PSY 382 Exam 3 Study Guide Fall 2024 PDF

Psy 382 EXAM 3 Study guide – Fall 2024 EXAM 3 Study Guide All populations 1. Be able to compare the various racial/ethnic groups we’ve discussed in terms of a. Socioeconomic Status (income, education, social status) i. NH Whi...

Psy 382 EXAM 3 Study guide – Fall 2024 EXAM 3 Study Guide All populations 1. Be able to compare the various racial/ethnic groups we’ve discussed in terms of a. Socioeconomic Status (income, education, social status) i. NH Whites 1. high educational attainment 2. high income 3. low poverty 4. Non-Hispanic Whites, who make up about half of the U.S. population, experience a 10% poverty rate. While this is a relatively low percentage compared to most other racial/ethnic groups, the large size of their population means the total number of Whites in poverty is significant. Additionally, compared to groups like Asians, Whites may have lower educational attainment and higher poverty rates, but they still face relatively low psychosocial risks overall, including in terms of income and wealth. ii. NH Blacks 1. low educational attainment 2. low income 3. high povety iii. NH Asian 1. high educational attainment 2. high income 3. low poverty iv. Hispanic 1. lower educational attainment 2. low income 3. high poverty v. Native American 1. low educational attainment 2. low income 3. high poverty b. Education attainment i. NH Whites 1. high school grad= 97% 2. enroll in college= 41% 3. college grad= 45% ii. NH Blacks 1. high school grad= 95% 2. enroll in college= 36% 3. college grad= 28% iii. NH Asian 1. high school grad= 99% 2. enroll in college= 61% Psy 382 EXAM 3 Study guide – Fall 2024 3. college grad= 72% iv. Hispanic 1. high school grad= 88% 2. enroll in college= 33% 3. college grad= 25% v. Native American 1. high school grad= 92% 2. enroll in college= 26% 3. college grad= 12% c. Income levels (WEEK 15) i. NH Whites = $58,270 ii. NH Blacks= $34,598 iii. NH Asian= $67,065 iv. Hispanic = $40,963 v. Native American= d. Household income levels i. NH Whites= $1 ii. NH Blacks= 63 cents iii. NH Asian= $1.26 iv. Hispanic= 73 cents v. Native Americans 60 cents e. Poverty i. (status) 1. NHW = 10.1% (ten percent of a bigger group is a bigger number) 2. NH Blacks = 20.8 3. NH Asian = 10.1 (low poverty) 4. Hispanic = 17.6 5. Native = 25.4 2. Be knowledgeable about overall life expectancy trends and differences between week 15 a. Men and women i. there is a 4.6 year difference between non-hispanic black and white men ii. there is a 2.9 year differnce between non hispanic black and white women iii. there is a 9.5 year differnce between non-hispanic white/black women and non-hispanic white/black men iv. more information in week 13 slide 22 graph b. Racial/ethnic groups – who is living longest, shortest, in between i. current life expectancy by race/ethnicity (week 15 slide) 1. NH Asian= 84.5 (longest) a. 2019=85.6 b. 2020=83.6 c. 2021=83.5 d. 2022=84.5 Psy 382 EXAM 3 Study guide – Fall 2024 2. Hispanic= 80 a. 2019=81.9 b. 2020=77.9 c. 2021=77.8 d. 2022=80 3. NH White= 77.5 a. 2019=78.8 b. 2020=77.4 c. 2021= 76.7 d. 2022=77.5 4. NH Black= 72.8 a. 2019=74.8 b. 2020=71.5 c. 2021=71.2 d. 2022=72.8 5. AI/AN= 67.9 a. 2019=71.8 b. 2020=67.1 c. 2021=65.8 d. 2022=67.9 Black/African American Health` 1. Relative to other groups, especially non-Hispanic Whites, how do Blacks/African Americans compare in terms of a. Life expectancy trends i. whites have a life advantage of 3 ½ years over blacks ii. During COVID 1. there was a 5.5 differnce between white and black in the year 2021 2. there wasa 4.7 difference between white and black in year 2022 3. White a. 2019= 78.8 b. 2020= 77.4 c. 2021=76.7 d. 2022=77.5 4. Black a. 2019= 74.8 b. 2020= 71.5 c. 2021=71.2 d. 2022= 72.5 iii. between females there is a 2.9 year difference 1. white female= 81 years 2. black female= 78.1 iv. between white and black men, there is a 4.6 year life expectancy differnce b. Infant mortality trends i. there is a drastic difference between blacks and whites with blacks having 10.97/1000 more infant mortality and whites having 4.67/1000 Psy 382 EXAM 3 Study guide – Fall 2024 1. WEEK 13 slide ii. White (4.67/1000) 1. postneonatal mortality= 1.63 2. neonatal mortality= 3.04 iii. Black (10.97/1000) 1. postneonatal mortality= 3.82 2. neonatal mortality= 7.16 c. Survival trends in the context of disease i. diabetes 1. blacks are 2x more likey than whites to die from diabetes ii. stroke 1. Black men experice 70% higher mortality 2. black women experince 30% iii. Cardiovascular (heart disease) 1. 