Thursday, April 26, 2012

Blog Assignment #11


Regarding the public health issue of alcohol abuse, several key determinants must be taken into account, since they serve as important precursors and may indicate possible targets for prevention initiation. A human factor contributing to the issue would simply be alcohol use itself- this would be classified as behavioral. Another might be genetics; research shows that some individuals genetically have a higher tendency to become addicted to alcohol as well as other drugs. This claim is supported by evidence that alcoholics are six times more likely than nonalcoholics to have blood relatives that are also alcoholic.
The agent or vector involved would be the nature of alcohol itself; alcohol is considered to be a drug because it's components essentially poison the body. Addiction is also extremely relevant, because it is kind of the first step when looking at alcohol abuse. How does this addiction come about? Over time, the nature of alcohol (chemically) is such that regular consumption disrupts the balance of GABA (gamma-aminobutyric acid), which affects impulsiveness as well as nervous system functions. The consumption of alcohol also raises dopamine levels, which make the drinking experience more enjoyable, but at the same time contribute to the development of addiction.
The issue of alcohol abuse is also caused by environmental factors, both physical and socio-cultural. For example, there is a direct correlation between easy access to cheap alcohol and alcohol abuse. This is a physical environmental factor, because it has to do with the number of stores that sell alcohol within an area and how far they are from the population whose alcohol use is being studied, as well as the accessibility of alcohol in terms of cost in that location, relative to the economic status of people living in that location.
A socio-cultural factor would be something more like peer pressure among adolescents and the normalcy of drinking- the way it is perceived as something socially acceptable in certain contexts, such as among college-age students. A final environmental factor that is extremely prominent and influential in terms of increasing rates of alcohol abuse would be media and advertising. Advertisements are all over the place, and portray alcohol as glamorous, that it's associated with many positive things, and they convey that excessive drinking is not only acceptable but something that should be encouraged in order to create a fun environment or experience with friends.

Wednesday, April 25, 2012

Blog Assignment #10


Alcohol abuse affects every gender, race, and nationality. In the US alone, 17.6 million people (about 1 in every 12 adults), abuse alcohol or become dependent on alcohol. In general, men are more alcohol-dependent than women and experience more problems, but across both genders, problems are highest for young adults aging from 18-29 years old. People who start drinking at an early age are at a much higher risk of developing these problems as well, compared to those who start at or after the age of 21.


Surveillance is used to assess my problem because it is necessary to perform epidemiological studies when researching substance abuse. Close observation of all aspects of alcohol consumption must be made so that the problem is defined and it's specific statistics noted before they are assessed.

I found several statistics regarding this topic while trying to quantify it's magnitude in the US. They are not quite specific enough yet (I'm considering focusing on men and women and maybe the differences between the two instead of one or the other), but they will help me create a problem statement. Some of these are direct indicators, which measure the problem of alcohol abuse directly, and others are indirect indicators, which measure alcohol abuse by measuring related factors. I'll be sure to label each statistic as either direct or indirect. As I searched for statistics online, I realized that I wanted to focus on drinking among adolescents, specifically college-age students, above the age of 18 and until the age of 20 or 21. Since most statistics are in terms of 18 to 20 year olds, I might just settle for that.

(indirect)
16-24 year olds have the second highest alcohol-related traffic fatalities according to age groups in the US from 1982-2004

(indirect)
Lower percentage of alcohol-involved fatal crashes occurred for women drivers in the US from 1998-2004

(direct)
Rates of drinking increase dramatically from 9th to 10th grade in high schools.

(direct)
Statistics of mean age at first use of alcohol by age, sex, and race among ever-drinkers from ages 12-20 in the US from 1991-2007, show that people of all races and sexes had their first drink between the ages of 12 and 20.

(direct)
Statistics of the mean frequency of drinking in the past 30 days by age, sex, and race among current drinkers(this is significant because they didn't stop drinking) from ages 12-20 from 1991-2007, show that their first drinks occurred between the ages of 18-20, despite race and sex.

(direct)
Binge drinking increases dramatically as age goes up and people reach adolescence and then college-age.

(indirect)
Statistics on the prevalence of driving a vehicle while under the influence of alcohol in the past 12 months by age, sex and race among 12-20 year olds in the US from 1995-2007, show a huge increase for 18-20 year olds, obviously.

