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FUNDAMENTALS OF FAMILY HEALTH-COURSE SYLLABUS
MASTER OF PUBLIC HEALTH PROGRAM

Pamela H. Payne, MD, MPH
Morehouse School of Medicine
Department of Community Health and Preventive Medicine
720 Westview Drive, SW
Harris Building Suite 20-B
Atlanta, Georgia 30310-1495
(404) 752-1946 (404) 752-1051 (F)

COURSE COORDINATORS:

Pamela Payne, MD, MPH
Morehouse School of Medicine, Dept. Of
Community Health/Preventive Medicine
(O)-752-1618 (B)-342-0754

Diane Rowley, MD, MPH
Centers For Disease Control
Division of Reproductive Health
(O)-488-5187

COURSE DESCRIPTION

This course will provide a foundation for individuals entering the Family Health Track of the Morehouse MPH Program. Using a biopsychosocial approach the course will describe the relationship between family structure and functioning on individual health. Particular attention will be placed on the study of undeserved groups in the U.S. (i.e. poor and minority) and on community-based approaches in preventive interventions aimed at the family. See Appendix 1 for pictorial model depicting course curriculum. (Pat White, M.H.Ed., 1995)

COURSE GOALS

1. To provide a generation description of family function and structure and they interact
2. To understand the impact of disease and well-being on family functioning
3. To gain knowledge of the physical, environmental and psychosocial factors that influence the health of families
4. To understand how to integrate social and public health services to meet family needs 

COURSE OBJECTIVES

After completion of the course, the student will be able to:

1. Compare and contrast the components of the traditional medical model with a biopsychosocial model
2. Examine the impact of nutrition on both the traditional and biopsychosocial model
3. Review the historical context/definition of minority family structure, particularly the African- American family structure over the last thirty years (urban vs. rural)
4. Examine the impact of social networks/family support on health

A. Influence on Black Church in Health of African-Americans
B. Extended family -Asians, Latinos
C. Alternative Health Care Models-Acupuncture, Voodoo, etc.

5. Understand the relationship of SES/Education on health
6. Review the Impact of Race/Ethnicity including Anthropological and Ethnographic Issues on Health Outcomes
7. Examine the Lifestyle/Behavioral Influences on Health
8. Recognize the continuum of Sexuality throughout a person's lifespan
9. Understand the age-specific reproductive decision-making of men and women
10. Review sexual orientation and gender orientation and its affect on health
11. Identify the psychosocial and economic effects of STDs, HIV/AIDS on the family
12. Identify the three public health functions according to the 1988 Institute of Medicine report
13. Review changing patterns of health services for family (i.e. welfare reform, managed care, etc.)
14. Review Community Empowerment Issues and Its Effect on the family
15. Identify the provision of services and health care needs from a family and community perspective
16. Identify the epidemiology of violence and discuss its impact on the family
17. Recognize environmental issues of the family, particularly minority groups including housing, transportation, health hazards, etc.
18. Review funding agencies associated with family services and introduce students to skills needed for obtaining a grant in the area of Family Health

REQUIRED READINGS

1. Last, JM. Public Health and Preventive Medicine. 13th Edition. Chapters 40,41,67 and 68.

2. Rowley, D and Heather Postson. "Racial Differences in Preterm Journal of Preventive Medicine.

Supplement to Vol.9:No.6,December 1993.

3. The Gap. Recommendations for Interventions to Reduce the Black-White Infant Mortality. DHR Reading Group. The Division of Public Health, Family Health Branch, December 1994.

4. Turbian, Kate. A Manuel for Writers of Term Papers, Theses, and Dissertations. Fourth Edition.

The University of Chicago Press, 1973. (ON RESERVE)

5. Kids Count Fact Book. Georgians for Children. 1994.

V. STUDENTS REQUIREMENTS

Students are required to attend all classes. Students must obtain excuse from a class within at least

24 hours from one of the Course Coordinators. Absences without excuses will result in a failing

grade.

