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HES 4503 Unit 2 Notes
CHAPTER 7Maternal, Infant, and Child Health
Introduction: MIC Health• Using age-related proles helps identi!" ris#s and target inter$entions
• Maternal% In!ant% and child health &MIC' enco(passes health o!:
o )o(en o! child*earing age !ro( pre-pregnanc" through
pregnanc"% la*or and deli$er"% and postpartu( periodo Child prior to *irth through adolescence
In!ants: less than + "ear
Children: +-+4 "ears
Mortalit" ,ates
• Maternal Mortalit" ,ate
o nnual nu(*er o! deaths o! (others . nnual nu(*er o! li$e
*irths / +%000%000
• In!ant Mortalit" ,ate
o eaths a(ong children less than +-"ear-old . nu(*er o! li$e
*irths in the sa(e "ear / +%000
National In!ant Mortalit"
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U1S1 In!ant Mortalit" ,ate *" ,ace.Ethnicit"
a(il" and ,eproducti$e Health
• a(ilies are the pri(ar" unit in hich in!ants and children are nurtured
and supported regarding health" de$elop(ent
• arious denitions o! !a(il"6
o U1S1 Census 7ureau denition o! !a(il"
group o! to people or (ore &one o! ho( is the
householder' related *" *irth% (arriage% or adoption andresiding together
• ll such people &including related su*!a(il"(e(*ers' are considered as (e(*ers o! one !a(il"
a(il" ,esearch Indicators
• Un(arried o(en are (ore li#el" than (arried o(en to e/periencenegati$e *irth outco(es
• Married o(en are (ore li#el" than un(arried% non-coha*itating
o(en to initiate prenatal care earl" in pregnanc"
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• Married o(en are less li#el" than un(arried% non-coha*itatingo(en to rel" on go$ern(ent assistance to pa" !or prenatal care
8eenage 7irths
• 8eenage pregnancies are (ore li#el" to result in serious health
conse9uences !or (other and *a*"• 8een (others are less li#el" to recei$e earl" prenatal care
• 8een (others are (ore li#el" to:
o S(o#e during pregnanc"
o Ha$e preter( *irth
o Ha$e lo-*irth-eight *a*ies
o Ha$e pregnanc" co(plications
• Higher In!ant Mortalit" ,ate
o o *irth eight
o
o o Sudden in!ant death s"ndro(e &SIS'
• +.3 teenage girls get pregnant at least once *e!ore age 20
• 8eens ho *eco(e pregnant and ha$e a child are (ore li#el" to:
o rop out o! school
o Not get (arried or to ha$e a (arriage end in di$orce
o ,el" on pu*lic assistance
o i$e in po$ert"
• Su*stantial econo(ic conse9uences !or societ"
;lo*al 8een <regnanc" ,ate
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a(il" <lanning
• eter(ining the pre!erred nu(*er and spacing o! children and
choosing the appropriate (eans to acco(plish it
• Co((unit" in$ol$e(ent in !a(il" planning and care includesgo$ern(ental and nongo$ern(ental organi=ations
• )hat is o(en>s 7irth ,ight?
Unintended <regnancies
• Unintended pregnanc"o Misti(ed or unanted
• @+.2 &50A' o! pregnancies in U1S1 are unintended
o 43A o! those end in a*ortion
• Unintended pregnanc" associated ith negati$e health *eha$iors
o ela"ed prenatal care
o Inade9uate eight gain
o S(o#ing
o lcohol and other drug use
Title X: a(il" <lanning ct• ederal progra( that pro$ides !unds !or !a(il" planning ser$ices !or
lo-inco(e peopleo i(s to reduce unintended pregnanc" *" pro$iding contracepti$e
and other reproducti$e health care ser$ices to lo-inco(eo(en
Supports 4%000B !a(il" planning clinics in U1S1
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$er 5 (illion o(en recei$e care at clinics !unded *" 8itle
Do ;ag ,ule6 enacted in +FG4% rescinded in 200F
Success o! Co((unit" Health a(il" <lanning <rogra(s
• Clinics ha$e i(pro$ed MIC health indicatorso Ha$e shon large reductions in unintended pregnancies%
a*ortions% and *irthso Each "ear% pu*licl" su*sidi=ed !a(il" planning clinics help
pre$ent +1F (illion unplanned pregnancies that ould result in: G0%000 unintended *irths% G+0%000 a*ortions% and
20%000 (iscarriages
• Each pu*lic health dollar spent sa$es J314 in Medicaid costs
*ortion
• egal in earl" stages o! pregnanc" since +F3 &,oe $1 )ade'
• MaKorit" o! a*ortions
o Un(arried o(en &G5A'
o )o(en aged 20-2F &51+A'
o ,ates highest a(ong Non-Hispanic *lac# o(en
• <ro-li!e $s1 <ro-choice
*ortion *" ge ;roup
Maternal Health
• ELect o! pregnanc" and child*irth on o(en are an i(portant
indicator o! health• <regnanc" and deli$er" can lead to serious health pro*le(s
• Maternal death
• Maternal (ortalit" and (or*idit" rates
o Causes include po$ert" and li(ited education
<renatal Health Care
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• Medical care !ro( ti(e o! conception until *irth process
• Earl" and continuous prenatal care leads to *etter pregnanc"
outco(eso ess li#el" to gi$e *irth to a lo *irth eight in!ant
,acial isparities in <renatal Care
In!ant Health
•
epends on (an" !actorso Mother>s health and her health *eha$ior prior to and during
pregnanc"o Mother>s le$el o! prenatal care
o ualit" o! deli$er"
o In!ant>s en$iron(ent a!ter *irth &ho(e and !a(il"% (edical
ser$ices'o Nutrition
o I((uni=ation
In!ant Mortalit"
• Measure o! a nation>s health
• ecline in in!ant (ortalit" due to:
o I(pro$ed disease sur$eillance
o d$anced clinical care
o I(pro$ed access to health care
o 7etter nutrition
o Increased education
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• eading causes o! in!ant death:
o Congenital a*nor(alities
o <reter(
o o *irth eight
o SIS &Sudden In!ant eath S"ndro(e'
