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General Public Health
CHAPTER ONE
General Public Health
1.1 GENERAL PUBLIC HEALTH QUESTIONS 1. What are the three core functions of public health? A. Assessment, policy development, assurance B. Prevention, legislation, enforcement C. Epidemiology, environmental health, individual health D. Health education, health promotion, health care E. None of the above 2. What is the relation between the core public health functions and the essential public health services? A. Core functions are a product of federal government, while the essential services are a product of state and/or local government B. The core functions and the essential services are different words for the same thing C. The core functions fall within the essential services D. The essential services fall within the core functions E. There is no relationship between the two 3. Licensing health-care facilities is an action that falls within which public health core function? A. Assessment B. Assurance C. Enforcement D. Regulation E. Safety 4. The Surgeon General oversees which of the following? A. American Red Cross B. Department of Health and Human Services C. Physician officers in the Army D. Nobody, the Surgeon General is a figurehead for the health of the nation and does not have authority E. US Public Health Service Commissioned Corps Board Review in Preventive Medicine and Public Health. DOI: http://dx.doi.org/10.1016/B978-0-12-813778-9.00001-3
© 2017 Elsevier Inc. All rights reserved.
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5. Which of the following is not true of water fluoridation? A. After discontinuation of water fluoridation, there is an increase in missing teeth B. After initiation of fluoridation, there is a decrease in dental caries C. Community water fluoridation reduces dental caries across all socioeconomic status groups D. The larger the population of those on community water fluoridation systems, the more expensive it is per individual E. Water fluoridation reduces the number of people without a single dental cavity 6. An unemployed single mother of four children (ages 2, 4, 7, and 9) presents to the county nutrition clinic after moving from another state. How many of the children will the Woman, Infants, and Children (WIC) program directly benefit? A. 0 B. 1 C. 2 D. 3 E. 4 7. The US PEPFAR Program targets which disease? A. AIDS/HIV B. Asthma C. Diarrheal disease D. Hepatitis E. Malaria 8. The Health Resources and Services Administration’s Ryan White Program is dedicated to helping those with which disease? A. Acute lymphoblastic leukemia B. Diabetes C. HIV D. Lung cancer E. Pediatric obesity 9. How often are the Healthy People objectives updated? A. Annually B. 3 years C. 5 years D. 10 years E. 20 years
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10. Compared to the general population in the United States, the prison population in the United States has a lower prevalence of which ailment? A. Diabetes mellitus B. HIV C. Substance abuse D. Tuberculosis E. None of the above 11. Which of the following is the leading cause of death in American jails? A. Accident B. Alcohol/drug overdose C. Heart disease D. Homicide E. Suicide 12. Which model of health behavior includes perceived susceptibility? A. Health Belief Model B. Social Cognitive Theory C. Theory of Reasoned Action D. Transtheoretical Model E. None of the above 13. Which model of health behavior proposes that the actual change in a behavior is correlated to the intention to change the behavior? A. Health Belief Model B. Social Cognitive Theory C. Theory of Reasoned Action D. Transtheoretical Model E. None of the above 14. Which model of health behavior includes reciprocal determinism? A. Health Belief Model B. Social Cognitive Theory C. Theory of Reasoned Action D. Transtheoretical Model E. None of the above 15. After years of deliberation, a smoker has decided to speak to his physician about quitting. The physician suggests setting a quit date. Which step in the Transtheoretical Model does setting a quit date represent? A. Precontemplation B. Contemplation
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C. Preparation D. Action E. Maintenance Which of the following is not considered to be one of the distinct categories of the Diffusion of Innovation Model? A. Early adaptors B. Early majority C. Innovators D. Late majority E. Majority What is the first step in completing the CDC’s Community Health Assessment and Group Evaluation (CHANGE) tool? A. Assemble the community team B. Build the community action plan C. Create a change summary statement D. Gather data E. Review all five change sectors Which of the following is not one of the five Community Health Assessment and Group Evaluation (CHANGE) sectors? A. Community-a-large sector B. Health-care sector C. School sector D. Volunteer sector E. Work-site sector What does CDC’s PATCH program stand for? A. Partnerships Aimed to Create Health B. People Against the Corruption of Health C. Planned Approach to Community Health D. Practitioner Alliance to Community Health E. Practice Arrangement to Create Health Which one of the following choices is not one of the Rothman community organization models? A. Social action B. Social planning C. Locality development D. Resource management E. All of the above are Rothman models
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21. The CDC’s Community Preventive Services Task Force publishes how many potential grades for each recommended topic? A. 2 B. 3 C. 4 D. 5 E. 6 22. Which of the following is the target population for which the Assessment Protocol for Excellence in Public Health (APEX PH) is intended for use? A. Individuals B. Local health departments C. State health departments D. Federal government E. International public health emergencies 23. Mobilizing Action for Planning and Partnerships (MAPP) is best suited for addressing which of the following components of a local health department? A. Mission B. Organizational administrative processes C. Organizational structure D. Strategic plan E. Values 24. An administrator in a publically funded teen health clinic wants to start health education program. While thinking back to her days studying public health, she remembered a popular eight-step approach to create a health program. Which of the following programs is she thinking of? A. EMTALA B. Ishikawa (fishbone) C. MAPP D. PRECEDEPROCEED E. SMART Objectives 25. The PATCH Model is a tool that was created within the context of which of the following? A. APEX PH B. MAPP C. PACE EH D. PDSA
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E. PRECEDEPROCEED 26. Which of the following options is not one of the “four Ps” of health-care social marketing? A. Place B. Price C. Principle D. Product E. Promotion 27. What is the name of the program that is administered by the Centers for Disease Control and Prevention’s Division of Community Health to address local racial and ethnic disparities in health status? A. Consortium for Equal Health for All B. Equal Opportunity for Health C. Race and Ethnicity Health Task Force D. Racial and Ethnic Approaches to Community Health E. United Care for All People
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1.2 GENERAL PUBLIC HEALTH ANSWERS 1. A. Assessment, policy development, assurance The three core functions of public health are assessment, assurance, and policy development. These three functions are further broken down into the 10 essential public health services, as shown in the answer for question 2 (directly below). 2. D. The essential services fall within the core functions The three core public health functions are assessment, assurance, and policy development. These three stages revolve in a continuous motion. Because the scope of these three functions is so broad, the 10 essential public health services were developed to further differentiate the stages of the public health process. The essential services framework groups public health activities into categories that can be recognized by budget officers, legislators, and the public at all levels of government. The essential services are evaluated in attaining public health accreditation. The essential services fit within the context of the core functions, as shown below: 3 Core Function
10 Essential Services
Example
Assessment
Monitor health status to identify health problems
Assessment
Diagnose and investigate health problems and hazards in the community
Injury & disease registries Epidemiology Community needs assessment & status indicators (report cards) Vital statistics Injury, communicable, and chronic disease detection STD counseling and testing Outbreak investigation Environmental risk assessment Laboratory services Population-wide health promotion (e.g., education, programs for physical fitness) Health education Work-site health promotion
Policy development Inform, educate, and empower people about health issues
(continued)
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10 Essential Services
Example
Policy development Mobilize community partnerships to identify and solve health problems Policy development Develop policies and plans that support individual and community health efforts Assurance
Assurance
Assurance
Assurance
