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Broad street pump) where did the cholera epidemic take place?
London in 1854
Broad street pump) what was the name of the physician that plotted and investigated 578 cases in the city?
Broad street pump) what did John snow find when investigating?
Broad street pump use
Broad street pump) what happened when the pump was disabled?
The epidemic subsided
What is considered to be one of the founding events in the field of public health?
Broad street pump
Lessons from the broad street pump) even if you do not know how to cure a problem...
You may still be able to prevent it
Lessons from the broad street pump) you do not need to know the cause of a problem to prevent it...
You just need to understand something about the mechanisms through which the problem is transmitted or sustained
Lessons from the broad street pump) you can often prevent a problem through...
Changing some aspect of human behavior
Lessons from the broad street pump) while individual behavior change can contribute to prevention...
Complete prevention of a problem often relies upon public action
Rationale for promoting prevention) George Albee thought process of one-to one therapy (2)
-It is a limited mode of helping and there is no way we can assign one professional for one person only
-mental health therapy is also not available or effective with everyone
Rationale for promoting prevention) instead of treating disorders,
- Why not prevent them from occurring to begin with?
- *John snow and public health model
2 approaches for prevention
-preventing psychiatric disorders problem behaviors and social problems
-promoting competence, wellness, and capacity to address problems
caplan model: primary prevention (2)
-given to an entire population when they're is no known need or distress
-reduce exposure to potentially harmful circumstances
ex) vaccines , pre-school programs
Caplan's model: secondary prevention (3)
- intervention at early signs of difficulty
-assumes that there is a reliable way of identifying people at risk
-risk does not mean problems will develop
Caplans model: secondary prevention: what is a person that is labeled "at risk"
- Describes person in a situation that puts them at risk
- *drug abuse
- *teen pregnancy
- *dropping out of high school
Caplan model: tertiary prevention: (30
- focuses open groups with an existing disorder
-population level strategy rather than 1on1 rehab
-can be difficult to distinguish from treatment
Caplan model: tertiary prevention: interventions aimed at? (2)
-preventing further problems
-limiting or addressing disability
US institute of medicine report) Universal preventative measures
For everyone in a given population group
Ex) TV ads about why drugs are bad
US institute of medicine report) selective preventative measures
For groups of people at above average risk for specific problems
Ex) screening for colon cancer after 45 years old
US institute of medicine report) indicated preventative measures
- For individual people who are at high risk for developing disorder in the future especially if they show early symptoms
- ***not treatment for full disorder
Ex) programs for children who experienced child abuse
Population focus of prevention) what do prevention programs focus on?
- Reducing the rate of disorders within a population
- **programs need to measure their success
Population focus of prevention) incidence
- The rate of new cases of a disorder during a give period
- *usually a year
Population focus of prevention) prevalence
The total number of cases in a population
Population focus of prevention) prevention programs aim to lower the incidence of new cases which...
Lower the prevalence in a population
Prevention vs Promotion) promotion
- Help people develop skills and abilities that support well being and health
- **help people function to their fullest potential
- **ex) encourage seniors to be physically active
There are often debates over ______ _____ to prevention or promotion efforts
Risk and resiliency) Emmy werner: Kauai longitudinal study (3)
-followed children burned on the island and followed for 40 yrs
-30% had risk factors in their lives
- -2/3 of the children who had 4 or more risk factors in infancy developed problems before adulthood
- *meaning that 1/3 did not develop serious problems
Ability of some individuals to overcome adverse conditions and experience healthy development
Factors associated with resilience) what are some individual difference? (5)
-self perceptions of competence, worth, confidence
-temperament & personality
-self regulation skills
-positive outlook on life
Factors associated with resilience) individual differences: cognitive abilities examples
-executive functioning skills
Factors associated with resilience) individual differences: self perceptions of competence, worth, confidence
Factors associated with resilience) individual differences: temperament and personality
Factors associated with resilience) individual differences: self regulation skills
-affect and arousal regulation
Factors associated with resilience) individual differences: positive outlook on life
-belief that life has meaning and faith
Factors associated with resilience) relationships differences: (3)
-close relationships with competent adults
-connection to pro-social and rule abiding peers
Factors associated with resilience) community resources and opportunities (4)
-connection to pro-social organizations
-quality of social services and health care
Prevention & promotion programs) Search Institute
Assess and develop programs to promote developmental assets
Prevention & promotion programs) search institute: what are developmental assets?
Factors within the child or the child's environment that promote healthy child and youth development
Prevention & promotion programs) communities that care (2)
-Assess community needs/resources
-recommend evidence based approaches
Prevention & promotion programs) what are communities that care effective in?
-reducing adolescent substance abuse and delinquency
What are the 5 steps of communities that care approach?
1. Get started
2. Get organized
3. Develop community profile
4. Create a plan
5. implement & evaluate
Prevention equation) Albee equation
- Stress + physical vulnerability
- Coping skills+ social support+ self-esteem
- ***this equals to individual level incidence of disorders***
- *if confused look at power point
Prevention equation) What are the 5 interventions that impact Albee equation?
1. Reduce or manage perceived stress
2. Reduce the negative impact of physically biologically based vulnerability
3. Increase coping skills
4. Increase perceived social support
5. Increase self esteem
Prevention equation) Elias equation
- Stressors + environmental risk factors ------------------------------------------------------------
- Positive socialization practices + social support resources + opportunities for positive relatedness and connectedness
**equates to environmental level of incidence of disorders
Prevention equation) 5 interventions that are applied for Elias equation
1. Reduce/eliminate stressors
2. Reduce influence/presence of physical risk factors that result in increased vulnerability
3. Improve socialization practices
4. Increase accessible social support resources
5. Increase opportunities for positive relatedness
Risk factors in equation) what are the 3 numerator on the equation?
