This assignment relates to Global Issues in the Healthcare field and the creation of fish bone diagrams and neighborhood assessments. The order contains 4 separate assignments with different page requirements. Please upload each assignment as a separate file and be sure to review the detail instructions for each assignment. I will be checking each assignment instruction against the paper written to ensure compliance.
Assignment 1: FISHBONE DIAGRAM ASSIGNMENT (2 pages, 2 references)
The Fishbone Diagram is an important thought exercise in this class. For this order, you will need to turn in a Fishbone Diagram for a journal article that I will select (see selections below). You will also need to do one for your final project and possibly your final paper as well.
For this order, you will likely have to hypothesize causes that are not explicitly addressed in the journal article to make the connections between the health outcome and the social determinants. Be sure to indicate which bones are from the paper by highlighting that cause with a different color.
1. The main outcome of the paper should be the fish’s head.
2. You need to first draw the immediate causes of the outcome.
o These may or may not be mentioned in the paper.
o If the main immediate causes are not mentioned in the paper, you can list the ones you may already know.
o You may also have to look up what the main causes of the health outcome are.
3. Next draw the causes of the causes until you reach the social determinant(s) of the main outcome.
o Again, not all of the causes linking the immediate causes to the social determinant(s) will be addressed in the paper. That is okay. Use logic and the knowledge you already have to fill in the diagram to the best of your ability.
4. Thought bubbles for possible solutions are optional.
5. Make sure to include all key variables that are included in the paper you are diagramming.
6. All bones that are derived from the paper should be highlighted in some way. I used yellow highlighting in the ppt, but you can use red text, italic text, etc.
7. Keep in mind that social determinants can have negative and positive impacts on outcomes.
8. I will accept the following file types: pdf, ppt, pptx, doc, docx. Your fishbone diagrams can be either hand written (legibly and as a pdf) or typed (as a ppt, pptx, doc, or docx file).
9. Make sure to put your name and the paper you are using on the diagram somewhere.
10. I have provided a ppt file with the fishbone diagram to make things a little easier for you (attached to this order)
The following articles are the ones that are eligible for review:
• Bennett GG, Wolin KY, Robinson EL, Fowler S, Edwards CL. Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health. 2005 Feb;95(2):238-40.
• Herrick AL et al. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS and Behavior 2013;17 (4):1423-30.
• Malmusi D, Borrell C, Benach J. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010 Nov;71(9):1610-9.
• Mansdotter A, Lindholm L, Lundberg M, Winkvist A, and Ohman A. Parental share in public and domestic spheres: A population study on gender equality, death and sickness. J Epidemiol Comm Health. 2006;60:616-620.
Assignment 2: MAP THE INTERVENTION ACTIVITY (2 pages, 2 references)
In this assignment, you will map an intervention or observational study analysis to its theory. Choose an article from the list below; each one uses one or more of the following health behavior theories: HBM, SCT, or TTR.
• DiClemente RJ, Wingood GM. A randomized controlled trial of an HIV sexual risk reduction intervention for young African American women. J Am Med Assoc. 1995;274(16):1271–6.
• Chernick LS, Schnall R, Higgins T, Stockwell MS, Castaño PM, Santelli J, Dayan PS. Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention. Contraception. 2015;91(3):217-25.
• Using the table template I used in the lecture (based on the RHAP program, see below), map the intervention or study design to the theoretical constructs.
• The table should list and describe all the constructs for the theory under consideration.
• If the paper does not address a particular construct, indicate this in the table.
• Provide a brief introduction to the paper, as well as a brief conclusion summarizing the study findings.
• This assignment is to be uploaded. Only doc or docx files are accepted.