Blog Assignment #9


Substance abuse is a major public health issue for a multitude of reasons. Not only does it contribute to already rising health care costs, but it is also a huge factor contributing to an increase in crime rates, homelessness, and domestic violence or abuse. Even productivity in the workplace is affected by substance abuse. Substance abuse includes drugs as well as alcohol and these things can lead to mental health issues that are often overlooked when discussing this topic. For example, a surprising amount of suicides and attempts at suicide are caused by the person being under the influence of a drug of alcohol. This shows that substance abuse can be a very direct cause of death, and not just a factor among many other things that contributes to a person being injured or sick, and conveys the overall seriousness of the issue as more than just a generation of young people engaging in high-risk behavior for amusement.

I chose this topic, for the time being, because it is incredibly relevant, especially for college students. Drinking is something that is almost a part of college culture and so integrated into the lifestyle of many social environments that many individuals do not bother to stop and think about their decisions and the possible consequences of their decisions. Many do, but even personally, I know many who do not and consciously choose not to so that they won't have to change their minds or their plans for that evening.

Like many other public health issues, substance abuse is almost entirely preventably, if not entirely. It is an issue that involves individuals consciously making the choice to give into substances like drugs and alcohol. I definitely believe that society is partially at fault for making these things to accessible and then advertising them in such an excessive fashion. However, if substances are something that so easily turned into a norm in our society, it is something that we can also transform into the opposite, even though this will be much more difficult. I find hope in the fact that this is preventable, because it is sad the way people only understand the risk factors of substance abuse after a tragedy has already occurred. Hopefully, public health as a field can do something so that such is not the case.

Essentially, I chose this topic of substance abuse because I do think wholeheartedly that it's something the public health field has the capability to fight. I've also known friends or family either experiencing alcoholism or who have experienced tragedies because of alcoholism combined with a split second of bad luck, such as a car accident in which the person hurt was not the one drinking. I feel as though the confidence that “nothing bad will happen” in terms of these situations is actually overconfidence, and the good time that substance abuse can lead to is never really more valuable than someone's life or future.

Blog Assignment #8


1. A human right is something inherent to all human beings, whatever our nationality, place of residence, sex, race, heritage, religion, language, or any other status. A human right is meant to protect every individual from abuse of any kind, be it social, legal, or political. Human rights are important for public health because it is the role and responsibility of public health professionals to protect and promote human rights so that people are as safe as possible from all kinds of threats. The promotion of human rights directly impacts the health of individuals in a positive way. In fact, Article 3 of The Universal Declaration of Human Rights states that, “Everyone has the right to life, liberty and security of person.” Essentially, the right to life is the same thing as the right to health.

2. Good standard of living relates to health because it involves making sure that everyone and their family has food, clothing, housing and medical care, as well as any social services they might need, especially in times of unemployment, sickness, disability, widowhood, old age, etc. This is a major human right because it is definitely beneficial to health; a huge factor that contributes to public health is the environment in which one is living. Lack of sanitary conditions access to medicine, a place to live or warm clothes during a cold season will negatively effect an individual's health by making it so that people will have more infections and diseases. These things may arise from the weather, perhaps from unclean water or the inability to afford healthy foods. A higher standard of living ensures that a person's living environment will be sanitary and safe and allow them to make healthier choices, consisting of the least amount of threats possible to one's health.

3. The States have an obligation to guarantee a woman's right to safe motherhood and affordable access to care and are responsible or at least accountable for maternal deaths at a national level.

4. I think that motherhood is specifically mentioned in the UDHR and was specifically addressed by the Committee on the Elimination of Discrimination Against Women because of a general understanding that pregnancy is a vulnerable and fragile time, requiring special health care. Article 25 protects children that are still within their mothers by protecting the women who carry them, because the women are the only party involved who are currently living individuals with clear and definite human rights. Although the living status of a fetus is disputable, clearly the UDHR is trying to protect it because the only difference between mothers or mothers-to-be and men is the life inside of them. If they didn't consider this the way I've described, there wouldn't be an article specifically talking about women who are expecting.

