NUR426 Exam 3 PDF

Chapter 3: Epidemiology and Nursing Practice Epidemiology and Nursing - Nursing as an art and a science uses health promotion, disease prevention, health education, and population-based initiatives in an effort to maximize the health and wellness of individuals through population-level s...

Chapter 3: Epidemiology and Nursing Practice Epidemiology and Nursing - Nursing as an art and a science uses health promotion, disease prevention, health education, and population-based initiatives in an effort to maximize the health and wellness of individuals through population-level strategies - As 21st-century health professionals, nurses are now more than ever required to demonstrate both competency and proficiency in the principles of epidemiology Epidemiology - The term epidemiology is the combination of three Greek words: epi, translated as “upon”; demos, translated as “people”; and logy, or “the study of something.” It is defined as the study of factors that influence health and disease in populations - It goes beyond the 1:1 patient-clinician mode - It includes group of people where they live, work, and play - Nurses are a extreme important part of data gathering through - Assessment - Timely reporting - Based on three elements - Person - Which groups of individuals are affected - Place - Where is the health issue occurring? - Time - Over what specific time period is the health issue occurring? Cellular to Global - Epidemiology and biostatistics are critical fields to understand health outcomes from a cellular to global level - Example: - Mycobacterium tuberculosis (TB) affects health on cellular, individual, community, and global levels Epidemiology - John Snow - founder of modern epidemiology - His investigation identified the Broad Street pump as the source of cholera epidemic in London - His investigation resulted in: - Improved sanitation - The introduction of disease mapping Broad Street Water Pump - Snow demonstrated that greater numbers of cholera deaths were clustered within the vicinity of a specific public water source, the Broad Street water pump. The death rate in this region far exceeded those in other areas of London Phases of Epidemiology - Sanitary phase - Illness related to foul emissions from soil, air, and water - Infectious disease phase - Individual organisms linked to specific diseases; links exposures to occurrences - Risk factor phase - The linking of exposures to the occurrence of injury or disease that helps to identify risk factors that, when reduced, may result in a subsequent reduction in morbidity and mortality - Modern Day: - Ecological model:  - Biological and behavioral influences - Role physical and social environment plays on health Environmental Risk Factors (Know examples like lead, arsenic, etc.) - Environmental health looks at 3 crucial areas in ensuring health of the public - Safe air quality conditions - Safe water supplies - Safe soils - Public health professionals use a combination of education, engineering, and enforcement to reduce risk Genetic Risk Factors (Genomics) - The field of genetic epidemiology (genomics) seeks to understand and explain heritability of factors that have an impact on the development of illness and disease - What are some practical and ethical dilemmas associated with genomics? Epidemiological Frameworks - Three frameworks guiding the field of epidemiology: Epidemiology Triangle (Memorize three components of epidemiology triangle) - Agent: Pathogen causing disease - Host: Individual or animal being affected - Environment: Everything outside of the agent and the host that influences the delivery of the disease Epidemiological Constructs (Do not need to memorize) - Three constructs were added to the Epidemiological Triangle: Seven Questions for an Epidemiology Investigation - Who? - What? - When? - Where? - Why?  - How? - How long? Casualty - In epidemiology, determining if a relationship exists between the risk factor and health effect - Examine possibility of casualty- determine if there is a statistical relationship between risk and health issue - Casual relationship - Indirect → Ex. Obesity does not cardiovascular disease. Obesity influences someone getting cardiovascular disease - Direct → Directly associated Web of Causation Framework (Know the definition)(Bottom left picture) - The framework shows the complexity of how illness, disease, and injury are determined by multiple causes affected by interactions of biological and sociobehavioral determinants of health Ecological Model (Upper right picture) - Used to - Design health promotion interventions - Understand health behavior - Include groups as a unit of analysis - Used as an effective model, it should - Define - Promote understanding - Promote population health and wellness Epidemiology Tools: Demography - Demography: Person-related variables are compared over two or more time periods to establish trends within the population of interest - Sources of demographic data: - Census  - Community level data - National surveys Life Expectancy - A measure of the health of populations - Defined as the average number of years a person born in a given country would live if mortality rates at each age were to remain constant in the future - There is a wide range among countries in relation to the average life expectancy at birth Epidemiology Tools: Biostatistics - The analysis of data related to human organisms - Used in public health science and other biological sciences - Examines variations among biological organisms (people, mice, cells) - A core part of public health science Mean, Median, and Mode - Mean: Sum of values/total number of values in set - Median: Middle value in a set of values - Mode: Values that occurs most time within a data set Percent Change - Compares the change