Earl"-i!e Mortalit" 8i(e <eriods
I(pro$ing In!ant Health
• <re(ature *irths
• o *irth eight
• Cigarette s(o#ing
• lcohol and other drugs
• 7reast!eeding
• SIS
Childhood Mortalit"
• Most se$ere (easure o! health in children
• ,ates ha$e generall" declined in past !e decades
• Unintentional injuries are the leading cause o! death in children
o Specicall"% motor vehicle deaths% especiall" those not
earing seat *elts.restraints
Childhood Mortalit": eading Causes
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eath ,ates% Children +-4
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eath ,ates% Children 5-+4
Childhood Mor*idit"
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• Unintentional inKuries
o Signicant econo(ic% e(otional% and disa*ling i(pact
• Child (altreat(ent
o Strong co((unit" response needed
• In!ectious disease
o I(portance o! i((uni=ation schedule
Co((unit" <rogra(s !or )o(en% In!ants% and Children
• ederal go$ern(ent has o$er 35 progra(s in + diLerent agencies to
ser$e needs o! nation>s children
• Man" are categorical progra(s
o nl! availa"le to #eo#le $ho %t into a s#eci%c &rou#
o Man" !all through the crac#s
Maternal and Child Health 7ureau
•
8itle o nl" !ederal legislation dedicated to pro(oting and i(pro$ing
health o! (others and children
• Maternal and Child Health 'ureau &MCH7'
o Esta*lished in +FF0 to ad(inister 8itle !unding
o cco(plishes goals through 4 core pu*lic health ser$ices
In!rastructure *uilding% population-*ased% ena*ling% and
direct health care ser$ices
)IC &)o(en% In!ant% Children'
• Clinic-*ased progra( designed to pro$ide nutritional and health-
related goods and ser$ices to pregnant% postpartu(% and *reast!eedingo(en% in!ants up to + "ear o! age% and children under age 5
• Sponsored *" the US esta*lished in +F4
• Eligi*ilit" re9uire(ents
o ,esidenc" in application state% inco(e re9uire(ents% at
nutritional ris#6
• 200G: F15 (illion participants
o Nearl" hal! o! all in!ants *orn in U1S1% O o! children ages +-5
)IC Enrollees
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Health Insurance
• Children ithout insurance (ore li#el" to ha$e necessar" care dela"ed
or recei$e no care
• Medicaid: lo-inco(e indi$iduals and !a(ilies
o Children are slightl" (ore than hal! o! all *eneciaries
• CHI<: targets uninsured children hose !a(ilies don>t 9uali!" !or
Medicaid
<ro$iding Child Care
• M a(il" and Medical ea$e ct
o ;rants +2 ee#s unpaid Ko* protected lea$e to (en or o(en
a!ter *irth o! child% adoption% or illness in i((ediate !a(il" nl" aLects *usinesses ith 50B e(plo"ees
• Cost o! childcare
• Child Care and e$elop(ent 7loc# ;rant
ther d$ocates !or Children
• Nu(erous groups ad$ocate !or children>s health and el!are
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o Children>s e!ense und &C'
o United Nations Children>s und &UNICE'
o (erican cade(" o! <ediatrics &<'
CH<8E, Gdolescents% Poung dults% and dults
Introduction
• dolescents and "oung adults: +5-24
o dolescence generall" regarded as pu*ert" to (aturit"
• dults: 25-4
• ges +5-4 are so(e o! the (ost producti$e% or (ost producti$e "ears
o! people>s li$es
dolescents and Poung dults
• dolescence is a diQcult stage
o <eriod o! transition !ro( childhood to adulthood
• Poung adults co(plete ph"sical groth
o E/perience signicant li!e changes
ea$e ho(e% Koin (ilitar"% *egin careers% etc1
• Man" health *elie!s% attitudes% and *eha$iors adopted and consolidated
e(ographics: dolescents and Poung dults
• Nu(*er o! adolescents and "oung adults
o In 20+0% o$er +.5 o! U1S1 population
o In 20+2% @55A o! adolescents ere non-Hispanic )hite• i$ing arrange(ents
o In 20+0% less than O li$ed in single parent !a(ilies
o ariations *" race and ethnicit"
Mortalit" !or dolescents R Poung dults
• Signicant decline in death rates o$er past se$eral decades
o Mostl" due to (edical ad$ances and inKur" and disease
pre$ention
• Male (ortalit" rate is higher than !e(ale
• Most threats !ro( *eha$ior rather than disease• Unintentional inKuries &42A'% ho(icide &+A'% suicide &+A'
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eath ,ates *" eading Causes% ges +5-24
Mortalit": +5-24 "ears o! age
•
O o! all deaths in the +5-24 age group are !ro( (otor $ehicle inKurieso )hat>s the (aKor contri*utor?
• Ho(icide and suicide rates up 200-300A o$er the last 50 "ears
• Signicant racial disparities a(ong race and leading causes o! death
Mor*idit": +5-24 "ears o! age
• Co((unica*le diseases
o Measles i((uni=ations are i(portant
o Se/uall" trans(itted diseases &S8s'
ge group ac9uires nearl" hal! o! all ne S8s in the U1S1
So(e eLects can last a li!eti(e
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8rends in Co((unica*le iseases (ong +5-24 Pear lds
Health 7eha$iors and i!est"le Choices o! High School Students
• Unintentional inKuries
• iolence
• 8o*acco use
•
lcohol and other drugs• Se/ual *eha$iors unintended pregnancies and S8s
• <h"sical acti$it"
• $ereight and eight control
Health 7eha$iors and i!est"le Choices o! College Students
• Unintentional inKuries
• iolence
• 8o*acco use
• lcohol and other drugs
•
Se/ual *eha$iors unintended pregnancies and S8s
Co((unit" Health Strategies: dolescents and Poung dults
• Main !actors aLecting co((unit" health are social and cultural !actorsand co((unit" organi=ing
o )hat are so(e e/a(ples o! social and cultural !actors?
