Community Health Nursing- Fall 2013
Final Exam Study Guide (50 Questions)
1.
Understand Public Health and its philosophy on care of communities and populations
 PHN Characteristics:
 A focus on populations, rather than on single individuals or families, who live in the
community
 An emphasis on prevention
 Concern for the interface between health status of the population and environment
(physical, biological, sociocultural)
 Use of political processes to influence public policy to achieve goals
 The primary goals of public health (prevention of disease and disability) is achieved by ensuring
that conditions exist in which people can remain healthy. Emphasizes health protection, health
promotion, and disease prevention of a population (i.e. look at children in the Head Start
program to evaluate if the program is achieving its goals).
 Focuses on the effect of the community’s health status (resources) on the health of the
individuals, families, and groups.
 Benefits:
 Dramatic increase in life expectancy
 Decreased number of deaths from stroke, coronary heart disease, and cancer.
 Declines in death rates of adults and children.
 Population-focused PH approaches could help prevent up to 70% of early deaths in
America, compared with only 10% for medical treatment.
2. Define aggregate
 A population: a collection of individuals who share one or more personal or environmental
characteristic(s).
The term population may be used interchangeably with the term aggregate.
3. Know all levels of prevention
Primary
Secondary
Tertiary
 The action taken prior to the  The action which halts the
 All the measures available to
onset of disease, which
progress of a disease at its
reduce or limit impairments
removes the possibility that
incipient stage and prevents
and disabilities, and to
the disease will ever occur.
complications – early
promote the patients’
detection and treatment.
adjustment to irremediable
 Pre-pathogenesis phase of a
conditions.
disease/problem.
 Attempt to arrest the disease
process, restore health by
 Use when the disease
 “Health promotion” and
seeking out unrecognized
process has advanced
“specific promotion”
disease and treating it before
beyond its early stages.
 Control the underlying cause
irreversible pathological
 Interventions: disability
or condition that may result
changes take place, and
limitation and rehabilitation
in disability
reverse
communicability
of
(the combined and
 “positive” health”
infectious
diseases.
coordinated use of medical,
encourages achievement and
social, educational, and

Protects
other
from
the
maintenance of “an
community
from
acquiring
vocational measures for
acceptable level of health
the
infection
and
therefore
training and retraining the
that will enable every
provides secondary
individual to the highest
individual to lead a socially
prevention for infected
possible level of functional
and economically productive
persons (primary for
ability.”
life.
potential contacts)
 Ex: medical treatment,
 Accomplished by measure
physical and occupational
designed to promote general  Interventions: early diagnosis
(screening) and adequate
therapy, and rehabilitation.
health and well-being, quality
treatment.
of life of people, or specific

4.
5.
6.
protective measures.
Ex: A school nurse develops a
health education program for
a population of school aged
children that teaches them
about the effects of smoking
on health.

Ex: Mammography to detect
breast cancer, pap smears to
detect cervical cancer, etc.
Review Florence Knightingale
 Improved soldier’s health using a population-based approach that improved both
environmental conditions and nursing care.
 Using epidemiology measures – she decreased mortality
 Organized hospital nursing practices and nursing education in hospitals to replace untrained lay
nurses with Nightingale nurses
 She thought nursing should promote health and prevent illness and she emphasized proper
nutrition, rest, sanitation, and hygiene.
What is taken into consideration when funds are allocated to communities for initiatives?
 The distribution of health care is affected largely by the way in which health care is financed in
the United States. Third party coverage (public or private) and socioeconomic status, because it
determines the ability to purchase insurance or pay out of pocket costs, greatly affect the
distribution of health care.
 Barriers to health care access:
 The uninsured
- Unable to afford insurance
- May lack access to job-based coverage or because of their age or good health status,
may not perceive need for insurance.
- Because the eligibility requirements for Medicaid, the near poor are actually more
likely to be uninsured than the poor
 The poor
- Socioeconomic status is inversely related to mortality and morbidity for almost every
disease r/t poor housing, malnutrition, inadequate sanitation, and hazardous
occupations.
 Access to care
- Medicaid improves access to health for the poor, however the poorest Americans
have Medicaid insurance, yet have the worst health.
