying more expensive care, not higher quality care and certainly not health" Who is John Snow? father of modern epi Who is Edwin Chadwich? father of sanitation movement in England Who is William Thomas Green Mortion? first physician to use anesthetic What is the rose curve? - not evenly distributed, usually target the tail with highest risk, but we should shift the entire curve - Each individual person doesn't change his or her behavior much, but the effect on the group as a whole can be huge. - The average people (social norm), who are now healthier, exert a healthy influence on the people who are at high risk What are some of the influences of health behavior? - Socioeconomic Status - skills - culture - beliefs - attitude - values - religion - gender What is the first step in planning? assessment What is the second step in planning? development of an intervention What is the third step in planning? evaluation Who is Edward Jenner? invented small pox vaccine (under questionable medical practice) Who is Alexander Fleming? discovered penicillin What are the leading causes of death in the US in 2000? 1. heart disease 2. cancer 3. stroke What are the actual causes of death in the US in 2000? 1. tobacco 2. poor diet/physical inactivity 3. alcohol What is the first step to addressing public health problems? define the problem What is the second step to addressing public health problems? Identify the risk factors associated with the problem. What is the third step to addressing public health problems? Develop and test community level interventions to control or prevent the cause of the problem What is the forth step to addressing public health problems? Implement interventions to improve the health of the population. What is the fifth step to addressing public health problems? Monitor those interventions to assess their effectiveness What is a theory? A set of statements or principles devised to explain a group of facts or phenomena. What do theories explain and suggest? Theories explain behavior and thus can suggest ways to achieve behavior change. What is a model? A composite, a mixture of ideas or concepts taken from any number of theories and used together. What do models help us understand? Models help us to understand a specific problem in a particular setting. Where do theories come from? Theories are born from the need to solve a problem or to find an explanation that would account for some repeatedly observed occurrence. What is inductive reasoning? a logical process in which multiple premises, all believed true or found true most of the time, are combine to obtain a specific conclusion What does health behavior include? Health behavior includes all of those things we do that influence our physical, mental, emotional, psychological, and spiritual selves. Why use theory and models? - They help us understand why people behave the way they do - They are based on concepts and take into account the main factors influencing health behavior - They provide direction and justification for program planning activities What are the behavioral ecology factors? - close to the individual - related to social groups individuals participate in - related to community, society and culture - political and socioeconomic structures The most optimistic classify only about _____ of deaths as preventable by medical care 15% Overall, Cancer mortality has ___________ in the last 25 years not changed Only _________ make a difference in health outcomes a handful of preventative screenings Of the 30 years of increased life expectancy achieved between 1890s and the 1990s, only ______ could be attributed to medical care five years What makes up SES? income, education, environment. (not race) What is phase 1 of the precede-proceed approach? social assessment = assessment of quality of life and social factors surrounding one or more health problems; ranking or positioning the health problems in context. What is phase 2 of the precede-proceed approach? epidemiological assessment = Assessment of prevalence/incidence of a health condition, any co-morbid conditions, and affected populations. What does phase 2 of the precede - proceed approach tell you? The nature and extent of a health problem or problems, patterns and trends, and the affected populations. What does phase 1 of the precede - proceed approach tell you? From an ecological perspective, provides an overview of the connection between health and other factors, as well as potential social or quality of life outcomes for your program. May also give you an indication of the importance placed on a particular health issue in the community. What is phase 3 of the precede-proceed approach? behavioral and environmental assessment = Assessment of the behavioral and environmental risk factors contributing to the health conditions you want to address (as identified in the epidemiological data). What does phase 3 of the precede - proceed approach tell you? Behaviors and environmental conditions that you may need to target in an intervention in order to address the identified health problem(s). What is phase 4 of the precede-proceed approach? education and ecological assessment = assessment of attitudes, knowledge, social/cultural norms, community organization, and other factors that contribute to the behavioral and environmental risk factors identified in Phase 4. What does phase 4 of the precede - proceed approach tell you? Factors that inform, motivate or lead to the behavioral/environmental risk factors. You may need to target these in order to influence those risk factors. What is phase 5 of the precede-proceed approach? administrative/policy assessment = assessment of administrative, organizational, and political resources available to support the development and implementation of a health promotion program. What does phase 5 of