A sample table is below:
RHAP Program SCT intervention components
Concept Definition Components
Self-Efficacy Confidence in ability to take action and persist in action Discuss the illusion of self-efficacy or overconfidence that are often described in some songs
Observational learning (modeling) Observing others and copying their behavior Discuss the risky behaviors described by the artist such as drinking and having sex
Expectations Beliefs about likely results of action Discuss the serious and negative consequences of sexually risky behaviors such as teen pregnancy and STDs
Outcome expectancies Values placed on the on the result of the action Not explicitly addressed
Emotional arousal When people become fearful, they engage in actions that a defensive Not explicitly addressed
Behavioral capability Knowledge and skills to influence behavior Sessions 2-4 provided information about HIV and HIV prevention
Reinforcement Responses to a person’s behavior that increase or decrease the chances of recurrence Discuss the illusion of money and cars as rewards of sexually risky behavior that is often described in the songs
Locus of control Belief in personal power over life events Not explicitly addressed
Assignment 3: NEIGHBORHOOD PROJECT ASSIGNMENTS (6 pages (but please make it 3 single space, 10 references)
The neighborhood project is designed to help you observe the social determinants of health in NYC neighborhoods. The learning objectives of the assignment include:
• Learning how to access and present demographic and health data retrieved from local and national web-based data sources
• Assess how neighborhood conditions might affect specific health outcomes
• Describe the potential pathways of influence between health outcomes, proximal risk factors and root causes
• Begin to consider social, psychological and biological mechanisms that connect these factors
• Improve ability to synthesize health data and conceptual maps of relations
• Practice delivering a concise presentation on a complex health issue
Students will be randomly assigned to one of the UHF neighborhoods in class. Within each neighborhood group, each student should pick a different health outcome from one of these choices: (LET ME KNOW IMMEDIATELY WHAT YOU SELECTED SO THAT I CAN INFORM MY TEAM MATES)
• Self-reported health
• Access to Health Care
• Influenza vaccination
• Colon cancer screening
• Breast cancer screening
• High blood pressure
• High cholesterol
• Alcohol consumption
• Physical activity
• Sexual behavior
• Emergency preparedness (2012 NYC CHS)
• Environmental health (2012 NYC CHS)
You may not choose a health outcome that is not on this list. You will be able to find neighborhood-level data for these outcomes in the 2012 and 2014 NYC Department of Health and Mental Hygiene Community Health Survey datasets.
There are two components to the neighborhood project. (1) Each student will submit a 3-page summary of the social determinants of a health outcome in your assigned neighborhood. (2) Students who were assigned the same neighborhood will provide a PowerPoint presentation on the social, physical, and service environment of their NYC neighborhood as well as the social determinants of the health outcomes each student evaluated.
Analysis and synthesis of secondary data
First, you will use available health department and census data to describe the target neighborhood. You do not need to download and analyze datasets. Data for NYC are readily available online through the NYC Department of Health and Mental Hygiene as well as the NYC Departments of Planning and Sanitation in reports and online databases that will give you estimates. The following websites will get you started.
Check the NYC health department website (various sources), for example: http://www.nyc.gov/html/doh/html/community/community.shtml
Epiquery (https://a816-healthpsi.nyc.gov/epiquery/) will likely be very helpful.
Use Info Share or data from the health department or Department Of City Planning website; it is important that your health outcome data match your neighborhood unit/area. You can access neighborhood data using InfoShare: http://www.infoshare.org.
You can also use American Fact Finder – a US Census website. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml
There are so many different types of neighborhood units. What are we using and how does it relate to the other units?
You should use United Hospital Fund (UHF) neighborhoods because that is the level at which you can easily get health data. Think about the problems you will encounter using a neighborhood unit this large. Pay particular attention to what neighborhood unit you are using. Try to consistently use the same one for this exercise because each different type of unit may not necessarily map neatly on to another. Here are four common neighborhood unit types that are used for health analyses in NYC:
• UHF Neighborhoods are defined by the United Hospital Fund for its Health Atlas and other purposes. UHF Neighborhoods consist of between three and six zip codes. There are between 33 and 42 UHF Neighborhoods in New York City, depending on who is defining them and for what purpose.
NB: The assigned neighborhoods are UHF neighborhoods.