• lcohol use is a (ain pro*le(
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dults Health <role
• ges 25-4
o ,epresent more than half o! U1S1 population
• Mortalit"
o Mostl" !ro( chronic diseaseso Man" associated ith unhealth" *eha$iors and poor li!est"le
choiceso i!est"le i(pro$e(ents and pu*lic health ad$ances ha$e led to
decline in (ortalit" rates !or adults
dult Mortalit" ,ates
• escri*e and co(pare rates *" race.ethnicit"% age% and t"pe o! disease
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Cancer
() cause of death for adults a&ed *+-*o Males: prostate% lun&% and colorectal
o e(ales: *reast% lun&% and colorectal
Cardio$ascular isease
• ge-adKusted (ortalit" rates dropped o$er past 0 "ears
o Mainl" due to pu*lic health eLorts:
S(o#ing cessation
Increased ph"sical acti$it"
I(pro$ed nutrition
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Health 7eha$iors and i!est"le Choices
• ,is# !actors !or chronic disease
o Most signicant !or adults: s(o#ing% lac# o! <% 7MI% alcohol
• ,is# !actors !or personal inKur"
o Motor $ehicle sa!et" seat*elts and alcohol use• areness and screening o! certain conditions
o H"pertensions% dia*etes% cholesterol
Co((unit" Health Strategies
• E(phasis on indi$idual responsi*ilit" !or health
• <ri(ar"% secondar"% and tertiar" pre$ention eLorts !or adults
o <ri(ar": e/ercise and nutrition progra(s
o Secondar": sel! and clinical screenings to identi!" and control
disease processeso
8ertiar": (edication co(pliance
CHAPTER .lder Adults
Introduction
• Nu(*er o! elders and proportion to total population increased
signicantl" in the 20th centur" and earl" 2+st centur"
• ,epresent )/0)1 o! the population
• ld6 is a relati$e ter(
enitions
• ged
• ging
• ;erontolog"
• ;eriatrics
• ;eriatrician
• 8er(s
o Seniors
o lder dults
o Mature dultso Elderl"
o ged
ging M"ths
• geis(
• Co((on ("ths not accurate representation o! elders
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o E/1 MaKorit" o! elders toda" are acti$e and ell
S"(*olic ge <"ra(id
• ld ld: G5B
• Middle ld: 5-G4
• Poung ld: 5-4
e(ograph": <opulation <"ra(ids% U1S1
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8hree actors Lecting <opulation Si=e and ge
• ertilit" rates
• Mortalit" rates
• Migration
U1S1 is still the )orld>s eading estination to I((igration
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ependenc" and a*or orce ,atios
• ependenc" ,atio:
o Econo(icall" unproducti$e to econo(icall" producti$e
• a*or orce ,atio:
o Nu(*er o! people actuall" or#ing and those ho are not%
independent o! their ages
ependenc" ,atio% U1S1% 20+0-2050
ther e(ographic aria*les
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• Lect co((unit" health progra(s !or older (ericans:
o Marital status
o i$ing arrange(ents
o ,acial and ethnic co(position
o ;eographic distri*ution
o Econo(ic statuso Housing
Marital Status
• 3.4 o! elder (end are (arried
o ust o$er hal! o! elder o(en are (arried
• Elder o(en are 3 ti(es (ore li#el" to *e idoed
o )h"?
• Nu(*er o! di$orced elders continues to rise
i$ing rrange(ents• Closel" lin#ed to inco(e% health status% and a$aila*ilit" o! caregi$ers
• 2.3 o! non-institutionali=ed elders li$e ith so(eone else
• nl" 5A o! elders li$e in nursing ho(es
• )hat>s *een "ou e/perience ith !a(il".grandparents?
,acial and Ethnic Co(position
• lder population groing (ore di$erse
• 20+0 elders:
o G0A )hite% FA 7lac#% A Hispanic% 3A sian
•
Co(ing decades:o <ercentage o! elder hites ill decline and older (ericans o!
