1. Risk Assessment

2. Definition of Risk Assessment A scientific process of evaluating the adverse effects caused by a substance, activity, lifestyle, or natural phenomenon. A scientific process of evaluating the adverse effects caused by a substance, activity, lifestyle, or natural phenomenon. Characterized by uncertainty Characterized by uncertainty Establishes a range of probability Establishes a range of probability

3. (McKenzie, Pinger and Kotecki, 2002) Definition of Risk Factor Risk Factors increase the probability of disease, injury, or death. Risk Factors increase the probability of disease, injury, or death.

4. Healthy People Disease prevention and health promotion instead of only finding the cure Disease prevention and health promotion instead of only finding the cure (since 1979) Studying the risk factors for getting a disease became increasingly important. Studying the risk factors for getting a disease became increasingly important.

5. Types of Disease Communicable (infectious) Communicable (infectious) Non-communicable Non-communicable Acute Acute Chronic Chronic

6. Examples of Risk Factors Obesity Obesity Alcoholism Alcoholism Poverty Poverty No helmet No helmet Tobacco use Tobacco use Environment Environment

7. Establishing Risk Factors How do we know what the risk factors are?

8. Analytical Studies Retrospective Retrospective CaseCase ControlControl Prospective Prospective CohortCohort

9. Considerations of Risk Assessment Culture Culture Religion Religion Age Age Socioeconomics Socioeconomics Environment Environment Physical Biology Physical Biology Behavior/attitude Behavior/attitude Resources Resources

10. (DiClemente, Crosby & Kegler, 2002) Resource Theory Define the resource reservoir Define the resource reservoir Pathways to obtain resources?Pathways to obtain resources? Status to obtain resources?Status to obtain resources? Recognize the lack of resources Recognize the lack of resources Women’s HIV prevention exampleWomen’s HIV prevention example

11. Kidder, Tracey, Mountains Beyond Mountains. (2003) Risk Vs Resource Need Vs Strength Needs should be prioritized using the availability of resources. Needs should be prioritized using the availability of resources. “Giving people medicine for TB and not giving them food is like washing your hands and drying them in the dirt.” “You want to stop HIV in women? Give them jobs.” Resources can be determined by “mapping” a community. Resources can be determined by “mapping” a community.

12. (McKenzie, Pinger & Kotecki 2002) “Ownership” is crucial There is no point in intervening if the community does not feel that they own the problem!

13. (DiClemente, Crosby & Kegler, 2002) Prevention Marketing Theory Step 1: Communitywide risk assessment Step 1: Communitywide risk assessment Who is doing what, with whom, where, when, how and how oftenWho is doing what, with whom, where, when, how and how often Step 2: Social Marketing Step 2: Social Marketing Commercial marketing principles and techniques achieve socially beneficial goals (Kotler & Zaltman, 1971)Commercial marketing principles and techniques achieve socially beneficial goals (Kotler & Zaltman, 1971)

14. Examples of Prevention Marketing Adolescents: “Brain on Drugs” Adolescents: “Brain on Drugs” Children and Adolescents: Vaccines Children and Adolescents: Vaccines All ages: Santa Claus eating cheese All ages: Santa Claus eating cheese All ages: “Got Milk” All ages: “Got Milk” Children and Parents: Bill Cosby Children and Parents: Bill Cosby

15. National Reports Monthly Vital Statistics Monthly Vital Statistics Morbidity and Mortality Weekly Report (MMWR) Morbidity and Mortality Weekly Report (MMWR) Includes outbreaks, environmental hazardsIncludes outbreaks, environmental hazards

16. Exemplary Tools of Risk Assessment Individual Individual Community/population Community/population

17. Examples of Risk Assessment on the Web Harvard Center for Cancer Prevention www.yourcancerrisk.harvard.edu Harvard Center for Cancer Prevention www.yourcancerrisk.harvard.edu www.yourcancerrisk.harvard.edu Breast, Prostate, Lung, Colon, etc.Breast, Prostate, Lung, Colon, etc. National Institutes of Health National Institutes of Health www.nih.gov 10 year risk of heart attack10 year risk of heart attack Memorial Slone Kettering Cancer Center Memorial Slone Kettering Cancer Center www.mskcc.org www.mskcc.orgwww.mskcc.org Lung cancer, etc.Lung cancer, etc.

18. Dennison, Barbara A., MD, Risk Evaluation in Pediatric Practice, Pediatric Annals (Jan 2004) Classifying BMI Underweight Underweight BMI < 5 th percentileBMI < 5 th percentile Healthy weight Healthy weight 5th > BMI BMI < 85 th percentile At Risk of Being Overweight At Risk of Being Overweight 85 th > BMI > 95 th percentile85 th > BMI > 95 th percentile Overweight Overweight BMI > 95 th percentileBMI > 95 th percentile

19. Comorbidity! One risk factor is never enough One risk factor is never enough A good Risk Assessment identifies all the risks! A good Risk Assessment identifies all the risks!

20. National Health Surveys National Health Care Survey National Health Care Survey Behavioral Risk Factor Surveillance System Behavioral Risk Factor Surveillance System Your Risk Behavior Surveillance System Your Risk Behavior Surveillance System National Health and Nutrition Examination Survey National Health and Nutrition Examination Survey National Minority Substance Abuse and HIV Prevention Initiatives Survey [SAMHSA] National Minority Substance Abuse and HIV Prevention Initiatives Survey [SAMHSA]

21. In Conclusion Nurses don’t necessarily need to know 1. The cure 2. The causative agent But we can’t prevent the disease from occurring without knowing the RISK