30% more likey to die from heart disease 2. compared to white, blacks are significanly greater CVD risk (incidence and outcome) iv. cancer 1. Black men lower 5-year survival across most cancers 2. Black men twice as likely to die from prostate cancer 3. Black women breast cancer mortality is 40% higher 4. black women stomach cancer mortality is 2.3x higher 5. black men stomach cancer mortality is 2.5x higher d. Leading causes of death i. BLACK AND WHITE MEN (SHARED) 1. heart disease (higher in white) 2. cancer (higher in white) 3. unintentional injury (higher in black) 4. chronic lower respiratory disease (higher in white) 5. stroke (higher in white) 6. diabetes (higher in black) ii. BLACK MEN 1. homicide 2. kidney disease 3. septicemia (septic) 4. hypertension iii. WHITE MEN 1. alzheimer disease 2. suicide 3. influenza and pneumonia 4. chronic liver disease iv. BLACK AND WHITE FEMALE (SHARED) 1. heart disease (higher in white) 2. cancer (higher in black) 3. stroke (higher in black) 4. diabetes (higher in black) Psy 382 EXAM 3 Study guide – Fall 2024 5. alzheimer disease (higher in white) 6. unintentional injury (higher in white) 7. septicemia(higher in black) 8. kidney (higher in black) v. BLACK FEMALE 1. hypertention vi. WHITE FEMALE 1. influenza and pneumonia 2. How do NH Blacks/African Americans compare in terms of diabetes, cardiovascular disease, and cancer risk and the outcomes (likelihood of hospitalization, amputations, ESRD, mortality)? a. diabetes and outcome i. compared to NHW, there are significant disparities in in diagnosed and undiahnosed diabetes and outcomes for most racial/ethnic minorites 1. age-adjusted prevalance (diagnised and undiagnosed included) a. NHW= 7.4% b. Black=12.1 2. Foot Exam (percent of population) a. NHW= 66.3 b. black= 67.3 3. Rentinal, eye exam percent of pop) a. NHW= 63.9 b. Black= 57.5 4. Hospilaized w/long-term complications (rate per 100,000 pop) a. white= 12.5 b. black= 44.2 5. ESRD (rate per 100,000 pop) a. white= 138.2 b. black= 437.5 6. Mortality (rate per 100,000 pop) a. white= 19.1 b. black= 38.8 ii. 1.6x more likey to have been diagnosed with diabetes iii. 2.5x more likey to be hospitalized for diabetes iv. 3.5x more key to be hospitalized for lower extremity amputation 1. diabetes will begin to affect extremities far away from the heart and then work its way to it v. 3.2 times more likey to start end-stgae renal disease vi. 2x more likey to die from diabetes b. cardiovascular disease and outcome i. 9.8% of black adults meeti ideal cardiovascular health criteria ii. at similar risk of getting coronary heart diease as white iii. 30% more likey to have high BP Psy 382 EXAM 3 Study guide – Fall 2024 iv. black women are 50% more likey to have higher BP compared to white women v. 10% less likey to have their high BP controlled vi. 30% more likey to die from heart disease vii. Age adjusted prevalence ( including diagnosed and undiagnosed and parentheses 1. White = 5.6% 2. black= 5.2% viii. age adjusted rate of high blood pressure ( age adjusted percent of population 18 +) 1. White= 43.6% 2. black= 57.1% ix. age adjusted percentage with high blood pressure blood pressure is under control ( percent of population ) 1. White= 50.8% 2. black= 44.6% x. high cholesterol ( percent of population) 1. White= 25% 2. black= 22.2% xi. advice to quit smoking by doctor ( rate per 1,000 population) 1. c xii. prescribed critical medication after MI ( rate per 1 million population) 1. White= 96.1% 2. black= 97.5% xiii. mortality ( rate per 100,000 population) 1. White=164.4 2. black= 208.6 c. cancer and outcome i. Black men lower 5-year survival across most cancers ii. black men twice as likely to die from prostate cancer iii. black women similar rate of breast cancer to white women but 40% higher mortality 1. higher rates of death from breast cancer per 100,000 women in 1995 iv. black women 2.0 rate of stomach cancer but 2.3 times higher mortality v. black men have a 1.8 rate of stomach cancer with a 2.5 times higher mortality d. stroke i. black are 50% more likey to have a stroke ii. black women 200% more likely to have a stroke iii. Black women have a 30% higher mortality iv. black men experience 70% higher mortality 3. How do NH Blacks/African Americans compare in terms of healthcare quality and access? Psy 382 EXAM 3 Study guide – Fall 2024 a. 11.4% of black adults (19-64) are unisured compared to 6.8% of NHW adults (blacks have less access to healthcare) b. there are disparties between these races regarding insurance deprivation, epsecially during COVID i. Black 1. feb= 17% 2. june= 21% 3. sept= 26% ii. White 1. feb= 11% 2. june= 12.5% 3. sept= 12% c. NH Blacks/African Americans face significant disparities in both healthcare quality and access, with lower insurance coverage, fewer preventive services, and poorer outcomes for chronic and maternal health. These disparities are rooted in systemic inequities. 