Forming community partnerships Community planning Development of policies and guidelines Set the agenda Legislative activities Enforce laws and regulations Consumer protection and that protect health and sanitation ensure safety Air and water quality Hazardous materials management Fluoridation services Medical examiner and forensics Enforcement agencies related to the agency’s police authority Link people to needed Provide health-care services personal health services in underserved and assure provision of communities health care Coordination of health services Clinical preventive services Communicable disease treatment Dental health services Assure a competent public Maintenance of appropriate health and personal healthcertification and licensure care workforce Mandated continuing education Maintaining labor force Employee training and programs Evaluate effectiveness, Continuous quality accessibility, and quality of improvement activities personal and population(monitor and improve based health services systems and outcomes) Facilities licensing Laboratory regulation Biomedical, clinical, and preventive investigation (continued)
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(Continued) 3 Core Function
10 Essential Services
Example
Combination of all three core functions
Research new insights and innovative services to health problems
Health services research Innovative technologies
3. B. Assurance As described in the answer above (question 2), the 10 essential public health services were developed within the context of the 3 core public health functions: assessment, assurance, and policy development. Licensure of health-care facilities falls within the essential service of evaluating effectiveness, accessibility, and quality of personal and population-based health services. This service is within the core function of assurance. 4. E. US Public Health Service Commissioned Corps The Office of the Surgeon General sits within the Office of the Assistant Secretary for Health, a part of the Department of Health and Human Services. The Surgeon General, along with the Assistant Secretary of Health, oversees the US Public Health Service Commissioned Corps (USPHS). The Surgeon General is nominated by the President of the United States and sits for a 4-year term. In addition to overseeing USPHS, the Surgeon General is designated as the Chair of the National Prevention Council, an organization that provides leadership in prevention, wellness, and health-promotion activities. The Surgeon General also serves as a figurehead and provides Americans with the best health information available to increase health and well-being. The mission of the USPHS is to protect, promote, and advance the safety of the nation. This mission is accomplished through rapid response to public health needs, leadership in public health, and advancement of the practice of public health. USPHS workers deploy to support public health responses to both natural and manmade events. Specific USPHS deployment activities include serving vulnerable populations, addressing disease control and prevention, supporting biomedical research, and regulating water supply. 5. D. The larger the population of those on community water fluoridation systems, the more expensive it is per individual As the number of people in a community receiving water fluoridation increases, the average cost per individual decreases. This is due to economies of scale. The financial benefits of water fluoridation are
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enormous, as those receiving fluoridated water have less caries and missing teeth. Every dollar spent on water fluoridation has been estimated to save $38 in dental costs. All of the other statements in the question are true. Water fluoridation serves as a primary prevention to decrease the number of dental caries across all socioeconomic groups. When fluoridation services are discontinued there is a decrease in overall dental health status in the population. C. 2 Because the Women, Infants, and Children (WIC) program only benefits children aged 5 and under, only two of the children are able to directly receive WIC benefits. WIC is operated and funded by the US Department of Agriculture, which funds local non-profit and public health agencies. Components of WIC include nutrition education, health-care referrals and financial assistance for needy families with children aged 5 years old and younger. To be eligible, families must be nutritionally at-risk and fall below a specific income. Pregnant and breastfeeding mothers are also eligible to receive WIC benefits. A. AIDS/HIV PEPFAR stands for the US President’s Emergency Plan for AIDS Relief. It is the largest program within the US President’s Global Health Initiative, a program aimed at saving the greatest number of lives by supporting the health infrastructure of other nations. Other programs within the Global Health Initiative include the President’s Malaria Initiative and Feed the Future. C. HIV The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program provides HIV-related care to those with insufficient health-care resources. The program is funded by the Department of Health and Human Services, the HRSA, and the HIV/AIDS Bureau. D. 10 years The Office of Disease Prevention and Health Promotion (ODPHP), within the Department of Health and Human Services publishes the new Health People objectives every 10 years. These science-based objectives (more than 1000) create an agenda for improving the nation’s health. Each objective is outlined with baseline measures and specific goals for improvement. Government organizations, communities, and
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other entities often follow the Healthy People objectives to plan strategic goals. 10. E. None of the above The United States has the largest prisoner population in the world. The average age of prisoners is advancing due to the aging baby boomer population and external political factors. With the ability to monitor and treat captive population, correctional medicine is a pure form of preventive medicine. Across the board, prisoners experience earlier onset and increased prevalence of chronic diseases, such as hypertension and diabetes. The prison population also has a higher prevalence of sexually transmitted diseases. Rates of HIV in prison are roughly four times as high as HIV rates found in the general population. Furthermore, an estimated 35% of the prison population carries chronic hepatitis C. Half of all prisoners have a mental disorder. Prisons house more mentally ill persons than hospitals and mental health facilities. Substance abuse, a type of mental disorder, is also much more prevalent in the prison population than the general population. Due interplay between the environment, host, and vector, tuberculosis (TB) infection is common in prison. TB has been found to be at least three times more prevalent within prison than outside of prison. 11. E. Suicide Because jails typically incarcerate perpetrators for under 1 year while prisons nearly exclusively house inmates with sentences over one year, the population characteristics within jails and prisons are not the same. Because of this and over factors, health status between the two populations may differ. Prisoners have guaranteed access to care during the duration of the sentence, while jail inmates have less predictable health-care utilization while not incarcerated. Suicide is routinely the leading individual cause of death in American jails. Nearly 1/3 of jail inmate deaths are attributed to suicide. In descending order, the cause of death in jail are illness (including heart disease, cancer, etc.), suicide, alcohol/drug intoxication, accident, and homicide. There are roughly 140 jail inmate deaths per 100,000 inmates. Most jails (B80%) do not report a single death annually. Illness is directly responsible for 50% of deaths in jail, while illness is responsible for roughly 90% of death in prison. The two leading
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causes of illness-related death in prison are heart disease and cancer. After illness, the next most common causes of death amongst prisoners in descending order are suicide, homicide, alcohol/drug intoxication, and accident. A. Health Belief Model The Health Belief Model hypothesizes that an individual will make a particular health decision and take action based on their own perception of susceptibility to the illness and their ability to control it. The Health Belief Model consists of the following principles; perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. C. Theory of Reasoned Action The different health belief models can be thought of as maps that provide guidance in a series of steps (constructs) to understanding health behavior. Each model emphasizes a different construct over the others. The Theory of Reasoned Action assumes that people are rational and that their behavior is under control. Therefore, it is thought that behavioral intention leads to an actual behavioral change. The Theory of Planned Behavior is a modified version of the Theory of Reasoned Action that further explains an individual’s perception of control over their own behavior. B. Social Cognitive Theory Reciprocal determinism states that there is a fluid relationship between the individual and environment, where each one reacts with the other to shape behavior. A change in any of these factors will affect the other two. C. Preparation The Transtheoretical Model is a stepwise map of intentional behavior change through the stages of precontemplation, contemplation, preparation, action, and maintenance.