between a time 1 and a time 2 measurement related to a demographic variable or health statistic Rates - A rate represents the proportion of a disease or other health-related event such as mortality within a population - It is the basic measure to describe the risk of disease in a certain population over a certain period of time Type of Rates - Mortality (Death) and Morbidity (Sickness/illness) - Attack Rates (The initial group of people that get sick) and Secondary Attack Rates (The second group of people that get sick from the first group) Prevalence (Memorize bolded) - The number of existing cases (numerator) divided by the total number of persons in the population (denominator) multiplying by a given multiplier (for example, 100,000) Incidence (Memorize bolded)  - The number of new cases diagnosed in a given period of time divided by the total number at risk in the population over that same time period and multiplied by a given multiplier (for example, 100,000) Prevalence Pot Dependent and Independent Rates - Example: If you were concerned with the infant mortality rate in Reno compared with the infant mortality rate in Las Vegas, the two rates would be independent of each other - By contrast, if you wanted to compare the rates between Reno and the rate in Nevada, the rates are dependent; that is, all of the cases in Reno are included in the court of cases in Nevada because Reno is in Nevada Epidemiology Tools - Descriptive epidemiology (Describes a health issue) - Description of the health concern and exposed population - Focused on person, place, and time - Analytical epidemiology (Testing a hypothesis) - Test hypothesis by using a comparison group to explore the difference among groups - Determine the association between the risk and occurrence of the health condition Analytical Epidemiology: Study Design - Observational - Cross-sectional design - Case-control study - Cohort study - Experimental - Randomized control trials Cross-Sectional Design (We study a population at one single point in time) - Estimate of disease status and risk factors collected at the same time Case-Control Study (Study with cases [people with a disease] and a control group [people that don’t have the disease]) (Top right picture)  - Compare the ratio of disease of those exposed and those not exposed to the risk factor - Data collected retrospectively - Statistical measure: odds ratio Cohort Studies (Know over time) - Follow a specific population over time - Data can be collected prospectively or retrospectively - Statistical measure: relative risk Clinical Trial and Casuality (Bottom left picture) - Trials compare a control group to one or more experimental groups - Findings suggest causal statements of relationships - Gets much closer to establishing casuality than cohort or case-control studies Ecological Fallacy (Top right picture) - It is critical to remain cognizant of the risk of committing an ecological fallacy - The fallacy refers to the erroneous assumption that one can draw conclusions for individuals based on group findings, which occurs when the researcher draws conclusions at the individual level based solely on the observations made at the group level Outbreak Investigations - For communicable disease, noncommunicalble disease, and exposure to toxins - Investigate - Analyze data - Interpret data - Implement health promotion and risk reduction - Evaluate short- and long-term effects Outbreak Investigations Surveillance - “The ongoing, systematic collection, analysis, and implementation of health-related data essential to planning, implementation, and evaluation of public health practice.” Passive Surveillance (Collecting data from someone else)(Know the difference between passive and active surveillance) - Occurs when data are collected based on individuals or institutions that report on health information either voluntarily or by mandate - The onus for collecting and reporting the data to public health or governmental agencies is on healthcare providers or public health professionals in the field Active Surveillance (Interviewing a healthcare provider/hospital administrator) - Involves the deployment of public health professionals, including nurses, to identify cases of a disease or health condition under surveillance Results of Surveillance - Data from surveillance helps researchers evaluate the impact of disease on the health of populations, such as the calculation of - Global Burden of Disease: The difference between a population’s actual health status and its “ideal” health status if everyone were to live to their fullest potential and lifespan - Disability-Adjusted life years (DALY): Considers not only mortality but also morbidity and disability associated with a disease or risk factor In-Class Questions - What are the three different components of the epidemiology triangle? - Agent, host, and environment - You are teaching a new PHN intern about the difference between passive and active surveillance. Which of the following examples would be considered active surveillance? - You decide to interview hospital administrators and physicians after a communicable disease outbreak - You survey patients at the local health department that have recently been diagnosed with a STI - You go to a hospital and review medical records of patients that were admitted for a new rare infectious disease Chapter 9: Communicable Disease Communicable Disease Across Time - 1900s → Communicable disease (CD) leading cause of death - 1950-1960 → Measles, mumps and CP endemic in school children - End of 20th century → More CDs begin to emerge - 2000s → CDs are major contributors for morbidity and mortality Global Causes of Death (2020)  - Communicable diseases were in the top 10 causes of death: - COVID-19 - Lower respiratory infections - Diarrheal