4. How do NH Blacks/African Americans compare to NH Whites in terms of value of a dollar and accumulated wealth? a. NHW= $1 b. Black= 63 cents c. for every dollar that whites have blacks only have 6 cents 5. What is the relationship between SES and NH Black/White health disparities – is it related, does it partially explain, or fully explain differences? a. no equivalence of SES across race i. blacks revive less income at the same educational level ii. have less wealth at equivalent income levels iii. have less purchasing power (at a given level of income) because of higher costs of good and services b. The relationship between socioeconomic status (SES) and health disparities between Blacks and Whites is significant, but it only partially explains these differences. i. While SES plays a critical role in shaping access to healthcare, health behaviors, and environmental exposures, it doesnt fully account for the disparities observed. Structural racism, implicit bias, and systemic inequities in healthcare and society contribute to persistent health gaps even when SES is controlled. Psy 382 EXAM 3 Study guide – Fall 2024 Native American Health 1. What was the major cause of Native American population shift in the last 500 years? a. introduction of disease b. segregation/discrimination c. genocide (colonization of America is debated as the largest in history) 2. What has been the relationship between Native Americans and the U.S. Government? a. 1778 - Continental Congress: Reaffirms 1763 British policy (tribes accorded independent nation status; lands west of the Appalachian mountains are Native American; royal government must approve all land purchases). b. 1787 - Northwest Territory Ordinance: Opens the Midwest for settlement; declares U.S. government responsible for Native American property rights and liberty. (Beginning of Encroachment) c. 1824 - The Bureau of Indian Affairs was created under the jurisdiction of the Secretary of War. d. 1830 - Indian Removal Bill: Mandates all Indians must move west of the Mississippi. e. Indian Removal Act (1830): This act called for the expulsion of all Native Americans from southeastern states and their relocation to the territory west of the Mississippi. f. 1830–1880 - As forced segregation becomes the new Native American reality most reservations are established. g. 1871 - Appropriations bill rider: ended federal recognition of Native American tribes as independent or as domestic dependent nations h. 1924 - Indian Citizenship Act: Grants US citizenship i. 1934 - Indian Reorganization Act: Ends allotment, encourages tribal self-government, restores freedom of religion, extends financial credit to the tribes i. gave preference in BIA employment to Native Americans ii. permitted consolidation of Native American lands split up through inheritance iii. promotes the revival of Native American culture and crafts. j. 1952 - Relocation Program: Moves Native Americans at government expense to urban areas for better jobs. 3. What was the Termination Act of 1953? a. The most controversial governmental policy toward reservation life b. It reduced costs and ignored individual needs c. Federal services were stopped immediately d. The effect of the governmental order was disastrous e. In 1975, the government resumed the services 4. Is health status (risk of disease, mortality) the same across all Native Americans or are there differences? a. Health status among Native Americans varies significantly based on tribal affiliation, geography, socioeconomic factors, and access to resources Psy 382 EXAM 3 Study guide – Fall 2024 5. What is the rate of diabetes among Americans in general and among Native Americans in Southern Arizona specifically? a. In southern Arizona, there is a 50% prevalence b. In 2021, an estimated 11.6% of the U.S. population 