Author: Arshya Gurbani

Naming Flu Viruses-Nothing to Sneeze At!

By Arshya Gurbani

I’m sorry about the title, too. I heard a pretty ridiculous pun today, and I guess they’re just contagious…much like the flu.

That’s right–sure as the sun rising each morning and the certain as the pride every Tarheel felt following last week’s momentous basketball victory…flu season is back again. In the US, flu season tends to peak somewhere between December and March. A highly variable virus, influenza strains are often different than the previous years’, which leads to the need to constantly update and refine  recommended vaccines for the year. It’s why you have to go back to get a flu shot every year.

Of course, it’s important to know what you can do to prevent getting ill. If you need a refresher, quick shout-out to a fellow UpstreamDownstream blogger from the past: Surviving Flu Season.  But I thought it’d be kind of fun to talk about the influenza virus itself. (You may roll your eyes at “fun” but you’re still reading…)

There are 4 types of the influenza virus, A-D. Influenza A and B are the most common causes of the seasonal epidemic known as the flu that afflicts the US. The A viruses has hemagglutinin and neuramidase surface proteins, also called H and N subunits. That’s where the name of a particular strain comes from. Remember the H1N1 pandemic in 2009? That’s right–the H1 refers to 1 of 18 known H subtypes, and N1 refers to one of 11 known N subtypes. Both of these proteins live on the outside layer of the virus, also known as the viral envelope. They act sort of like bridges, connecting the virus to our cell membranes by latching on to one of the sugars in our cell membranes, sialic acid–H helps the virus enter our cell, and N helps it leave. Pretty nifty, right? Here’s a helpful visual from David Goodsell’s “Molecule of the Month” blog featuring H and N:



As mentioned earlier, the strain of influenza virus most prevalent in any given season can change. Now that we have a vague idea of the naming system, let’s talk about which strains vaccines recommended for the 2016-2017 season protect against. There are 3-component and 4-component vaccines:

  • A/California/7/2009 (H1N1)pdm09-like virus
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like virus (B/Victoria lineage)
  • B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) –only in 4 component vaccines

So far this season, according to a Morbidity and Mortality report looking at data from Oct-Feb, the A(H3N2) virus has been the most prevalent. Around 94% of infections were caused by Influenza A, and 98% of these were attributed to the H3N2 strain. Overall, the report says, it’s been a pretty moderate season.

I hope you enjoyed that brief dip into biology–who knows, if enough of you did, maybe this post can go, you know ….viral.




Why our perception of beauty is skewed

My friend asked me last night, seemingly out of the blue, “Do you ever wonder why stores separate their plus size clothes?”

The truth is, it didn’t cross my mind until she asked it. But I haven’t stopped thinking about it since because, really,  it seems like a classic microagression–a small, perhaps mundane but not insignificant–manner by which to separate people who lie outside of what, at some point, became considered the norm. Not that it should matter, but a 2016 VCU article cited data claiming that over 60% of women in the US wear clothes that are plus or extended sized. Another article notes that plus size women account for 28% of the clothing market (Binkley, 2013). With an affected population that substantial, it’s even more glaring how insensitive we can be.

A 2016  article published in Body Image links anti-fat attitudes, body shaming, self-compassion, and fat-talk in female college students. They found that internalizing body-shaming led to engaging in fat-talk, among other negative anti-fat attitudes. They found the converse to be true as well–that self-compassion leads to better psychological well-being and less engagement with objectification and self-denigration. The health education and communication implication of all this, is to promote self-compassion (Webb, 2016).  It isn’t hard to imagine that segregated stores don’t play into a healing cycle very well.

Though there has been a recent movement for models to that match all body types, the retail industry still largely caters to a frankly thinner than average body type. Consider the last mannequin you saw that wasn’t unrealistically proportioned. I can’t recall a single one…

One article says these social pressures, among others like harsh lighting and narrow spaces in dressing rooms,  are driving plus-sized women to opt towards online shopping (Money, 2017).  Despite some small successes, Money says, men and women of size “are clearly tired of limited options and unwelcome shopping experience”.

The thing is, it wasn’t a question out of the blue. She had gone shopping with her cousin. It should have been a fun  outing– bonding, enjoying rare time together, catching up and picking out clothes for each other. Instead, they parted ways near the entrance of the store.


Binkley, Christina (2013, June 12), “On plus side: New fashion choices for size 18,” The Wall Street Journal, Retrieved from 23949904578540002476232128.