diseases - Tuberculosis Communicable Disease and Surveillance (Know the difference between 3 bolded) - Public health’s responsibility, local to global surveillance of diseases - Epidemic - Significant increase in a disease - Endemic - Usual number of cases of a disease within a population - Pandemic - Epidemics occurring around a global Nurse’s role in Communicable Diseases - Preventative measures - Understand CDs - Individual level - Population level - Proper cleaning of equipment - Prevent transmission to coworkers, self, and patients - PPE - Care to patients What Does it Meant to Understand CDs? - Caring for the patient with a CD requires considering the implications for the population, including understanding - The infectious agent - Who is at risk - Mode of transmission - Prevention - Treatment Communicable Disease and the Burden of Disease - Today, improvements in technology and transportation have brought people closer together - Eliminated geographical barriers to transmission of disease - Increase in emerging and reemerging CDs - Zika - Ebola - Tuberculosis - SARS-CoV-2 Infectious Respiratory Diseases - Many different CDs (bacterial and viral) can affect the respiratory system - Chicken pox - Diphtheria - Rubella - Influenza (Flue peaks in December and February) - Vaccinations = Decline in these diseases Malaria Diarrheal Disease - Caused by - Bacteria, virus, and protozoa - Mode of transmission - Waterborne (Ex. Cholera) - Foodborne/person to person (Ex. E. Coli) - Most common route: Fecal-oral route - Good hand hygiene, especially hang washing, and soap alone can reduce the incidence by as much as 48% - Efficient sanitary systems and safe drinking water also play a huge role in preventing diarrheal diseases Emerging Communicable Diseases - Emerging disease: “[O]ne that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range.” - New diseases emerging one per year - Response to new diseases results in a burden on the economic, social, and healthcare systems of countries - Pandemics require a coordinated early response across political entities such as countries or states - Smallpox has been eradicated and some CD’s are close to eradication: - Polio - Dracunculiasis (Guinea Worm) - Other CD’s are reemerging in forms that are resistant to drug treatments: - Malaria - Tuberculosis - Bacterial pneumonias Tuberculosis (TB) - The World Health Organization (WHO) End Strategy and the United Nation’s Sustainable Development Goals - Aim to have a 90% reduction in TB deaths and 80% reduction in TB incidence by 2030 Communicable Disease Transmission - Three key components needed in transmission cycle are: - Agent - Environment - Host The Cycle of Transmission (Picture is important to know for exam)  - The epidemiological triangle is expanded to help disease researchers understand the cycle of transmission Agent Characteristics - Agent or pathogen: The infectious organism that causes the disease - Six general categories of pathogens - Bacteria - Rickettsia - Viruses - Mycoses - Protozoa - Helminths Types of Infectious Agents (Understand different categories, review some of the example agents) Specific Agent Characteristics (Memoreze infectivity) - Infectivity - Capacity of agent to enter and multiply in host - Pathogenicity - Capacity of agent to cause disease in human host - Toxigenicity - Ability to release toxins that contribute to disease within the human host - Antigenicity - Ability to produce antibodies in human host - Virulence - Ability to cause disease Environmental Characteristics - Environment: Conditions external to the host and agent associated with the transmission of the agent - Reservoir: Where the agent resides - Human - Animal - Water, food, air, or soil Types of Transmission (Review types of transmissions, fomite zoonotic, vector) Human Reservoir (Dont worry too much about knowing different types of carriers)(Understand that a carrier is someone that has a pathogen in them but not show any symptoms) - A person who is acutely ill OR - A carrier - Incubating carrier - Infected but has not yet shown signs of disease - Convalescent carrier - Infected but no longer shows signs of acute disease - Chronic carrier - Infected but shows no signs of disease for a long period of time Mode of Transmission - Fomite? Doorknobs, phones, etc. Vector? Host Characteristics - The human at risk for disease due to exposure to the agent - Susceptibility of the host - the likelihood of becoming infected with the agent - Immunity - Resistance Host Characteristics: Immunity (Don’t worry too much about humoral/cellular immunity) - Innate → “First responders” with immune cell and chemicals OR - Adaptive → Targeted to specific pathogens through creation of antibodies - Humoral immunity → Production of antibodies via B cells OR - Cellular immunity → Destruction of pathogens with T cells - Active immunity → Acquired through exposure to the agent OR - Passive immunity → Transferred from one individual to another - Artificial passive → Involves the transfer of antibodies and can be done in various forms Host Characteristics: Defense Mechanisms - Avoidance - Prevent exposure via anatomic or chemical barriers - Ex. Body’s epithelial surfaces (i.e., skin) - Resistance - Resists disease without antibodies - Inherited or acquired - Tolerance  - Host’s responses that enhance tissues’ capacity to resist damage induced by pathogens - Colonization: - Infected with agent but no sign of disease - Can spread disease - Example: Methicillin-resistant staphylococcus aureus (MRSA) Breaking the Chain of Infection (Important to know that chain of transmission can be broken at any point) Outbreak Investigation Steps - A systematic epidemiological investigation can: - Determine if there is a sudden increase in the incidence of a CD - Define what