Blog Assignment #7


  1. In Contagion, the main character's name is Beth Emhoff. She's a woman that has just returned to Minnesota from Hong Kong and becomes sick. Although she initially dismisses her illness as a result of jet lag, she is found dead two days after she reaches home. The doctors tell her husband that they have no idea what has caused her death, and pretty soon, lots of people, starting with her immediate family (except for her husband, who was for some reason immune to it), start to show the same symptoms that she had before she died. A pandemic begins and the remainder of the movie involves the doctors, specially the American CDC and the World Health Organization, trying to contain this microbe and the entire society starts to collapse as people grow more and more paranoid with fear. In the end, everyone was killed.
  2. An outbreak is a sudden rise in the incidence of a disease. An outbreak investigation is when people search for the source of the outbreak. Isolation is the social separation of a person who has or is suspected of having a contagious disease.A quarantine is a state, period, or place of isolation in which people or animals that have been exposed to infectious or contagious disease are placed. In Contagion, there was obviously an outbreak of some kind of lethal disease. Doctors attempted to investigate this outbreak by tracking down people who died in unusual or unexplainable ways, because this disease was something that killed people in ways that were not understood. In addition to this, those who were discovered to be infected by the disease were isolated and quarantined; they were put into large places where they would not infect anyone else in society, such as a large stadium of some sort.
  3. Health agencies would have been better prepared if they had an already decided location to use in case of an emergency such as a pandemic. If they didn't have to waste time searching for an appropriate location, they'd be able to isolate infected people much more quickly and therefore have more time to figure out the source of the disease. In addition to this, perhaps people with unexplained illnesses should be quarantined earlier rather than later, just in case, and at least until the illness is explained or proven not to be contagious. The small inconvenience it may cause that individual patient is probably worth the safety of the entire population.

Blog Assignment #6


“Climate Change: The Public Health Response” talked about the the ways in which public health professionals are preparing for climate change and the significance of this. But how is climate change something that affects public health? Things like increased heat stress could affect people's health in a certain area. Food and water-borne diseases can be caused by changes in the weather, as can motor-vehicle crashes. For example, extreme rain or storms can cause both of these things. This isn't something that had ever occurred to me before as a result of the climate. Even an incidence as simple as falling down due to slipping on ice can be a public health risk caused by the weather!

Mitigation is basically preventing climate change as much as possible before it inevitably occurs. In other words, mitigation coupled prevents some of its effects all together. Mitigation relates to primary prevention in that it's the first step or measure taken to prevent climate change, as aforementioned. Adaptation's purpose is to decrease the intensity of the effect of climate change after it has already occurred. It is a form of secondary or tertiary prevention because it focuses on making something more manageable, rather than preventing it's occurrence, and thus adaptation is implemented after mitigation.

“Climate Change: The Public Health Response” mentioned ten different public health services that act as a basis for climate change adaptation. One that particularly resonated with me was the responsibility of public health officials to inform, educate and empower people about health issues. Like me, there are many individuals who are somewhat ignorant to the close relationship between climate change and public health. This is definitely something worth working on. As the article explained, the spread of knowledge is only the first step. With that knowledge, people can be motivated to act as agents of change when it comes to public health matters, once they realize that climate change affects them and the people they love as well.

My hometown, Warwick NY, has done just a few things in order to fight or prepare for climate change. Firstly, we have adopted part of the Appalachian Trail and the students in my high school's environmental science department are responsible for maintaining the portion of the trail we've adopted, by keeping it clean and making sure no harm comes to it. This way, the trail and the nature surrounding it is being protected instead of destroyed. In addition to this, my town, despite it's small size, is building wind turbines at one of our elementary schools in order to harness energy from wind and save energy. More can definitely be done, but first people need to be educated on the problems that currently exist and the ways in which they can potentially make a difference.

Blog Assignment #5


During the 2th century, life expectancy for US residents has increased exponentially and the population's health in general has improved in ways that could not have been predicted beforehand. Basically, 10 achievements within the public health field contributed to this: vaccine-preventable diseases, prevention and control of infectious diseases, tobacco control, maternal and infant health, motor vehicle safety, cardiovascular disease prevention, occupational safety, cancer prevention, childhood lead poisoning prevention, and public health preparedness and response.

Currently, due to the introduction of new vaccines, the US immunization policy is able to target 17 diseases, preventing about 42,000 deaths and 20 million cases of disease. Simultaneously, vaccinations have saved money; the cost of treating diseases as opposed to preventing them would have been much higher, whether in terms of direct or total societal costs. The vaccines for pneumococcal infections were particularly impactful, as were those for Hepatitis A, Hepatitis B, and varicella.

Infectious diseases were best controlled and prevented by improvements made in state and local public health infrastructure. For example, one of these improvements was major advances in lab techniques and technology. Investments in disease surveillance helped us identify contaminated foods more efficiently. Finally, HIV testing has been expanded to screening a wider age range and new blood donor screenings have been implemented. As a result, those with HIV were treated at earlier stages of the disease and reduced the number of people with West Nile Virus. In addition to this, canine rabies was eliminated in the US.

Tobacco control has proven effective at the federal and state level. Although the percentage of smokers of all ages decreased from the late 1900's until recent times, these rates have been halted and remained relatively unchanged since 2003 for adolescents. Adult smoking has remained unchanged since the 1990s. Thus, although progress has been made, smoking still exists as a relevant problem in terms of cost. Currently, smoke-free laws exist in 25 states and the District of Columbia.

