people abuse different substances (ch2)

HCA 3306, Community Health 1

Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to:

2. Recognize effective principles of health programming for community health on a global scale. 2.1 Explain the key importance of epidemiology in advancing community and public health. 2.2 Recognize community health programs in the substance abuse field.

6. Formulate plans to educate a given community on issues of alcohol, tobacco, and drug use.

6.1 Incorporate descriptive epidemiology in assessing substance abuse programming. 6.2 Ascertain effectiveness in substance

Course/Unit Learning Outcomes

Learning Activity

2.1

Unit Lesson Chapter 2 Chapter 3 Unit II Case Study

2.2

Unit Lesson Chapter 2 Chapter 3 Unit II Case Study

6.1

Unit Lesson Chapter 2 Chapter 3 Unit II Case Study

6.2

Unit Lesson Chapter 2 Chapter 3 Unit II Case Study

Required Unit Resources Chapter 2: Descriptive Epidemiology in Community and Public Health Chapter 3: Analytical Epidemiology in Community Public Health

Unit Lesson

Understanding Epidemiology Anyone who aspires to a health care leadership role today needs a solid understanding of epidemiology. That is true if you plan to manage health care services in a clinic or hospital setting. It is also true if you plan to work on the community/public health side of things. Your understanding begins with a broader look at the public health approach. Health problems in America are diverse and constantly changing. They can include infectious problems, intentional and unintentional injuries, environmental health issues, chronic disease states, and a wide variety of other problems.

UNIT II STUDY GUIDE

Epidemiology in Community Health

HCA 3306, Community Health 2

UNIT x STUDY GUIDE

Title

So we begin with a simple question: What is the problem? In epidemiology, we identify problems through a process called surveillance, which is step one. Today, we have many sophisticated surveillance systems in place to watch for emerging health trends, and there is one thing we can count on as health care professionals. There will always be a problem to solve in American public health. Surveillance involves the participation of health care professionals at all levels and in all settings. It includes the reporting of diseases seen in clinics and emergency rooms, hospital admissions, and sentinel surveillance for specific types of public health events. The global identification and response to severe acute respiratory syndrome (SARS) and Ebola would form excellent examples of such surveillance. The identification of Legionnaires’ disease at the American Legion convention in Philadelphia is another great example, and the annual tracking of influenza cases is very relevant here. Recently, surveillance has focused on pertussis (whooping cough), a disease that was nearly eradicated in America, but today, it must be carefully surveilled because of parental decisions not to vaccinate their children for this disease. Surveillance helps us to find the problem, and then we move on to the second question: What is the cause of the problem? Perhaps, there are factors that make certain populations more susceptible to a particular disease or condition. Perhaps, there is something in the environment that is the true cause of illness. Or, perhaps, human behaviors are actually the cause. Risk factor identification is step two in our public health approach. Step three is intervention and evaluation. As a simply stated question for this step, we might ask the next question: What works? Here, we consider interventions that might be effective to address the problem at hand. We consider what has worked in the past for addressing similar types of health problems, and we consider proposed interventions that might make sense for our presently impacted population. Finally, step four is implementation. With a proposed public health intervention strategy in hand, we now focus on how to actually implement that intervention. We need to be realistic about the resources available. We need to be realistic about the client population served and their likelihood to cooperate with the intervention. We need to answer a very practical question: How can we do this?

Public Health Core Sciences For perspective, the focus of this unit is epidemiology, but we must think of that topic in the context of five core sciences within the domain of public health. Those five sciences are prevention effectiveness, surveillance, informatics, laboratory, and our current focus of epidemiology. Putting it all together to see the flow, surveillance monitors a public health situation. Epidemiology helps us to determine where diseases originate and how they move through populations. It focuses on how we can prevent disease, and public health laboratories play an important role by performing tests to confirm diagnoses. Laboratories also support research and training, and the emerging field of informatics allows us to collect, compile, and present health information in the most meaningful ways. The electronic health record (EHR) is closely connected to public health informatics, allowing better and quicker research than ever before possible. It is likely that new understanding of pathology, diagnosis, and treatment will be coming with the years ahead, simply because we now have the ability to mine for data about any condition or treatment through the interoperable EHR. Together, the five core sciences of public health give caregivers the answers they need for the pressing health issues in their client populations. Public health is better able to respond today, utilizing the contributions from each of the five core sciences. One important point is that any one science alone is not sufficient. Our advances in public health come when all five sciences work together.

Epidemiology Epidemiology provides us with an opportunity to determine where diseases and conditions truly originate, and sometimes, that means looking quite a distance upstream, past the most immediate and obvious observations, to the real cause of a problem. We also consider how diseases are transmitted through populations. Perhaps, the best definition of epidemiology comes to us from A Dictionary of Epidemiology by

HCA 3306, Community Health 3

UNIT x STUDY GUIDE

Title

Oxford University Press. There, we see epidemiology defined as the study of the distribution and determinants of health-related events, states in specified populations, and its application to the control of health problems (“Epidemiology,” 1988).

Key Concepts of Epidemiology Epidemic is a term used often in health care, perhaps, sometimes too loosely. You need to understand this term precisely. An epidemic is a disease occurrence among a population that is in excess of what is expected in a given time and place. As of this writing, a measles epidemic is taking place in 19 states and several foreign nations. The epidemic has been tracked back to travelers from Israel, Ukraine, and the Philippines where large measles outbreaks have occurred (Centers for Disease Control and Prevention, 2019). Cluster refers to a group of cases in a specific time and place that may be more than anticipated. Several areas of the United States have been designated as cancer clusters because of unusually high incidence of cancer in the area. Sometimes, this can be linked to a particular environmental exposure. Endemic refers simply to any disease or condition that is present in a particular population at all times. Chicken pox is an example of an endemic disease that exists in the United States every year at a predictable rate. It is always with us. Malaria is an example of an endemic disease that is present in many parts of Africa on an ongoing basis. Pandemic is any disease or condition that spreads across nations. Historically, HIV/AIDS was considered to be a pandemic. Additionally, the Spanish influenza of 1918 was a classic pandemic, killing 50 million people across the world. In modern times, the 2020 Coronavirus, or COVID-19 quickly reached pandemic levels and has had devastating consequences. Rate refers to the number of cases of any disease or condition occurring during a specific timeframe. Rates are always based upon the total population existing during that timeframe. For example, the neonatal mortality rate is the number of deaths occurring in the first 28 days of life, divided by the number of live births in a particular year.

Epidemiology Study Types In experimental studies, epidemiologists are able to control certain variables from the start of the study. This type of study truly is an experiment. One classic example would be a study to determine the effectiveness of a vaccine. In the experimental design, researchers randomly assign study participants to a test group or a control group, administer the vaccine to the test group, and then see if the vaccine actually reduces the incidence of the disease. Observational studies are quite different. Here, the epidemiologist cannot control the variables at play, but they can observe impacts. Observational studies are divided among descriptive types and analytic types. Descriptive studies are perhaps the most common in epidemiology, and they are foundational to our work in community health. Here, the researcher does not manipulate anything, but instead, he or she collects information that characterizes or describes a particular health event, disease, or condition. Descriptive epidemiology asks questions such as the three listed below.

• When was the population impacted?

• Where specifically was the population impacted?

• Who specifically was impacted? Meanwhile, in analytic studies, the epidemiologist considers comparisons between different groups to evaluate possible causative factors or risk factors. Analytical epidemiology asks questions such as the two listed below.

• How specifically was the population impacted?

• Why specifically was the population impacted?

HCA 3306, Community Health 4

UNIT x STUDY GUIDE

Title

Data Sources and Collection Epidemiology encompasses a vast amount of data from a wide range of sources. Let’s consider the primary types and sources. When we are obtaining data from individual clients, we generally use questionnaires or surveys. A challenge here is the typically low return rate for such instruments, but important data can be obtained in this way, and the cost is usually reasonable. To obtain data from the environment, sampling is performed. Typical sources include water samples, soil samples, air samples, and sensors for various environmental conditions such as temperature or humidity. Health care providers can clearly be a valuable source of data, and we most commonly access their information via notifications to local and state health departments. For example, certain reportable diseases generate mandatory reporting to the health department, thereby creating important data for epidemiologists. And finally, financial and legal records do provide useful information for our science, including sales records for things like cigarettes and over-the-counter medications. While legal records for DUI and violent crimes can also provide important perspectives for researchers.

References Centers for Disease Control and Prevention. (2019). Measles cases and outbreaks.

https://www.cdc.gov/measles/cases-outbreaks.html Epidemiology. (1988). In A dictionary of epidemiology (2nd ed.). Oxford University Press.

Suggested Unit Resources In order to access the following resource, click the link below. Viruses have a bad reputation, but some of them could one day save your life, says biotech entrepreneur Alexander Belcredi. In this fascinating talk, he introduces us to phages—naturally-occurring viruses that hunt and kill harmful bacteria with deadly precision—and shows how these once-forgotten organisms could provide new hope against the growing threat of antibiotic-resistant superbugs. TED. (Producer). 2018. TEDTalks: Alexander Belcredi – How a long-forgotten virus could help us solve the

antibiotics crisis. Films on Demand. https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl aylists.aspx?wID=273866&xtid=209787

The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in the Films on Demand database.