constitutes a case - Determine the severity of the outbreak - Case Fatality Rate (CFR) - Map out the epidemic curve - Generate a hypothesis - Conduct a case finding - Determine common source of exposure - Identify source of transmission or take action Case Fatality Rate and the Epidemic Curve - CFR - Determines severity of the outbreak - Represents number of fatal cases divided by the number of cases - Epidemic Curve - Plotted on graph - Shows number of cases on the Y-axis - X-axis placed by date - Shows time elapsed from exposure to clinical symptoms Epidemic Curve Managing an Outbreak - Identify and isolate source → Know how to break the cycle - Find incubation period → Exposure to onset of symptoms - Achieve herd immunity → Greater population protected - Requires prompt action on multiple levels - Begins with a determination of how best to break the cycle of transmission - Reservoir? - Host? - Examples of public health interventions: - Altering the public to an ongoing risk to reduce further exposure - Providing treatment to those exposed if warranted - Identifying contacts to prevent a secondary outbreak if warranted Infectious Agents and Attack Rates - Disease is not necessarily immediately apparent following transmission of the pathogen - The incubation period for the pathogen is the period of time between exposure and first signs of disease - The infectious period is the period during which an infected person can transmit the infection to another susceptible host Herd Immunity - The immunity of a population to an agent: - Having a large enough portion of the population immune (by vaccine or past infection) prevents spread of the disease to persons in the population who do not have immunity - Threshold of immunity - Percentage of the population that must be immune to achieve herd immunity to a specific agent - Even if a few members of the community become infected, the population as a whole is protected from an outbreak Attack Rate and Secondary Attack Rate - Attack rate: The number of persons who are ill divided by the total population (ill + sick) - Secondary attack rate: The total number of new cases among contacts divided by the total number of contacts Sexually Transmitted Infections (STIs) - Transmitted through sexual contact and exchange of bodily fluids - Preventable disease - More than 25 infectious agents - May cause serious illness and disability - Reproductive health problems  - Fetal and perinatal health problems - Cancer Notifiable STIs in the U.S. - There are 3 notifiable STIs that have federally funded control programs - Chlamydia - Gonorrhea - Syphilis STI Risk Factors - Main risk factor: Unprotected sexual contact - Disparities based on: - Gender - Ethnicity - Sexual orientation - Socioeconomic factors - Underreporting of STIs in nonpublic healthcare settings - Access to care HIV and AIDs - Can go 15 years after exposure before developing AIDs - 13% are unaware they are infected - 25- to 29-year-olds have the highest rate of new cases - Men who have sex with men, black, and Hispanic/Latinx communities have the highest incidence - Numbers are increasing among older adults Solving the Mystery of Communicable Diseases - It’s important to separate agent from the disease or diseases from the agent - Must understand portal of entry, virulence, and infectivity to help determine level of risk to a population - How many cases constitute a PH intervention? - Depends on severity of infection and disease - Ask how many people could be affected by the outbreak given mode of transmission? How infectious is the agent? Controlling Communicable Diseases - Three main approaches: - Change the environment - Increase host resistance - Deactivate the agent Chapter 10: Noncommunicable Diseases Noncommunicable Disease (NCD) - Refers to diseases that are not passed from one person to the next (directly or indirectly) and are not caused by an infectious agent - Long duration - Usually slow progression - Require medical attention over time - Tend to limit ability to perform activities of daily living (ADLs) - Four main categories for NCDs: - Cardiovascular disease  - Cancers - Chronic respiratory diseases - Diabetes Nursing Role - Nurses play a significant role in reducing the burden of NCDs through interventions at various levels - Primary → Prevention, interventions before someone has a disease - Secondary → Screenings and testings - Tertiary → How to promote quality of life after disease Treatment and Preventions of NCDs - Cannot be prevented or cured through vaccination or medication - They require: - Maintaining a healthy lifestyle - Early diagnosis and treatment - Long-term management The World Health Organization (WHO) and NCD’s - The majority of NCDs can be prevented by reducing risk factors - Modifiable behavioral risk factors - Genetic risk factors - Environmental risk factors - Sociodemographic risk factors - Require a comprehensive approach: - Individual level - Community level - Global level Chronic Care Model → Major model used to combat high rates of NCDs This could be called the integrated delivery care model Helps providers reframe their care from treating pts in the acute phase of disease to treating NCDs through long-term management Measure of Burden of Disease for NCDs - Burden of disease - Uses the disability-adjusted life-year (DALY) measure to determine the extent of the burden a disease has on a population - Involves calculating not only the cost of treatment but also the social and economic impacts - Allows for the assessment of the comparative importance of a disease, injury, or risk factor Life Expectancy - Based on mortality rates - The number of years a person could be expected to live based on the current mortality rates in a specific setting, usually a country Health-Adjusted Life