Blog assignment #12: Identifying Key Determinants

Key determinants are important precursors of a public health problem, and therefore possible targets for prevention initiatives. There can be five different types of key determinants: Biological, socio-cultural, environmental, economic and political determinants. In my public health problem's case -- increased incidence of lung cancer associated with cigarette smoking among adult women (age 18 to 65) in the United State from 1991 to 2006, biological factors mostly can be identified as genetic, biologic differences that affect development of lung cancer in women. According to American Society of Clinical Oncology, there has been studies shown genes that cause women to be more vulnerable to the harmful effects tobacco smoke. They also mentioned that the increase in the incidence of lung cancer in women from 1991 to 2006 (when the incidence of lung cancer in men decreased)can be attributed to the differences in how the chemicals in tobacco are metabolized by the body; also changes to genes that control cell growth, which may result in the development of cancer,a decreased ability of the body to repair damaged DNA,as DNA damage can promote the development of cancer, difference in hormone secretions can be reasons why there has been a discrepancy between the incidence of lung cancer in women and in men. This issue also can be attributed to many socio-cultural factors which are related to social class, social environment, and the social norms. Although the status of women the society is now equated to that of men, there has been a long stereotype that women are inferior to men. Seeking gender equality, self-confidence, freedom, many women this time period started smoking; According to a study in the journal, Tobacco Control, in this time period, many tobacco advertisements targeting younger women focused on the themes of friendship with other women, self-confidence, and independence. Not only for younger women, advertising messages targeting older women included social acceptability, relaxation, a woman's need for pleasure, and an escape from daily life. These cigarette advertisements may have helped form illusions about women's smoking cigarettes, therefore leading to decisions that "benefits outweigh advantages" despite numerous campaigns warning the harmful effects of cigarette. Also, wrong impression that smoking helps you lose weight lured many adult women to start smoking. According to the U.S Centers for Disease Control and Prevention (CDC), at least 500,000 teenage girls use tobacco products, and they claimed that the reasons why they started smoking included the popular belief that smoking can help control weight. For environmental determinants, which are physical factors that individuals are not usually able to change, include secondhand smoking and exposure to asbestos which are used as flame retardant in buildings. Economic determinants include any issues related to money; in this case, as the number of women with jobs increased (U.S department of labor: women's share of force -- By 1998, nearly three of every five women of working age were in the labor force. Among women age 16 and over, the labor force participation rate was 33.9 percent in 1950, compared with 59.8 percent in 1998), more women were able to afford cigarettes. I do not believe there were any executive, legislative or judicial decisions that may have promoted the increase in women's cigarette smoking, because thanks to numerous efforts of public health agencies tax on tobacco has been increased to deter people from buying cigarettes. Considering this public health issue in many aspects,I conclude this issue to be multifactorial (mostly biological and socio-cultural determinants) and needs more attention from the society


Reference - citations are not in proper formats but i will put them later when I write the final paper
http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Features/Cancer+Screening+and+prevention/women+and+lung+cancer
http://www.lungcancer.org/reading/about.php
CDC
U.S. department of labor

Blog assignment #11: magnitude of the topic of interest

The purpose of surveillance is not only to collect various data from the states (data collected by local states), but also to actively conduct a number of surveys to understand the status of American population's health better. In my topic's case, surveillance is used to assess the prevalence of lung cancer as a whole -- not only the population of American women--, to identify risk factors, and find the trends. Some public health agency actively go to the public, get some samples, and conduct examinations and tests. Further, surveillance could be used to assess the how the health-related behaviors such as smoking cigarettes and alcohol consumptions. There are two types of indicators: direct indicators and indirect indicators. In my case, direct indicators will be prevalence of women in the united states who got diagnosed with lung cancer and the increased number of lung cancer deaths in women. Because smoking is now commonly known to be the primary cause of lung cancer, indirect indicators will be increased number of female smokers, the number of cigarette purchases made by female customers. Of course, lung cancer can develop due to various factors such as genetic factors, hormones, and environmental factors, but according to cancer.com, "From 1991 to 2005, the number of new lung cancer diagnoses in women in the United States increased by 0.5% per year, while the number of new lung cancer diagnoses in men decreased by 1.8% per year. The number of male smokers has declined by about half over the last four decades; however, the number of women smokers has decreased by only 25%" From this piece of statistic, I think the increase number of women with lung cancer can be more attributed to smoking habits. I think the source of this data is pretty reliable since the website is run by American Society of Clinical Oncology. The American Cancer Society's most recent lung cancer statistics in the United States for 2009 include an estimated 116,900 men and 103,350 women will be diagnosed with lung cancer and an estimated 88,900 men and 70,490 women will die from lung cancer. This indicates that lung cancer tend to affect men more than women; this however does not mean that this statistic contradicts with the one above since its comparing the the prevalence of lung cancer in men vs. in women. This source is again reliable because its from the American Cancer society. Its weakness is that it does not show the "increase number of female smokers," it rather only compares the number of cases of lung cancer in men to women. National Cancer institute stated on their website that a new study reveals that incidence rates of lung cancer among people who have never smoked (never smokers) are higher in women than in men. Lung cancer incidence rates among female never smokers aged 40 to 79 ranged from 14.4 to 20.8 per 100,000 person-years, while incidence rates among male never smokers aged 40 to 79 ranged from 4.8 to 13.7 per 100,000 person-years. This is a reliable source as well because its by National cancer institute. Though it indicates that women are more prone to get lung cancer than men-- it only shows genetic factors or factors that can contribute to development of lung cancer, excluding the primary cause of lung cancer. This is also a weakness because it's missing out the biggest factor.