Hispanic origin ill *eco(e the largest (inorit" group in the U1S1
;eographic istri*ution
• 2.5 li$e in southern states
• ess than +.2 li$e in +0 states:
o C% % I% MI% N% NP% NC% H% <% 8D
• ,easons so(e states ge6
Econo(ic Status
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• +F0: 25A o! elders li$ed in po$ert"
• 20+0: FA in po$ert"
• Inco(e
o Social Securit" &reported *" GA o! elders'
o Inco(e !ro( assets &reported *" 53A'
o <ri$ate pensions &reported *" 2GA'o ;o$ern(ent e(plo"ee pensions &reported *" +4A'
o Earnings &reported *" 2A'
Education
• <ercentage o! elders ho co(pleted high school rose !ro( 2GA in+F0 to F15A in 20+0
• ust o$er 22A o! elders had a *achelor>s degree or higher in 20+0
• iLerences *" race and ethnicit"
• 7a*" *oo(ers (ost educated cohort in U1S1 histor"
Housing
• Most li$e in ade9uate% aLorda*le housing
o G0A on% 20A rent
• Elder ho(es (ore li#el" to *e older R ha$e loer $alue
• 30A o! elders pa" (ore !or housing than the" can aLord
Health <role o! lder dults
• Health status o! elders has i(pro$ed o$er the "ears
• Chronicall" disa*led has *een decreasing
•
Health status usuall" not as good as "ounger counterparts
Mortalit"
• 8op causes o! death !or elders
o Heart disease
o Cancer
o Stro#e
o Chronic loer respirator" disease &C,'
o l=hei(er>s isease
Mor*idit"
• cti$it" li(itations increase ith age
• Chronic conditions
• I(pair(ents
o er" pre$alent in older adults
o Ma" *e sensor"% ph"sical% (e(or"
Health 7eha$iors and i!est"le Choices
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CHAPTER )2Communit! Health and Minorities
U1S1 <opulation *" ,ace.Ethnicit"% 200G
U1S1 <opulation <roKection *" ,ace.Ethnicit"
,acial and Ethnic Classications
• ,ace $s1 Ethnicit"
• Challenges ith classications representing di$ersit" o! population
• Sel!-reported data can *e unrelia*le
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• Man" non!ederal s"ste(s do not collect racial and ethnic data
Health ata Sources and i(itations
• Challenges in co(plete and accurate collection o! racial.ethnic datao Unrelia*ilit" o! sel!-reported data
o 7arriers to data collection a(ong health care pro$iders
o Classications are social constructs that change o$er ti(e and
$ar" across societies and cultureso 7iased anal"sis
• HHS has long-ter( strateg" !or i(pro$ing collection and use o! racial
and ethnic data
• I(portant to understand health *elie!s o! $arious groups
o Heterogeneit" ithin groups
(ericans o! Hispanic rigin
• Hispanic origin is ethnicit" ¬ race'
o Me/ican% <uerto ,ican% Cu*an% Central (erican% or South
(erican descent% or so(e other Spanish origino Nearl" all Hispanics &FA' in U1S1 classied as hite race
• ne o! the (ost rapidl" groing ethnic groups in the U1S1
• Educational attain(ent
• Inco(e
• Health *elie!s
!rican (ericans
• 7lac# or !rican (ericans
o <eople ha$ing origins in an" o! the *lac# racial groups !ro( !rica
• More than +.2 li$e in southern regions
• 2nd largest (inorit" group in U1S1
• Educational attain(ent
• Inco(e
• Health *elie!s and culture
sian (ericans and <acic Islanders
• No to separate racial groupso sian (ericans
<eople o! sian descent ho trace their roots to (ore than
20 diLerent sian countrieso <acic Islanders
<eople o! Haaii% ;ua(% Sa(oa% or other <acic Islands
and their descendants
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<o$ert" ,ates *" ,ace and Hispanic rigin% U1S1
Nati$e (ericans and Health Care
• Man" tri*es are so$ereign nations
o 8ri*es trans!erred land in U1S1 to !ederal go$ern(ent in return !or
pro$ision o! certain ser$ices
• Indian Health Ser$ices &HIS' ithin HHS
o ,esponsi*le !or !ederal health ser$ices to Nati$e (ericans andlas#a Nati$es
;oal to raise health status to highest possi*le le$el
• Education
• Inco(e
• Health *elie!s
I((igrant and ,e!ugee Health
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Cancer Screening and Manage(ent
• Incidence and death rates highest a(ong *lac# (ericans !or $arious
cancerso Man" disparities attri*uted to li!est"le !actors% late diagnosis%
access to health care
• ess pri(ar" and secondar" pre$ention in $arious (inorit" groups
Cancer Incidence and eath ,ates% U1S1 *" Cancer Site and ,ace
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C
• eath rates $ar" idel" a(ong racial and ethnic groups
o 7lac# (ericans ha$e higher rates !ro( CH and stro#e
• H8N pre$alence as ris# !actor $aries according to race.ethnicit"
o 7lac# (ericans tends to de$elop H8N earlier in li!e than hites
un#non reason
ge dKusted <re$alence o! iagnosed or Undiagnosed H"pertension indults
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ia*etes
• $erall pre$alence has risen in U1S1 in recent "ears
o <re$alence in those 20 and older $aries in (inorit" groups
o Increase in age-adKusted death rates in all racial and ethnic
groups Signicantl" higher in (inorit" groups
ge-dKusted <re$alence o! ia*etes *" ,ace.Ethnicit"% U1S1
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HI In!ection . IS
• <roportional distri*ution o! IS cases has increased in 7lac#
(ericans and Hispanics and decreased in )hite (ericanso ttri*uted to higher pre$alence o! unsa!e or ris#" health
*eha$iors% and lac# o! access to health care to pro$ide earl"
diagnosis and treat(ent
,ates o! iagnoses o! HI In!ection a(ong dults and dolescents *",ace.Ethnicit"
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Child and dult I((uni=ation ,ates
• Earl" childhood i((uni=ations do not $ar" signicantl" *" race orethnicit"
• lder adult i((uni=ation rates are su*stantiall" loer in (inorit"
groups% e$en though an o$erall increase has occurredo &inuen=a $accine and <neu(ococcal $accine'
Inuen=a: He(ophilia
<neu(ococcal: Meningococcal
;oals:
Socioecono(ic Status and ,acial and Ethnic isparities in Health
• Man" !actors contri*ute to health disparities
o Econo(ic% educational% *eha$ioral% cultural% legal% and political
Socioecono(ic status &SES' is considered the (ost
inuential single contri*utor to pre(ature (or*idit" and(ortalit"
• ssociation *eteen SES and race.ethnicit" is
co(plicated and cannot !ull" e/plain all disparit"
,elationship 7eteen ,ace and Health
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• ,ace could *e directl" and indirectl" related to health
o irect: gene related disease
o Indirect: (ultiple inuencing !actors
Education% inco(e% en$iron(ent% culture% etc1
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Health Status *" ,ace% Ethnicit" and Inco(e
• )hites ha$e the highest le$el o! satis!action
E9uit" in Minorit" Health
• Si(ple solutions are unli#el"
o E9uit": e$er"one gets &J+00%000'
Usuall" easier% *ut diQcult to guaranteeo E9ualit": diLerent outco(es in the end
J50%000 $s1 J+00%000
• Solutions to pro*le(s !or one group (a" not or# !or another
• Solutions (ust *e culturall" sensiti$e
Cultural Co(petence
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• set o! congruent *eha$iors% attitudes% and policies that co(etogether in a s"ste(% agenc"% or a(ong pro!essionals% that ena*leseLecti$e or# in cross-cultural situations
o )hether a progra( is responsi$e.eLecti$e toards (inorit"
groups o! specic populations.cultures
7od" contact Co((unication . language *arriers
• Culture is $ital in ho co((unit" health pro!essionals deli$er ser$ices
and ho co((unit" (e(*ers respond to progra(s and inter$entions
E(poering the Sel! and the Co((unit"
• 8o ena*le people to sol$e their co((unit" health pro*le(s
o 8hree #inds o! poer associated ith e(poer(ent
3ocial4 access to *ases6 needed to gain political poer
Political4 poer o! $oice and collecti$e action
Ps!cholo&ical4 indi$idual sense o! potenc"
• E/1 Condence in (iddle school that "ou ill go to
college
• E/1 Condence in college that "ou ill ha$e asuccess!ul career a!ter graduation
• Condence and *elie! in onesel!