the precede - proceed approach tell you? the practical details about putting a program into action. What is phase 6 of the precede-proceed approach? implementation = Putting your program in place, after using your assessment process to design it. That is what is meant by PROCEED. What is phase 7 of the precede-proceed approach? Process evaluation (Phase Seven): An assessment of program implementation. what is phase 8 of the precede-proceed approach? Outcome evaluation (Phase Eight): An assessment of the short-term impacts of a program (2-3 years). What is phase 9 of the precede-proceed approach? Impact evaluation (Phase Nine): An assessment of the long-term effects of your program, the kinds of effects that might happen in several years or more. What is the main difference between the risk and protective factor planning model vs. the precede - proceed model? A key difference is that the risk and protective factor planning model is a THEORY-BASED planning model that focuses on certain health risk behaviors as the targets of change. What are risk factor domains? Individual Peer Family School Community Society/Environment What are protective factor domains? Individual Social bonding Healthy beliefs and clear behavior standards What is the most widely used model? Health Belief Model HBM is what is known as a _____ theory value expectancy theory What is the HBM perceived seriousness construct? Speaks to an individual's belief about the seriousness or severity of a disease What is the HBM perceived susceptibility construct? Speaks to an individual's assessment of his or her chances of getting the disease What is the HBM perceived benefits construct? Speaks to an individual's conclusion as to whether the new behavior is better than what he or she is already doing What is the HBM perceived barriers construct? Speaks to an individual's opinion as to what will stop him or her from adopting the new behavior What is the HBM cues to action construct? Those factors that will start a person on their way to changing behavior Of all the constructs, which is the most significant in determining behavior change? perceived barriers What is the HBM self efficacy construct? personal belief in one's own ability to do something What are some of the critics of the HBM? - Focus is on individual decisions - It is not always clear how all HBM constructs operate in changing behavior - A lot of programs use HBM constructs, but not necessarily all of them together What is the essence of the theories of reasoned action and planed behavior? Health behavior results from intention influenced by attitude, norms, and control What is the attitudes construct of the TRA/TPB? A series of beliefs about something that affects the way we think and behave What is the subjective norms construct of the TRA/TPB? - The behaviors we perceive important people expect of us and our desire to comply with these expectations - Social pressure to engage or not engage in certain behavior What is the volitional control construct of the TRA/TPB? -The extent to which we can decide to do something, at will - In some situations a person may not have complete control over a behavior even though the intention to engage in the behavior is great. What is the behavioral control construct of the TRA/TPB? - The extent of ease or difficulty we believe the performance of a behavior to be What differentiates between TRA and TPB? The addition of the behavioral control construct What are some critiques of TRA and TPB? - TRA/TPB assumes that behavior is the output of rational, linear decision making processes. - There are a number of issues with the clarity of TPB constructs - Time between intent and action is not considered. Who were the authors of the TTM? Prochaska and DiClemente What is the TTM? The TTM is a composite of numerous different behavior change approaches from psychology What is the pre contemplation stage of the TTM? - No intent to take action/change behavior - sometimes due to being uninformed or lack of self efficacy What is the contemplation stage of the TTM? - Individuals recognize there is a problem and they are starting to think about changing What is decisional balance? weighing the perceived pros and cons or cost and benefits of the new behavior against the old What is Chronic contemplation? when individuals remain in the contemplation stage for extended periods of time What is the preparation stage of the TTM? -Intention to take action in the immediate future, say in the next month. - Typically a short stage since once people decide to change a behavior they are often anxious to get started What is the action stage of the TTM? - A specific, relevant modification in behavior is made. - Just because there is action does not necessarily mean the behavior will change. During the action stage of the TTM, what needs to happen in order for it to be successful? In order for action to be successful, it needs to be measured against criteria previously determined to reduce the risk of disease What is the maintenance stage of the TTM? - Striving to maintain change, prevent relapse. - With some behavior changes, maintenance goes on for years - For some behavior changes, maintenance is the most challenging stage In general, maintenance begins after _____ months of being in the active stage of changing and continue for at least ______ months six What is the termination stage of the TTM? Individual no longer "succumbs to temptation" and has self-efficacy about maintenance Do all health behaviors have a termination stage in the TTM? no What is Consciousness Raising? the process whereby people obtain information about themselves and the problem behavior. What is dramatic relief? - being able to express feelings about or react emotionally to the behavior in question What is environmental reevaluation? looking at