VI. STUDENT EVALUATION

Students will be evaluated in the following manner:

Class Attendance and Participation 25%

Lecture Pre/Post Tests 25%

Final Paper 50%

Total Grade 100%

 

TOPIC AREAS/TIME FRAME

Class 1: January 11
Introduction to Course: Dr. Diane Rowley, Dr. Pamela Payne
Biopschosocial Model of Health: Dr. Brenda-Hayes Wilson, Annie Carr, (Dr. William Richardson)

Class 2: January 18
Family Theory, structure, relationship and functioning:
Dr. JoeAnn Rhone, Yvone Hipps, Pat White

Class 3: January 25
Social Anthropological Issues of the Family
Guest Lecturer: Dr. Leith Mullins, Yvonne Johns

Class 4: February 1
Social-Cultural Context of Families and Its Impact on Health
Guest Lecturer: Dr. Asa Hillard

Class 5: February 8
On Site Visit: West End/Southside Medical Center Satellite Clinics-Atlanta Housing Authority Sites
Karen Williams

Class 6: February 15
Support Mechanisms for Families
Dr. Joyce Gullory

Class 7: February 22
Public Health Functions at the Family/Community Level
Dr. Sonya Eke, Fred Murphy, Karen Williams

Class 8: February 29
Sexuality and Health
Dr. June Dobbs Butts, Guest Lecturer: Dr. John Chissell

Class 9: March 7
Cultural Competencies Needed in Planning and Implementation of Family Health Services
Mary Langley, Fred Murphy, (Community Person-Maggie Robinson)

SPRING BREAK: MARCH 14

Class 10: March 21
Impact of Environment on Family
Dr. Elizabeth Bowen, (Jennifer Friday, Dr. Robert Bullard)

Class 11: March 28
Funding Sources and Grant writing Skills Needed for Family Health Services
Dr. Lawrence Saunders, Caroline Pyle, Selma Morris

Class 12: April 4
Lifespan and Related Health Needs
Dr. Gwen Dean, Dr. Dawn Smith, Dr. Harry Strothers

Class 13: April 11
On Site Visit: Department of Human Resources-Division of Public Health
Dr. Virginia Floyd, Olivia Smith

OTHER SUGGESTED READINGS:

1. Macadoo, Harriett. Black Families. 1988. (2nd edition)

2. National Academy of Sciences. Nutrition During Pregnancy.

3. Newman, B. & Newman, P. Development Through Life-A Psychosocial Approach. Dorsey Press. 1979.

4. Experience of Violence: Ethnic Groups, in Reasons for Hope: A Psychological Perspective on Violence and Youth Edited by Leonard D. Eron, Jacquelyn H.

5. Gentry and Peggy Schiegal American Psychological Association, Washington, 1994

6. The Future of Children, Volume 2, Number 2. US Health Care for Children David and Lucile Foundation

7. Earls, Felton. Health Promotion for Minority Adolescents: Cultural Consideration. Editors, Susan Millstein, Anne C. Petersen, Elena Nightingale, New York, Oxford University, 1993

8. Hatch, J. Moss, N., Sara, A, Presley-Cantrel, Mallory, Community Research: Partnership in Black Communities, American Journal of Preventive Medicine

9. Michielutte, R., Sharpe, P., Dignan, MB, Blinson, K. Cultural Issues in the Development of Cancer Control Programs for American Indian Populations. Journal of Health Care for the Poor and Underserved, 1994, 5:280:296

10. Health Behavior Research in Minority Populations: Access, Design, and Implementation: National Institution of Health: A National Heart, Lung and Blood Institute. US Department of Health and Human Service, Publication Number 92-2965, 1992, 237-241

11. Alive and Well: A Research and Policy "Review of Health Programs for Poor Young Children, National Center for Children in Poverty. Columbia University, School of Public Health, 1991

12. Life in Black America. Edited by James Jackson Sage Publications 1991

13. Staples, R. The Black Family 1986 Wadsworth Press

14. Cultural Competence for Evaluators. USPHS. Alcohol, Drug Abuse, and Mental Health Administration. 1993.

15. Minority Health Issues for an Emerging Majority. 4th National Forum on Cardiovascular Health, Pulmonary Disorders, and Blood Resources. NIH. 1992.