• Marginali=ation: li(itations to health care &access to !ood%i((uni=ations% etc1'
o )o(en
o o-inco(e
o <regnant teenagerso ,acial (inorit" groups
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CHAPTER ))Communit! Mental Health
Introduction
•Mental illness is the leading cause o! disa*ilit" in the North (ericaand Europe
o @2A o! (erican adults ha$e diagnosa*le (ental or addicti$e
disorders during a gi$en "earo A o! adults in the U1S1 ha$e serious (ental illness
• 8he needs o! people ith (ental illnesses are di$erse
• @+.2 o! people ith (ental illness ha$e (ore than one disorder
5e#ression is the most commonl! dia&nosed mental disorderin the U030
Mental isorders in (erica &National Institute o! Mental Health'
• Mood isorders
o MaKor epressi$e isorder
o "sth"(ic isorder &depression longer than 2 "ears'
o 7ipolar isorder
o Suicide
• Schi=ophrenia &geneticall" related'
• n/iet" isorders
o <anic isorder
o *sessi$e-Co(pulsi$e isorder &C'
o <ost-8rau(atic Stress isorder &<8S'o ;enerali=ed n/iet" isorder &;'
o Social <ho*ia
o gorapho*ia
o Specic <ho*ia
• Eating isorders
o nore/ia Ner$osa
o 7uli(ia Ner$osa
o 7inge Eating
• ttention ecit H"peracti$it" isorder &H'
• utis(• <ersonalit" isorders
o ntisocial <ersonalit" isorder
o $oidant <ersonalit" isorder
o 7orderline <ersonalit" isorder
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Causes o! isa*ilit" !or ll ges% U1S1% Canada% and )estern Europe% 2000
• 8he (ost co((on cause !or disa*ilit" is Mental Health
o 2nd: lcohol and rug Use
o 3rd: l=hei(er>s isease
enitions
Mental Healtho E(otional and social ell-*eing ps"chological resources !or
dealing ith da"-to-da" pro*le(s o! li!e Mental Illness
o ll diagnosa*le (ental disorders
Mental 5isorderso Health conditions characteri=ed *" alterations in thin#ing% (ood%
or *eha$ior associated ith distress and.or i(paired !unctioning
;ood Mental Health
• dults ith good (ental health are a*le to:
o unction under ad$ersit"
o Change or adapt to changes around the(o Maintain control o$er their tension and an/iet"
o ind (ore satis!action in gi$ing than recei$ing
o Sho consideration !or others
o Cur* hate and guilt
o o$e others
Classication o! Mental isorders
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• Classication o! (ental disorders is ar*itrar" *ecause it is *ased ondescriptions o! *eha$ioral signs and s"(pto(s rather than clinical(easure(ents
o &et>s chec# out the Vung sel!-e$aluation scaleW'
o Clinical sur$e"s
• Diagnostic and Statistical Manual of Mental Disorders, *th edition% *" the (erican <s"chiatric ssociation
o 8he (ost inuential *oo# in (ental health
• ac# o! cultural com#etence (a" lead to (isdiagnoses
•
Causes o! Mental isorders
• S"(pto(s can arise !ro( $arious causes &genetic and social':
o <oor prenatal care
o <ostnatal en$iron(ent
o
;eneticso En$iron(ental !actors
o 7rain !unction i(pair(ent
o Su*stance a*use
o Maladapti$e !a(il" !unctioning
• <8S
• MaKor epression
• 7orderline <ersonalit" isorder:
o ra(atic (ood change
o poor relationship handling &(other anting to #ill her children'
o Sel!-har(
Mental Illness in (erica
• Mental illness is one o! the (ost per$asi$e health pro*le(s in the U1S1
• Ho(icide and suicide are the X2 and X3 causes o! death in the +5-24
age groupo ssociated ith (ood disorders and <8S
• High rates o! alcohol% to*acco% and other drug use !or coping ith li!e>s
pro*le(s is another social indicator o! (ental illness1o lcohol.su*stance a*use% etc1 &used to treat (ental illness'
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Stress
• ;eneral daptation S"ndro(e &;S' caused *" stress
o Stage +: lar(
ight-or-ight
o Stage 2: ,esistance
ealing ith the stress
<h"siological and ps"chological changes
o Stage 3: E/haustion
7urnout
)hen diseases are (ore pre$alent
• high *lood pressure% eight gain% etc1
Stress
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• ight or light reaction
• iseases o! adaptation
• <s"choph"siologic disorders
• $oiding stress!ul situations is pre!era*le to (anaging stress
• Stress (anage(ent
• Co((unit" support
Histor" o! Mental Health Care in (erica
• Collecti$e response to (ental illness has *een c"clic in the U1S1
o <eriods o! enthusiastic re!or( and periods o! national
a(*i$alence
o Stig(a o! (ental health &still pre$alent toda"'
Mental Health Care *e!ore )orld )ar II
• Colonial (erica>s (entall" ill ere cared !or *" !a(ilies or pri$ate
careta#ers
• Institutionali6ation rst appeared in the )th centur!