the behavior being changed in light of its impact or effect on the physical and social environments What is social liberation? options or alternatives are sought that support new behavior What is self- reevaluation? - the process in which people look at themselves with and without the problem behavior and assess the differences in their self esteem What is stimulus control? when people remove the cues or triggers for the problem behavior from their environment What is helping relationships? - relationships with people who act as support system for changing the unwanted unhealthy behavior What is counter conditioning? a healthier behavior is substituted for the unhealthy one What is reinforcement management? rewards and punishments What is self liberation? people choose to change their behavior, believe they can, and commit to making the change What is the goal of the PAPM? The goal of the PAPM is to explain how a person comes to the decision to take action, and how he/she translates that decision into action. Which stages of the PAPM are most difficult? stage 1 or 4 What are some critiques of the stage models? - People don't always go through a fixed set of stages, in a straight line, as both the TTM and PAPM propose. - Instead, people often go in circles, moving from one stage to the next, then doubling back and re-entering the process. - How do you measure what stage people are in? Measurement of stage can sometimes be arbitrary. What is vicarious learning? learning by observation of others Who was the originator of SCT? Albert Bandura Changing behavior is a function of _________ and _______. Individual (internal) characteristics, Environmental (external) factors What is the reciprocal determination of SCT? Behavior is part of a continuous interactive cycle that includes individuals and their social environment including Personal factors, Environmental factors and Behavioral factors What is the behavioral capability construct of the SCT? - A person's level of knowledge and skill in relation to a behavior - Before doing something, you have to know what it is you're going to do and know how to do it What is the expectations construct of the SCT? - What a person thinks will happen if she or he makes a behavior change - People behave in a certain way because of the results they expect What is the expectancies construct of the SCT? - Whether a person thinks the expected outcome is good or likely to be rewarded - The value we place on the outcome What is the self-control construct of the SCT? - How much control a person has over making a change What would an internally controlled person say about their self control? - Internally controlled people believe that everything that happens to them is a result of their own decisions and behaviors. They believe they have control over all aspects of their lives and their destiny What would an externally controlled person say about their self control? - Externally controlled people believe that forces outside of their control, such as fate, God's will, or important and powerful people, govern all aspects of their lives What is the emotional coping construct of the SCT? - A person's ability to deal with emotions involved in behavior change - In certain situations people become fearful and, when this happens, their behavior becomes defensive in an effort to reduce fear What is the vicarious learning construct of the SCT? A person learns by observing the behavior of others and the consequences of that behavior What is the situation construct of the SCT? The social/physical environment in which the behavior takes place, and a person's perception of those factors What is the reinforcement construct of the SCT? - Positive or negative responses to a person's behavior - Seen in children with positive and negative rewards for good and bad behavior What are some critiques of the SCT? -SCT is very complex; it may be viewed as less of a theory than a related "grab-bag" of constructs. - SCT has gone through a number of evolutions; as it evolved, it retained earlier constructs, increasing the general complexity of SCT and reducing its clarity as a theory. What is a social network? A social network is the network of relationships surrounding a person, or larger networks involving the person. What has the SNT gained prominence for recently? Has gained increasing prominence recently, especially in the area of HIV/AIDS and in the development of network-based interventions What are some critiques of the SNT? - SNT is a limited theory and approach - primarily useful for small or defined group interventions. - Using SNT is labor-intensive and can be difficult. Identifying networks/network members and conducting interviews is time consuming; in some circumstances, confidentiality concerns can be a barrier. What is diffusion of innovations? Addresses the gap between introduction of a new technology or behavior and the actual adoption of the behavior by a large community or group. ex. condoms for HIV/AIDS prevention Diffusion of innovations places an emphasis on... dissemination What is innovation development? refers to the development of the innovation itself. What is dissemination? process by which the innovation is communicated. What is adoption? refers to the "uptake" of the innovation by the target population What is implementation? regular use of the innovation, focus on improving self-efficacy and skills of adopters. What is maintenance? focus on sustainability, keeping adoption of the behavior. what are the key stages to adoption? 