EPI 390Exam #3 Study Guide Lectures: 16 – 25Lecture 16-17 - What is NIDA?National Institute for Drug Abuse; it specializes on drug health. Focus on marijuana and it’s affect on public/individual health.- What is/are: drugs, illicit drugs, misuse, abuse and dependence?a. Drug: any substance, natural or artificial, other than food, which by its chemical nature alters structure or function in the living organism. i. Some ambiguity with alcohol b. Illicit drug: A drug that is unlawful to possess or use. i. Unlawful use of prescription drugs c. Drug misuse: The use of prescribed drugs in greater amounts than, or for purposes other than, those prescribed by a physician or dentist. i. Paints, glues, solvents d. Drug abuse: The use of a substance in a manner, amounts, or situations such thatthe drug use causes problems or greatly increases the chances of problems occurring. i. Social, legal, occupational, psychological or physical e. Drug dependence: a state in which the individual uses the drug so frequently andconsistently that it appears that it would be difficult for the person to get along without using the drug. i. Physiological dependence- Why is addiction a difficult concept in DDE?Addiction is not a formally used term, carries social stigma, and does not refer to a specific condition. - How does the DSM handle substance use?o Tolerance and withdrawal1. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the substance to achieve intoxication or the desired effect (outcome). b. Markedly diminished effect with continued use of the same amount of the substance. 2. Withdrawal, as manifested by either of the following:a. The characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for withdrawal from the specific substances). b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.- What is the MTF?Monitoring the Future (MTF)i. Another surveillance system ii. Annual cross-sectional survey on drug use iii. Goal: Estimate the amount of drug use among high school students in the US iv. Run by the University of Michigan v. Great estimates for prevalence. Harder to learn about incidence and risk factors – alone or in combination.Note: Remind yourself of the distinction between prevalence and incidence.- What is SAMSHA?Substance Abuse and Mental Health Services AdministrationWorks with longitudinal study SAMSHA is not specific to MI o What ‘is’ binge drinking in Michigan? Binge drinking for males = 5 drinks per hour, for females = 4 drink per hour Episodic Binge Drinking = multiple single episodes of binge drinking o Review the MI Alcohol Surveillance Brief (2010) Control - non-alcohol users Location - Michigan Variables - violence, mental distress indicators Comparison Groups - current drinkers, binge drinkers Stratification – gender, grade level - What is the NSDUH?National Survey on Drug Use and Health (NSDUH)i. Annual x-sectional survey on drug use in the US ii. Non-institutionalized persons 12+ 1. Households 2. College dorms 3. Homeless shelters iii. Computer-assisted interview (anonymity, etc.) iv. Survey team not affiliated with US governmentLecture 18-19- What are the challenges in using self-report data in DDE?o Validation  Studies such as the NSDUH will validate responses on drug use with biological data - i.e. A blood cotinine test for smoking, though this cannot be done on all individuals (too expensive) o Instead, gather a sample of respondents and correlate their response with the drug test results  Doesn’t solve the problem, but allows us to see how big of a problem self-report is (or isn’t) o Computer assisted interview  Less stigmatizing than a face to face interview o Quality control questions  Ask the same question different ways to test for consistency o “Gating” systems  Not asking every question to every individual  i.e. “Have you ever smoked a cigarette” if YES, ask “At what age did you first smoke a cigarette” if NO, skip cigarette module o Less burden on respondent- Know the highlighted pieces of the “Drugs of Abuse…” chart.- What were the main ideas conveyed in the Halsted NPR audio?Halsted was dependent on cocaine, he wasn’t an abuser. He was one of the top surgeons, despite his cocaine use.The cocaine was originally used as an anesthetic, until Halsted realized how addictive it was. He continued its use, but tried to protect his students and patients fromthe drug.- The polydrug use (PDU) models (Simple Additive, etc.)…generally, what do they attempt to convey about PDU?Polydrug use deals with the interactions of multiple drugs and the many ways they affectthe user.- Review the KFE manuscript links (abstracts, etc. as indicated under the link headings)-Typhoid Mary-- What is typhoid? A bacterial infection spread through food/water from fecal matter of an infected individual. It is caused by the bacterium Salmonella typhi. Before antibiotics, it was often fatal.- Be able to relate the main points depicted in the video.o What were the main issues from an epi point of view?Mary Mallon was a carrier and therefore a threat to the public health. She was healthy, though, and quarantining her was an infringement on her rights and liberties.o From a public health PoV?Because Mallon was a cook, she had a higher chance of infecting others than other healthy carriers who didn’t handle food. She caused 47 cases of Typhoid in 8 years. o Why might her situation have motivated NYC to establish a public health department?To have a procedure in place to contain an infectious disease and prevent its spread, as well as have protocol for dealing with healthy carriers in a just way.o What hypothesis(es) were in play (from the PoV of the public health practitioners), that brought them to believe that Mary was the source of the outbreak?They knew that infected individuals could spread the disease through uncooked food and they hypothesized it had to be someone in contact with the family. False assumptions also influenced their hypotheses, such as that disease came from filth and the poor, which included immigrants like Mallon.Lecture 20-21 - What are zoonotic diseases?Infectious diseases that at some point are spread from animal to human (they can still be spread animal to animal or human to human during their infection cycle).o General examples? Viruses, bacteria, mycoses,