Stage
Intervention
Precontemplation
Assess knowledge Discuss benefits and risks Education & research of benefits Share success stories Provide personal feedback and advise to change Discuss the benefits and risks Outline reason to change behavior
Contemplation
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(Continued) Stage
Preparation
Action
Maintenance
Intervention
Review & evaluate barriers to change Discover resources & support network Discuss strategies for change Develop a plan Set a date for change Emphasize support Encourage motivation Set date to quit (smoking, alcohol, drugs) Affirm decision to change Coach through relapse triggers Troubleshoot problem areas Discuss coping strategies Focus on progress Provide follow-up Reaffirm commitment Support change efforts Practice coping skills Relapse prevention skills
Once the decision to quit smoking has been made, the preparation stage begins. This includes setting the quit date. The action stage begins on the quit date. 16. E. Majority The Diffusion of Innovation Model is a model of the social system that breaks down the pace at which an innovation is adapted. An innovation is new idea, practice, service, or object being introduced to the population. Consider for example new dietary recommendations. Predictably, dietary recommendations will not be adopted by everyone in the population at the same rate and time. The Diffusion of Innovation model is broken down into six chronological categories. From first to last adaptors, the categories are innovators, early adaptors, early majority, late majority, late adaptors, and laggards. Many professionals do not recognize late adaptors as a category. The incorrect answer to this question is majority, as there is not a distinct category dedicated solely to the majority. This model recognizes that communication is important to promote social change and bring along diffusion of innovation. The pace of adaption is influenced by perceived benefit of the change compared to the perceived risk, the ease of adaption, and whether there is evidence that the adaption works.
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17. A. Assemble the community team Community Health Assessment and Group Evaluation (CHANGE) was developed by the Healthy Communities Program of the Division of Adult and Community Health (within the CDC) to serve as a tool to help communities recognize and assess community policy, systems, and environmental changes over time. This tool has fallen out of favor with the CDC and is no longer funded by it, yet it is still used by state and local health departments across the United States. The summary of steps in the CHANGE model are as follows: Step 1—Assemble the community team Identify and assemble a diverse team with a maximum of 1012 individuals. Step 2—Develop a team strategy Decide whether to use the CHANGE tool as a group or divided into subgroups. Step 3—Review all five CHANGE sectors I. Community-at-large sector II. Community institution/ organization sector III. Health-care sector IV. School sector V. Work-site sector. Step 4—Gather data Gather data using multiple measures and methods to minimize bias. Step 5—Review gathered data Sit with the team to discuss what the data means in reference to the CHANGE tool. Step 6—Enter data Designate a data manager to input the information for each site. Step 7—Review consolidated data After rating each sector, complete the following steps, so the team can determine areas of improvement and subsequently develop a community action plan. Step 7a: Create a CHANGE summary statement Step 7b: Complete the sector data grid Step 7c: Fill out the CHANGE strategy worksheets Step 7d: Complete the Community Health Improvement Planning template.
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Step 8—Build the Community Action Plan Be specific with objectives and proposed time periods for the projects. 18. D. Volunteer sector Community Health Assessment and Group Evaluation (CHANGE) was developed by the Healthy Communities Program of the Division of Adult and Community Health, within the CDC to serve as a tool to help communities recognize and assess community policy, systems, and environmental changes over time. CHANGE has fallen out of favor with the CDC, yet it is still used by state and local health departments across the United States. The volunteer sector is not one of the five sectors identified in Step 3 of the CHANGE community development tool. The five sectors are as follows: 1. Community-at-large sector 2. Community institution/ organization sector 3. Health-care sector 4. School sector 5. Work-site sector. 19. C. Planned Approach to Community Health PATCH is an organizational tool used on the local level to plan, conduct, and assess health programs. It is an acronym for Planned Approach to Community Health and was developed in the 1980s as a joint effort between the CDC and state/local health departments to create a local-based process based on current knowledge in health theory, promotion, education and community development. It was created within the context of the PRECEDE model. Because PATCH is community-based, each individual community is able to tailor fit the PATCH process to fit their unique locale. The phases of PATCH are as follows: 1. Mobilizing the community 2. Collecting and organizing data 3. Choosing health priorities 4. Developing a comprehensive intervention plan 5. Evaluating PATCH 20. D. Resource Management In 1967, Jack Rothman presented an article identifying three distinct community organization models; social action, social planning, and
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locality development. All three of these models have become frameworks used in social planning. 21. B. 3 The CDC’s Community Guide reviews public health interventions to analyze which interventions have a positive net impact. The Community Preventive Services Task Force uses the information obtained from the Community Guide to issue evidence-based recommendations to public health organizations. It may be thought of as analogous to the US Preventive Services Task Force, but the recommendations are for communities rather than primary care clinicians. There are only three types of stances: recommended, recommended against, and insufficient evidence. 22. B. Local health departments Assessment Protocol for Excellence in Public Health (APEX PH) is a three-step process that helps local health departments (LHDs) assess their internal capacity, better understand local health issues, and create action plans. The APEX PH was created as a group effort between the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County Health Officials, the National Association of County and City Health Officials and, the CDC to provide LHDs with a tool to increase organizational capacity and strengthen their role within the community. 23. D. Strategic plan Mobilizing for Action through Planning and Partnership (MAPP) was developed by the National Association of County and City Health Officials with support from the CDC to perform community assessment and planning, with the vision to assist in communities achieving improved health and quality by mobilizing partnerships and taking strategic action. MAPP consists of community partnership development, visioning, continuous assessments, identifying strategic issues, formulations of strategic objectives, and implementing (while assessing) the process. Unrelated to this question, although relevant to MAPP is the Protocol for Assessing Community Excellence in Environmental Health assessment. It similar to MAPP, but focuses exclusively as being an assessment tool to create an operational plan (as opposed to strategic plan) tailored for environmental health.