The past decade has shown significant decreases in the number of infants born with neural tube defects, as well. Technological advancements and the implementation of a standardized newborn-screening of diseases has allowed for earlier life saving treatments. In addition to this, motor vehicle crashes, which are among the top 10 causes of death in the US and the number one cause for certain age groups, have been prevented through measures such as safer vehicles, safer roadways and safer road use. Cardiovascular disease and stroke are the first and third leading causes of death in the US, and have been reduced by the elimination of risk factors such as uncontrolled hypertension, high cholesterol, and smoking. Improvements in treatments and medications has naturally contributed to this decline as well. For example, evidence-based screening recommendations have begun to reduce mortality and serve as a cancer preventative measure. Occupational safety is also less of a problem today, thanks to better working conditions required by the government. Similarly, with help from the government, childhood lead poisoning is being prevented by the creation and enforcement of laws. Finally, after 9/11, our country's public health preparedness and response has been given more attention and become much better.

Achievements involving infant care particularly resonated with me when reading this article, in addition to increased cancer screening. The former is important because it's something so simple but so beneficial and preventative! Infants are so fragile before their immune systems have developed, and illnesses among infants is something that I've seen personally- it made me very nervous. The fact that diseases are being caught as early as possible and treated before it can significantly impact that child's life, is a great thing. Similarly, I've always felt as though increases in cancer screening would be beneficial. Many of my relatives have suffered or died from cancer, and it was always caught during a later stage. Increased testing for such things would allow cancer to be found during earlier stages, thus increasing the chances of a successful treatment. Lots of times, the difference between life and death is simple the stage at which cancer is found, and if screenings occur more often, more will be found in time to save a life.

A current public health problem in my opinion is lack of nutrition for the younger generation. Although schools are making many efforts to solve this, many more can and should be made. For example, unhealthy snacks and sugary drinks simply should not be an option at schools. If children cannot afford nutritious foods at home, they should at least not have unhealthy options at school, especially because when given two options, children will choose that which is tastier and probably less healthy. This is an important issue because it will affect the general health of the next generation of Americans, and their habits will carry onto their children, affecting future generations. Fortunately, however, this is something that can be easily solved. I'd definitely like to see an achievement take place in terms of this problem within the next decade. More can be done for future generations by changing food and drink options in schools than can be done for those who are already overweight or unhealthy. In addition to this, schools are the best medium through which to promote nutrition, as they are the the one way to reach every child in the country.

Blog Assignment #4


The Dartmouth Atlas Project is basically a text in which medicine and it's many variations are described. It keeps track of differences in treatment and cost of healthcare and focuses on various specific communities. This project involved the studying of medical records such as billing and it was discovered that the amount of treatments and the amount of money spent in each community were not across the board. Certain communities were much more cost efficient. However, it was not a result of less patients or the general financial status of patients in these areas. Cost efficiency in these communities arose from a larger number of provided services. For example, if an area had a large number of doctors, more treatments would occur than were necessary at times, either because the patient didn't need or want them, but still needed to be paid for.
It's my personal opinion that all individuals should have equal rights to health care, simply because each individual has the right to be healthy and a right to life. Healthcare is a right. Those with more access to money should not be privileged in terms of their health and life; rather, we should all be given that privilege and it should be treated as a right. If we are all equal according to the U.S. Constitution, then health care should be a standard thing for everyone. There should be a minimum amount of health care that is available to all, and extra healthcare beyond that point should be something that can be bought. The problem is that it's difficult to decide where to draw the line- what is the minimum amount of healthcare that each person deserves? Healthy people are less expensive than sick people. Equal and widespread healthcare would eventually be beneficial to the system in addition to simply the individuals being treated.
On the program, several medical systems were visited, including Grand Junction, Seattle, Everett and Autumn (New Hampshire). Many innovations came out of these medical systems.
For example, one such innovation implemented in Grand Junction was particularly interesting to me. A doctor opted to receive the same amount of money from each patient if they required the same amount and kind of care. This idea developed further into what is called the Independent Practice Association, or IPA. This way, doctors had no problem treating patients of lower financial status because they didn't lose anything by doing so. I found to to be interesting in a positive way because quite often doctors have a reputation of being profit-oriented and selfish. However, this innovation in Grand Junction shows a different side to doctors.
In Seattle, the innovation that I found to be most interesting was called Group Health. It's a very modern system in that it consisted of electronic medical records. This way, both the doctor and the patient are able to access the same information in the same way and there is less distance between the doctor and patient, as well as less ignorance on the end of the patient. What struck me most was that this innovation led to an increase in virtual medical treatment! For example, doctors began interacting with and treating their patients over e-mail. This way, visits to the doctor were not always as necessary as they had been, saving time and energy for both the doctor and patient. My own father is a pediatrician, and sometimes his appointments with patients occur over a web-camera with his patients, but this is only a recent thing that has begun. Group health is a very patient-oriented system in that it allows for maximum care for the patient. Since doctors are paid a salary, they are able to spend more time with each individual patient throughout the day and treat them more carefully.
In Everett, the most important innovation involved ending the number of unnecessary treatments that take place and thus creating cost efficiency. This way, patients wouldn't be getting MRI's unless questions asked beforehand revealed for sure that it was something they truly needed or qualified for. I thought this was a really good idea, because medical services aren't something that should be used or wasted when they aren't necessary.
Finally, in New Hampshire, I found it to be a very positive thing that shared decision making is taking place. In this system, the patient has more of a say in terms of their own treatment. They are educated about their entire situation and have the freedom to choose which treatment they would prefer after being made aware of the pros and cons of each. By giving this freedom to the patient, doctors become less like figures of power and authority and their relationship with their patients is probably better and one full of trust, which is very important.
These innovations can easily be re-created and spread. However, this probably hasn't happen due to a lack of communication in between medical communities and a lack of leaders who are willing to take charge and initiate change in the first place. If medical communities adopted new things from one another and communicated more, perhaps at several annual conferences in which they share their innovations, these innovations would be spread more easily. We'd also need individuals in each community to take control and be the one to organize everyone together and implement these innovations at a systematic level. Once this leader has a group of people behind them, the process would expedite.