- Primary reasons for difficult to access care: the insurer not approving, covering, or
paying for care; client has preexisting conditions; and physicians are refusing to
accept the insurance plan.
- Other reasons include: lack of transportation, physical barriers, communication
problems, childcare needs, lack of time/information, or refusal of services by
providers, lack of after-hours care, long office waits, and long travel distance.
- Reimbursement for services provided to Medicaid recipients is low, physicians are
discouraged from serving this population.
 Rationing health care: implies reduced access to care and potential decreases in the
acceptable quality of services offered.
- A health care shift from reactionary, acute-care orientation toward a proactive,
primary prevention orientation is necessary to each a more cost-effective and more
equitable health care system.
 Healthy People 2020
- Strategies to provide better access for all people
What would be ideal primary care

7.
8.
9.
Primary care is the first level of the private health care system, which is delivered in a variety of
community settings – provides first contact and continuous, comprehensive, and coordinate
care. Ex:
 physicians’ offices, urgent care centers, in-store clinics, community health centers, and
community nursing centers.
 Comprehensive range of services, including public health; prevention; diagnostic, therapeutic,
and rehabilitative services.
 Essential care made universally accessible to individuals and families in the community;
encourages self-care and self-management in health and the social welfare of daily life.
Review current social trends that impact communities
 Changing lifestyles: to be healthy one must take care of one’s own self
 Growing appreciation of the quality of life
 shift in values changing the importance of financial success
 Changing composition of families and living patterns
 Rising household incomes
 average per-person income has been increasing
 Gap between the richest (25%) and the poorest (25%) is widening
 Revised definition of quality health care
 American spend considerable money on health care, nutrition and fitness, because health is
seen as an irreplaceable quality
 Complementary therapies are those that are used in addition to traditional health care, and
alternative therapies are those used instead of traditional care. People often spend
considerable amount of their own money for these types because few are covered by
insurance
Review the steps on making an ethical decision
 Making decisions in an orderly process that considers ethical principles, client values, and
professional obligations; must address ethnic diversity and growing multiculturalism in
American society.
 Framework:
 Identify the ethical issues and dilemmas
 Place them within a meaningful context
 Obtain all relevant facts
 Reformulate ethical issues and dilemmas
- Ethical issues: moral challenges facing the nursing profession (i.e. how to prepare an
adequate and competent workforce)
- Ethical dilemmas: puzzling moral problems in which a person, group, or community
can envision morally justified reasons for both taking and not taking a certain course
of action (i.e. how to allocate limited resources to two equally needy populations).
 Consider appropriate approaches to actions or options (utilitarianism, deontology,
principlism, virtue ethics, ethics of care, feminist ethics)
- Primary principles: respect for autonomy, nonmaleficence, beneficence, social
justice
- Virtue ethics: acquired traits of character that dispose humans to act in accord with
their natural good
 Make the decision and take action
 Evaluate the decision and action
 The steps of a generic ethics framework are often nonlinear, and with one exception, they do
not change substantially.
Understand what advocacy is and what it looks like
 Act of pleading for or supporting a course of action on behalf of a person, group or community;
a response to social change, reimbursers, and providers in the health care system.
 Requires a balance between “doing for” and “promoting autonomy”
10.
11.
12.
13.
 The nurse promotes, advocates for, and strives to protect the health, safety, and rights of
the patient.
 Advocate: One who works to protect the rights of the client while supporting the client’s
responsibility for self-determination.
 Providing the opportunity for information exchange, thus giving clients the tools that can
empower them in making the best decision from their perspective.
 Enabling the client to make an “informed decision.” This is a powerful took for building selfconfidence. It gives the client the responsibility for selecting options and experiencing the
success and consequences of the options based on current data.
 Empowering clients in their decision making when they can recognize events that are
beyond their control and can link events that occur by change with predictable events to
make decisions they want.