6. What do you think causes the high Southern Arizona diabetes rates? a. attributed to a change in lifestyle pre to post-reservation (1879) b. possible genetic vulnerability i. moving to the reservation, which contains high caloric foods, causes the body to not be used to it and have storage issues→diabetes c. The river people are pima indians slide i. 50% diabetes prevalence ii. highest rates of diabetes in the world 7. Relative to other groups, especially non-Hispanic Whites, how do Native Americans compare in terms of a. SES i. Native Americans face substantial SES disparities relative to NH Whites, driven by a combination of historical injustices, systemic inequities, and geographic isolation 1. they have low income, education, and social status compared white b. Discrimination i. overt discrimination against native americans is embedded in US culture c. Health behaviors i. highest rates for tobacco product use or nicotine vaping in the past month ii. highest rates for illicit drug use in the past year iii. highest rates for substance use disorder in the past year 1. past year substance use disorder 2. past year alcohol use disorder 3. past year drug use disorder d. Risk of diabetes and diabetes outcomes i. percentage of people diagnosed with diabetes aged 20+ is 15.9% e. Risk of heart disease i. low rates of heart disease with 2.6 ii. keep in mind that their life expectancy is in their 60s, so they don't life long enough to get heart disease f. Life expectancy i. 67.9 ii. 2019= 71.8 iii. 2020= 67.1 iv. 2021=65.6 v. 2022= 67/9 (+2.3) vi. they have a lowe life expectancy g. Major causes of death i. COVID ii. Accidents (unintentional injuries) iii. Diabetes 1. compared to NHW AI/AK Psy 382 EXAM 3 Study guide – Fall 2024 a. 1.5x more likey to be diagnosed with diabetes b. 2x more likey to start treatment for end-stage renal disease (ESRD) c. 1.6x more likey to die from diabetes iv. Chronic liver v. cirrhosis Asian American Health 1. Are Asian Americans a homogeneous or heterogeneous population (i.e., largely similar or quite diverse)? a. They are heterogeneous. Very diverse population 2. Is any diversity among Asian Americans associated with SES or health differences among them? a. Yes, diversity among Asian Americans is strongly associated with SES and health differences. Subgroups with higher SES tend to have better health outcomes, while those with lower SES face more challenges, partly due to disparities in access to resources, education, and culturally appropriate healthcare b. Education attainment i. indian= 76.1 ii. Korean= 58.7 iii. Chinese= 56.8 iv. Japanese= 49.1 v. Hawaiian Islander= 26.5 3. Relative to other groups, how do Asian Americans compare in terms of a. Income i. $67,065 b. childhood poverty i. low income = 26% ii. poverty= 10% iii. extreme poverty→ no stat iv. they are the lowest in poverty rates (less poor than rest) c. Education attainment i. high school grad= 99% ii. enroll in college= 61% iii. college grad= 72% d. Health behaviors i. smoking rates = 5.40% 1. lowest of all ii. Obesity= 17.4 1. lowest population with obesity compared to the rest 2. men= 17.5 3. women= 17.2 4. unisured= 6% (lowest) iii. prevalence of diabetes among AA 45-84 1. South Asian 29.1% Psy 382 EXAM 3 Study guide – Fall 2024 2. Filipino= 31% 3. NH Pacific Islander = 34.5% e. Life expectancy trends i. 84.6 years of age ii. 2019= 85.6 iii. 2020= 83.6 iv. 2021= 83.5 v. 2022= 84.5 f. Overall disease risk and outcomes i. 1.4 times more likely to have been diagnosed with diabetes (variance by specific group) ii. 1.6 times more likely to start treatment for ESRD iii. 70% less likely to be hospitalized for lower extremity amputation iv. 20% less likely to die from diabetes. v. 4.4% diagnosed with heart disease vi. 30% less likely to have been diagnosed with cardiovascular disease vii. 10% less likely to have been diagnosed with high blood pressure viii. 50% less likely to die from heart disease 1. Even when diagnosed, Asians have a better outcome than NHW who are also diagnosed ix. prevalence of cancer is low in AA 1. breast 2. cervical 3. prostate x. lower infant mortality xi. lower risk of most disease 4. Does Asian American health follow Whitehall's findings? a. Asian American health largely follows the Whitehall findings, with a clear gradient linking higher SES to better health outcomes as they have high attainment in SES, education, and income, along with low poverty rates Hispanic/Latino health 1. Are Hispanics/Latinos a homogeneous or heterogeneous population (i.e., largely similar or quite diverse)? a. Hispanics/Latinos are heterogeneous, with 23 nationalities and 12 languages/dialects 2. Relative to other groups, how do Hispanics/Latinos compare in terms of a. Income i. median household income of $40,963 b. childhood poverty i. low income= 63% ii. poverty= 31% iii. extreme poverty= 13% c. Education attainment i. they have the lowest educational attainment 1. 