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NUR 345 Exam 3 Study Guide
A) Environmental Health (~12 questions) Dr. Standifer
1. Define know the theories applicable to environmental health (specifically know
the Precautionary Principal)
Precautionary Principle
• Social responsibility to protect the public from exposure to harm when scientific
investigation has found a plausible risk. The precautions can be relaxed only if further
scientific findings emerge that provide sound evidence that no harm will result.
2. Distinguish between a hazard and risk and identify from an example which is
being described. (Shark slide)
Hazard: Something that can potentially cause harm (relatively no harm unless exposed)
Risk: hazard+exposure HEALTH RISK!
Environmental Health Hazards
• A substance that has the ability to cause an adverse health event
• Includes physical, chemical, and biological factors that are external to a
person
• Can be natural or human-made
Examples:
Pesticides
Chemicals in consumer products
Radiation
Health risks
● Respiratory system/lung toxicity
● Neurotoxicity
● Hematotoxicity
● Skin, eye, and mucous membrane toxicity
● Reproductive system toxicity
● Other major organs and systems toxicity
● Carcinogenic effects
3. Define environmental justice and how injustice can impact health (What
populations are most at risk and why; Environmental racism; and Climate justice.
Make sure that you can identify the examples of injustice from the video about
Flint, MI water crisis)
Environmental Justice
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• “The fair treatment and meaningful involvement of all people regardless of race, color,
national origin, or income with respect to the development, implementation and
enforcement of environmental laws, regulations and policies.” – EPA
Populations of Special Concern
• Pregnant women
• Children
• Elderly
• Individuals with disabilities
• Vulnerable populations
• Workers
Environmental Racism
• Differentially affects or disadvantages individuals, groups or communities based on
race or color
• Intentionally or unintentionally (unconscious bias)
• Form of environmental injustice- reinforced by government, economic, and political
structures and institutions
• Benefits white people, while shifting cost to people of color
• Disregarding racism as a contributor to health disparities ignores social history and the
experience of afflicted individuals and perpetuates inequities.
Environmental Injustice Example:
The Flint, MI Lead-Tainted Water Crisis 2014
Climate justice
Connects the climate crisis to the social, racial and environmental issues in which it is
deeply entangled. It recognizes the disproportionate impacts of climate change on
low-income and BIPOC communities around the world, the people and places least
responsible for the problem.
4. Identify control strategies and be able to give examples of each.
Control Strategies
• At the Source
• Along the path
• At the level of the person
• Secondary prevention
5. Discuss the differences between the methods of surveillance/assessing
exposures (ex. when given an example be able to identify what type of
surveillance is being used)
Methods of Surveillance/Assessing Exposures
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• Toxicology studies- Toxicology is a field of science that helps us understand the
harmful effects that chemicals, substances, or situations, can have on people, animals,
and the environment. For example, in agriculture, toxicology determines the possible
health effects from exposure to pesticides or herbicides, or the effect of animal feed
additives, such as growth factors, on people.
• Epidemiologic studies- the foundation for disease control and prevention through
tracking the prevalence of the disease, characterizing the natural history, and identifying
determinants or causes of the disease. . It defines risk factors for a disease and targets
for preventive medicine. The four types of epidemiologic studies commonly used in
radiation research are cluster, ecologic, case-control, and cohort studies. An additional
approach for estimating risk in radiation research
• Environmental monitoring- a tool to assess environmental conditions and trends,
support policy development and its implementation, and develop information for
reporting to national policymakers, international forums and the public.Monitoring water
quality is an example of environmental monitoring since you are tracking and measuring
the pollutants in the water
• Biological monitoring- using biomarkers to represent or estimate exposure. A
biomarker is a biochemical, molecular, genetic, immunologic, or physiologic indicator of
events in a biological system. As a result, biomarkers are indicators of exposure, effect,
and/or susceptibility. Examples of biological monitoring include obtaining a blood lead
level and/or zinc protoporphyrin level in a worker with known lead exposure
• Product surveillance- Performs and/or documents regulatory reportability decisions on
complaints in accordance with applicable local laws regulations. Communicates with
local and international competent authorities, including generation and/or submission of
medical device event reports as required by applicable local laws and regulations.
6. Identify and differentiate between the roles of the National Environmental
Public Health Tracking Network, Air Quality Index, and ToxFAQs
The National Environmental Public Health Tracking Network
Brings together health data and environmental data from national, state, and city
sources and provides supporting information to make the data easier to understand.