 Products: decreased morbidity and mortality
 Framework
 Act in the client’s, group’s, or community’s best interests
 Act in accordance with the client’s, group’s, or community’s wishes and instructions
 Keep client, group, or community properly informed
 Carry out instructions with diligence and competence
 Act impartially and offer frank, independent advice
 Maintain client confidentiality
Know ethnocentrism, stereotyping, prejudice and racism  all inhibit cultural competence
 Ethnocentrism: belief that one’s own group or culture is superior to others
 Stereotyping: the basis for ascribing certain beliefs and behaviors about a group to an individual
without giving adequate attention to individual differences.
 Prejudice: the emotional manifestation of deeply held beliefs about other groups; it involves
negative attitudes.
 Racism: a form of prejudice that refers to the belief that persons who are born into particular
groups are inferior in intelligence, morals, beauty, and self-worth.
What is cultural competence
 A combination of culturally congruent behaviors, practice attitude and policies that allow nurses
to work effectively in cross-cultural situations
 Care is designed for the specific client
 Care is based on the uniqueness of the person’s culture and includes cultural norms and
values.
 Care includes self-employment strategies to facilitate client decision making to health
behavior
 Care is provided with sensitivity and is based on the cultural uniqueness of clients.
 Maintain a broad, objective, and open attitude toward individuals and their cultures; and avoid
seeing all individuals as alike.
What factors can lead to Poor Health
 Poverty: primary cause of vulnerability
 Age
 Limited human capital: limited human potential of the people living in a community
 Education
 Lack of resiliency: lack of ability to withstand many forms of stress and deal with several
problems simultaneously without developing health problems.
 Disenfranchisement: sense of social isolation; a feeling of isolation from mainstream society
Understand EBP, what needs to be included when you incorporate EBP in your practice
 Evidence-based medicine: being aware of the evidence on which one’s practice is based, the
soundness of the evidence, and the strength of inference the evidence permits

Evidence-based public health: a public health endeavor in which there is an informed, explicit,
and judicious use of evidence that has been derived from any of a variety of science and social
science research and evaluation methods
 Evidence-based nursing: an integration of the best evidence available, nursing expertise, and
the values and preferences of the individuals, families, and communities who are served
 Evidence-based practice: includes the best available evidence from a variety of sources,
including research studies, evidence from nursing experience and expertise, and evidence from
community leaders
 Systemic Review: summary of the research evidence that relates to a specific question and
to the effects of an intervention
- aim is to evaluate and interpret all available research that is relevant to particular
research
- can be accessed from most databases
 Randomized Control Trial: (RCT): generally ranks as highest level of evidence followed by
other RCTs, nonrandomized clinical trials, prospective cohort studies, case control studies,
case reports, and expert opinion
- gold standard of evidence
14. What are the levels of evidence
i.
Editorials, Expert Opinion
ii.
Case-Control Studies
iii.
Cohort studies
iv.
Randomized control trials
v.
Systematic reviews: Systematic reviews (higher quality) are the most time-intensive articles
to write and are therefore rarer (lower quantity) than other types of studies.
15. Review healthcare teaching and adult learning principles
 Health teaching: patient education (problem focused), focused on health promotion/disease
prevention for families and individuals (communities not afflicted).
 Empowerment to chain behaviors and lifestyles
Learning Principles
Pedagogy
Andragogy
 Others decide
 Decide themselves
importance
 Validate and evaluate
 Accept as taught
 Lifetime experience
 Limited past experience
 Immediate usefulness
 Future use of
 Focus application of
information
facts
 Focus on facts
 Teacher-learner
collaborate
 Teacher authority
 Teacher plans lesson
 Shared content planning
 Passive
 Active
 3 Domains:
• Cognitive: Intellectual skills, Understanding, Knowing (Blooms taxonomy: Knowledge,
comprehension, application, analysis, synthesis, evaluation)
• Psychomotor: motor skills (neuromuscular coordination)
• Affective: attitudes and emotions (changes in attitudes and development of values)
 Health Education Process:
• Identify educational needs
• Establish educational goals and objectives
• Select appropriate educational methods
• Implement the educational plan
• Evaluate the educational process
16. What is readiness to learn
17.
18.
19.
20.
 Emotional readiness: motivation and readiness, internal and external reinforcement
 Experiential readiness: background, skill, ability, self-perception of skill, developmental stages
What is the purpose of a community assessment and what are the steps
 Using the nursing process to promote community health; logical, systematic approach to
identifying community needs, problems, and identifying community strengths and resources.
