Epidemiologic Principles and Measures
Utilizing epidemiologic principles can help address national practice problems by identifying the frequency and distribution of disease (Bemker & Ralyea, 2018). Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States (US) with smoking as the highest contributor to mortality and morbidity (American Lung Association; 2020; Institute for Health Metrics and Evaluation, 2022). The leading cause of COPD is smoking, and COPD is ranked number two of the eight national practice problems (Institute for Health Metrics and Evaluation, 2022). A significant issue for Caucasians in Henderson County Kentucky is COPD (Kentucky Health Facts, 2020). The highest modifiable risk factor in the state of Kentucky for COPD is the prevalence of smoking, which is at a rate of 23%. The rate of smoking in Henderson County is at a rate of 27%, and the national average is 15% (American Lung Cancer, 2021; Kentucky Health Facts, 2020).
In Henderson County Kentucky, the prevalence of COPD in US adults aged 18 years or greater in 2019 was 9.5% with the state of Kentucky having a prevalence of 11.1%, which was the second-highest state in the country (Centers for Disease Control and Prevention, 2019.) In the US, the age-adjusted prevalence of COPD among US adults was 6% in 2019 (Centers for Disease Control and Prevention, 2019). The life expectancy rate in Henderson County Kentucky is 75.4 years vs 79 years in the US in 2022 (National Center for Health Statistics, 2022). Also, the age-adjusted death rate of COPD per 100,000 is 105.6 overall in the US. Kentucky has the highest age-adjusted death rate for COPD per 100,000 which is 174.6 (Centers for Disease Control and Prevention, 2019). The incidence rate of COPD in the US is 115,000 new cases per year (COPD Foundation, 2015).
Descriptive and Analytic Epidemiology
Utilizing descriptive and analytic epidemiology can help address the issue of smoking and COPD amongst Caucasians in Henderson County Kentucky. The three W’s can be used including person, place, and time, and age, sex, race, marital status, and personal characteristics can be used to address the causation of the disease (Bemker & Ralyea, 2018). To impact the prevalence and incidence of smoking and COPD, many public health agencies have targeted youth for education about cessation and abstinence from smoking (Centers for Disease Control and Prevention, 2019). When using the Web of Causation with smoking and COPD, the environmental conditions and social and community impacts the incidence of smoking and COPD in Henderson County Kentucky. For instance, environmental conditions include that children are more likely to smoke if their parents smoke (Kalmijn, 2022). The social and community impacts include a higher smoking rate in the community can also impact the smoking rate in youth (Kalmijn, 2022). In 2019, 29.7% of high school students in Kentucky reported using tobacco products (Centers for Disease Control and Prevention, 2019). Kentucky is one of the highest tobacco-related revenue states due to tobacco being a major cash crop, but it receives one of the lowest grades compared to other states with tobacco use prevention, which is based on dollars spent on the programs and the number of programs available (American Lung Cancer, 2021). Health policy changes and state funding can assist with nicotine abstinence in Kentucky’s youth (Centers for Disease Control and Prevention, 2019). COPD typically impacts people who are over 40 years of age, but prevention of this disease must start younger by promoting smoking cessation and abstinence (COPD Foundation, 2015).
Sex is another factor to examine with COPD. Nationally, women have the highest age-adjusted prevalence of COPD at 6.4 vs men at 5.2 in 2019 (Centers for Disease Control and Prevention, 2019). However in 2019, nationally men have the highest age-adjusted death rate per 100,000 for COPD among adults at 116.2 vs women at 98 (Centers for Disease Control and Prevention, 2019). Race and marital status can also be examined. Caucasians make up 88% of the population in Henderson County Kentucky, and the divorce rate is 3.7 per 1,000 residents in Kentucky (United States Census Bureau, 2021). A study found adults who smoke were 53% more likely to end up in divorce, but the study could not find the causal direction between divorce and smoking (Doherty & Doherty, 1998). There was not up to date literature found regarding smoking and links to divorce. Socioeconomic status can be another factor related to smoking and COPD. Smoking rates are linked to lower socioeconomic status and the poverty rate in Henderson County Kentucky is 18.2% compared to 11.6% in the US. (Welfare Info, 2018). It is important to identify cost-effective smoking cessation programming due to the high poverty rate in Henderson County Kentucky (Welfare Info, 2018).
Use of Surveillance
Just like smoking did not necessarily correlate to the effect of divorce, using surveillance to determine causation is important. The strongest cause of COPD is smoking (American Lung Association, 2020). According to Bemker and Ralyea (2018), surveillance can be used to assist with prevention by setting goals for an organization. Prevention efforts should be focused on protecting patients, healthcare workers, and visitors, and completed in a cost-effective manner (Bemker & Ralyea, 2018). One way to influence determinants of health and reduce COPD-related morbidity and mortality is to focus on cost-effective ways to reduce smoking. In Henderson County Kentucky, there are issues with transportation and lower socioeconomic status. Ways to combat that would be to develop cost-effective programs to manage COPD and smoking cessation via telehealth or telephone for appointments and coaching (Jolly et al., 2019). Another way to influence smoking is by focusing on educating youth on the effects of smoking and prevention (Scheffers-Van Schayck et al., 2021).
According to Klinger et al. (2017), Surveillance data is collected without informed consent, so it is important to examine the data before public release to ensure there are no ethical concerns about how that data impacts vulnerable populations. Smoking in Henderson County Kentucky is linked to lower socioeconomic status. It will be important during the surveillance of data to find ways to positively impact that group, but ensure the surveillance of data is not inflicting emotional or social harm. One ethical concern to address with smoking and COPD is the stigmatization of smoking as a public health tool (Lozano et al., 2020). Smoking-related stigma has been associated with more attempts to quit smoking, which is a positive outcome for public health. However, it is important to provide cost-effective and accessible tools to assist with smoking cessation, or else the stigmatization can have negative effects on smokers who struggle to quit and do not have access to the tools for cessation (Lozano et al., 2020).
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Lozano, P., Thrasher, J. F., Forthofer, M., Hardin, J., Shigematsu, L. M. R., Arillo Santillán, E., & Fleischer, N. L. (2020). Smoking-Related stigma: A public health tool or a damaging force?. Nicotine & Tobacco Research, 22(1), 96–103. https://doi.org/10.1093/ntr/nty151
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