The Tracking Network has data and information on environments and hazards, health
effects, and population health.
Kentucky’s Air Monitoring Network KY Energy and Environment Cabinet
Measuring
• Carbon monoxide
• Lead
• Nitrogen Dioxide
• Ozone
• Particulate Matter
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• Sulfur Dioxide
ToxFAQs
• Agency for Toxic Substances and Disease Registry summaries of hazardous
substances
7. Discuss and describe environmental health hazards as well as what a healthy
environment includes to understand the impact that the environment has on our
health
Environmental Health Hazards
• A substance that has the ability to cause an adverse health event
• Includes physical, chemical, and biological factors that are external to a person
• Can be natural or human-made
Examples: Pesticides, Chemicals in consumer products, Radiation, Common Human
Health Risks from Environmental Hazards
• Respiratory system/lung toxicity
• Neurotoxicity
• Hematotoxicity
• Skin, eye, and mucous membrane toxicity
• Reproductive system toxicity
• Other major organs and systems toxicity
• Carcinogenic effects
The environment is everything around us- the air we breathe, the water we drink and
use, and the food we consume. It’s also the chemicals, radiation, microbes, and
physical forces with which we come into contact. Our interactions with the environment
are complex and are not always healthy.
Requirements for a Healthy Environment
• Clean Air
• Safe & Sufficient Water
• Adequate and Safe Food
• Safe and Peaceful Settlements
• Stable Global Environment
9. Know the data around modifiable environmental risk factors including
the percentage of deaths caused by them worldwide.
B) Health Promotion, Health Education and Health Literacy (~8 questions) Dr.
Feld
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1.Define health education and be able to differentiate between and identify
examples of each of the three learning domains (cognitive, affective, and
psychomotor)
Health Education
... is any combination of learning experiences designed to predispose, enable, and
reinforce voluntary behavior conducive to health in individuals, groups or
communities. – Green and Kreuter, 2004. Includes a broad and varied set of
strategies aimed at influencing individuals within their social environment for
improved health and well-being
Health Education 3 Learning Domains
Cognitive Domain: knowledge memory, recognition, understanding, reasoning,
application, problem solving
Affective Domain: attitudes changes in attitudes and values; motivation
Psychomotor Domain: skills, skill performance, demonstration, hands-on. Ideally,
communities and individuals will acquire knowledge, new skills, and/or motivation
3. Describe the logical order of the levels of Blooms Taxonomy. *Use the
diagram of Blooms from this lecture*
4. Identify different types of literacy and strategies to assess health literacy.
(ex. REALM-SF and NVS)
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Assessing “Health Literacy”
• Rapid Estimate of Adult Literacy in Medicine revised, short form (REALM-SF)
Patients are given a copy of the REALM-SF form with these words
They are asked to read each word out loud.
Inability to do so or taking longer than 5 seconds is left unscored.
Higher score = higher literacy
Menopause
Antibiotics
Exercise
Jaundice
Rectal
Anemia
Behavior
Score Grade range:
0: Third grade and below; will not be able to read most low-literacy materials; will
need repeated oral instructions, materials composed primarily of illustrations, or
audio or video tapes.
1-3: Fourth to sixth grade; will need low-literacy materials, may not be able to read
prescription labels.
4-6: Seventh to eighth grade; will struggle with most patient education materials; will
not be offended by low-literacy materials.
7: High school; will be able to read most patient education materials.
Newest Vital Sign (NVS)
1. If you eat the entire container, how many calories will you eat?
2. If you are allowed to eat 60 grams of carbohydrates as a snack,
how much ice cream could you have?
3. Your doctor advises you to reduce the amount of saturated fat in
your diet. You usually have 42 g of saturated fat each day, which
includes one serving of ice cream. If you stop eating ice cream,
how many grams of saturated fat would you be consuming each
day?
4. If you usually eat 2500 calories in a day, what percentage of your
daily value of calories will you be eating if you eat one serving?
Pretend that you are allergic to the following substances:
Penicillin, peanuts, latex gloves, and beestings.
5. Is it safe for you to eat this ice cream?
6. (Ask only if the patient responds “no” to question #5) Why not?
Test of Functional Health Literacy in Adults (TOFHLA)
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Short Test of Functional Health Literacy in Adults (STOFHLA)
5. Differentiate between individual and population level health promotion
efforts
Individual/family health promotion can include education addressing modifiable risk
factors.
Population Health promotion can include a wide range of social and environmental
interventions including public policies that reduce exposure to risks or remove
barriers to health. (Smoke-free, DUI, PE in schools)
C) Care of the Non-English Language Preference Patient (~5 questions) Prof
Walden
1. Identify the two approaches to providing language appropriate care and
how to provide appropriate communication to your patients.
Language-concordant care:
Services provided by a clinician who speaks the same language as the patient
Interpreter-mediated care:
A medical interpreter acts as a linguistic conduit between patient and clinician
2. Identify the types of patients who would need an interpreter to be provided
to them and which situations you would want to utilize an interpreter (ex.
obtaining a medical history) and who can (and cannot) be an interpreter for the
patient.
Who needs an interpreter?
● Patients, family members, or friends of the patient who have a Non-English
language preference (NELP)
● Hearing impairment or Deaf patient
When should an interpreter be used?
● Obtaining a medical history and performing physical exams
● Performing nursing and other patient assessments
● Obtaining consents for treatment or procedures
● Providing treatment
● When patients are receiving or recovering from anesthesia or sedation
● Arranging discharge and post-hospital care
● Providing patient education and discharge instruction
Should family be used?
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• The short answer is NO
• Increased risk of misinterpretation of information
• Violates HIPAA
• Violates UKHC hospital policy
Should staff?
• The short answer is MAYBE
2. Recognize appropriate and inappropriate communication methods
to an individual that needs and interpreter.
D) Structural Violence (~4 questions) Dr. Feld
2. Define and describe the key characteristics of structural violence.
Structural violence:
The root cause of the differences between people’s potential reality and their actual
circumstances.
•Potential life expectancy in the general population might be significantly longer than
the actual life expectancy for members of disadvantaged groups, due to factors like
racism, economic inequality, or sexism. In this example, the discrepancy between
the potential and the actual life expectancy results from structural violence.
Structural violence
“Violence with a clear subject-object relation is manifest [direct] because it is visible
as action. . . Violence without this relation is structural, built into structure…
...when one husband beats his wife there is a clear case of personal [direct]
violence, but when one million husbands keep one million wives in ignorance there
is structural violence.”
...in a society where life expectancy is twice as high in the upper class as in the
lower classes, violence is exercised even if there are no concrete actors one can
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point to directly attacking others.
3. Identify global and local forces that contribute to structural violence
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3. Describe practices or actions that have the potential to reduce
structural violence
E) Current Research, Innovations, and Issues (~10 questions) Prof Walden
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1. Define the main terms associated with the lecture (behavioral economics,
nudge theory, and design thinking)
Behavioral economics
● Parallels cognitive psychology
● Suggests how policymakers might restructure environments
● Humans are hard-wired to make judgment errors
● The understanding of where people go wrong can help people go right
Nudge Theory
• Positive reinforcement and indirect suggestions can influence people’s decisions and
actions- largely without realizing or conscious decision making, towards the positive
outcome/better for you option. Nudges must be transparent rather than deceptive.
Design Thinking
● Definition: non-linear, iterative process that teams use to understand users,
challenge assumptions, redefine problems and create innovative solutions to
prototype and test How we design our environment and communities to improve
health
● Leads to more successful and sustainable interventions
● Has facilitated improvements in patient, provider, and community satisfaction
● In public health it has increased efficiency and collaboration in intervention
development
2. Define the concept of behavioral economics and what the goal is (hint: it is
designed to help people not force people to make better choices)
Behavioral Economics
● Varies from classical economics which assumes people act rationally and make
choices in their best interest.
● Behavioral economics does not make this assumption and studies how various
factors such as environment and psychology lead people to suboptimal
outcomes.
● Definition: field of inquiry that uses principles of economics and psychology to
understand how individuals make decisions and uses those insights to try to help
people make choices that are consistent with their own long-term interests.