 Steps
 Data collection and interpretation
 Data gathering – obtaining existing readily available data (i.e. age of residents, gender
distribution, SES, racial distribution, vital statistic, community institutions, etc.)
 Data generation – developing data that does not already exist through interactions with
community members.
- Knowledge and beliefs, values and sentiments, norms, problem solving processes,
power & leadership, influence structures.
 Composite database analysis
 Data collection methods
 Collection of direct data
 Types
 WSS, key informant interviews, participant observation, secondary analysis, surveys
Define resilience
 Ability to withstand many forms of stress and deal with several problems simultaneously
without developing health problems.
Know the Family Theory Frameworks
 Structure-Function Theory: families are examined in terms of their relationship with other major
social structures (institutions)
 Systems Theory: encourages nurses to view clients as participating members of family
 Developmental Theory: looks at family system overt time through different phases that can be
predicted with known family transitions based on norms
 Interactional Theory: views family as a unit of interacting personalities and examines the
symbolic communications by which family members related to one another
Review risk reduction
 Application of selected interventions to control or reduce risk factors and minimize the
incidence of associated disease and premature mortality; is reflected in greater congruity
between appraised and achievable ages.
 The family health risk reduction is based on the assumption that decreasing the number or the
magnitude of risks will decrease the probability of an undesired event. Ex. To decrease the
likelihood of adolescent substance abuse family behaviors such as modifying parents alcohol
use, alcohol not be available in the house and family contracts may be useful
 Phases and activities of a home visit:
- Initiation Phase :clarify the source of the referral clarify the purpose of the home visit
- Pre-visit Phase: Initiate contact with the family, determine willingness, schedule visit
- In-Home introduce self- interact socially to establish rapport implement the nursing
process
- Termination review the visit with the family, plan for future visits
- Post-visit record the visit, plan for next visit
21. Know what the risks across the life span are (child, teen, adult, elderly etc.)
Children Health Concerns
Obesity
 HTN, hypertension, hyperlipidemia, bone & joint difficulties, hyperinsulinemia,
menstrual problems, teasing, scholastic discrimination, low self-esteem, negative
body image.
Injuries and
Infants: r/t small size and small airway (easily occluded), fit in places where head may
Accidents
be entrapped, handled on high surfaces  fall risk, increased risk of being crushed or
Abuse and
Neglect
Behavioral
Problems
Tobacco Use
Asthma
Environmental
Hazards
Homelessness
Reproductive
Health
Menopause
Osteoporosis
Breast Cancer
Genital Mutilation
Health Disparities
Men:


propelled in MVAs, at risk for suffocation, drowning, and burns. Homicide risk: Babyshaken syndrome and blunt trauma are the leading causes of trauma to the head.
Toddlers and Preschoolers: experience a large number of falls, poisonings, and MVAs.
School-Age Children: At risk for pedestrian and bicycle accidents, and sports and
athletic injuries.
Adolescents: Death and serious injury (higher for males), highest risk for MVA death,
drowning, and intentional injuries. Use of weapons, drugs, and alcohol  injuries,
gang involvement, suicide (2nd leading cause of death in 15-24 y.o.) Poor social
adjustment, psychiatric problems, and family disorganization increase risk for suicide.
3.1 million children were reported to have been abused or neglect; difficult to prove
 fatalities.
Alterations in behavior (child/adolescents): eating disorders, attention problems
(ADD/ADHD), substance abuse, elimination problems, conduct disorders and
delinquency, sleep disorders, school maladaptation.
Smoking is associated with cardiovascular disease, cancer, and lung disease. Children
exposed to secondhand smoke experience increased episodes of ear and UR
infections. Children of smokers are more likely to smoke. Adolescents who start
smoking are rarely able to quit. ½ of all teenagers who smoke regularly will die from
smoking-related disease.
Low-income and minority groups (esp. Hispanics and AA) are more likely to be
hospitalized or die from asthma.