1. awareness knowledge (innovation exists); 2. procedural knowledge (how to use); and 3. principles knowledge (understanding how the innovation works). What are the top 5 attributes determining speed and extent of diffusion? - Relative advantage - Is innovation better than what it will replace? - Compatibility - Does innovation fit with the intended audience? - Complexibility - Is the innovation easy to use? - Trialability - Can the innovation be tried before making the decision to adopt? - Observability - Are the results of the innovation observable and easily measurable? What are some critiques of the DOI? - Similar to Social Cognitive Theory, DOI describes multiple constructs and processes embedded within processes. - As a theory, it is hard to test or prove DOI as a whole - most DOI efforts incorporate selected constructs from DOI, not the entire package. What is the goal of social marketing? Goal is to influence "consumers" to "buy" a behavior change or health-related product/technology. What is market segmentation? a term common in marketing parlance. Refers to the segmentation of a target population into meaningful subgroups so that messages and campaigns can be appropriately channeled. What is targeting? The process of developing campaigns closely tailored to the needs, attitudes, beliefs and behaviors of specific market segments. What are some critiques of social marketing? - Assessing the impact of a social marketing campaign may be difficult because, if a behavior change is the goal, tracking exposure to the campaign for those exposed and assessing the degree to which behaviors, or at least attitudes, have changed is not always easy. - But some social marketing campaigns (and DOI efforts) introduce a product as the behavior change (e.g., condoms) - easier to track, simply because it is more tangible and observable. What is a communication channel? The MEDIUM through which you transmit the information: newspapers, TV, video, internet, interpersonal communication, rallies, etc. What are some critiques of communication theory? It is sometimes complicated and difficult to assess the impact of a communications effort. Why? Because there are many levels of possible impact. What is empowerment in terms of community mobilization? Empowerment means that the community takes charge of the issue, defines what the goals are, and takes the necessary action. What are some critiques of community and organizational change theories? - Mobilizing a community, or changing an organization, is a complex process. - There are typically no "off the shelf" solutions for which evidence is clear. - Change can be affected by factors outside of an intervention What are community interventions? - Broader interventions can be called community interventions (CI) - Community interventions tend to result in smaller changes, but over a large number of people - a larger absolute number Why are community interventions a good idea? shift the rose curve What is an intervention in the community? -More targeted interventions within a community - These focus on a segment of the community that is highly affected by a health problem. What does the term community context mean? The community context means a recognition that multiple social and political forces may intersect with a health issue. An increasing number of health promotion and related research efforts require the _________ of the community integration and participation What is tailoring? Tailoring involves development of programs or adapting an existing program to a new situation, community, or population. How would one tailor a program for a certain community? - Refer, as much as possible, to situations, people, and issues relevant to the target community/population. - Use language and materials appropriate for the audience. - Schedule activities so that members of the target population can participate. What are the steps to follow for tailoring a program? 1. Assessment of the problem (as in PRECEDE-PROCEDE or similar assessment). 2. Formative research and identifying any existing evidence-based programs or strategies. 3. Ongoing evaluation and assessment to track how well the program is going during implementation. What are some steps to take in order to keep your program sustainable? - Train and hire members of the community to operate the program. - Involve community stakeholders. - Write grant applications or letters seeking other funding sources. - Help link the program to others like it and practitioners in the field. What are some strengths to interventions in a school or workplace? access, One place, similar people, easier than finding randoms, data already there, want to learn, people there to help What are some weaknesses to interventions in a school or workplace? politics, parents, attitudes, not willing, time, resources, external factors What are communication campaigns? Coordinated processes of disseminating messages to influence behavior in a particular group/population When are communication campaigns most effective? Campaigns are most effective when they are seen, heard, and remembered against the din of other competing messages in the media What are the 4 stages in the planning approach for communication campaigns? 1. Planning and Strategy Development 2. Developing and Pretesting Concepts, Messages, and Materials 3. Implementing the Program 4. Assessing Effectiveness and Making Refinements What is media advocacy? The strategic use of mass media to apply pressure to advance healthy public policy. What is the purpose of media advocacy? - Influence public opinion - Influence policy makers - Influence policy What is the goal of media advocacy? focuses on behavior change of policy makers within an institution The most optimistic classify only about 15% of deaths as preventable by medical care. True or false? true _____ of people who get Rx don't even get them filled 20% _____ of people with routine medications do not take them consistently 50% An expert at John Hopkins estimates that number to be around ________ annually, which if accurate, makes medical care the 3rd largest killer in America 225,000