3. Define and identify examples of Nudge theory in given scenarios, how it is
used to improve health, and also be familiar with how to frame messaging, the
default decision, and choice architecture (ex. decoy effect)
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Nudge Theory/ Default Choice:
● The easiest/most obvious choice, the no-brainer, if I don’t decide this one will be
chosen for me
• Making an option the default leads people to focus on reasons to accept the default
• Gives the default the edge when the options are being weighed against each other
• Defaults are so influential in that they change the way we think about the options
• Generally presumed to be what everyone else does
• More likely to reject the alternative choice that requires more effort
Opt in = Default choice
Opt out = people who feel strongly enough to avoid the default option
Organ Donation Example
In countries (such as the U.S. and Germany) people must explicitly ‘opt out’ if they want
to donate their organs when they die, the default or ‘opt in’ is non-organ donation at the
time of death
• Fewer than 15% of people donate their organs at death.
In countries such as Austria, laws make organ donation the default option at the time of
death, and so people must explicitly ‘opt out’ of organ donation
• More than 90% of people donate their organs
Choice Architecture:
Consciously designing a set of options
• May be a process, the built/physical environment, or products to have a definitive
advantage or preference towards one choice, also includes the social environment and
how you feel
• In nudge theory it is the decisional environment or choice that is better for youprimarily related to behavioral economics: saving money and population health nudges
How:
• Social norms: (9 out of 10) everyone else is doing it, people don’t usually like to be
outliers
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• Just by being asked: Would you like to downsize? Would you like to substitute apples?
• The decoy effect: Occurs when people’s preference for one option over another
changes as a result of adding a third (similar but less attractive) option. The
phenomenon that an additional but worse option can boost the appeal of an existing
option
4. Distinguish the difference between ways of thinking/processing: System 1 vs
System 2
System 1:
Fast, automatic, and highly susceptible to environmental influences
System 2:
Processing is slow, reflective, and considers explicit goals and intentions
When is system 1 used?
● When situations are overly complex or overwhelming for an individual’s cognitive
capacity, or when an individual is faced with time-constraints or other pressures:
• System 1 processing takes over decision-making and relies on judgment, problem
solving or trial and error to make decisions
• Can lead to suboptimal decisions
• Habitual behavior is resistant to change without a disruption to the environmental cues
that trigger that behavior
5. Be able to identify specific examples from the “how people actually decide”
table and subsequent slides (specifically know: loss aversion, anchoring effect,
framing effect, sunk cost fallacy, confirmation bias, choice overload, projection
bias, restraint bias, and social proof-you will not need to know the others from
the table)
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Loss Aversion
• People’s inclination is to avoid losses rather than acquiring equivalent gains because
they would feel the loss greater
• We despise the feeling of regret and will go to great lengths to avoid it so when
presented with an equal chance of gaining the anticipation of the loss is more dreaded.
Anchoring Effect
• The tendency to rely heavily on the first piece of information (the “anchor”) when
forming judgments especially when it is a difficult decision.
• Based on people's need to develop an estimate and discomfort with uncertainty.
• This can create a scenario with patients where they hold on to that piece of
information/treatment option and estimate the correct answer.
Framing Effect
• Different wordings referring to the same information can shape the perception and
affect subsequent decisions.
Sunkcost Fallacy
• The tendency to keep doing an activity that is not beneficial or good thinking it would
minimize loss from the time and money that have already been spent.
• Sunk cost refers to resources that cannot be recovered.
Confirmation Bias
● The tendency to give more attention to information aligned with our preexisting
beliefs
Choice Overload
• Up to a point the further addition of choices presented to a consumer can potentially
have an adverse impact as people get overwhelmed.
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Projection Bias
• The tendency to assume that the best thing for us in the future to a large extent would
be similar to whatever we prefer now.
• Changes in our preferences tend to occur over time but we usually fail to consider that.
Restraint Bias
• The tendency to think we could withstand the trigger for impulsive behaviors when
contemplating future reactions.
• We habitually overestimate the strength of our determination and ignore the possibility
that we are likely to be distracted by temptation.
Social Proof
• The tendency to refer to or get affected by the behavior of others when deciding what
we should do ourselves.
• We judge the value of a product or course of action by the level of acceptance it
receives by its target group.
6. Define and understand the principles and process of design thinking and the
question we should start with
Design Thinking
● Definition: non-linear, iterative process that teams use to understand users,
challenge assumptions, redefine problems and create innovative solutions to
prototype and test
● How we design our environment and communities to improve health
● Leads to more successful and sustainable interventions
● Has facilitated improvements in patient, provider, and community satisfaction
● In public health it has increased efficiency and collaboration in intervention
development
Design Thinking and Nudge
• Design thinking can incorporate the nudge to improve health:
● Systems
● Processes
● Policy
● Medical records/forms
Why Nursing and Design Thinking?
● Requires deep empathy
● Understanding the needs and motivations of people
● Creatively taking multiple perspectives to problem solving
Public Health and Design Thinking
● Innovation is an essential competency among public health and health care to
address these inefficiencies
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● Innovation is uniquely challenging in public health because problems tend to be
complex, dynamic, context-specific, and can arise quickly and unpredictably,
raising the urgency for rapid and efficient responses
● Current educational models in public health provide limited training in creative
thinking and innovation skills
● Traditional public health education may be augmented through the inclusion of
innovative, non-linear, adaptive, and cost- effective tools like design thinking
How Might We?
• Identify a problem to solve
• Frame the problem as a question “how might we?”
• Transform the problem into an opportunity and an optimistic invitation to explore more:
● HOW: solution oriented
● MIGHT: encourages optimism
● WE: collaborative
Principles in Design Thinking
• Mash up
• Sketch
• Story telling
Example: Surgical
How might we?
• Have a clear view of the surgical site without weighting the adipose on another part of
the body
• Minimizing patient shame and embarrassment Problem: holding back adipose tissue
for morbidly obese patients in surgery
• Current practice for C-Section and other surgeries
• Use duct tape on gowns but taping to shoulder/chest so it can create breathing
problems, shame, stigma, and embarrassment
Mash up: See what is used in other industries
Sketch: draw multiple devices that may be able to be used to lift adipose on the other
side of the drape and not in patient’s view.
Story-telling: “There was a patient who came in needing multiple abdominal surgeries...”
Disasters and Emergency Preparedness (~7 questions) Jeff Key (Dr. Key’s
questions)
1. Be familiar with the START triage flowchart and be able to assign a patient the
correct color tag in a scenario.
The “START” System of Triage
● Simple Triage and Rapid Treatment (START)
● Developed in 1983 by the staff members of Newport Beach Fire Department
● Easy to use
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●
●
●
●
●
●
●
Focus is on signs and symptoms
Fast
4 Focus Points of START
Ability to follow directions and walk
Respiratory effort
Pulse/perfusion
Mental Status
2. For a mass casualty event/incident know what defines them (think how many
patients) and what the different terms related to the incidents mean?
Mass Casualty Event: Greater than 100 patients
Types of MCI
1.) Open Incident
● Unknown amount of casualties
● Search and rescue required
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●
2.)
●
●
Incidents are normally long and ongoing
Closed Incident
Number of patients not expected to change
Patients triaged, treated and removed from scene
3. Be familiar with NIMS and know what types of events have NIMS as a standard
approach.
National Incident Management System (NIMS)
● NIMS is a standardized approach to incident management and response in the
U.S. that was established by the Department of Homeland Security in 2004.
● The development of this standardized system was a result of 9/11/2001.
Incidents
● Natural Disasters: hurricanes, fires, flooding, ice storm
● Acts of Terrorism: 9/11, public shootings
● Failing infrastructure: building collapse, bridge collapse
● Transportation incidents: plane crash, train crash, multi-vehicle wreck
Benefits of NIMS
● Standardized organizational structures, processes, and procedures.
● National standards for planning, training, and exercising.
● Personnel qualification standards.
● Interoperable communication processes, procedures, and systems.
● Information management systems with a commonly accepted architecture.
● Supporting technologies and infrastructure, including communication systems,
information systems, and specialized technology.
4. Be familiar with carbon monoxide poisoning and prevention.
CARBON MONOXIDE POISONING
• Greatest occurrence in wintertime due to poorly vented furnaces
• Headache/dizziness/seizures
• Shortness of air, vomiting, chest pain
• CO has a higher affinity to hemoglobin than O2-patient will read 100% even when they
are not
• Place patient on pulse ox that monitors CO
• Place on high flow O2 via Nonrebreather mask
• Treat with hyperbaric chamber and oxygen washout
Prevention: Don't run a car or truck inside a garage attached to your house, even if you
leave the door open. Don't burn anything in a stove or fireplace that isn't vented. Don't
heat your house with a gas oven. Don't use a generator, pressure washer, or any
gasoline-powered engine less than 20 feet from any window, door, or vent.
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5. Know the phases of disaster management and be able to choose which is
being applied in a scenario.
DISASTER MANAGEMENT
PREVENTION
Nurses may be involved in the following activities:
• Identifying potential hazards
• Identifying vulnerabilities
• Strengthening capacity
• Identify existing strengths, attributes and resources available within a community,
organization or society to manage and reduce disaster risks and strengthen resilience.
PREPAREDNESS
Nurses may be involved in the following activities:
• Issuing timely warnings
• Implementing protective actions
• Undertaking emergency management activities
• Evacuating population pre-disaster as needed
REACTION/RESPOND
Nurses may be involved in the following activities:
• Establishing control of the situation by:
• Identifying the disaster management team leader.
• Determining and clearly articulating roles of each member of the team, including your
own role.
• Setting up a viable and realistic triage system.
• Implementing life-saving actions (i.e., S.T.A.R.T., decontamination)
• Implementing public health management and surveillance (i.e. quarantine)
• Evacuating populations immediate post disaster as needed
Other activities in which nurses would not usually be directly involved:
• Restore emergency communications and restore emergency transportation
REACTION/RESPOND: DECONTAMINATION (CHEMICAL EXPOSURE)
Used with chemical exposures for 3 primary reasons:
1. To prevent further absorption of a chemical by the victim;
2. To prevent the chemical from spreading on the victim’s body;
3. To prevent the chemical from spreading to others.
Process includes:
1. Removing potentially contaminated articles (clothing, jewelry, etc.);2. Washing
exposed areas or entire body;3. Safely disposing of contaminated articles and wash
water.
Reaction: Isolation and Quarantine
Isolation:
• Individual-level
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• Generally for communicable/infectious diseases
Quarantine:
• Population-level
• Used across spectrum, from communicable disease to natural or chemical disasters,
etc.
• 3 levels
1. Shelter-in-place
2. Targeted restriction on movements and activities
3. Compulsory restriction of all movements and activities
DISASTER MANAGEMENT: RECOVERY
Nurses may be involved in the following activities:
• Continuing to monitor communities/populations for ongoing effects (illness and injury
due to post- disaster environment)
• Re-establishing health services
• Debriefing population and responders
• Evaluating disaster management response
• Applying these lessons learned for the next steps in preparation for the next one
6. Know the onset of symptoms and timeframes for nerve agents.
Global Health (~5 questions) Dr. Feld
1. Define global health and where the US stands in terms of spending (as
compared to other OECD) and ranking of life expectancy with other countries
(according to the WHO.)
Global Health
● Global health is the understanding and promoting of health in a cross-cultural
and interdisciplinary context.
● Goal: Improving health for all people in all nations by promoting wellness and
eliminating avoidable disease, disability, and death.
● It includes the study, research, and health care practice with a focus on
improving health and health equity for populations worldwide.
● Outside of health care; epidemiology, sociology, economic disparities, public
policy, environmental factors, cultural studies, anthropology, engineering, etc.
● Stresses the commonality of our humanity and an approach to health which
requires a collective (partnership-based) action.
● Historically: Global “north” provided health care to people in the Global “south”
usually -by those with means and power- for those in need. (Medical missions,
colonial perspectives)
● In Ecuador our partners call us ‘blancos’- not necessarily because of skin color
as our groups is usually quite diverse, because of education and power.
● The global north has systematically contributed to economic disempowerment of
many countries/peoples.
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● Goals now include a focus on improving the upstream determinants of health,
health equity and solidarity- as well as decolonizing health.
Health Care Systems: Comparing countries
•OECD – Organization for Economic Co-operation and Development- 37 countries,
middle and high income countries
•US “health” spending vs OECD Countries: US spends 2.5 times as much $10,647
•Life Expectancy at birth: OECD Avg ____US 78.5 years Ranked 40th
2. Be familiar with the U.S. strengths and especially look at the reasons that the
U.S. is motivated to promote health worldwide.
U.S. does well in:
•cancer survival
•heart attack, and stroke survival
•Medicating those with long-term chronic conditions (diabetes)
US: Why Global Health?
● Protecting U.S. residents from threats to their health
● Humanitarian obligation to enable healthy individuals, families, and communities
everywhere to live more productive and fulfilling lives
● Broader mission of U.S. foreign policy
● Reduce poverty, build stronger economies, promote peace, increase national
security, and strengthen the image of the United States in the world
● Promotes peace/fewer wars or acts of violence
3. Define the UN Sustainable Goals and what they are designed to do (you won’t
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have to single out any of these just know in general).
4. Describe the DALY, what 2 measures does it include, why is it important,
calculate it. (The DALY basic formula, why it is used, and what the number
reflects- is it better to have a high or low DALY-there are no calculations on the
exam).
Disability-Adjusted Life Year(estimate the burden of disease on populations)
• Measures the amount of life lost in a population as a result of premature death or
disability, the gap between current health status and an ideal health situation
• DALYs were used in the Global Burden of Disease study to enable mortality and
morbidity comparisons to be made across countries
1 DALY = one lost year of "healthy" life
Years of Life Lost (YLL)
• due to premature mortality
Years Lost due to Disability (YLD)
• for time lived in states of less than full health
DALY= YLL + YLD
BETTER TO HAVE LOW DALY
Human Trafficking (~10 questions) Brittney Thomas (Professor Walden’s
questions)
1. Describe what ICE stands for
“ICE” technique
● Isolate the victim
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● Confidentiality is paramount
● Enlist an interpreter
2. Identify the key characteristics used to assess or determine if someone is
being trafficked (both sex trafficking and labor trafficking) including venues used
for both sex and labor trafficking.
• The recruitment, harboring, transportation, providing or obtaining of a person for a
commercial sex act, in which a commercial sex act is induced by force, fraud or
coercion, or in which the person induced to perform such an act has not attained 18
years of age
• The recruitment, harboring, transportation, providing or obtaining of a person for labor
services by force, fraud or coercion for the purpose of subjection to involuntary
servitude, peonage, debt bondage or slavery
Sex Trafficking Venues
● Hotels/Motels
● Commercial Front Brothel
● Residential Brothel
● Online Ads
● Illicit Massage/Spa Business
● Escort Services
● Residential Based Commercial Sex
Labor Trafficking Venues
● Domestic
● Agriculture
● Traveling Sales Crews
● Restaurant/Food Services
● Begging Rings
RED FLAGS Physical Indicators
● Are not in control of their own money
● Lack of control of identification documents
● Individual is using false identification papers
● Potential victim is accompanied by another person who seems controlling and/or
insists on speaking for the victim
● Frequent relocation/ Evidence of travel (living out of suitcase, hotel, or car)
● Numerous inconsistencies in his or her story
● Hotel room keys, receipts, or items from hotels
● Large amounts of cash
● References to traveling to other cities/states or is from another city/state
● Sexual paraphernalia like bulk condoms
● Minors at hotels, truck stops, strip clubs
● Referencing travel for job opportunities like modeling, dancing, sales crews,
dancing/singing
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● Notebooks and/or slips of papers with names and dollar amounts and addresses
● Expensive and trendy jewelry and clothes that could not be supported by family’s
financial situation
RED FLAGS Behavioral Indicators
● Significant change in behavior to include virtual behavior that includes new
profiles, new friends, etc.Lies about age/identity
● Seems coached in talking to law enforcement
● Resists offers to get help out of situation
● Frightened, annoyed, resistant or belligerent to police
● Uses “prostitution” language like “daddy” or “the life” etc.
● Preoccupied with getting money
● Lack of knowledge of a given community or whereabouts
● Frequent Pregnancy Tests
● Under 18 dating much older, abusive, controlling men
● Not attending school or has numerous absences
● Chronic runaway/homeless youth
● Multiple people living in one house
Male Specific Indicators
● Higher rates of illicit drug use than with girls
● Higher arrest rates (drug possession, panhandling, disorderly conduct, etc.)
● Endure high levels of injuries related to violence
● More isolated from family and friends
● Link between meeting basic needs and sexual orientation or gender identity
● Boys appear to be largely recruited by customers, friends and peers and do not
commonly have “pimps” “Market Facilitators”
3. Know the ways in which the human trafficking victims can enter the health care
system and why they may use those routes.
Where Are Patients Showing Up In The Health Care System
● Health Care Providers are a main point of contact for trafficking victims
● One study of homeless runaway youth stated that :75% had seen a doctor in the
last 6 months, 42.6% received a general check-up
● Victims also enter the medical care system through: ›Mobile, Free or low-cost
clinics›Detoxification units›Mental health facilities
● May arrive with infectious and/or communicable diseases since they circumvent
formal medical care
4. Identify the data around Commercially Sexually Exploited Children (CSEC)
including the average ages as well as how kids are typically introduced to
trafficking.