Expectancy (HALE) Don’t worry too much about memorizing definition - Average number of years that a person can expect to live in good health by adjusting for disease/injury - WHO uses HALEs to measure the average level of health in countries and regions by evaluating population-specific prevalence of disease and injury as well as severity distribution of health states Life Expectancy Vs. HALE Premature Death and YPLL - Premature Death: - NCDs often lead to premature death - Death that occurs earlier than the standard life expectancy - Premature death reflects the number of years of potential life lost - Years of Potential Life Lost (YPLL) - Calculated by subtracting the age at which a person dies from their life expectancy Years of Potential Life Lost (YPLL) - If life expectancy in the United States is 78 years, what would the YPLL be for a man that died of a heart attack at 42? - The YPPL would be 36 - If you calculate the YPLL for a 53-year-old who died of a heart attack in Afghanistan in 2017, the YPLL would be 0 because the life expectancy was 51.7 years - The YPPL would be 0 Disability-Adjusted Life Years (DALY) Don’t worry too much about calculating - Measurement of the gap that exists between the ideal health status of a disease- and disability-free population that lives to an advanced age - 1 DALY represents 1 lost year of life - DALY = YLL + YLD NCDs in the United States - The four common risk factors that account for most NCD’s (in the U.S. and globally) are modifiable - Nutrition → Eating habits, diet - Physical activity → Exercise - Tobacco use - Alcohol use Seven of the 10 leading Causes of Death in the United States are NCDs (2021) 1. Heart disease [635,547] 2. Cancer [605,213] 3. COVID-19 [416,893] 4. Accidents [224,935] 5. Stroke )cerebrovascular diseases) [162,890] 6. Chronic lower respiratory disease [143,342] 7. Alzheimer’s disease [119,399] 8. Diabetes [103,294] 9. Influenza and pneumonia [56,585] 10. Nephritis, nephrotic syndrome, and nephrosis [54,358] Heart Disease and Stroke - First and fourth leading causes of death (2021) - Costly - One in four deaths attributable to heart disease - One in every six deaths attributable to stroke - Dietary risk exposures are the most significant attributable risk factors to CVD burden of disease Cancer - Cancer is the second leading cause of death in the United States - It is the second leading cause of death globally - Screenings have decreased death numbers - Survival rate has increased Risk Factors for Cancer - Risks are a combination of: - Behavioral factors - Genetic factors - Environmental factors Chronic Lower Respiratory Diseases (CLRD) - Chronic Obstructive Pulmonary Disease (COPD), asthma, occupational lung disease, pulmonary hypertension - What are some risk factors? Diabetes - Eighth leading cause of death - Projected prevalence of over 783 million by 2045 - Type 2 is most common - Interventions to reduce risk of type 2 - Exercise  - Eat healthy - Maintain healthy body weight - Is prevalence pot growing or shrinking for diabetes? Increasing Behavioral Risk Factors for NCD’s - Behavioral risk factors - Nutrition - Exercise - Obesity - These risk factors are higher in the southern U.S. - Tobacco use - Cancer, pulmonary disease, cardiovascular disease - Alcohol use - More than 200 types of disease and injuries are associated with alcohol use Environmental Risk Factors - Pollutants increase the risk of: - Asthma - Cardiovascular health problems - Cancer Genomics and Risk for Noncommunicable Disease - Human genomics is the study of the genetic structure or genome of a living human - Research shows there is a genetic role in major NCDs including cancer, diabetes, and asthma - Monogenetic - Linked to a specific gene - Polygenetic  - Multiple genes act together Prevention Strategies for NCD’s - Primary Prevention: Behavioral changes - Healthy eating - Exercise - Population-level primary prevention programs help to change barriers to a healthy lifestyle - Secondary Prevention: Screenings and testings - Screenings → Early detection of disease → Treatment - Screenings are NOT diagnostic - Tertiary Prevention: Reducing morbidity and disability - Reduce morbidity and disability associated with disease - Prevent premature death - Global priority, reduce individual risk factors, behavioral changes, populations at highest risk are those with the fewest resources Ethical Dilemma - Central risk factor - Lack of access to health care including preventive screening, early and ongoing treatment, and resources needed to manage care - For those who are unable to obtain adequate insurance or who do not have adequate transportation to services, care is often delayed until the disease has become advanced Health-Related Quality of Life (HRQoL) - The self-perceived impact of physical and emotional health on quality of life. Includes general health, physical functioning, pain, vitality, etc. - Central to Healthy People 2030’s overarching goals - CDC’s HRQoL tool includes standard 4-item set of Healthy Days core questions and the Standard Activity Limitation and Healthy Days Symptoms modules. When used together, the measure make up the fill HRQoL-14 measure Chronic Disease Self-Management (CDSM) - Ongoing process by which individuals with a chronic illness or condition engage in self-management of medications, symptoms, and promotion of their own health - Can be applied to both NCDs and CDs Cultural Shifts and NCDs - In the past 50 years, there have been cultural shifts in the United States in relation to risk behaviors associated with NCDs - A cultural shift is defined as a change in society’s dominant views, morals, and behaviors - Example: How society perceives smoking in public places. This change has reduced secondhand smoke exposure Chapter 12: Substance Use and the Health