• Zip Codes are United States Postal Service designations used to deliver postal mail. There are 1,672 in New York State and 185 in New York City. Zip codes change periodically as the population pattern changes and the Postal Service reorganizes its delivery services.
• Community Districts (CDs) were established by the New York City Charter in 1969 to facilitate delivery and accountability of city services. The New York City Department of City Planning issues maps of the fifty-nine Community Districts that make up the five boroughs. Each Community District is referred to by a borough and sequence number (e.g. BX-1 = Bronx Community District 1). Each borough has between three (Staten Island) and eighteen (Brooklyn) Community Districts.
• A census tract is an area defined by the Bureau of the Census as part of their counting districts. It has an average population of 4,000 people, ranging from 1,500 to 8,000, and varies in size according to the population density of an area. Areas with denser populations will have smaller sized census tracts (as small as a few blocks), and areas with sparser populations will have larger sized census tracts. There are 2,281 Census Tracts in New York City and 5,514 in New York State.
• As a resource, you might want to look at Chapter 19 in Macrosocial Determinants of Health, which is available through NYU libraries as an e-book.
Next you will conduct a neighborhood assessment by researching about 305 Upper East Side, New York Neighborhood.
How do I know where to conduct research? Our neighborhood is so large!
The choice of which blocks to assess is entirely up to your team. You can look at the census tracts in the neighborhood and randomly sample several tracts to assess. You can purposively pick census tracts (or blocks) to assess. Some neighborhoods are large, and therefore quite diverse. You should pick different areas to assess so that you can get a broader sense of the neighborhood.
You may want to look at land use maps to help you select areas to assess. For example, the Department of City Planning’s (DCP) Community data portal (http://www.nyc.gov/html/dcp/html/neigh_info/nhmap.shtml) has Community District (CD) profiles (not UHF neighborhoods) that you could use. DCP also has land use maps:http://www.nyc.gov/html/dcp/html/landusefacts/landusefactsmaps.shtml.
You may want to look at the distribution of demographics in your neighborhood to help you decide where to go. To do that, you might have to look at census data by census tract contained within the neighborhood or find a map that show how people are clustered by demographic variables.
Draw a Fishbone Diagram to flesh out the proximal risk factors, secondary and ultimately “root” or “fundamental” causes of the health outcomes in question.
Neighborhood project summary (25)
In this assignment, students will explore the social, physical, and service environment of an NYC neighborhood (305 Upper East Side, New York Neighborhood) using existing data and research. Students will choose one disease or health behavior that represents a significant burden to your target community and analyze the social determinants of that health outcome with a fishbone diagram. Products will include the fishbone diagram and a 3-page summary of your findings.
The summary should include the following elements:
• Description of the health outcome (5 pts)
o One to two sentences describing the health outcome general with respect to morbidity and/or mortality and risk factors.
o Proportion of the community with the health outcome.
o Proportion of the community with the risk factors for the health outcome.
• Description of the neighborhood boundaries and elements of the community relevant to your health outcome (5 pts)
o Population characteristics (e.g., gender, race/ethnicity, age, income, poverty, etc.)
o Physical environment (e.g., housing type and condition, types of businesses, transportation access, schools, etc.)
o Social environment (e.g., faith communities, signs of social cohesion or social capital, etc.).
o Community resource infrastructure (e.g., hospitals, schools, drug treatment programs, etc.)
• Description of major social determinants of your health outcome in the target community, based upon your review of available data and field observation. This is illustrated through your fishbone diagram and should be discussed in the paper. (5 pts)
• Suggest both policy and public health practice recommendations and new research directions. (5 pts)
• Writing, formatting, and referencing. (5 pts)
Format guidelines for the final project summary
The final project summary should use the following format:
• 3 pages total
• Single spaced
• 1 OR ½ inch margins
• Arial 11 point font
• Citations should use the American Journal of Epidemiology reference style. See the instructions for authors for details. Do not use footnotes or endnotes, but rather a page entitled “References.”