Protective factors : denominators, which are they ? (5)
- -social competencies
- *coping skills
- *developmental assets
- *positive socialization practices
-social support resources
-opportunities for connectedness
Do programs work?) 4 questions to ask to determine effectiveness
-how well does it work?
-under what conditions?
-what are the mechanisms that account for its effects?
Assessing whether prevention programs work) 2 ways to measure?
-best practice approaches
Assessing whether prevention programs work) meta-analytic techniques (2)
-combines quantitative analyses
-looks for effect size
Assessing whether prevention programs work) META-ANALYTIC technique: what is effect size?
Strength of the effect of that intervention (IV) on the chosen outcomes (DV)
Assessing whether prevention programs work) best practices approaches (2)
-reviews qualitative analyses & quantitative data
- -context dependent
- *look at programs in settings
Results of prevention of meta-analyses) Duke and wells 1997: how many primary prevention programs were aimed at children and adolescents?
Results of prevention of meta-analyses) results from durlak and wells 1997
59% to 82% of program participants surpassed the performance of children in control groups
Results of prevention of meta-analyses) durlak and wells 1998 results
Average participant was better off than 70% of control group members
Results of prevention of meta-analyses) durlak and wells 1998: how secondary or indicated prevention programs for children?
Meta-analysis) 5 documented significant effects for wide range of prevention programming (5)
-prevention of childhood and adolescent depression
-teen pregnancy &n subsequent teen pregnancies
-childhood and adolescent drug use
Meta-analysis) limitations (2)
-findings can be difficult to translate into clear guidelines for programs
-lacks qualitative piece
Principles of effective prevention programs) theory driven and evidence based (3)
-programs have theoretical justification
-address risk and protective factors identified in research
-empirical support of efficacy
Principles of effective prevention programs) comprehensive
Programs provide multiple interventions in multiple settings to address interrelated goals
Principles of effective prevention programs) appropriately timed (2)
-programs are provided before the onset of a disorder
-at an appropriate development stage for the participants or during important life transitions
Principles of effective prevention programs) socioculturally relevant (2)
-Programs are culturally sensitive
-incorporate cultural norms when appropriate
Principles of effective prevention programs) behavioral and skills-base (2)
-Programs include a strong behavioral component that focuses on the acquisition of specific skills
-ensures opportunities for practicing those skills
Principles of effective prevention programs) sufficient dosage (2)
-Programs are of a sufficient length and intensity to ensure the desired effects
-have a booster sessions when appropriate
Principles of effective prevention programs) positive relationships
Programs specifically promote the development of positive relationships to provide mentoring and social support
Principles of effective prevention programs) second order change
Programs include a focus on changes in setting and communities
Principles of effective prevention programs) support for staff (2)
-Programs provide appropriate training for staff
-ongoing support to ensure effective implementation and evaluation
Principles of effective prevention programs) program evaluation (3)
-programs have ongoing processes to ensure continual evaluation and improvement, assessment of outcomes, and assessment of community needs
Cost-effectiveness analyses) how does it view prevention/promotion programs?
Cost-effectiveness analyses) what do they try to determine?
The return on that investment
Cost-effectiveness analyses) what do they only look at?
Relative costs of programs
*out of several effective programs, which will lower the incidence of the problem for the least amount of money?
3 strikes of injustice summary
The 3 strikes policy prevented more crime but cost more than the 4 programs it was being compared to
Cost-Benefit analysis) question they ask
Are the broad economic benefits greater than the program costs?
Cost-Benefit analysis) what dopes the cost measure?
-program cost per person served
Cost-Benefit analysis) what does benefit measure? (2)
-Services not needed
-earned wages and paid taxes
High scope/ Perry preschool project) what weas it?
program that provided high quality, academically based day care to children born into poverty
High scope/ Perry preschool project) how was it evaluated?
Using randomized control trial
Prevention of HIV/AIDS infection) one main factor to preventing?
Promotion of healthy sexual behaviors
Prevention of HIV/AIDS infection) how many interventions did CDC identify as demonstrating best evidence?
Project safe) who does it target?
Minority women who have been diagnosed with an STD at a public health clinic
Project safe) goals
Increase healthy sexual behavior and decrease subsequent STD infections
Prevention of childhood behavior disorders) what does it promote?
Promotion of positive parenting
Prevention of childhood behavior disorders) incredible years (Webster-Stratton) what is it?
-parent training program targeted for parents of young children with behavioral problems
Prevention of childhood behavior disorders) incredible years, what does it incorporate?
Principles of effective prevention programs
Prevention of bullying) what does it promote?
Safe school climates
Prevention of bullying) olweys bullying prevention program: what is it? (6)
-give survey on school bullying activity
-discuss the results of the survey
-increase supervision in hot spots
-encourage pro social play
-have regular class meetings and clear rules
Prevention of bullying) olweys bullying prevention program: is it effective?
Yes when implemented with high fidelity
Prevention of bullying) olweys bullying prevention program: does it allow for flexibility with the other schools?
Yes, it tailors to specific schools
Implementation & sustainability ) what does emerging research address?
Actual implementation of prevention/promotion initiative in local contexts
What would you like to do?
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