Blog assignment #10

In my last blog post, i said that i wanted to write my paper on the increased incidence of leukemia after atomic bombings in japan in the early 1900s. However, after i discussed my topic with Dr. Kahan, i realized that it will be much easier for me to analyze more of a current problem. So, I picked one topic of my interest: lung cancer. Because my parents and my boy friend have been smoked cigarettes, I am very interested in lung cancer and its current status. I went to the website of CDC, which i believe a reliable source. On its website, CDC said that although the number of smokers in the United States has decreased due to the decrease in the number of male smokers. However, among women in the United States, reductions in smoking are more recent, beginning in the late 1970s. Lung cancer death rates for U.S. women are among the highest in the world. To mention the particular statistics, it said that "in the United States, incidence of lung cancer has increased significantly by 0.4% per year from 1991 to 2006 among women" Time frame is from 1991 to 2006 and the population of this problem definition is women in the United States (CDC did not mention the age group; i have not gotten any chance to contact them and ask them, but i am soon going to ask them about it). As i said above, I am very interested in this topic because so many people around me, including myself (rarely), are smokers. I am very worried about my mom particularly because she has attempted to quit smoking so many times but failed. this is reason why i am interested in this topic

Blog assignment #9: my topic for the final paper

I have not done any full research on this topic, but I have always wondered and fascinated by the atomic bombings of Hiroshima and Nagasaki during world war II. On Wikipedia, it says that within the first two to four months of the bombings, the two atomic bombs killed 90,000–166,000 people in Hiroshima and 60,000–80,000 in Nagasaki, with roughly half of the deaths in each city occurring on the first day. What I am interested in is the aftermath rather than the acute effects. In my paper, I would like to address the increased incidence of leukemia attributed to radiation exposure among 1905-1920 birth cohorts from 1940-1970 in Japan exposed to the two atomic bombs in 1945. This is very important because nuclear weapons have been developed and improved over the course of couple decades, and under the contract the use of nuclear weapons is prohibited; however, we still often are threatend by nuclear weapons present, and just in case it is important to learn how it affects/might affect the health of the population. Some people would not find this interesting because this topic could feel unrealistic since nuclear weapons are not as common-- should not be common :) I, however, find this interesting because I read a book about this japanese family who raised a monkey deformed due to exposure to radiation during atomic bombing. It was many years ago but the story was very touching, and I have always wanted to learn about radiation exposure and how it affects people. Also, since I am from South Korea, which is a country in vicinity to Japan, and therefore could have gotten affected by the bombing and radiation follwed, I would like to investigate.

Blog assignment #8

We have learned a lot of things; As i said on my blog page at the beginning of this semester, I just vaguely thought public health is about promoting the health of the public, the population. I feel like since the beginning of the semester, i have gotten to know the various branches of public health and their roles and health care/ 2010 health reform which recently was passed. Although all the lectures were very interesting, i found infectious diseases, chronic diseases, and obesity lectures very engaging. I think i am most interested in diseases like epidemiology part of public health, rather than politics.. I had vaguely known that many Americans suffer from, dying from chronic diseases, I did not expect it to be that problematic. When i was listening to obesity lecture, I was upset how some people in our society did not get to choose but to become obese. It was a big shock to me when i found out that 67% of American are obese. Before i took this course, i did not know how public health was so much related to politics. We learned in class that the core functions of public health are assessment, policy development and assurance. As much as policy development is one of the core functions of public health, it is so much related to politics and it has to be statigic..so i think this is the thing that was most unexpected..Since the beginning of this class, i think i got to learn more about public health and what part of public health im most interested in. i still want to major in public health (Epidemiology) But i know there are still many branches in epideology; i think i will need to see which part of epidology i want to study and contribute.