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24. D. PRECEDEPROCEED The PRECEDEPROCEED Model is the predominant model used to plan a health-education program. PRECEDE stands for predisposing, reinforcing, and enabling constructs in educational/environmental diagnosis and evaluation. PROCEED stands for policy, regulatory, and organizational constructs in educational and environmental development. This model can be used to provide guidance for any health education program. There are eight stages of the PRECEDEPROCEED Model: 1. Social assessment 2. Epidemiological assessment 3. Educational and ecological assessment 4. Administrative and policy assessment and intervention alignment 5. Implementation 6. Process evaluation 7. Impact evaluation 8. Outcome evaluation EMTALA stands for Emergency Medical Treatment and Active Labor Act. It is federal legislation dictating that hospitals receiving Medicare dollars must screen and stabilize all patients the come through the emergency room. An Ishikawa diagram (aka fishbone diagram, cause and effect diagram) is a quality-management tool used to identify the root cause of a problem and identify opportunities for improvement. MAPP stands for Mobilizing Action for Planning and Partnerships. It is a tool used by communities to perform community assessment and planning. SMART objectives is an acronym for creating goals that are specific, measurable, attainable, realistic and timely. 25. E. PRECEDEPROCEED The Planned Approach to Community Health (PATCH) Model was created within the context of the PRECEDE model. PATCH is a community health planning model to increase the capacity of health agencies to plan, implement, and evaluate community health promotion programs. APEX PH is an acronym for Assessment Protocol for Excellence in Public Health. It provides local health departments with a tool to increase organizational capacity and strengthen their role within the community.
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MAPP stands for Mobilizing Action for Planning and Partnerships. It is a tool used by communities to perform community assessment and planning. PACE EH stands for Protocol for Assessing Community Excellence in Environmental Health. It is an assessment tool used to create an operational plan tailored to improving environmental health. PDSA is an acronym that stands for plan, do, study, act. It represents a continuous quality improvement cycle. 26. C. Principle The “four Ps” of social marketing in health-care include place, price, product, and promotion. The health-care service should be in a place that is accessible and appropriate. The price component includes social, environmental, monetary, and environmental costs. The product should be attractive and beneficial to the recipient. Finally, the product should be promoted to the target audience and information disseminated to the appropriate target. Some experts also believe that positioning should be included as the fifth P in health-care social marketing. Positioning would entail framing an issue so that the target population relates to it. Meanwhile, in the for-profit world, the fifth P stands for profit. 27. D. Racial and Ethnic Approaches to Community Health The CDC’s Division of Community Health operates the Racial and Ethnic Approaches to Community Health (REACH), a program designed to reduce racial and ethnic disparities in health. The REACH program provides monetary awards to community-based programs that administer programs intended to increase the health status of Blacks, American Indians, Hispanics, Asians, Alaska Natives, and Pacific Islanders. These programs typically focus on providing education and intervention on proper nutrition, physical activity, tobacco use, and chronic diseases, such as diabetes. Outside of REACH, the other question options do not exist. Other Division of Community Health (DCH) programs include Partnerships to Improve Community Health (PICH) and National Implementation and Dissemination for Chronic Disease Prevention. These programs (including REACH), as well as others, typically expire and renew according to times of need and political climate. The DCH aims to be the national leader in advancing the practice of community health and making healthy living easier. Specific DCH principles include maximizing public health impact, advancing health equity, using evidence-based practices, and engaging the community.
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BIBLIOGRAPHY [13] [4a] [4b] [5] [6] [7] [8] [9] [10] [11] [1215] [16] [1718]
[19a] [19b]
[20] [21] [2223] [2425] [26] [27]
Shi L, Johnson JA. Novick & morrow’s public health administration principles for population-based management. 3rd ed Sudbury, MA: Jones and Bartlett Publishers; 2013. p. 5663. USPHS: About us. hhttp://www.usphs.gov/aboutus/i [accessed 05.10.2016]. About the Office of the Surgeon General. hhttp://www.surgeongeneral.gov/ about/index.htmli [accessed 05.10.2016]. Guide TC. Summary—oral health, dental caries: community water fluoridation. hhttp://www.thecommunityguide.org/oral/fluoridation.htmli [accessed 05.10.2016]. Marotz LR. Health, safety, and nutrition for the young child. 9th ed Stamford, CT: Wadsworth Publishing Co.; 2014. p. 517. hhttp://www.pepfar.gov/about/index.htmi [accessed 05.10.2016]. HRSA HIV/AIDS programs. hhttp://hab.hrsa.gov/i [accessed 05.10.2016]. About healthy people. hhttps://www.healthypeople.gov/2020/About-HealthyPeoplei [accessed 05.10.2016]. Lorry CKM, Schoenly L, Knox CM. Essentials of correctional nursing. New York: Springer Publishing Co; 2012. p. 916. Noonan M, Rohloff H, Ginder S. Mortality in local jails and state prisons, 20002013—statistical tables. Bureau of Justice Statistics; 2015. Glanz K, Lewis FMM, Rimer BK, McGinnis MJ. Health behavior and health education: theory, research, and practice. 2nd ed San Francisco, CA: JosseyBass Inc., US; 2002. Skolnik RL. Global health 101. 2nd ed Sudbury, MA: Jones and Bartlett Publishers; 2011. p. 1267. Centers for Disease Control and Prevention. Community Health Assessment and Group Evaluation (CHANGE) action guide: building a foundation of knowledge to prioritize community needs. Atlanta, GA: U.S. Department of Health and Human Services; 2010. Kreuter MW. Community health promotion: the agenda for the ’90s, PATCH. J Health Educ 1992;23(3):1359. U.S. Department of Health and Human Services. Planned approach to community health: guide for the local coordinator. Atlanta, GA: U.S. Department of Health and Human Services, Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion http://www.lgreen.net/patch.pdf. Weil M. Community practice: models in action. New York: Haworth Press; 1997. p. 28. Systematic review methods. hhttp://www.thecommunityguide.org/about/ methods.htmli [accessed 05.10.2016]. Rowitz L. Public health leadership: putting principles into practice. 3rd ed Sudbury, MA: Jones & Bartlett Publishers; 2014. p. 1904. Sharma M, Romas JA. Theoretical foundations of health education and health promotion. 2nd ed Sudbury, MA: Jones and Bartlett Publishers; 2012. p. 438. Corcoran N, editor. Communicating health: strategies for health promotion. 2nd ed Thousand Oaks, CA: SAGE Publications; 2013. CDC. About Division of Community Health (DCH). Division of Community Health (DCH): making healthy living easier. hhttps://www.cdc.gov/nccdphp/ dch/about/index.htmi [accessed 05.10.2016].
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1.1 GENERAL PUBLIC HEALTH QUESTIONS 1. What are the three core functions of public health? A. Assessment, policy development, assurance B. Prevention, legislation, enforcement C. Epidemiology, environmental health, individual health D. Health education, health promotion, health care E. None of the above 2. What is the relation between the core public health functions and the essential public health services? A. Core functions are a product of federal government, while the essential services are a product of state and/or local government B. The core functions and the essential services are different words for the same thing C. The core functions fall within the essential services D. The essential services fall within the core functions E. There is no relationship between the two 3. Licensing health-care facilities is an action that falls within which public health core function? A. Assessment B. Assurance C. Enforcement D. Regulation E. Safety 4. The Surgeon General oversees which of the following? A. American Red Cross B. Department of Health and Human Services C. Physician officers in the Army D. Nobody, the Surgeon General is a figurehead for the health of the nation and does not have authority E. US Public Health Service Commissioned Corps Board Review in Preventive Medicine and Public Health. DOI: http://dx.doi.org/10.1016/B978-0-12-813778-9.00001-3
© 2017 Elsevier Inc. All rights reserved.
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5. Which of the following is not true of water fluoridation? A. After discontinuation of water fluoridation, there is an increase in missing teeth B. After initiation of fluoridation, there is a decrease in dental caries C. Community water fluoridation reduces dental caries across all socioeconomic status groups D. The larger the population of those on community water fluoridation systems, the more expensive it is per individual E. Water fluoridation reduces the number of people without a single dental cavity 6. An unemployed single mother of four children (ages 2, 4, 7, and 9) presents to the county nutrition clinic after moving from another state. How many of the children will the Woman, Infants, and Children (WIC) program directly benefit? A. 0 B. 1 C. 2 D. 3 E. 4 7. The US PEPFAR Program targets which disease? A. AIDS/HIV B. Asthma C. Diarrheal disease D. Hepatitis E. Malaria 8. The Health Resources and Services Administration’s Ryan White Program is dedicated to helping those with which disease? A. Acute lymphoblastic leukemia B. Diabetes C. HIV D. Lung cancer E. Pediatric obesity 9. How often are the Healthy People objectives updated? A. Annually B. 3 years C. 5 years D. 10 years E. 20 years
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10. Compared to the general population in the United States, the prison population in the United States has a lower prevalence of which ailment? A. Diabetes mellitus B. HIV C. Substance abuse D. Tuberculosis E. None of the above 11. Which of the following is the leading cause of death in American jails? A. Accident B. Alcohol/drug overdose C. Heart disease D. Homicide E. Suicide 12. Which model of health behavior includes perceived susceptibility? A. Health Belief Model B. Social Cognitive Theory C. Theory of Reasoned Action D. Transtheoretical Model E. None of the above 13. Which model of health behavior proposes that the actual change in a behavior is correlated to the intention to change the behavior? A. Health Belief Model B. Social Cognitive Theory C. Theory of Reasoned Action D. Transtheoretical Model E. None of the above 14. Which model of health behavior includes reciprocal determinism? A. Health Belief Model B. Social Cognitive Theory C. Theory of Reasoned Action D. Transtheoretical Model E. None of the above 15. After years of deliberation, a smoker has decided to speak to his physician about quitting. The physician suggests setting a quit date. Which step in the Transtheoretical Model does setting a quit date represent? A. Precontemplation B. Contemplation
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C. Preparation D. Action E. Maintenance Which of the following is not considered to be one of the distinct categories of the Diffusion of Innovation Model? A. Early adaptors B. Early majority C. Innovators D. Late majority E. Majority What is the first step in completing the CDC’s Community Health Assessment and Group Evaluation (CHANGE) tool? A. Assemble the community team B. Build the community action plan C. Create a change summary statement D. Gather data E. Review all five change sectors Which of the following is not one of the five Community Health Assessment and Group Evaluation (CHANGE) sectors? A. Community-a-large sector B. Health-care sector C. School sector D. Volunteer sector E. Work-site sector What does CDC’s PATCH program stand for? A. Partnerships Aimed to Create Health B. People Against the Corruption of Health C. Planned Approach to Community Health D. Practitioner Alliance to Community Health E. Practice Arrangement to Create Health Which one of the following choices is not one of the Rothman community organization models? A. Social action B. Social planning C. Locality development D. Resource management E. All of the above are Rothman models
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21. The CDC’s Community Preventive Services Task Force publishes how many potential grades for each recommended topic? A. 2 B. 3 C. 4 D. 5 E. 6 22. Which of the following is the target population for which the Assessment Protocol for Excellence in Public Health (APEX PH) is intended for use? A. Individuals B. Local health departments C. State health departments D. Federal government E. International public health emergencies 23. Mobilizing Action for Planning and Partnerships (MAPP) is best suited for addressing which of the following components of a local health department? A. Mission B. Organizational administrative processes C. Organizational structure D. Strategic plan E. Values 24. An administrator in a publically funded teen health clinic wants to start health education program. While thinking back to her days studying public health, she remembered a popular eight-step approach to create a health program. Which of the following programs is she thinking of? A. EMTALA B. Ishikawa (fishbone) C. MAPP D. PRECEDEPROCEED E. SMART Objectives 25. The PATCH Model is a tool that was created within the context of which of the following? A. APEX PH B. MAPP C. PACE EH D. PDSA
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E. PRECEDEPROCEED 26. Which of the following options is not one of the “four Ps” of health-care social marketing? A. Place B. Price C. Principle D. Product E. Promotion 27. What is the name of the program that is administered by the Centers for Disease Control and Prevention’s Division of Community Health to address local racial and ethnic disparities in health status? A. Consortium for Equal Health for All B. Equal Opportunity for Health C. Race and Ethnicity Health Task Force D. Racial and Ethnic Approaches to Community Health E. United Care for All People