Lead poisoning, pesticides or poor air quality + developing organs and smaller size =
increased concentration of toxins
Populations at risk: children with respiratory diseases or from low-income families.
 chronic illness (i.e. TB, asthma, anemia, and chronic OM), more frequent
hospitalizations, behavioral problems (i.e. sleep disorders, withdrawal, aggression, or
depression), school performance problems r/t lack of attendance, developmental
delays.
Women’s Health Concerns
Unintended pregnancy, preconception concerns (i.e. folic acid deficiency, alcohol
use  birth defects, mental retardation, neurodevelopmental disorders), lack of
prenatal care
Changes in vaginal/urinary tract, cardiovascular system, bone density, libido, sleep
patterns, memory, emotions.
Falling level of estrogen  bone loss.
2nd leading cause of death among all women (higher in whites than AA).
Excision of the clitoris with partial or total removal of the labia minora then fusion
of the labia majora  morbidity, hemorrhage, infection, tetanus, and septicemia.
Long term effects: impaired urinary/menstrual functioning, chronic genital pain,
cysts, neuromas, ulcers, urinary incontinence, and infertility.
Women of color, incarcerated women, women with disabilities, lesbians, and older
women.
Men are reluctant to seek care and are not well connected to the health care system, which
increases their risk and severity of illness
o Ethnic minorities such as Latinos & AA are even less likely to seek primary care
Prostate cancer – occurs in 1 in 6 men (second leading cause of cancer deaths in men), genetic risk
factor.

Testicular cancer – cause unknown, rare, r/t cryptorchidism, painless, common side: testicular
enlargement.
Shared Health Concerns
Mortality
Diseases of the heart #1 COD for both males and females, followed by various
cancers.
Cardiovascular
Heart disease one of the most significant public health concerns; CHD
Disease
responsible for majority of deaths – diagnoses include: MI, acute ischemic heart
disease, angina pectoris, and atherosclerosis.
Risk factors for CHD: smoking, increasing lipids, HTN
Stroke
Men are 1.25x more likely than women to experience a stroke; AA males are 2x
more likely to experience a stroke than white males.
Diabetes Mellitus
20.8 million people have DM; 11% of all men over the age of 20 have DM.
Mortality rates from DM highest among low-income and minority groups.
Complications associated with DM: heart disease, stroke, HTN, retinopathy,
kidney disease, neuropathies, amputations, and dental disease.
Mental health
Women experience certain conditions more than men. Psychosocial factors such
as life stress, trauma, and interpersonal relationships have been cited as causing
depression among women. Poor mental states adversely affect men’s physical
health by depressing the immune system and indirectly by motivating the men to
participate in unhealthy behaviors (i.e. increased alcohol consumption, smoking,
poor eating habits, and avoiding health care interventions).
Cancer:
2nd leading cause of death in the US.
Leading causes of cancer death:
Males: cancer of the lung/bronchus, colon/rectum, and prostate.
Women: cancer of the lungs, breast, and colorectal
HIV, AIDS, STDs
HIV is leading cause of death of AA males (25-44 yo)
Accidents and
Young men are more prone to injuries r/t risk taking behaviors. MVAs = leading
Injuries
care of unintentional fatal injuries, followed by falls and poisoning.
Older Adults:
 The population of Americans 65 years of age and older is steadily growing, accompanied by an
increase in chronic conditions, greater demand for services, and strained health care budgets
 Nurses address the chronic health concerns of older adults with a focus on maintaining or
improving self-care and preventing complications to maintain the highest possible quality of life
22. Who are victims? What are some characteristics? Who are abusers?
 Victims
 Men are more likely to be victimized by strangers
 Women are more likely to be victimized by intimate partners, relatives, friends, and
acquaintances
 Family is most likely to murder a young child
 IPV is the primary crime against women
 Young AA men have the greatest risk for being a victim and a predator
 Children with disabilities
 Abusers
 Who are they:
- Parents are normally the child abusers
- Sexual abused is perpetrated by family members, strangers, acquaintances, trusted
community leaders
- 2/3 of elder abuse is by adult children
 Characteristics:
- Jealous, controlling, low self-esteem, borderline personality disorders, possessive,
emotionally dependent
Power and control: coercion, threats, using the kids, intimidation, emotional abuse,
minimizing, denying, blaming, male privilege, economic abuse, isolation
- Tension building: frustration and anger build, victim identifies cues and tries
avoidance strategies
- Battering: can last hours and days, physical and sexual
- Apologetic: blaming outside factors, engages in behaviors to gain forgiveness
23. Know most common types of cancer
 Three leading causes of cancer death for males are cancer of the lung and bronchus, colon and
rectum, and prostate.
 Lung cancer is the leading cause of cancer deaths in women followed by cancer of the breast
and colorectal cancer.
24. Review care of the homeless
 Health care is usually crisis oriented and sought in emergency departments, and those who
access health care have a hard time following prescribed regimens.
 Homeless people devote a large portion of their time trying to survive; health promotion
activities are a luxury for them – not part of their daily lives.
 Healthy People 2020 Objectives r/t to Homeless
 Increase the proportion of persons with health insurance
 Increase proportion of persons who have a specific source of ongoing care
 Reduce the proportion of families that experience difficulties or delays in obtaining health
care, or who do not receive needed care for one or more family members.
 Comprehensive health care and social services in workplace, school, faith based communities
(once you have them there, make it possible to get it all done)
 Wrap around services “one-stop” shopping
 intent to meet and care for all families needs in one visit as it is difficult for them with
limited resources to follow up. It is actually more cost effective
 Top 3 things nurses should strive for when working with VP: Social Justice, Advocacy, and
Culturally/Linguistically Care
 Social Justice: humane care and social supports for most in need
 Advocacy: nurse takes action for another
 Culturally/Linguistically Care: communicating health related assessment and info in
recipients language when possible
25. Know VP and at risk groups
 VPs
 Poor, homeless, marginally housed – poorer environment increases disease risks, less
nutrition, higher risk jobs, multiple stressors without a cushion.
 Pregnant adolescents
 Migrant workers and immigrants
 Severely mentally ill individuals
 Substance abusers
 Abused individuals and victims of violence
 Persons with or at risk for communicable disease
 Persons with HIV, Hepatitis B, or STD positive
 Risk factors
 poverty
 age
 Limited human capital: all the strengths, knowledge, and skills that enable a person to live a
productive happy life
 Education
 Lack of resiliency
 Disenfranchisement: those that live on the fringe of society, with few social ties to the
community. Feeling of separation from mainstream society (migrant workers, homeless)
-
- a lot believe that events are outside their control (fatalism)
26. What is harm reduction
 Also called harm minimization
 A public health approach to substance abuse problem. This approach acknowledges, without
judgment, that licit and illicit drug use is a reality, and the focus of interventions is to minimize
these drugs’ harmful effects rather than to simply ignore or condemn them; also facilitate
responsible use of substances.
 Recognizes that addiction is a health problem, any psychoactive drug (i.e. caffeine) can be
abused, accurate information can help people make responsible decisions about drug use, and
people who have ATOD can be helped.
27. Understand drug addiction vs. drug dependence
 Drug addiction: pattern of abuse characterized by an overwhelming preoccupation with
obtaining and using a drug; high tendency for relapse if drug is removed.
 Drug dependence: physiological change in central nervous system as a result of chronic drug
use.
 Those dependent on drugs continue using them to prevent symptoms of withdrawal
 Must be gradually tapered (morphine) rather than abruptly stopped to prevent symptoms
of withdrawal.
 Physiological: feelings of satisfaction and a desire to repeat drug experience or to avoid the
discomfort of not having the drug (craving/compulsion)
 Physical: when there is an abstinence effect  physical changes (uncomfortable)
28. Risk factors for alcoholism
 Familial transmission of alcoholism
 Family environment/gene-environment interaction
 Persons with underlying mood disorders or other mental illness may try to self-medicate with
psychoactive drugs (i.e. a depressed person might consume alcohol and become more
depressed)
 Setting
 The influence of the physical, social, cultural environment within which the use occurs
 Social conditions influence the use of drugs: fast pace of life, competition at school or
workplace, pressure to accumulate material possessions are daily stressors
 Socioeconomic status  many of life’s opportunity’s seem out of reach and instead of seeking
relief through medical care, they escape the pain/hopeless reality and rely on alcohol to do so
because it is cheaper and more readily available.