Blog Assignment #3


The video influenced the way I think about vaccines in that I was never before aware that there was a whole population of people against vaccinations for their own children. To me, this matter seemed clearly black and white and the positive nature of vaccines seemed like common and accepted knowledge or fact, but such is not the case.
A herd community is a community that, due to lack of immunization, brings back diseases that are gone. Inevitable cause an outbreak that will spread.
Vaccines have increased life spans by 30 years; their benefit is clear as so many disease are now gone. 16 diseases are currently preventable for children.
Vaccination is different from other types of personal health decisions because it affects other people as well.
Some moms want their children to contract illnesses and get sick as people have been for so many years; don't see anything wrong with getting sick or having the chicken pox. Why not just keep vaccines even if polio and such diseases are gone? Due to rare but serious adverse risks. A certain proportion of people get swelling and pain lasting from an hour to a day. A very very very small percentage of people get an allergic reaction. Even smaller subset of people have actual serious reactions (deafness, seizures, brain damages); so small that something else could have caused it. In one case, caused ADD and learning disorders in an initially healthy and precocious child. Barbara Fisher finds the risk of injury or death to be greater than the benefit.
Parents accuse vaccination as a cause for ADHD and autism, and they prefer the Measles over Autism.
The MMR Triple shot is blamed most for causing autism in children. Vaccines also cause brain injury in a small segment of the population.
Young mothers not only don't see certain diseases but didn't even grow up with them, making vaccination a matter of faith. Some parents see doctors as profit-oriented... they see vaccines as a business meant to make people money. Does financial benefit matter though? Who cares if the doctors are making money, at least they're saving lives.
Vaccinations also carry with it the problems of it's own success in this way. It's success leads people, especially parents, to question the doctor's motives.

Blog Assignment #2


  1. The design of this study was that of a population study in 29 health centre districts in Japan. The study began in 1965. The subjects of this study were adults either 40 years old or over the age of 40, including both men and women. These subjects were interviewed and followed through a link between the risk-factor records, a residence list based on the annual census, and death certificates. The study itself was designed with a focus on discovering the effect of a husband's smoking on the risk of lung cancer in his non-smoking wife. Thus, the study consisted of detailed questions for the subjects about their daily lifestyles, including smoking habits. Because there were many questions as opposed to just one about smoking, the answers contained minimal subjective bias. The results of this study showed statistically that the wives of heavy smokers had higher risks of lung cancer than than those of non-smokers.
  2. Something that I found very interesting within the results of this study was the fact that, despite the age and occupation of the husbands, the wives of ex-smokers experienced more deaths from lung cancer than those of currents smokers. This was surprising because I expected the opposite, seeing as ex-smoker's are no longer influencing their wives' healths with secondhand smoke while current smokers continue to do so on a daily basis.
  3. The advantage of using this kind of study design, as stated above, is that the subjects don't know that they're being interviewed for the purpose of discovering the effects of their smoking. Therefore, they are less inclined to lie about sone specific question or any at all when answering such a wide variety of questions; they don't know what's being focused on anyway, so they answer everything honestly.