Commercially Sexually Exploited Children (CSEC)
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● 1 out of every 3 teens who run way will be lured into sex trafficking within 48
hours of leaving home
● Of the nearly 25,000 runaways reported to NCMEC in 2017, 1 in 7 were likely
victims of child sex trafficking. Of those, 88% were in the care of social services
when they went missing
● 14-16 is the US average age of entry into pornography and child sex trafficking
5. Be familiar with the stages of the grooming process and what order they occur
in.
6. Be able to discuss the right given to children under HB3: Human Trafficking
Victims’ Rights Act
Kentucky’s Safe Harbor for Children (HB 3:Human Trafficking Victims Rights Act)
● Court Designated Workers can screen for trafficking
● When child victims of HT in detention are discovered, triggers notice to their
attorney and hearing to consider release
● Children under 18 cannot be charged with prostitution or loitering for prostitution
● Child victims of HT cannot be charged with or adjudicated guilty of status
offenses
● Mandatory reporting of HT regardless of perpetrator (can be other than family
member/custodian)
● Cabinet must provide appropriate services to HT victims
● Cabinet must develop state plan, regulations and report
● Children receive treatment at Child Advocacy Centers
7. Define and give examples of recruitment methods and be able to identify the
recruitment methods from the lecture in a given scenario.
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1. Personal Social Networks
Traffickers commonly recruit friends of family members, friends of other girls they have
trafficked, and others in their neighborhood. They recruit in many places such as
malls,transit stations, beaches, gas stations, campuses, clubs, and restaurants.
Schools,malls, and transit locations in particular are associated with minors. Young
traffickers who are often gang-involved traffickers use their networks in their school and
in their community, often recruiting their classmates.
2. Romantic Relationships
Many traffickers engage in romantic or physical relationships with the recruits to appeal
to their victims’ emotional and economic needs. They use a sort of bait and switch
tactic, building a relationship with the victim, then asking the victim to engage in
commercial sex to help the two of them accomplish their dreams of being together.
3. Online ads
Ads for recruitment often pose as a legitimate employment opportunity, calling for
“models” and presenting the opportunity for a photo shoot. Traffickers also search
existing online advertisements on sites like Craigslist and Backpage for women and girls
who might be working independently. Labor trafficking victims are often recruited
through false job ads.
4. The Lure of Wealth
Former traffickers said that pointing out to victims that they were “already doing it for
free” particularly influential with those who were economically disadvantaged. The
traffickers offer the victim economic security. For traffickers, prominently displaying their
wealth was key to recruiting with many citing their outward displays of wealth as a
primary means of attraction for victims.
5. Current Victims
Girls already involved with the trafficker are often made to help with recruiting,
especially from train stations, bus stops, bus stations, clubs, detention facilities, group
homes, continuation schools, homeless shelters, and from social media. These girls are
typically called “bottoms”. Although the bottom is both a victim and an offender, law
enforcement takes the position that if the person is actively involved in recruitment, they
will be charged with trafficking
8. Identify and define the role of health care in aiding trafficking victims.
Why Is Trafficking a Health Care Issue?
● Health care is central to restoring the well-being of trafficking survivors
● High risk for health related problems
● May arrive with infectious and/or communicable diseases since they circumvent
formal medical care
9. Be able to explain the important parts of medical documentation including the
law around reporting guidelines and how to appropriately document suspected
trafficking.
Medical Documentation
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● Written records are not only used to describe physical injuries but also to address
the emotional impact of the abuse.
● Document the time between the abuse and the time the exam is conducted
● Describe the patient’s demeanor.
● Patient’s words should be set off in quotation marks;
● Do NOT use phrases implying doubt, such as “patient alleges”
● Only use medical terms rather than legal jargon
● DO NOT summarize the patient’s report OR refer to the perpetrator of the abuse
with terms that might be used by the patient, such as “my boyfriend.”
● Supplement with photographs documenting physical injuries and body maps
identifying the extent and location of the injuries.
● When observations conflict with a patient’s statement, record reasons for the
differences
Reporting Guidelines
● The new law states the reporting is MANDATORY if you suspect a minor is being
trafficked.
● You report to your local DCBS office just as you would for any other type of
suspected abuse of a minor. When making the referral specifically mention case
is “human trafficking”