• <opulation groth led to institution groth
o Harsh treat(ents and unpleasant conditions
7urning% ph"sical restriction% etc1
8he Moral 8reat(ent Era
• 7egan in +F2
• 7elie! that en$iron(ental changes can aLect the (ind and alter
*eha$ioro Mo$ed people !ro( settings causing li!e stressors into rural%
peace!ul setting
• ppeared to ha$e success and *eca(e idel" accepta*le
o Not $er" ideal can *e e/pensi$e
• Moral Treatment4 to (o$e people aa" !ro( their real.stress!ul li!e
8he State Hospitals
• 5orothea 5i8 ad$ocated !or pu*lic hospitals pro$iding decent care !orindigents ith (ental illness
• State hospitals *uilt% *ut deterioration o! ser$ices occurred as chronic
nature o! (ental illness as disco$eredo ong ter( or li!eti(e sta"s ere the nor(
o Capacities ere 9uic#l" reached personal care as lost
restraints *eca(e (ore practical staL turno$er as high
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o Not enough (one" go$ern(ent anted to reduce costs
• +F40% population in state (ental institutions as nearl" a hal! (illion
(an" ere elderl"
• Electroconvulsive Thera#! 9ECT: as introduced in +F3F still used
toda"
o Most eLecti$e !or Se$ere% ong-ter( epression• o*oto(ies practiced
o <artial re(o$al o! the *rain
Mental Health Care a!ter )orld )ar II
• NIMH esta*lished &National Institute o! Mental Health'
• Deinstitutionalization !ro( state hospitals propelled *" econo(ies%
idealis(% legal considerations% and antips"chotic drugso 8r" to re(o$e patients !ro( the state hospital
o llo the( to li$e at ho(e
•
Co((unit" (ental health centers !ull" staLed centers originall"!unded *" the !ederal go$ern(ent pro$iding co(prehensi$e (entalhealth ser$ices to local populations
Mental Health Care Concerns 8oda"
• E/periences o! people ith serious (ental illness has i(pro$ed
signicantl" in the past 50 "ears
• Challenges re(ain:
o Ho to pro$ide ser$ices to the homeless
o ,esol$ing pro*le(s o! those ith (ental illness ho are incarcerated
Ho(elessness
• 21+ (illion adults e/perience ho(elessness o$er the course o! a "ear
o G0A te(poraril" ho(eless
o +0A episodicall" ho(eless
o +0A chronicall" ho(eless
• *out hal! o! all ho(eless adults ha$e su*stance use disorders
o Co-relation *eteen (ental health and su*stance a*use
• Man" ha$e (aKor depression and other co-occurring (ental illness
ails and <risons• <eople ith serious (ental illness perpetrate (ore $iolence than
others
• 35A o! people ith (ental illness are $icti(i=ed *" $iolence
More than half of all #rison and jail inmates have mentalhealth #ro"lems
o 8he" o!ten ha$e (ore than one t"pe o! (ental illness
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• nce released *ac# into the co((unit"% the" are (ore li#el" toco((it cri(e i! untreated
• More than hal! &5A' ha$e (ental illness in State
• Higher percentage in ocal ails &4A'
<re$ention
• <re$ention in co((unit" (ental health is considered (ore cost-
eLecti$e than treat(ento <ri(ar"
Education a*out (ental health illnesses
<ro$ide care !or children in need &di$orced parents%trau(atic e/perience'
Counseling and social support groups
o Secondar"
Screening.uestionnaire
o 8ertiar"
,eha* centers
8reat(ent.inter$ention
• <re$enti$e co((unit" (ental health care ser$ices
o <ri(ar"
Educationo Secondar"
lcoholics non"(ous &'
o 8ertiar"
lcoholics non"(ous &'
8reat(ent
• 8reat(ent approaches
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o ;oals to reduce s"(pto(s% i(pro$e personal and social
!unctioning% de$elop and strengthen coping s#ills% pro(ote*eha$iors that (a#e a person>s li!e *etter
<s"chotherap" &<s"chocogniti$e 8herap"'
• <atient la" don on so!a and tal#s to therapist
<s"chophar(acolog"• (edication
<s"chiatric reha*ilitation
• Specic setting in reha*
Sel!-help groups
• E/1 lcoholics non"(ous
• <s"chotherap" and cogniti$e *eha$ior theor"
o Histor" o! e/perience related
Such as *io!eed*ac#% stress (anage(ent and rela/ation
trainingo pplied to less se$ere cases
ederal Initiati$es !or Mental Health Care
• Most !ederal support has *een !or research% sur$eillance% and goal
settingo ess support !or pre$ention% earl" inter$ention% and treat(ent
• Achieving the Promise: Transforming Mental Health Care in America
o ;uide*oo# and plan to ease (ental health issues
• Medicaid spending and (ental health concerns
Co((unit" Mental Health and Managed Care
• ocused on reducing costs o! care and (a#ing sure outco(es are
eLecti$e
• 7eha$ioral health care ser$ices
• Parit! the concept o! e9ualit" in health care co$erage !or people
ith mental illness and those ith other medical illnesses orinjuries
o Insurance co(panies don>t ant to pa" !or (ental illness
*ecause it is long-ter( care% and it can increase e/penses
CHAPTER );Alcohol, To"acco, and ther 5ru&s4 A Communit! Concern
Introduction
• Use% (isuse% and a*use o! (ind-altering su*stances predates recorded