29. Review the principles of smoking cessation
 Approximately 35 million Americans try to quit smoking each year
 Medical and behavioral treatments
 Nicotine replacement therapy: used to help smokers withdraw from nicotine while focusing
their efforts on breaking the psychological craving or habit. The following products can
almost double the changes of successfully quitting:
- Nicotine gum and skin patches (OTC)
- Nicotine nasal spray and inhalers (prescription)
 Smoking cessation clinics, hypnosis, acupuncture
 Most effective way to get people to stop smoking: prevent relapse by using multiple
interventions and continuous reinforcement; most people require several attempts.
30. How is violence defined and why are some countries more prone to it
 Violence: nonaccidental acts, interpersonal or intrapersonal, that result in physical or
psychological injury to one or more of the people involved.
 The United States has a sizeable problem with violence; some societies are basically nonviolent,
and for them violence is not a significant health problem. It remains unclear if violence stems
from innate aggressive drive or is a learned behavior.
 Factors that contribute to violence:
 Work: poverty  stress  aggression  violence
- Repetitive, boring jobs
- Work frustration
- Hostile work environments
- Unemployment/economic downturns
 Education
- Bullying
- Corporal punishment
 Media: hitting, kicking, stabbing, and shooting are seen daily as ways to handle anger and
frustration.
- Creates frustration
- Violent portrayals
 Organized religion
- Male over female dominance
- Uphold punishment
- Discourage divorce
 Population: urban crowding + racial inequality  violence
 Community facilities: watching physically aggressive sports can encourage violence when
people hit or shove one another.
31. Understand rape, family violence
Family Violence
 Most go unreported
 Intergenerational transmission of violence
 Social attitudes contribute to perpetuation of family violence
 Children with disabilities 3.5 times more likely to be abused
 Family more likely to murder a young child
Neglect
Physical
 Physical, educational, emotional
 Spanking, throwing something, grabbing, pushing,
beating, kicking, biting, burning, shaking
 Failure to provide food, shelter,
abandonment, expel from home,
 Physical signs: cauliflower ears, whiplash syndrome in
inadequate supervision.
infants, burns, fractures, body marks, cranial trauma.
 Allowing truancy, failing to enroll in
 Behaviors: parents do not volunteer info, delay in care
school, failing to attend to special
seeking, stories contradict, record of hospital shopping,
needs.
drug or alcohol use.
Emotional
 Inattention to affection, no provision
of psychological care, spousal abuse
 Extreme of bizarre forms of punishment, habitual
in presence of child, allowing
scapegoating, belittling, rejecting treatment
drug/alcohol use by child.
 Results of emotional abuse often show up years later
 Behaviors of child wary of or craves
(cognitive, emotional, or mental disorders)
attention of others sometimes
Sexual
complete strangers, delayed
 Fondling, intercourse, incest, rape, exhibitionism,
development, poor grooming.
prostitution or pornography featuring children.
 Indicators: Repeated UTI’s without positive culture,
STDs, enlarged vaginal opening, genital itching
 Perpetrated by family members, strangers,
acquaintances, trusted community leaders
Rape
 Sexual intercourse forced on an unwilling person by threat of bodily injury or loss of life
 6/10 sexual assaults are by people they know
 20% of rapes are not reported to police
 20-25% of college women repot experiencing rape or attempted rape during college years, with 90%
of assailants known
 1/6 women and 1/33 men report an attempted or completed rape at some time in their lives.
 Sexual violence can affect health ranging from chronic pain, headaches, stomach problems, STDs,
unwanted pregnancies, generalized fear and anxiety, eating disorders, and depression. Victims may
engage in negative health behaviors such as smoking, abusing alcohol/drugs, or engaging in risky
behavior.
 Occurs between 8pm and 2am
32. Review vector disease
 Lyme disease - ixodid ticks
 Rocky Mountain spotted fever – ticks
 Prevention and control of tick-borne diseases (vaccines where available, avoid tick areas,
proper clothing, inspection, repellants)
 West Nile Virus – mosquitos
 Plague (Black Death) - vector-borne bacterium