88% high school grad Psy 382 EXAM 3 Study guide – Fall 2024 2. 33% enroll in college a. 13% graduate college 3. 25% college grad d. Health behaviors i. prevalence of 44.8 for obesity among adults aged 20 + 1. women= 43.7 and men=45.7 ii. health behaviors are stronger for those born outside of the US iii. smoking rates are 7.70% iv. 18% of Latino pop is uninsured e. Life expectancy trends i. ~80 years (age) ii. 2019= 81.9 iii. 2020=77.9 iv. 2021=77.8 v. 2022= 80 (+2.2) vi. there is a 3.1 difference between then and NHW due to SES disparities and COVID burden f. Survival trends in the context of disease i. although cancer is the leading cause of death for Hispanics, rates are lower than other groups ( below 150/100,000 deaths, but above 100). ii. Life expectancy is in the 80s, so they live long enough to be able to experience cardiovascular disease, but their heart disease rates are lower compared to other groups 1. only group outside of COVID where heart disease is not going to be an issue/happen 2. was at ~250/100,000 deaths in 2000 and decreased to ~150/100,000 in 2013 g. Overall disease risk and outcomes i. diabetes among 45-84 has a prevalence of 25.3% 1. high rates of diagnosed diabetes (12.1%) ii. Heart disease of 18+ is 3% (you have to live long enough to get heart disease) iii. highest rates of overweight/obesity (76.6%) iv. high rates of dyslipidemia and metabolic syndrome v. high rates of undiagnosed or poorly managed disease vi. Low self-rated health, quality of healthcare 3. Do Hispanics have health disparities? a. Yes, Hispanic and Latino people experience health disparities in the United States, including access to healthcare, chronic conditions, cancer, and preventative screening 4. What is the Hispanic health paradox? a. Lower mortality rates of Hispanics relative to non-Hispanic whites despite the poor risk factor profile of the former b. Why? Psy 382 EXAM 3 Study guide – Fall 2024 i. Cultural values promote and maintain strong social bonds (network, size/integration, cohesion) leading to health advantages ii. Familismo (importance of family) iii. Personalismo (valuing and building warm relationships) iv. Simpatia (importance of maintaining interpersonal harmony) v. Respeto (respect for and inclusion of elders) 5. Who has better health – U.S.-born Hispanics or Foreign-born Hispanics? a. Despite greater SES risk, foreign brin Hispanics consistently display better health and health outcomes than US-born Hispanics b. immigrants bring better health rates to the US, and they are the reason for the number/percentage of life expectancy i. if removed US net decrease of life expectancy 6. What are the health effects of living in a high-density Hispanic neighborhood like a barrio vs. a low-density neighborhood (fewer Hispanics)? a. Higher density of Hispanics in a neighborhood has been associated with better health outcomes i. lower risk of depression ii. lower risk of infant mortality iii. lower incidence of non-infectious cancers iv. greater likelihood of surviving illness and disease v. lower all-cause mortality 7. Are there effects for non-Hispanics living in a high-density Hispanic neighborhood? a. Hispanic Acculturation and Longevity Outcomes (HALO) states that the benefits are experienced by non-Hispanics living close in proximity Non-Hispanic White health 1. What is the emerging trend referred to as the “deaths of despair”? a. An unusual occurrence of death in the 45-55 age range 2. How is non-Hispanic White mortality in middle age (45-54) compare to racial/ethnic minorities? a. Figure 1.1 All-Cause Mortality by Race and Ethnicity (50-54) Years 2000-2015 i. Hispanics start 300/100,000 in the year 2000 but decrease ii. ALL Non-White Hispanics start at ~485/100,000 and increase to 500/100,000 in 2015 iii. White Non-Hispanics with High school or less start at 700/100,000 and increased to +900/100,000 in 2015 1. the only group to be increasing iv. Black