16. Health Behavior Research in Minority Populations. Access, Design & Implementation. NIH, 1992.

17. Billingslea, A. Climbing Jacobs Ladder, Simon and Schuster, New York, 1992.

18. Braithwaite, R. and Taylor, S. Health Issues in the Black Community. 1992.

 

REFERENCE JOURNALS

1. Journal of Health Care for the Poor and Underserved.

2. Health and Social Work

3. Social Issues

4. Ethnicity and Disease

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Lead Based Paint Hazards
by
Barbara A. Haley
U.S. Department of Housing and Urban Development

Extent of the Problem:

Of all occupied housing units built before 1980, approximately 83 percent, or about 64.4 million homes, are estimated to have lead-based paint somewhere in the building. Lead does not dissipate, biodegrade, or decay, so lead deposited into dust and soil becomes a long term source of lead exposure. Anyone is susceptible to its pernicious effects, but young children are especially vulnerable.

Homes built before 1940 are more likely to have lead-based paint than newer homes. Data from the 1990 National Survey of Lead-Based Paint in Housing indicate that an estimated 88 percent have it the interior on the exterior. By contrast, it was used in an estimated 76 percent of homes built between 1960 and 1979, the year that lead in house paint was prohibited.

Data showing exposure to lead suggest that households with lower incomes or living in less expensive dwellings are more likely than upper income households or households in more expensive dwellings to have lead-based paint somewhere in the unit. Although not statistically significant, data from the National Survey of Lead-Based Paint in Housing show a similar pattern. Specifically, in 1990, 85 percent of households with incomes under $30,000 had lead-based paint (vs. 81 percent for incomes at $30,000 and above). In that year, 92 percent of households in owner occupied dwellings with a market value under $40,000 had lead-based paint (vs. 90 percent for $40,000 - $79,000; 68 percent for $80,000 - $149,000; and 85 percent for $150, 000 and over). In that year, 85 percent of renters who paid less that $400 per month for their dwelling had lead-based paint (vs. 81 percent for renters paying $400 and more).

Except during renovations, intact lead-based paint poses little immediate risk to occupants, but non-intact paint - chipping, peeling, chalking, or otherwise deteriorating paint - may present an immediate danger to occupants. Therefore, of particular concern are the 14.4 million housing units that containing deteriorated lead-based paint and the 3.3 million deteriorated units that are occupied by young children at any single point in time.

The most notable improvement in reducing lead exposure in the U.S. has been that ambient air, which is due to the reduction in the amount of lead in gasoline. Air and solder in cans were the two major sources of lead in food. The issue of lead in house dust and urban soil, which mostly originate in lead paint has grown in relative importance in recent years as these other sources of childhood lead exposure have declined.

Lead-contaminated house dust and soil, ingested via normal repetitive hand to mouth activity, is now recognized as a major contributor to the total body burden of lead in children. An estimated 13 million, or 17 percent, of private housing unit have interior dust levels above Federal guidelines. Similarly, 16 million, or 21 percent, of private housing have soil lead levels above guidelines. Due to the methodological problems, these estimates are regarded by experts as very conservative.

Measurement of blood lead levels is the standard means of establishing lead exposure. The Centers for Disease Control and Prevention (CDC) believe that the threshold level of lead in the blood that is associated with deficits in the neurological development in children is as low as 10-14 ug/dl. Some neurotoxicologists assert that there may be no level of exposure that is absolutely safe.

Results from the third National Health and Nutrition Examination Survey indicate that 8.9 percent of children in the U.S. aged one to five years have blood lead levels at or above 10 ug/dl. For non-Hispanic black children, approximately one-fifth are at this level. The prevalence for children from low-income families (16.3 percent) was four times higher than for high-income children (4.0 percent). Non-Hispanic black children from low-income families had the highest proportion of elevated blood levels. In short, lead exposure during early childhood produces deficits in learning and short-term memory in both humans and animals.

Lead causes non-specific, decremental loss of tissue and organ function. Although the lead industry disputes this, neurotoxicologists believe that the evidence for lead effects on children's brains at doses well below those which are symptomatic is more persuasive than for any other neurotoxin. Most research attention has been paid to the effects of lead on IQ, but lead hagram grand program.

Consequences of Exposure:

Lead is a powerful toxicant with no known beneficial purpose in the human body. High levels of internal exposure that are left untreated cans cause convulsions, coma, and death. The primary target organ is the central nervous system. Since children are still developing neurologically, they are more at risk from exposure to lead than adults. Their bodies absorb and retain a larger percentage of ingested lead per unit of body weight than adults. Their frequent hand-to-mouth activity brings them in greater contact with the environment.

A large body of evidence from experimental studies with animals supports the conclusion that low-level lead exposure posed risk of developmental neurotoxicity in children, causing abnormalities in their neurobehavioral and neuropsychological development. It does not seem to matter what the specific sources of lead are. Leaded children seem to score poorly on measures of neurological evaluation over children with lower lead levels. In short, lead exposure during early childhood produces deficits in learning and short-term memory in both humans and animals.

Lead causes non-specific, decremental loss of tissue and organ function. Although the lead industry disputes this, neurotoxicologists believe that the evidence for lead effects on children's brains at doses well below those which are symptomatic is more persuasive than for any other neurotoxin. Most research attention has been paid to the effects of lead on IQ, but lead has also been shown to affect attention, language function, and academic performance.

There is a long delay between the onset of low level lead exposure and the development of toxic manifestations. Lead, possibly at any exposure, but certainly at blood levels now considered in the normal range, can effect human reproduction. In addition, evidence is accumulating to suggest that lead body burdens stored in bone are not as "inert" as previously believed and that there may be a significant mobilization of lead during pregnancy, possibly causing effects on fetal development and growth of infants.

Recent analyses provide evidence that lead toxicity could begin at nanogram rather than microgram range of blood lead concentrations. In other words, the threshold for lead toxicity might occur at levels that are lower than current exposure levels.

National, State, and Local Efforts:

The Residential Lead Based Paint Hazard Reduction Act of 1992, which is Title X of the Housing and Community Development Act of 1992 (Public Law 102-550), contains major changes in Federal law pertaining to the control of lead-based paint hazards and the reduction of lead exposure. Title X authorizes a grant program for State and local governments for the evaluation and reduction of lead-based paint hazards in privately owned housing built before 1978 and occupied by families of low and moderate income. Housing units are treated for lead paint hazards with methods ranging from specialized cleaning and maintenance efforts to full-scale removal of all paint.

The recipients of the grants provide matching funds for additional rehabilitation and lead hazard reduction work and related services. This includes in kind services in the form of blood testing and screening of children under the age six, public education and outreach programs directed to low-income families in priority housing in target neighborhoods, and rehabilitation in conjunction with lead hazard-reduction efforts. Title X also prescribes hazard evaluations and reductions for federally assisted housing built before 1978.

National surveillance of blood lead levels is essential for targeting interventions, tracking programs in eliminating childhood lead poisoning, and evaluating lead exposure in workers in lead-contaminated environments. The optimal model for national surveillance is the notifiable disease system that CDC has used since 1961. Through this system, cases of illness are reported electronically to CDC by State epidemiologists. The CDC is providing funding to State health departments to build capacity for surveillance of blood-lead levels in children and workers.

Centers for Disease Control and Prevention (CDC) provides grant funds for the initiation and expansion of State programs and community-based childhood lead-poisoning prevention programs that:

-- screen large numbers of young children for lead poisoning;

-- identify possible sources of lead exposure;

-- monitor medical and environmental management of identified children;

-- provide information to the public, health professionals and policy makers; and

-- encourage community action programs to eliminate childhood lead poisoning.

Grant funds may also be used to develop the infrastructure needed to ensure timely and effective screening of children and identification and remediation of environmental lead hazards. The best estimate for the total amount of Federal assistance expended on lead hazard evaluation and reduction activities for Fiscal Year 1993 is $163.9 million.

International:

Available information suggests that average blood-lead levels may vary by a factor of 10 or more between geographic regions. Alcohol drinking, smoking, urban residence, exposure to industrial emissions, and consumption of vegetables grown in contaminated areas are risk indicators for increased blood-lead levels. Lower lead concentrations are associated with frequent intake of dairy products and fish.

The use of lead-glazed pottery and general environmental contamination are probably responsible for high average blood lead levels observed in infants in Mexico and non-white urban children in South Africa. In Jamaican communities with conventional and cottage lead smelters, blood lead is more strongly correlated with soil lead than dust lead. The predictors of soil lead levels were distance to the nearest smelter and waste materials from smelters. High blood lead levels are not restricted to the third world. Low socioeconomic status can act as a proxy variable and correlate with lead exposure in children.

Conclusions:

During the past ten to fifteen years, average blood lead levels have decreased in the U.S. and in several European countries at about five to fifteen percent per year. This decrease is due to the reduction of lead in gasoline, canned food, and drinking water.

In the U.S., lead dust from deteriorating paint and homes that are being remodelled is the main source of lead poisoning among children. Efforts to deal with this problem are still in their infancy. This includes promoting public awareness of the problem as well as reduction of lead-based paint hazards themselves. A lack of trained personnel and funding are two major obstacles in reducing this hazard. However, the most serious lead problem today is the high exposures in developing countries.

Selected References

Brody, D.J., Pirkle, J.L., Kramer, R.A., Flegal, K.M., Matte, T.D., Gunter, E.W., and Pashal, D.C. 1994. "Blood Lead Levels in the US Population." Journal of the American Medical Association 272, 4, 277-316.

Burgoon, D.A., Rust, A., and Schultz, B.D. Forthcoming. "A Summary of Studies Addressing The Efficacy of Lead Abatement." In Lead in Paint, Soil, and Dust: Health Risks, Exposure Studies, Control Measures, Measurement Methods, and Quality Assurance. ASTM STP 1226. Michael E. Beard and S.D. Allen (eds.), Philadelphia: American Society for Testing and Materials.

Davis, M.J., Elias, R.W., and Grant, L.D. 1993. "Current Issues in Human Lead Exposure and Regulation of Lead." Neurotoxicology 14, 2-3, 17-27.

Grandjean, P. 1993. "International Perspectives of Lead Exposure and Lead Toxicity." Neurotoxicology 14, 2-3, 9-12.

Needleman, H.L. 1993. "Current Status of Childhood Low-Level Lead Toxicity." Neurotoxicology 14, 2-3, 161-6.

U.S. Department of Health and Human Services. 1991. Preventing Lead Poisoning in Young Children: A Statement by the Centers For Disease Control. Atlanta, GA: Public Health Service.

U.S. Department of Housing and Urban Development. Forthcoming. Annual Report on Lead-Based Paint poisoning Prevention; A Report to the Congress of the United States.

U.S. Department of Housing and Urban Development. 1990. Comprehensive and Workable Plan for the Abatement of Lead-Based Paint in Privately Owned Housing; Report to Congress. HUD-PDR-1295.

U.S. Environmental Protection Agency. 1995. Report on the National Survey of Lead-Based Paint in Housing. EPA 747-R95-005.

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