histor"
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• Chronic alcohol and other drug a*use or dependence is regarded asdestructi$e *eha$ior in (ost cultures
• Lects indi$iduals and the surrounding co((unit"
Conse9uences o! rug *use
iolence ssociated ith rug and lcohol Use
our 8"pes o! ,ape:
• ates% a(il" (e(*ers% c9uaintance% Stranger%
Scope o! the Current rug <ro*le(
• More deaths% illnesses% and disa*ilities can *e attri*uted to su*stance
a*use than an" other pre$enta*le health condition
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• Econo(ic costs include direct costs &health care% pre(ature death%i(paired producti$it"' and indirect costs &cri(e and la en!orce(ent%courts% Kails% social or#'
• 8hose a*using drugs are threats to the(sel$es% their !a(ilies% and their
co((unities
enitions
• rug
o an" su*stance other than !ood% that can alter the ph"sical%
(ental% or cogniti$e a*ilit" o! an ani(al or hu(an
• <s"choacti$e drugs
o drug altering sense% (ental a*ilities% cogniti$e a*ilit"% *eha$iors
• rug use
• rug (isuse
o inappropriate use o! prescription and non-prescription
•
rug a*useo an" detri(ental use o! drugs
• rug dependence
o ph"sical.(ental addiction% ithdraal% or cra$ing !or a drug
actors that Contri*ute to lcohol% 8o*acco% and ther rug *use
• ,is# actors
o actors that increase the pro*a*ilit" o! drug use
o Increase the change o! using drugs
• <rotecti$e actors
o actors that loer the pro*a*ilit" o! drug use
o ecrease change o! using drugs
• 7oth can *e genetic or en$iron(ental
Inherited &;enetic' ,is# actor
• Most research related to drug dependence and inherited ris# is on
alcoholis(
• ,esearch has shon genetic and *iological (ar#ers (a" predispose
so(eone to increase suscepti*ilit" to de$elop alcohol-related pro*le(so So(e people are (ore li#el" addicted to su*stance a*use due to
genetic !actors that (a#e the( prone to the *eha$ior
En$iron(ental ,is# actors
• <ersonal !actors
o Stress le$els% li!e e$ents% personal en$iron(ent &classroo('%
education le$el
• Ho(e and !a(il" li!e
o <arents T alcoholic -Y children are (ore prone
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• School and peer groups
o <eer pressure
• Sociocultural en$iron(ent
o Culture% Socioecono(ic status
8"pes o! rugs *used and ,esulting <ro*le(s• egal drugs
o lcohol% nicotine% nonprescription &o$er-the-counter' drugs%
prescription drugs
• Illegal &illicit' drugs and controlled su*stances
o MariKuana% narcotics% cocaine and crac# cocaine% hallucinogens%
sti(ulants% depressants% clu* drugs and designer drugs% ana*olicdrugs% inhalants
egal rugs
•
Can *e legall" *ought and sold in the (ar#etplaceo Includes drugs that can *e closel" regulated% li#el" regulated%
and not regulated at allo Strict
<rescription pain-#illers% (orphine
o Moderate
N"9uil &sho I'% alcohol% to*acco
o Non-regulated
CaLeine
8C (edicine
ood: soda% tea% spic" !ood% sugar% salt
lcohol
() dru& #ro"lem in the United 3tates
• 7inge drin#ing
• Underage drin#ing
• <ro*le( drin#ers
• lcoholis(
• 7lood lcohol Concentration &7C'
• S &etal lcohol S"ndro(e'o Children *orn !ro( (other ho a*uses alcohol during pregnanc"
Mental retardation% partial !or(ation o! *od"% death
Nicotine
• <s"choacti$e and addicti$e drug present in to*acco products
3!nar Amendment
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o Initiated *" Mi#e S"nar &congress(an' o! #laho(a
o ,estrict selling to*acco to people "ounger than +G "ears old
• En$iron(ental to*acco s(o#e &E8S' or second-hand s(o#e
o Lecting !a(il" (e(*ers and pets
$er-the-Counter rugs &8Cs'• egal drugs other than alcohol and to*acco that can *e purchased
ithout a ph"sician>s prescriptiono Usuall" less poisonous% higher.ide sa!et" (argin
Cough drops% cough (edicine
• Care!ull" regulated *" the ood and rug d(inistration &'
• Most onl" pro$ide s"(pto(atic relie!% not a cure
• Su*Kect to (isuse and a*use
o Cough (edicine -Y hallucinations
<rescription rugs• Can *e purchased onl" ith a ph"sician>s prescription *ecause the"
ha$e serious side eLects !or so(e people
• ,egulated *" the
• $er 4%000 prescription drugs a$aila*le
o pain (edicine
o (etha(pheta(ine
• Su*Kect to (isuse and a*use
o 8a#ing (edicine not prescri*ed !or "ou
• ,is# o! dependence
•
,is# o! unintentional o$erdose
Controlled Su*stances and Illicit rugs
• 8hose regulated *" the Controlled Su*stances ct o! +F0
o Cannot *e culti$ated% (anu!actured% *ought% sold% or used ithin
the connes o! the lao 3chedule I high potential !or a*use no accepted (edical uses
Strongl" regulated
Heroin% S% ecstas"
o 3chedule II< - ha$e (edical uses scheduled *ased onpotential !or ris# o! dependence or a*use
o 5ru& Enforcement A&enc! 95EA: responsi*le !or en!orcing
Controlled Su*stances ct
MariKuana
• <roducts deri$ed !ro( he(p plant
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Most a"used illicit dru& in the U030o 8here is no appro$ed ph"sical addiction.dependence !or the use
o! (ariKuanao 8here is ME=TA> addiction !or the use o! (ariKuana
Colo(*ia% Canada% gron in *ase(ents% online shops
• cute eLects reduced concentration% sloed reaction ti(e% i(pairedshort ter( (e(or"% i(paired Kudg(ent
• Chronic ELects
o a(age to the respirator" s"ste( &i! s(o#ed'% a(oti$ational
s"ndro(e
• Increased appetite% rela/ation%
Narcotics
• piu( and its deri$ati$es% mor#hine and heroine% co(e !ro( an
oriental popp" plant
•
Narcotics nu(* the senses and reduce paino Pain Relief
surgeries
o High potential !or a*use
• piu( poppies do not gro in the U1S1 drug traQc#ing pro*le(s
• Heroin addiction leads to signicant co((unit" health pro*le(s
Cocaine and Crac# Cocaine
• Cocaine is the ps"choacti$e ingredient in the lea$es o! the coca plant
• <oer!ul and addicti$e euphoriant.sti(ulant
•
<uried !or(s salt &hite poder'% dried paste &crac#'
Hallucinogens
• <roduce illusions% hallucinations% changes in perceptions
• S"nesthesia (i/ing o! the senses
• 7oth naturall" deri$ed and s"nthetic
• S% pe"ote &cactus'% (ushroo(s
Sti(ulants
• rugs that increase the acti$it" o! the central ner$ous s"ste(
• (pheta(ines
o Schedule II prescription drugs idel" a*used
o Metha(pheta(ines o!ten (ade in clandestine la*s
epressants
• Slo don the central ner$ous s"ste(
• Ma" loer an/iet" and inhi*itions
• 8olerance de$elops
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• Strong ph"sical dependence
• lcohol% *ar*iturates% *en=odia=epines
o loer *lood pressure% treat inso(nia
Clu* rugs and esigner rugs• Illicit drugs% pri(aril" s"nthetic% (ost co((onl" encountered at
nightclu*s and ra$es
• M5MA 9ecstas!: (ost popular clu* drug
• ,oh"pnol &,ues' date rape6 drug
• esigner rugs s"nthesi=ed *" a(ateur che(ists in secret la*s
o Colorless% tasteless% easil" dissol$ed in a drin#
o Constantl" change design to sta" ahead o! la en!orce(ent
na*olic rugs
•
<rotein-*uilding drugs• na*olic.androgenic steroids% testosterone% hu(an groth hor(one
o Increase (uscle (ass% decrease *od" !at% increase per!or(ance%
• Ha$e so(e legiti(ate (edical uses
• So(eti(es a*used *" athletes and *od"*uilders
• cute chronic side eLects
o Mood sings% suppression o! se/ hor(one e/pression% reduced
si=e o! testicles% increased si=e o! *reasts &g"noco(astia'increases cholesterol le$el% increase s"nthesis o! glucose% heartattac#s.C
Inhalants
• Collection o! ps"choacti$e *reatha*le che(icals
• <aint sol$ents% (otor !uels% cleaners% glues% aerosol spra"s
o Soa# paper *ags to inhale
• Eas" a$aila*ilit"
• o cost
• !ten drug choice o! "outh
• cute and chronic eLects
<re$ention and Control o! rug *use
• ,e9uires #noledge o!:
o Causes o! drug-ta#ing *eha$ior
o Sources o! illicit drug
o rug las
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o 8reat(ent pro*le(s
o Co((unit" organi=ing s#ills
• <ersistence% and cooperation o! $arious indi$iduals and agencies
e$els o! <re$ention
• <ri(ar" <re$entiono i(ed at those ho ha$e ne$er used drugs
Education
• Secondar" <re$ention
o i(ed at those ho ha$e used% *ut are not chronic a*users
• 8ertiar" pre$ention
o i(ed at drug a*use treat(ent and a!tercare% including relapse
pre$ention
Ele(ents o! <re$ention• Education
• 8reat(ent
• <u*lic polic"
• a en!orce(ent
• Education and 8reat(ent ;oals are the sa(e:
o ,educe de(and !or drugs
• <u*lic <olic" and a En!orce(ent goals are the sa(e:
o ,educe suppl" and a$aila*ilit" o! drugs
;o$ern(ental rug <re$ention and Control gencies and <rogra(s
• Include a (ultitude o! !ederal% state% and local agencies
• i( to reduce either the suppl" or de(and !or drugs
ederal rug Control Spending
8/18/2019 HES 4503 Unit 2 Notes
http://slidepdf.com/reader/full/hes-4503-unit-2-notes 53/53
ederal gencies and <rogra(s
• Qce o! National rug Control <olic"
• epart(ent o! Health and Hu(an Ser$ices
• Su*stance *use and Mental Health Ser$ices d(inistration &SMHS'
• National Institute on rug *use
• epart(ent o! Ho(eland Securit"• epart(ent o! ustice
• 7ureau o! lcohol% 8o*acco% irear(s% and E/plosi$es &8'
State and ocal gencies and <rogra(s
• State depart(ents o! health% education% (ental health% Kustice% and la
en!orce(ent all address drug a*use pre$ention and control issues
• So(e states ha$e passed las that conict ith !ederal las
• ocal co((unities ha$e indi$iduals% tas# !orces% or agencies to
prioriti=e pro*le(s and decide approaches !or sol$ing the(
Nongo$ern(ental rug <re$ention and Control gencies and <rogra(s
• Co((unit"-*ased drug education progra(s
• School-*ased drug education progra(s
o ,E% student assistance progra(s% peer counseling progra(s
• )or#place-*ased drug education progra(s
o E(plo"ee assistance progra(s
• oluntar" health agencies
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