• Only doc or docx files are accepted.
• The fishbone diagram should be inserted into the document as a figure or jpg.
• Page limits do not include the fishbone diagrams, references, or any tables you wish to present.
Your papers must not plagiarize. See: www.indiana.edu/~wts/wts/plagiarism.html. These papers will be submitted to Turnitin. See also the NYU CGPH Statement of Academic Integrity.
Assignment 4: FINAL PAPER INSTRUCTIONS (10 pages, 15 references)
Each student must write a final paper for this class, either on (1) the social determinant of a health outcome or (2) at least three theory-based interventions for a health outcome. Paper topics must be approved by the instructor (Once you pick a topic, provide me with a short write up so that I can send it to the professor for approval. Refer to Final Paper Choice 1 below). Each student will be required to read and comment on a draft of another student’s paper; this will count towards your participation grade. Specific directions for each choice are below.
Format guidelines for the final paper assignment
The final paper should use the following format:
• 1.5 spacing
• 1 inch margins
• Arial 11 point font
• Citations should use the American Journal of Epidemiology reference style. References should be on a separate page. See the instructions for authors for details.
o I highly encourage you to use a reference citation manager software such as Endnote (available for free through NYU here), Zotero, etc.
o Do not use the endnote or footnote function in MS Word.
• Only doc or docx files are accepted, except for fishbone diagrams, which may be emailed to me (email@example.com) separately as doc, docx, jpg, pdf, or ppt files.
Your papers must not plagiarize. See: www.indiana.edu/~wts/wts/plagiarism.html. These papers will be submitted to Turnitin. See also the NYU GIPH Statement of Academic Integrity.
Final Paper Choice 1
Review and synthesize the research literature on a particular social determinant of a particular health condition. You must select one health problem or condition that interests you and one of its social determinants. You must develop a fishbone diagram connecting your health outcome to your SDH.
Word limit: 2500-3500 words
Word limits do not include the fishbone diagram, bibliography, or the table summarizing each article. Appendices, if necessary, should be kept to a minimum and are not included in the page limits. It is expected that a minimum of at least 10 references will be included in the analysis (further references are likely to be necessary).
Final papers will be evaluated according to the following criteria:
1. Introduction: Description of the health outcome and its epidemiology. Description of the social determinant being investigated. Discussion of the research question (2.5 pts).
2. Methods and Results: Review and synthesis of literature/findings (i.e. description of search criteria and selection process, evaluation of article results, relevance of literature selected, presentation of results). You must report at least 5 measures of association (i.e., odds ratio, rate ratio, hazard ratio, difference between means, etc.) from among the 10 papers and their 95% confidence intervals. (7.5 pts).
3. Discussion: Discussion and analysis of findings (i.e. how well does the literature answer the research question, limitations). As discussed in class, Margaret Whitehead developed a typology of four actions we can take to address health inequalities: strengthen individuals; strengthen communities; improve living and working conditions; and promote healthy macro-policies. Think about the social determinant and health outcome for this paper. Based on Whitehead’s typology, at least one paragraph of your discussion should describe one approach for each action category that could address disparities in your health outcome caused by your social determinant of health. You can describe actions you have read about this semester (if so, provide a reference) or you can offer your own ideas. (5 pts).
4. Fishbone diagram: Illustrate the social determinants of the health condition of interest using a fishbone diagram. The fishbone should be on a separate page; you can insert the fishbone as an image (2.5 pts).
5. Table summarizing articles: At a minimum, list author, publication year, setting, population, results (2.5 pts).
6. Writing: Clarity, appropriate language, absence of jargon, organization of paper, grammar, spelling, etc. (5 pts).
Papers that review fewer than 10 papers will lose points. Do not review a review article (including systematic reviews or meta-analyses) or an editorial; however, review articles can be used as background references for the introduction and discussion sections. If you are unsure if a particular article is acceptable, email the instructor.
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