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1.2 GENERAL PUBLIC HEALTH ANSWERS 1. A. Assessment, policy development, assurance The three core functions of public health are assessment, assurance, and policy development. These three functions are further broken down into the 10 essential public health services, as shown in the answer for question 2 (directly below). 2. D. The essential services fall within the core functions The three core public health functions are assessment, assurance, and policy development. These three stages revolve in a continuous motion. Because the scope of these three functions is so broad, the 10 essential public health services were developed to further differentiate the stages of the public health process. The essential services framework groups public health activities into categories that can be recognized by budget officers, legislators, and the public at all levels of government. The essential services are evaluated in attaining public health accreditation. The essential services fit within the context of the core functions, as shown below: 3 Core Function
10 Essential Services
Example
Assessment
Monitor health status to identify health problems
Assessment
Diagnose and investigate health problems and hazards in the community
Injury & disease registries Epidemiology Community needs assessment & status indicators (report cards) Vital statistics Injury, communicable, and chronic disease detection STD counseling and testing Outbreak investigation Environmental risk assessment Laboratory services Population-wide health promotion (e.g., education, programs for physical fitness) Health education Work-site health promotion
Policy development Inform, educate, and empower people about health issues
(continued)
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10 Essential Services
Example
Policy development Mobilize community partnerships to identify and solve health problems Policy development Develop policies and plans that support individual and community health efforts Assurance
Assurance
Assurance
Assurance
Forming community partnerships Community planning Development of policies and guidelines Set the agenda Legislative activities Enforce laws and regulations Consumer protection and that protect health and sanitation ensure safety Air and water quality Hazardous materials management Fluoridation services Medical examiner and forensics Enforcement agencies related to the agency’s police authority Link people to needed Provide health-care services personal health services in underserved and assure provision of communities health care Coordination of health services Clinical preventive services Communicable disease treatment Dental health services Assure a competent public Maintenance of appropriate health and personal healthcertification and licensure care workforce Mandated continuing education Maintaining labor force Employee training and programs Evaluate effectiveness, Continuous quality accessibility, and quality of improvement activities personal and population(monitor and improve based health services systems and outcomes) Facilities licensing Laboratory regulation Biomedical, clinical, and preventive investigation (continued)
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(Continued) 3 Core Function
10 Essential Services
Example
Combination of all three core functions
Research new insights and innovative services to health problems
Health services research Innovative technologies
3. B. Assurance As described in the answer above (question 2), the 10 essential public health services were developed within the context of the 3 core public health functions: assessment, assurance, and policy development. Licensure of health-care facilities falls within the essential service of evaluating effectiveness, accessibility, and quality of personal and population-based health services. This service is within the core function of assurance. 4. E. US Public Health Service Commissioned Corps The Office of the Surgeon General sits within the Office of the Assistant Secretary for Health, a part of the Department of Health and Human Services. The Surgeon General, along with the Assistant Secretary of Health, oversees the US Public Health Service Commissioned Corps (USPHS). The Surgeon General is nominated by the President of the United States and sits for a 4-year term. In addition to overseeing USPHS, the Surgeon General is designated as the Chair of the National Prevention Council, an organization that provides leadership in prevention, wellness, and health-promotion activities. The Surgeon General also serves as a figurehead and provides Americans with the best health information available to increase health and well-being. The mission of the USPHS is to protect, promote, and advance the safety of the nation. This mission is accomplished through rapid response to public health needs, leadership in public health, and advancement of the practice of public health. USPHS workers deploy to support public health responses to both natural and manmade events. Specific USPHS deployment activities include serving vulnerable populations, addressing disease control and prevention, supporting biomedical research, and regulating water supply. 5. D. The larger the population of those on community water fluoridation systems, the more expensive it is per individual As the number of people in a community receiving water fluoridation increases, the average cost per individual decreases. This is due to economies of scale. The financial benefits of water fluoridation are
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enormous, as those receiving fluoridated water have less caries and missing teeth. Every dollar spent on water fluoridation has been estimated to save $38 in dental costs. All of the other statements in the question are true. Water fluoridation serves as a primary prevention to decrease the number of dental caries across all socioeconomic groups. When fluoridation services are discontinued there is a decrease in overall dental health status in the population. C. 2 Because the Women, Infants, and Children (WIC) program only benefits children aged 5 and under, only two of the children are able to directly receive WIC benefits. WIC is operated and funded by the US Department of Agriculture, which funds local non-profit and public health agencies. Components of WIC include nutrition education, health-care referrals and financial assistance for needy families with children aged 5 years old and younger. To be eligible, families must be nutritionally at-risk and fall below a specific income. Pregnant and breastfeeding mothers are also eligible to receive WIC benefits. A. AIDS/HIV PEPFAR stands for the US President’s Emergency Plan for AIDS Relief. It is the largest program within the US President’s Global Health Initiative, a program aimed at saving the greatest number of lives by supporting the health infrastructure of other nations. Other programs within the Global Health Initiative include the President’s Malaria Initiative and Feed the Future. C. HIV The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program provides HIV-related care to those with insufficient health-care resources. The program is funded by the Department of Health and Human Services, the HRSA, and the HIV/AIDS Bureau. D. 10 years The Office of Disease Prevention and Health Promotion (ODPHP), within the Department of Health and Human Services publishes the new Health People objectives every 10 years. These science-based objectives (more than 1000) create an agenda for improving the nation’s health. Each objective is outlined with baseline measures and specific goals for improvement. Government organizations, communities, and
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other entities often follow the Healthy People objectives to plan strategic goals. 10. E. None of the above The United States has the largest prisoner population in the world. The average age of prisoners is advancing due to the aging baby boomer population and external political factors. With the ability to monitor and treat captive population, correctional medicine is a pure form of preventive medicine. Across the board, prisoners experience earlier onset and increased prevalence of chronic diseases, such as hypertension and diabetes. The prison population also has a higher prevalence of sexually transmitted diseases. Rates of HIV in prison are roughly four times as high as HIV rates found in the general population. Furthermore, an estimated 35% of the prison population carries chronic hepatitis C. Half of all prisoners have a mental disorder. Prisons house more mentally ill persons than hospitals and mental health facilities. Substance abuse, a type of mental disorder, is also much more prevalent in the prison population than the general population. Due interplay between the environment, host, and vector, tuberculosis (TB) infection is common in prison. TB has been found to be at least three times more prevalent within prison than outside of prison. 11. E. Suicide Because jails typically incarcerate perpetrators for under 1 year while prisons nearly exclusively house inmates with sentences over one year, the population characteristics within jails and prisons are not the same. Because of this and over factors, health status between the two populations may differ. Prisoners have guaranteed access to care during the duration of the sentence, while jail inmates have less predictable health-care utilization while not incarcerated. Suicide is routinely the leading individual cause of death in American jails. Nearly 1/3 of jail inmate deaths are attributed to suicide. In descending order, the cause of death in jail are illness (including heart disease, cancer, etc.), suicide, alcohol/drug intoxication, accident, and homicide. There are roughly 140 jail inmate deaths per 100,000 inmates. Most jails (B80%) do not report a single death annually. Illness is directly responsible for 50% of deaths in jail, while illness is responsible for roughly 90% of death in prison. The two leading
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causes of illness-related death in prison are heart disease and cancer. After illness, the next most common causes of death amongst prisoners in descending order are suicide, homicide, alcohol/drug intoxication, and accident. A. Health Belief Model The Health Belief Model hypothesizes that an individual will make a particular health decision and take action based on their own perception of susceptibility to the illness and their ability to control it. The Health Belief Model consists of the following principles; perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. C. Theory of Reasoned Action The different health belief models can be thought of as maps that provide guidance in a series of steps (constructs) to understanding health behavior. Each model emphasizes a different construct over the others. The Theory of Reasoned Action assumes that people are rational and that their behavior is under control. Therefore, it is thought that behavioral intention leads to an actual behavioral change. The Theory of Planned Behavior is a modified version of the Theory of Reasoned Action that further explains an individual’s perception of control over their own behavior. B. Social Cognitive Theory Reciprocal determinism states that there is a fluid relationship between the individual and environment, where each one reacts with the other to shape behavior. A change in any of these factors will affect the other two. C. Preparation The Transtheoretical Model is a stepwise map of intentional behavior change through the stages of precontemplation, contemplation, preparation, action, and maintenance.
Stage
Intervention
Precontemplation
Assess knowledge Discuss benefits and risks Education & research of benefits Share success stories Provide personal feedback and advise to change Discuss the benefits and risks Outline reason to change behavior
Contemplation
(continued)
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(Continued) Stage
Preparation
Action
Maintenance
Intervention
Review & evaluate barriers to change Discover resources & support network Discuss strategies for change Develop a plan Set a date for change Emphasize support Encourage motivation Set date to quit (smoking, alcohol, drugs) Affirm decision to change Coach through relapse triggers Troubleshoot problem areas Discuss coping strategies Focus on progress Provide follow-up Reaffirm commitment Support change efforts Practice coping skills Relapse prevention skills
Once the decision to quit smoking has been made, the preparation stage begins. This includes setting the quit date. The action stage begins on the quit date. 16. E. Majority The Diffusion of Innovation Model is a model of the social system that breaks down the pace at which an innovation is adapted. An innovation is new idea, practice, service, or object being introduced to the population. Consider for example new dietary recommendations. Predictably, dietary recommendations will not be adopted by everyone in the population at the same rate and time. The Diffusion of Innovation model is broken down into six chronological categories. From first to last adaptors, the categories are innovators, early adaptors, early majority, late majority, late adaptors, and laggards. Many professionals do not recognize late adaptors as a category. The incorrect answer to this question is majority, as there is not a distinct category dedicated solely to the majority. This model recognizes that communication is important to promote social change and bring along diffusion of innovation. The pace of adaption is influenced by perceived benefit of the change compared to the perceived risk, the ease of adaption, and whether there is evidence that the adaption works.
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17. A. Assemble the community team Community Health Assessment and Group Evaluation (CHANGE) was developed by the Healthy Communities Program of the Division of Adult and Community Health (within the CDC) to serve as a tool to help communities recognize and assess community policy, systems, and environmental changes over time. This tool has fallen out of favor with the CDC and is no longer funded by it, yet it is still used by state and local health departments across the United States. The summary of steps in the CHANGE model are as follows: Step 1—Assemble the community team Identify and assemble a diverse team with a maximum of 1012 individuals. Step 2—Develop a team strategy Decide whether to use the CHANGE tool as a group or divided into subgroups. Step 3—Review all five CHANGE sectors I. Community-at-large sector II. Community institution/ organization sector III. Health-care sector IV. School sector V. Work-site sector. Step 4—Gather data Gather data using multiple measures and methods to minimize bias. Step 5—Review gathered data Sit with the team to discuss what the data means in reference to the CHANGE tool. Step 6—Enter data Designate a data manager to input the information for each site. Step 7—Review consolidated data After rating each sector, complete the following steps, so the team can determine areas of improvement and subsequently develop a community action plan. Step 7a: Create a CHANGE summary statement Step 7b: Complete the sector data grid Step 7c: Fill out the CHANGE strategy worksheets Step 7d: Complete the Community Health Improvement Planning template.