of Communities Substance Use and the Opioid Epidemic - In 2021, more than 100,000 people in the United States died from opioid-involved overdoses - More than 5% of the global burden of disease and injury is attributable to alcohol - Globally, 22.3% of the population uses tobacco Substance Use - This refers to the use of psychoactive substances that have a pharmacological effect on the brain and central nervous system (CNS) - Effects of these substances on an individual include altered mood, perception, and level of consciousness Social, Cultural, and Economic Context - Different impacts at the national level - Quantity consumed - Type of substance consumed - Cultural norms around consumption in relation to the quantity consumed - Lower socioeconomic status - Quality of the alcohol or drug Substance Use and Health - Classes of substances - Stimulants - Depressants - Inhalants - Dissociative anesthetics - Narcotics - Hallucinogens - Cannabis Measures of Use and Risk - Quantity (Dosage or amount) - Frequency (How often?) - Pattern (Are we doing it consistently? Or episodically?) - Duration (How long over your lifetime?) At-Risk Alcohol Use (Important to consider these factors and what type of beverage they are consuming) Barriers to Prevention of Substance Use and Related Harm - Lack of economic resources within a community reduces the ability to develop and/or enforce policies aimed at preventing at-risk substance use - How can you advocate for policies to prevent substance use and related harm? - Understand the context in which substance use occurs - Understand the extent of the burden of disease - Use evidence-based approaches that work across the continuum of use and the lifespan Substance Use and Risk - Defined as use that is linked to health-related harm: - Physical - Mental - Socioeconomic harm - Includes the full spectrum of use or behavior from low risk to a diagnosable substance - Increases the risk for injury, crime, and adverse health issues, and poses a risk for other individuals through environmental factors - Consequences range from low to high risk of diagnosis of a substance use disorder (SUD) - From fetal exposure to the last decades of life - Acute harm - Chronic harm Measurement, Surveillance, and Risk - The first step in conducting surveillance is defining how substance use is measured. Classification of use is as follows: - Abstinence → No use of substances - Low risk → Use of substance that places the user at little or no risk - Harm-related use → Associated with harm to the individual, family and/or community Other Substances and Harm-Related Use - Any use of tobacco or illegal substances is at-risk use - Use of prescribed psychoactive substance is considered risky use if use is not aligned with prescription - Pregnancy- NO acceptable level - There are national surveillance surveys on substance abuse conducted regularly in the U.S. (11 different surveys including BRFSS, NSDUH, and NESARC) Harm Associated with Substance Use Excessive Alcohol Use (Know how many drinks is considered binge drinking and heavy drinking) Understanding Risk Across the Life Span - Fetal Alcohol Spectrum Disorders (FASD): Occur due to exposure to alcohol in utero (Physical changes, growth deficiency, CNS function changes) - Alcohol use and adverse effects occur on the adolescent brain - For older adults, changes in the ability to metabolize alcohol increases risk (For older adults, drinking is dangerous because they are already at risk for falls) - Duration of use over lifetime increases risk for adverse outcomes such as liver disease and cancer Populations at Risk: Age, Race, and Other Health Factors - Environment plays a significant role in elevating the risk for engagement in harmful substance use - Gender differences may be a factor - Age differences - Prevalence decreases - Risk for harm increases - People experiencing poverty are at increased risk - Use a person-centered approach - Shift from calling a person an addict to referring to that person as someone who has an SUD - Harm-related substance use is the preferred term because it focuses on harm rather than on a clinical diagnosis Substance Use Disorder (SUD) - “A maladaptive pattern of substance use leading to clinically significant impairment or distress.” Can be diagnosed as moderate or severe - Physiological dependence - Withdrawal - Tolerance Substance Use and Health - Health and Medicine Division prevention Model - Clearly separates prevention from treatment - Universal Level - All populations regardless of identified risk - Selective Level - Specific subgroups known to be at-risk substance use  - Indicated Level - Specific subgroups at highest risk for development of SUD or showing early signs Harm Reduction Model - Any program, policy, and/or intervention that: - Seeks to reduce the harm related to at-risk substance use - Does not focus solely on attainment of abstinence - Aim for safer use or abstinence - Goal of reducing harm at the community and population levels Alcohol Use - A casual factor in more than 200 disease and injury conditions - Accounts for 5.3% of deaths worldwide - Adverse pathophysiological consequences (e.g., all alcohol drinks increase the risk for cancer) - Adverse psychosocial consequences (Drinking can impact employment, can cause legal issues, or give consequences to personal life) - Pregnancy - Fetal alcohol syndrome - Older adults - Organ damage - Falls - Interaction with prescription drugs Alcohol Screening Brief Intervention and Referral for Treatment )(A-SBIRT)(SBIRT is an alcohol screening tool) - This is a universal approach to screening for alcohol use - Screening for harm-related alcohol use is an essential component in the fight to prevent harm related to alcohol use Tobacco Use and Nicotine Vaping - Tobacco: - Accounts