Non-Hispanics start at +900/100,000 but decrease to 700/100,000 in 2015 b. Figure 1.2 With or Without College Degree i. Black with a college degree stay under 50/100,000 deaths from 1990-2020 ii. White with a college degree stayed under 50/100,000 deaths but did increase from 1990-2020 (closer to 50) Psy 382 EXAM 3 Study guide – Fall 2024 iii. Black with NO college degree began at 50/100,000 deaths in 1990 and increased to ~100/100,000 deaths in 2020 iv. White with NO college degree began under 50/100,000 deaths in 1990 and increased to +100/100,000 deaths in 2020 1. They have the most deaths 3. How does it compare to NH whites outside the U.S.? a. compared to other countries such as Canada, Australia, Sweden, France, Britain, and Germany, Non-Hispanic Whites increased in mortality to ~400/100,000 deaths between the ages of 45 to 54 between the years 1990 and 2015 i. It is unique to the US 4. What are the leading causes of death that appear to be driving this effect? a. Death from drugs, drinking, and suicide (+40 annual deaths per 100,000 people) Reducing Health Disparities 1. Be able to give an example of contemporary interventions at each of the following levels a. Individual level i. take an existing therapy–do a cultural translation and then use it to improve health ii. therapeutic efforts such as Cognitive Behavioral Therapy b. Community level i. community gardens promoting healthy eating and food security ii. community healthcare workers (Promotores de Salud) iii. community market conversion strategy 1. change the grocery options to promote a healthier diet by altering food access c. Federal/Policy Level i. policy and legislation ii. Healthcare reform (Affordable Healthcare Act) 2. What are culturally tailored interventions? a. The systemic modification of an empirically-based therapy or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meanings, and values. b. Who uses them? i. Culturally tailored interventions are used by various professionals and organizations to address specific needs within diverse communities (healthcare) c. Are there a lot or few? i. It's more of a theory than reality at this time, but there are many models, and the early results look promising ii. tailored interventions are the future of clinical psychology. d. Do they work? i. Generally, it has a medium effect size, which is pretty good, so they work Psy 382 EXAM 3 Study guide – Fall 2024 ii. on tailored interventions that improve outcomes for those they were intended for. e. What is meant by culturally translated? i. Cultural translation means not only adjusting language but the delivery of the treatment so that it is sensitive to the value of the population. 3. What are Promotores? a. What level of intervention are they associated with – individual, community, society? i. community b. Where do they come from, and what do they do? i. originated in Latin American ii. community members who function as liaisons between their community and healthcare providers c. Is this an effective level of intervention? i. the model is endorsed by most major healthcare organizations ii. Dominant form of healthcare monitoring, education, and delivery across the world 1. important in lower SES countries or those with high rural populations 4. Can the physical environment be changed to improve health disparities? a. yes, it can, as it's recommended by leading public health institutions, to create built environment change as an evidence-based strategy to prevent obesity and associated chronic disease b. What are some ways it can be changed to improve health? i. Place limits on marketing of junk food to children, like at schools or parks ii. promote local public markets iii. provide incentives for businesses that provide healthy food iv. use zoning tools to limit the location and density of fast-food restaurants. v. provide health information on menus vi. change grocery options to promote healthier diets by altering food access 5. What effect is the Affordable Care Act on insurance rates and what does this have to do with health disparities? a. The Affordable Healthcare Act has brought down uninsured rates to 9.2%, which is the lowest it has been in 50 years i. impacted disease prevention and management. b. this relates to health disparities because reform improves healthcare access for all c. people retain their money and the health of the community overall d. disparities among any of us affect all of us