Money, C. N. (2017). Do the Clothes Make the (Fat) Woman: The Good and Bad of the Plus-Sized Clothing Industry. Siegel Institute Ethics Research Scholars, 1(1), 1.

Webb, J. B., Fiery, M. F., & Jafari, N. (2016). “You better not leave me shaming!”: Conditional indirect effect analyses of anti-fat attitudes, body shame, and fat talk as a function of self-compassion in college women. Body image, 18, 5-13.


Promoting Healthy Habits? Tell a Story

Researchers at the University of Southern California have been studying how narrative influence health behavior. They wonder if it might not be more effective to present information as a story. Their results thus far show that, in fact, this may be the case.

Narrative communication has been defined “any cohesive and coherent story with an identifiable beginning, middle, and end that provides information about scene, characters, and conflict; raises unanswered questions or unresolved conflict; and provides resolution”.

A recent article published by the Contributor and re-published by US News  discusses a study that attribute the greater success of narrative-driven presentation to 2 key factors: 1) identification with characters and 2) transportation to and absorption in the story. Both of these psychological processes assist with retaining information. Harnessing this to create characters that are identifiable role models is the key, the author says, to reducing health disparity.

Not surprised by this finding? It does seem somewhat intuitive that something with a story-line is more appealing. The point is, it’s not necessarily how we think to present a message with a scientific or health-rooted concern. We tend to rely on facts, or on recommendations. The article suggests that collaboration across disciplines is important in reaching the most beneficial results.

Utilizing narrative can be tricky, however. A 2016 article on the subject, published in Health Affairs, notes some possible limitations to incorporating narrative into clinical practice. For instance, it may be hard to generalize data that is based on narrative–it may not appeal widely nor have equal effect in diverse populations. Confidentiality may be another barrier. These make it difficult, the authors say, to translate good narrative into practice. They do offer some recommendations on how to address the problem. However, it’s clear that there is a gap to be bridged.

It’s a good reminder that sometimes data collected is only a glimpse of the human it represents.


Dohan, D., Garrett, S. B., Rendle, K. A., Halley, M., & Abramson, C. (2016). The importance of integrating narrative into health care decision making. Health Affairs, 35(4), 720-725.

Hinyard, L. J., & Kreuter, M. W. (2007). Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Education & Behavior, 34(5), 777-792.


GOP Proposal for the American Health Care Act in the works

The Huffington Post reported this morning that the American Medical Association (AMA) is joining other big names in health and patient advocacy to push back against the GOP proposed health bill to replace The Affordable Care Act.

The AMA has historically been a key voice in health care, often opposing national level reform in order to protect clinical practice. However imperfect the 2010 roll-out of the Affordable Care Act (ACA/ObamaCare was), they agree that certain aspects of the ACA should not be rolled back now. In particular, they agreed that the ACA allowed for Medicaid expansion to cover more lower income individuals. They make the argument that the newly proposed bill provides government subsidies based on age, rather than income, which would be  problematic and cause loss of coverage and higher costs.

Other groups that are pushing back against this reform include the American Health Care Association, the American College of Physicians, the American Hospital Association, the National Center for Assisted Living, and the National Health Council. So who actually agrees with the proposed bill? The medical device industry, who claim that cutting taxes on medical devices will allow for growth in innovation that will eventually lead to better care. The counter argument to this claim, it seems, is that though quality of care must indeed improvement, this is irrelevant if people who need it cannot even afford coverage.

If you’d like to read up more on the proposal, the American Health Care Act, and how it differs from what is currently in place, check out Kaiser Health News’ article on the subject. They explain the funding changes the proposal suggests: how tax credits for insurance will change, the addition of caps to the current Medicaid funding, benefits fort he wealthy, penalties for those who have gaps in coverage, and a change to a free market system.

As expected, much is still unclear, but the calls to slow down the repeal process while details are ironed out appears to be quite loud.

Sources (linked in text): The Huffington Post, Kaiser Health News, U.S. Department of Health and Human Services

National Eating Disorder Awareness Week

By Arshya Gurbani

Feb 26th-March 4th is National Eating Disorder Awareness Week 2017. Whether you or someone you know is affected by an eating disorder or you just want to learn more about them, the National Eating Disorders Association has a lot of helpful toolkits to help jump start important conversations.

The most common and identifiable eating disorders are Anorexia Nervosa, Binge Eating Disorder, and Bulimia Nervosa, though there are other eating disorders not otherwise specified.