for more than 8 million deaths each year globally - Is the number one cause of preventable deaths in the United States - Is the only legal product that causes the deaths of half of its regular users - Prevalence of tobacco use - Prevalence of tobacco use differs among countries - Declining in the United States - Increasing globally, especially in low-income countries - Almost 80% of smokers live in middle- or low-income countries - What kind of products can you think of that contain tobacco? How are nonsmokers impacted? Screening and Treatment for Tobacco Use - Screening for tobacco use: - Assessment of quantity and frequency - What type of tobacco is used - History of past use - Duration of use - What is not a good question to ask? “Do you smoke cigarettes?” - Smoking cessation: - Brief help by a healthcare provider, counseling, behavioral therapies, mobile phone-assisted treatment, and medications Policy to Reduce Tobacco-Related Harm (Don’t worry about this slide) - Application of the Fair-Trade Act of 1949 to tobacco advertising - The Great American Smokeout - WHO’s MPOWER Drug Use Prevalence and Medication Assisted Treatment (MAT) (Know methadone and buprenorphine are the most common for MAT therapy) - By November 2021, the annual opioid overdose death rate rose 28.5% to an estimated 100,306 deaths - The use of stimulants such as methamphetamine and cocaine continues - MAT, a conjunction with other treatments, is an effective treatment for both opioid use disorders and alcohol use disorders (AUDs) - It is seen as part of a more comprehensive treatment plan that includes behavioral treatment Methamphetamines - These drugs are easily manufactured - Some of the components are caustic - “Superlabs” can manufacture up to 100 lbs per day - They pollute the environment - Long-term use can result in cachexia, alopecia, corneal ulcerations, repetitive behavior patterns, and severe mental illness symptoms Consequences of Drug Use - Consequences of drug use vary based on the pharmacokinetics of the drug used - Materna and infant risks - Effects on adolescent brain development - Increased use older adults - Once the drug has left the system, the person experiences a rebound effect - There is increased risk for comorbid mental disorders, STIs, and other drug-related adverse consequences Screening and Treatment for Drug Use - Screening - The Drug Abuse Screening Test (DAST-10) - National Institute on Drug Abuse (NIDA) ASSIST Tool - SBIRT for drug use (If on the exam it says SBIRT, think drug use or alcohol) - Substance Abuse and Mental Health Services guide - SAMHSA recommends the use of SBIRT framework to address drug use in the same way it is used for those with at-risk alcohol use Policy-Level Intervention - In the U.S., the organization focused on drug policy is the Office of National Drug Control Policy (ONDCP) - Under President Obama, focus of the ONDCP shifted from prosecution to increasing access to treatment - Under President Trump, focus has shifted back on criminalization of drug use and a “just say no” approach to prevention - Current grassroots efforts to reform drug policy in the U.S. focus on a harm reduction approach Substance Use and Communicable Diseases - Occurs across multiple levels - Increased risk of transmission - Poorer outcomes - Less apt to be engaged in care Substance Use and Stigma - Stigma is defined as a mark of disgrace or reproach - Moral views of substance use vary based on ethnic culture, social practices, the specific substance in question and the gender of the substance user - It can be a barrier to treatment Chapter 13: Injury and Violence Injury and Violence: The Big Picture - International and unintentional injury result in: - Long-term health consequences - Increased risk of death - Unintentional injuries are a major reason for visits - 37 million visits annually Unintentional Injury - An injury to a person that occurs in a short period of time and for which there is no intent to injure another or oneself - Disproportionately affects the and the impoverished - Examples: Motor vehicle crashes (MVC), drowning, burns, falls Incidence of Unintentional Injuries - Unintentional injuries are often and. It is the 3rd leading cause of the death in the U.S.  - Poisoning - 20 deaths per 100,000 population - Motor vehicle accidents - 11.5 deaths per 100,000 population - Falls - 12 deaths per 100,000 population Intentional Injury - “A deliberate act that causes either to the self or to others” - : Physical force used to violate, damage, or abuse others or oneself - Broader term is used in conjunction with intentional injury in the public health literature - Often occurs in conjunction with mental health disorders and substance use - Intentional injury deaths - Nonfatal physical assault injuries- over 402.5 per 100,000 population - Suicide - over 47,000 U.S. deaths - Homicide - over 19,000 U.S. victims Types of Intentional Violence - -Inflicted - Violence in which the perpetrator and victim are one and the - Suicide - Cutting/Self-mutilation - personal - Occurs between individuals and includes 2 different contexts in which violence occurs - Family - Community - Acquaintance - Stranger - - When large groups of people engage in violent behavior. Can be between nations, communities, or gangs - as a weapon of war - Terrorism - Wars Four Types of Violent Acts - Neglect - Emotional/ violence - Physical violence - assault Violence in the Workplace  - Intrusive violence → Includes criminal intent by strangers, terrorist acts, mental illness or drug-related aggression, and protest violence - violence → Includes staff-on-staff violence and bullying and domestic violence at work - -related violence → Encompasses consumers’, clients’, or patients’ (and family) violence against staff, vicarious trauma to staff, and staff violence to clients or consumers - Organizational violence → Is perpetrated against staff or consumers, clients, or patients Surveillance of Injury and Violence - Various reporting mechanisms at the local, state, and national levels - Examples of data sources: - Departments of Public Health - Motor Vehicle Crash (MVC) reports - Police reports - Death certificates and autopsy reports - Death Reporting System Determining Risk for Injury and Violence - Risk factors for injury and violence based on type of injury as well as: - Behavioral risk factors - risk factors - Socioeconomic risk factors ‘s Matrix - A method for determining risk factors associated with injury events - Based on the triangle - Original purpose related to MVC’s and risk Prevention and Nurses’ Role in Injury and Violence Prevention - National Center for Injury Prevention - Conducts surveillance - Collects data - Provides leadership  - Funds research on prevention - Nurses use a collaborative approach: - Doctor Jacquelyn Campbell, RN, and the American Nurses Association (ANA) and the 2013 Violence Against Women Act - Doctor Nancy Glass, RN, and MyPlan Epidemiology of Unintentional Injuries: MVC’s - MVC: - Road Traffic Injury (RTI): MVC Risk Factors Prevention of MVC’s - Preventions of MVCs through the use of: - Policy - Safe environmental conditions - Education WHO Global Plan for Road Safety - Five categories of prevention: - Building road safety management capacity - Improving the safety of road infrastructure and broader transport networks - Further developing the safety of vehicles - Enhancing the behavior of road users - Improving post-crash care Epidemiology of Burn-Related Injuries - Burn-related injury: - Globally: 195 burn-related deaths from fires annually Risk Factors for Burn Injuries Prevention of Burn Injuries - Primary - Secondary - Tertiary Epidemiology of Drowning - Defined as: - Globally: There are an estimated 372,000 deaths from drowning annually - 10 per day in the U.S. - Among the top 10 leading causes of death in children and young adults globally Risk Factors for Drowning Prevention of Drowning - Primary prevention - Secondary prevention Epidemiology of Falls - Fall: - Highest risk in what population?  - Globally, 646,000 fall-related deaths and 37.3 million falls that require medical attention annually - In the U.S., falls are the leading cause of nonfatal injury across all age groups except age 20-24 years Risk Factors for Falls in Children Prevention of Falls in Children - Family level: - Product regulation: Epidemiology of Unintentional Poisoning - Defined as: - The United States has a mortality rate of 25.8 per 100,000 (2020) - Globally, lead is a common cause of poisoning with 900,000 deaths globally per year Risk Factors for Unintentional Poisoning Prevention of Unintentional Poisoning - What are some prevention interventions for unintentional poisonings? Epidemiology of Self-Directed Violence (SDV) - Defined as: - In the U.S.: - Significant rise in the suicide rate from 10.5 per 100,000 in 1999 to 14.2 per 100,000 in 2018 - By 2019, suicide was the 10th leading cause of death - Globally, suicide is the fourth leading cause of death for persons age 15 to 29 years Risk Factors for SDV Prevention of SDV Child Maltreatment - 3 types of abuse: - At both the global level and in the United States, one in four adults have a history of physical abuse as a child Individual Risk Factors for Child Maltreatment - Risk for Victimization - Risk for Prepertration Family Risk Factors for Child Maltreatment Community Risk Factors for Child Maltreatment Prevention of Child Maltreatment - What are some prevention interventions for child maltreatment? Partner Violence (IPV) - Violence that occurs between people in an intimate relationship. Includes: - Physical violence - Sexual violence - Psychoogical/emotional violence - of physical or sexual violence Violence Against Women and LGBTQ+ - : “...a pattern of harassing or threatening tactics used by a perpetrator that is both unwanted and causes fear or safety concerns in the victim” - 1 in 4 American women and 1 in 10 males reported a lifetime impact of contact sexual violenve, physical violenve, and/or stalking - Lesbian, gay, biseual, and transgender persons (LGBTQ+) experience IPV at levels equal to or than the heterosexual population Risk Factors for Violence Against - Female gender, young age, being unmarried, being uninsured or on medical assistance, low income, and having a history of maltreatment as a child - At-risk use - Low self-esteem, mental health problems, unemployment, or desire for power and control in relationships - Residence in an area characterized by and social disadvantage Prevention of Violence Against Women - The main categories of prevention include: - Teaching safe and healthy relationship skills - Engaging influential adults and peers - Disrupting the developmental pathways toward partner violence - Creating protective environments - Strenthening economic supports for families - Supporting survivors to increase safety and lessen harm Epidemiology of Community Violence - Perpetrated in a public place by individuals who no have a relationship with the victims - Includes crime, use of weapons, and violence or potential violenve - Sniper attacks, wars, drive by - Increased risk: Economically depressed and disorganized communities with fewer resources and increased access to firearms - Protective factors at the community level: Norms supporting gender equity and better economic opportunities War: An Example of Collective Violence - War accounts for more death and disability than many major diseases combined - Affect on health: - in public health systems - Increases in transmission - Changes in the social systems that had previously kept the population healthy