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Step 8—Build the Community Action Plan Be specific with objectives and proposed time periods for the projects. 18. D. Volunteer sector Community Health Assessment and Group Evaluation (CHANGE) was developed by the Healthy Communities Program of the Division of Adult and Community Health, within the CDC to serve as a tool to help communities recognize and assess community policy, systems, and environmental changes over time. CHANGE has fallen out of favor with the CDC, yet it is still used by state and local health departments across the United States. The volunteer sector is not one of the five sectors identified in Step 3 of the CHANGE community development tool. The five sectors are as follows: 1. Community-at-large sector 2. Community institution/ organization sector 3. Health-care sector 4. School sector 5. Work-site sector. 19. C. Planned Approach to Community Health PATCH is an organizational tool used on the local level to plan, conduct, and assess health programs. It is an acronym for Planned Approach to Community Health and was developed in the 1980s as a joint effort between the CDC and state/local health departments to create a local-based process based on current knowledge in health theory, promotion, education and community development. It was created within the context of the PRECEDE model. Because PATCH is community-based, each individual community is able to tailor fit the PATCH process to fit their unique locale. The phases of PATCH are as follows: 1. Mobilizing the community 2. Collecting and organizing data 3. Choosing health priorities 4. Developing a comprehensive intervention plan 5. Evaluating PATCH 20. D. Resource Management In 1967, Jack Rothman presented an article identifying three distinct community organization models; social action, social planning, and
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locality development. All three of these models have become frameworks used in social planning. 21. B. 3 The CDC’s Community Guide reviews public health interventions to analyze which interventions have a positive net impact. The Community Preventive Services Task Force uses the information obtained from the Community Guide to issue evidence-based recommendations to public health organizations. It may be thought of as analogous to the US Preventive Services Task Force, but the recommendations are for communities rather than primary care clinicians. There are only three types of stances: recommended, recommended against, and insufficient evidence. 22. B. Local health departments Assessment Protocol for Excellence in Public Health (APEX PH) is a three-step process that helps local health departments (LHDs) assess their internal capacity, better understand local health issues, and create action plans. The APEX PH was created as a group effort between the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County Health Officials, the National Association of County and City Health Officials and, the CDC to provide LHDs with a tool to increase organizational capacity and strengthen their role within the community. 23. D. Strategic plan Mobilizing for Action through Planning and Partnership (MAPP) was developed by the National Association of County and City Health Officials with support from the CDC to perform community assessment and planning, with the vision to assist in communities achieving improved health and quality by mobilizing partnerships and taking strategic action. MAPP consists of community partnership development, visioning, continuous assessments, identifying strategic issues, formulations of strategic objectives, and implementing (while assessing) the process. Unrelated to this question, although relevant to MAPP is the Protocol for Assessing Community Excellence in Environmental Health assessment. It similar to MAPP, but focuses exclusively as being an assessment tool to create an operational plan (as opposed to strategic plan) tailored for environmental health.
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24. D. PRECEDEPROCEED The PRECEDEPROCEED Model is the predominant model used to plan a health-education program. PRECEDE stands for predisposing, reinforcing, and enabling constructs in educational/environmental diagnosis and evaluation. PROCEED stands for policy, regulatory, and organizational constructs in educational and environmental development. This model can be used to provide guidance for any health education program. There are eight stages of the PRECEDEPROCEED Model: 1. Social assessment 2. Epidemiological assessment 3. Educational and ecological assessment 4. Administrative and policy assessment and intervention alignment 5. Implementation 6. Process evaluation 7. Impact evaluation 8. Outcome evaluation EMTALA stands for Emergency Medical Treatment and Active Labor Act. It is federal legislation dictating that hospitals receiving Medicare dollars must screen and stabilize all patients the come through the emergency room. An Ishikawa diagram (aka fishbone diagram, cause and effect diagram) is a quality-management tool used to identify the root cause of a problem and identify opportunities for improvement. MAPP stands for Mobilizing Action for Planning and Partnerships. It is a tool used by communities to perform community assessment and planning. SMART objectives is an acronym for creating goals that are specific, measurable, attainable, realistic and timely. 25. E. PRECEDEPROCEED The Planned Approach to Community Health (PATCH) Model was created within the context of the PRECEDE model. PATCH is a community health planning model to increase the capacity of health agencies to plan, implement, and evaluate community health promotion programs. APEX PH is an acronym for Assessment Protocol for Excellence in Public Health. It provides local health departments with a tool to increase organizational capacity and strengthen their role within the community.
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MAPP stands for Mobilizing Action for Planning and Partnerships. It is a tool used by communities to perform community assessment and planning. PACE EH stands for Protocol for Assessing Community Excellence in Environmental Health. It is an assessment tool used to create an operational plan tailored to improving environmental health. PDSA is an acronym that stands for plan, do, study, act. It represents a continuous quality improvement cycle. 26. C. Principle The “four Ps” of social marketing in health-care include place, price, product, and promotion. The health-care service should be in a place that is accessible and appropriate. The price component includes social, environmental, monetary, and environmental costs. The product should be attractive and beneficial to the recipient. Finally, the product should be promoted to the target audience and information disseminated to the appropriate target. Some experts also believe that positioning should be included as the fifth P in health-care social marketing. Positioning would entail framing an issue so that the target population relates to it. Meanwhile, in the for-profit world, the fifth P stands for profit. 27. D. Racial and Ethnic Approaches to Community Health The CDC’s Division of Community Health operates the Racial and Ethnic Approaches to Community Health (REACH), a program designed to reduce racial and ethnic disparities in health. The REACH program provides monetary awards to community-based programs that administer programs intended to increase the health status of Blacks, American Indians, Hispanics, Asians, Alaska Natives, and Pacific Islanders. These programs typically focus on providing education and intervention on proper nutrition, physical activity, tobacco use, and chronic diseases, such as diabetes. Outside of REACH, the other question options do not exist. Other Division of Community Health (DCH) programs include Partnerships to Improve Community Health (PICH) and National Implementation and Dissemination for Chronic Disease Prevention. These programs (including REACH), as well as others, typically expire and renew according to times of need and political climate. The DCH aims to be the national leader in advancing the practice of community health and making healthy living easier. Specific DCH principles include maximizing public health impact, advancing health equity, using evidence-based practices, and engaging the community.
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BIBLIOGRAPHY [13] [4a] [4b] [5] [6] [7] [8] [9] [10] [11] [1215] [16] [1718]
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