The role of the media in discussing body image, weight, and eating disorders is powerful. “Media stories about obesity and eating disorders often create images that bear little resemblance to the scientific, clinical, and even lived realities of these conditions” begins one 2014 book on the subject (citation below). Another researcher discusses the role of Facebook in increasing anxiety around weight  or shape . This is not to say that media cannot have a positive impact or generate positive dialogue, but just to recognize that how we talk about eating disorders matters.

If nothing else, we can use this week as an opportunity to intentionally speak about body image and eating in a healthy way. One cool initiative here at UNC’s Campus is done in conjunction with our Campus Recreation facilities; group fitness instructors and coaches will incorporate the theme of NEDA throughout classes and training this week, through actions such as “Mirror-less Monday”, for which mirrors at the gym will be covered, encouraging participants to think about how they feel (as opposed to how they look).

At the end of the day, we all eat. ( Well, hopefully at the beginning of the day too…they still say breakfast is the most important meal!) It has to be incredibly difficult when a daily activity is a major cause of stress.

Eli, K., & Ulijaszek, S. (2014). Obesity, Eating Disorders, and the Media . New York : Ashgate Publishing .

Kaiser Health News covers the Repeal of ACA

You couldn’t really make the case that the American health care has ever been easy to follow. Maybe, though, it’s more on your radar now, with the Trump administration’s promise to repeal the Affordable Care Act and impending changes on the horizon. With a very uncertain political climate, the need for effective health communication is evident because transparency and comprehension are key for informed decision-making.

One source that may prove informative is Kaiser Health News. They’re open to would-be health communicators sharing and spreading their stories (for free, so long as you credit them), and they’ve been especially attuned to changes in health care policy of late. In fact, their beat Repeal & Replace Watch monitors the progress of the new administration, providing policy updates peppered with analysis and data to explain them. Some pieces are originals, and others link to reputable sources, allowing for breadth as well as depth of coverage.

Well, so I bet you’re wondering, “What did the cover today?” A lot! But here’s what I read: In an article on the individual health insurance market, they explain legislation discussed in Congress today.  We’ve been hearing for a while that the Trump White House has no concrete plan to roll out a new health care infrastructure, but this is the first tangible sign of what might lie ahead. Basically, as explained by KHN author Julie Rovner,  insurers thought that consumers were taking advantage of the market by only buying coverage when needed it—which makes them a high risk population. The new rule makes it harder to buy coverage for only short periods of time, and gives insurers more flexibility. However, Rovner notes, there is concern as to whether the rule can be implemented in time for 2018 roll-outs, because insurers would need to decide by early may where they will opt to sell insurance for next year.

She goes on with details on how key market players, representing insurers as well as patients, and politicians responded this news (mixed responses, of course).

Along for the (Fluo) Ride

By Arshya Gurbani, M.A. candidate 2018

Fluoridated water, at the right amounts, is beneficial for our dental care. In fact, the Centers for Disease Control and Prevention says it’s one of the ten greatest public health achievements of the 20th century! So why was it necessary for the Orange Water and Sewer Authority to shut down after a fluoridation leak (and water main break) last week? If you’re a resident of Chapel Hill or Carrboro wondering about the risks of “contaminated” water, questioning whether the closing of businesses and workplaces was a necessary loss of income, or if you’re just interested in the water you drink…look no further.

Here are 5 things you should know about the fluoridation of drinking water:

  • Fluoride has proven to be very effective in reducing tooth decay, in children and in adults (Centers for Disease Control)
  • It works by making your tooth enamel stronger which slows decay; it can also help reverse early tooth decay When you consume fluoride, it hangs out in your saliva and is bathes your pearly whites! (American Dental Association)
  • Recommended amounts of fluoride in drinking water are around 0.7 mg/liter—well below the identified danger zone of 2-4 mg/liter (Centers for Disease Control)
  • There’s no evidence that water at recommended levels in drinking water worsens or causes cancer (National Cancer Institute)
  • As of 2012, 75% of the U.S. Population had access to safe fluoridated water (American Dental Association).

On the other hand, there are some who believe that fluoride has no real benefits to adding fluoride to our water, and that in fact it may harm some populations, such as young infants. They note that most developed countries do not add any fluoride to their water, though some counter this by saying speculating that salt or other foods are supplemented.

So there is a bit of a debate on the subject. All things said, I’d be interested in knowing just how high fluoride levels got last week.

OWASA’s website posted this announcement, in case you’re local and are interested as well:

Customers are invited to receive information and to comment and ask questions about the water emergency in the OWASA Board of Directors’ meeting on Thursday, February 9th at 6 PM in the Chapel Hill Town Hall, 405 Martin Luther King Jr. Boulevard.



