hes 4503 unit 2 notes

8/18/2019 HES 4503 Unit 2 Notes

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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


• 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


• 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" &not 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'

8/18/2019 HES 4503 Unit 2 Notes


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

8/18/2019 HES 4503 Unit 2 Notes


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"

8/18/2019 HES 4503 Unit 2 Notes


• 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

8/18/2019 HES 4503 Unit 2 Notes


• 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

8/18/2019 HES 4503 Unit 2 Notes


• 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

8/18/2019 HES 4503 Unit 2 Notes


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

8/18/2019 HES 4503 Unit 2 Notes


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

8/18/2019 HES 4503 Unit 2 Notes


• 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

8/18/2019 HES 4503 Unit 2 Notes


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


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

hes 4503 unit 2 notes

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