Blog assignment #7: 2010 healthcare reform bill

This week, in public heatlh, we learned about health insurance, access to care, and the new health care reform. One statistic presented in class was comparing Per capita health spending to Per capita GDP. Compared to the other OECD countries, US is an outlier, in this case. This indicates that the United States spends way too much money on health care; however, international comparison (in a different statitstic) shows that average life expectancy of the United States is low relative to other developed countries. To tackle this irony, and to provide Americans better health care services more effectively, president Obama and the Congress have been working on and have finally gotten passsed "the 2010 Health Care reform bill." First of all, this bill will expend insurance to 32 million uninsured Americans. Under this health care reform bill, small businesses will get tax credits covering up to 50% of employee premiums. Also, it will constrain the growth of Medicare (which will be very helpful in paying for reform) by various ways, one of which, the donut hole coverage. Seniors with this coverage will be given rebate but be given limited precription medication coverage. As we have seen in class, among the uninsured, many of them are actually young adults because after thier parents' coverage, they do not feel the need of being insured. To solve this problem, the cut off age for young adults tto be covered by their parents' insurance became the age 27, indicating more young adults will be insured. New insurance plans will include checkups and other preventive care with no co pays. To improve transparency in insurance companies, from now on, they need to reveal how much money is spent, and there will be more and enhanced fraud abuse checks. Some small businesses might not be happy with health care reform bill because it will require them more than 50 workers to provide medical insurance for their employees or pay a 2-thousand dollar fine per worker. Also, now that the budget became tighter and the transparency is more emphasized, insurance companies are not satisfied. I think educated middle class will be the most happy with it because among the uninsured, most of them are uneducated, and therefore they do not realize how important it is to be insurance in a long term. They tend to see what's directly in front of them. Also, minorities and women are very in favor of this bill because this bill emphasiezes equity: for example, it is now illegal for insurance companies to make health care more expensive for women. I think it is a good piece of legislation; however its too ideal. it will be very hard to first implement this. I think it will cause so much chaos, especially, educating the uninsured will be extra hard...This will affect my family because we currently have Masshealth(we are from Massachusetts), which is a state-level insurance; Massachusetts provide insurance even for the people with no social security number(we are international students).

blog assignment #6

The economic recession has been the major effect on the health care system. Along with the economic recession, the congress is legislating helath care policies that can greatly affect the health care system; therefore, private and public health spending, or both, seem to change dynamically. The article that we are reading this week offered projections for private, public and national health spending. These projections were based on 2009 medicare trustees Report and total health spending is expected to grow faster after 2010 because of expected increase in personal income along with the economic recovery. Also as baby boommer generation move from private coverage to medicare, the private spending growth will seem to slow down, where as public spending growth will acclerate. Surprisingly, health spending is expected to grow to 4.5 trillion by 2019. However, public health spending seems to increase to 52 percent of all health spending by 2019 because of continued influence of the recession and possible demographic changes.The author of the article says, these projections do not include health care reform proposals and defense appropriations act, which extended COBRA coverage subsidization andlimited Medicare physician payment rates. Two primary factors that affect personal health care spending (purchase of health care products and services) are medical prices and utilization. Medical prices are influsenced by economywide factors. Then the author looks at various insurance payers: medicare, medicaid, private health insurance companies and people's out of pocket spending. As mentioned above, the author believes medicare spending growht will be expected to average 7.4 percent due to the baby boomers despite 21.3 percent reduction in physician payement rate recetly. The federal and state Medicaid is at its fastest growth rate for now; this is a result of rising unemployment. The article says, however, the medicaid spending growth seems to slow to 7 percent by 2012 as the economy improves. Another cause in increase of medicaid spending is increased number of the aged in the program; they tend to be more costly than other age groups. Due to reduction in the number of people with private health insurace, private health insruace premiums comparably increase. The article projects premium growth to reach 7.1 percent by 2015. At the same time, the services that require out-of-pocket costs are in less demand; enrollemnt growth in medicaid seems to increase.
Continued increases in healthcare spending and continued proportional increases in public spending suggest that the health care system in the united states is not working out efficiently, despite high demand of health care services, first of all. Also, as mentioned above, increases in pulbic spedning opposed to private insurance spending indicates that the economic recession is still influencing health care system. I think the most pressing issues for health care reform should be educating people about insurance and how being uninsured can actually lead to higher costs and how it can affect the society.