Take a Hike!

by Arshya Gurbani, M.A. candidate 2018

I know, I know—you don’t need a blog post to tell you that hiking comes with health benefits. No surprises there. Sometimes, though, it’s good to get a reminder to get outdoors and get moving! Consider this your friendly reminder, complete with serene photos, to lure you back outside as the weather warms up.

somewhere in North Carolina (courtesy of Unsplash)

somewhere in North Carolina (courtesy of Unsplash)

Hiking is essentially walking—a low impact sport that improves cardiovascular health, helps fight obesity and anxiety, and improves bone strength, as detailed by this nifty handout by the American Hiking Society.  Plus…you can challenge yourself on nature’s obstacle course of rocky surfaces, steep inclines, and slippery slopes. Just in case you’re not a walk in the park type of person.

A healthy mind is equally as important as a healthy body–being outdoors is restorative to mental and emotional health. When outdoors, you are exposed to fresh air, daylight, and beneficial organic compounds.  In fact, some say that outdoor activity should be medically prescribed!

Stone Mountain, Roaring Gap NC

Stone Mountain, Roaring Gap NC

So, if you can, here are a few suggestions to get hiking:

-Join a MeetUp—it’s a great option if you enjoy hiking in company, are terrified of getting woefully lost (yours truly), or are willing to car pool to a scenic location

-Plan a day out with friends—it’ll keep you accountable, and is a great way to catch up and enjoy the local beauty, without emptying your wallets

-Pack some water and snacks, walk out the door, and just keep walking—you don’t need to go far, chase high mountains or trudge through dense forests…just get outside and let your feet take you somewhere new.

Thanks for reading—now get outta here. Take a Hike!

somewhere near Jordan Lake, NC

somewhere near Jordan Lake, NC

Additional references:

Ewert AW, Mitten DS, Overholt JR. Natural Environments and Human Health. Wallingford, England: CABI; 2014.

Gatterer, H., et al. “Effect of weekly hiking on cardiovascular risk factors in the elderly.” Zeitschrift für Gerontologie und Geriatrie 48.2 (2015): 150-153.

Mitten, Denise, et al. “Hiking A Low-Cost, Accessible Intervention to Promote Health Benefits.” American Journal of Lifestyle Medicine (2016): 1559827616658229.

Wolf, Isabelle D., and Teresa Wohlfart. “Walking, hiking and running in parks: A multidisciplinary assessment of health and well-being benefits.” Landscape and Urban Planning 130 (2014): 89-103.



Gillings seminar on Advocacy for Public Health

By Arshya Gurbani, M.A. candidate 2018

On January 18th, I attended a timely panel on Advocacy for Public Health: Crafting Richer Message in a Turbulent Political Climate.  The event was hosted by the UNC Gillings School of Global Public Health.  With inauguration just two days away and the results of the November election still freshly divisive, the subject drew me in. I was impressed by how well the panel worked together to present a unified theme: that public health unites individuals from various fields—law, faith, policy, and moral philosophy—to frame messages and taken action around shared interests. Each speaker made a point that set up the following speaker, in a way that is sometimes absent from panel-style presentations.

The panel included:

-Scott Buris, JD, Beasley School of Law, Temple University

-Gene Matthews, JD, Network for Public Health, UNC Chapel Hill

-Sue Lynn Ledford, RN BSN MPA DrPH, Director Wake County Public Health Division

-Dr. Gary Gunderson, VP FaithHealth Wake Forest Baptist Health

They spoke about the need for collaboration of ideas even in a technical field like law–inspiration comes from all sorts, even though strategy may be left to lawyers. They spoke to the fact that the political issues that polarize us are a small fraction of the ones around which we can unite. They discussed the spectrum of moral values (based on Jonathan Haidt’s Moral Foundation Theory, which identifies and explains 6 moral foundations that guide human decisions) and how it relates to political liberals and conservatives values and perceptions.

I’ve included a link to the lecture below, so I won’t get into the nitty gritty here. The key takeaway was that a message must resonate within a “moral community in stress” while preserving its institutions and traditions. What struck me most was the animation with which the speakers presented their points. Peppering in personal anecdotes throughout the panel, and staying back after the lecture to speak one-on-one with any curious participants…it was clear how invested each speaker was.

At one point, the novel Girl with a Dragon Tattoo was brought up as an example of the power of subconscious representative models–having never read the book, it went over my head, but I saw folks in the audience nodding in agreement at this revelation! Whether or not you agree with the views presented, it was refreshing to see a passionate panel and engaged audience talk through a nuanced subject.

Link to webinar: