Author: Josh Boegner

Transgender Day of Remembrance

CW: Anti-Trans Violence, Homicide mention

Yesterday, November 20th, marked Transgender Day of Remembrance (TDOR), which honors the memory of those whose lives were lost due to anti-transgender prejudice. Recognized annually on November 20th, TDOR was initially started in 1999 as a vigil to honor the life of Rita Hester, a transgender woman who was killed a year prior. While many strides have been made in recent years in regards to trans visibility and awareness, transgender people still face violence at disproportionate levels.

According to the Human Rights Campaign, there were at least 23 deaths of transgender people in the United States that were due to violence, which at that point was the highest number ever recorded. In 2017, there have been at least 25 transgender people killed by violent means. These numbers are likely much lower than the actual rate of violence, as police can sometimes release incorrect names or genders of victims.

The experiences of violence are often intersectional, most of the victims counted were non-white transgender individuals, where race, class, and gender identity create an increased risk of experiencing violence. Below I have included some additional sources for further reading, and a link to tdor.info, where they have a printable list of victims from the past year, that is often read at vigils honoring TDOR.

Sources –

GLAAD: Transgender Day of Remembrance – https://www.glaad.org/tdor

Human Rights Campaign: Violence Against the Transgender Community in 2017 – https://www.hrc.org/resources/violence-against-the-transgender-community-in-2017

The New York Times: Violence Against Transgender People Is on the Rise, Advocates Say – https://www.nytimes.com/2017/11/09/us/transgender-women-killed.html

International Transgender Day of Remembrance – https://tdor.info/

Halloween Candy and the crux of Added Sugars

Halloween is one of my favorite holidays: with the costumes, fascination with the occult, the wonderful fall weather and fall themed foods, and one of my favorite vices being the candy. While I would argue that it’s the chocolate that I love, my sweet tooth cravings are most likely for sugar.

According to the American Heart Association, adult males are recommended not to consume more than 36 grams of sugar per day, while the recommendations for adult females is 25 grams. With that in mind, where does that leave some of our favorite Halloween Candy?

According to a recent study by FiveThirtyEight, the most popular Halloween Candy in the U.S. is Reese’s Peanut Butter Cups, with the top five being rounded out by Reese’s Miniatures, Twix, Kit Kat, and Snickers. Below are the sugar content in grams for each of the top 5 candies in the fun-size portions, except where otherwise noted:

Candy Sugar Content
Reese’s Peanut Butter Cups 10.5 grams
Reese’s Miniatures (3 pieces) 10 grams
Twix 8.5 grams
Kit Kat 7 grams
Snickers 8.5 grams

 

The key here is that we should enjoy our Halloween Candy in Moderation. Often for myself, Halloween starts the downward spiral of unhealthy eating that lasts into the new year. In order to combat this, I am going to (attempt) to cut out added sugar from my diet for the three weeks between Halloween and Thanksgiving. While skipping the half-priced post Halloween candy deals will be difficult, I am hoping to use this time to become more aware of the amount of added sugar I consume on a daily basis (just don’t ask me how many mini snickers I ate yesterday). For anyone who is interested in this, I have included a link in the sources below to a guide to a sugar detox. Happy Halloween!

 

Sources:

American Heart Association: Added Sugars –  http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Added-Sugars_UCM_305858_Article.jsp#.Wfc9CGiPLD4

FiveThirtyEight: The Ultimate Halloween Candy Power Ranking –

http://fivethirtyeight.com/features/the-ultimate-halloween-candy-power-ranking/?utm_source=fark&utm_medium=website&utm_content=link&ICID=ref_fark

Daily Burn: Sugar Detox Diet –

http://dailyburn.com/life/health/sugar-detox-diet/

Smoking Disparities among LGBTQ Populations

Recently, I was in a LGTBQ establishment, having a conversation with a friend during a night out, when a tobacco company representative kindly offered us a $2 off coupon for a pack of cigarettes. Needless to say, I accepted the coupon out of curiosity, having had similar experiences in other Queer spaces previously. For those that are not aware, tobacco is fairly engrained in Queer nightlife, most of the people that I know personally who smoke are either LGBTQ identified, or those who live back home in rural Michigan.

According to the Centers for Disease Control and Prevention, about 1 in 6 heterosexually identified adults in the United States are smokers, compared to Lesbian, Gay, and Bisexual adults where the smoking rate is nearly 1 in 4. For transgender individuals, there is little research to know what the smoking prevalence is.

The research on smoking rates among LGBTQ individuals in general has grown more recently, with one study noting the overlap between LGBTQ individuals living in rural Appalachia. Bennett, Ricks, and Howell found that among the LGB individuals, many of them lived with high levels of stress due to their isolated location and living within their identities in those rural areas. Many of those interviewed noted that tobacco smoking is connected to both stress and social structures, though did not seem as aware of how their LGBTQ identity and ability to be “out” as something that may contribute to smoking.

I may be one to have to occasional cigarette, and like my love for sugar, I’m aware of how that makes me appear as a hypocritical public health professional. On the flip side, I think we can all agree that nobody is perfect, and I hope that my owning of my imperfections highlights the level of transparency that I try to bring into my work.

 

Sources:

Centers for Disease Control and Prevention: Lesbian, Gay, Bisexual, and Transgender Persons and Tobacco Use: https://www.cdc.gov/tobacco/disparities/lgbt/index.htm

Bennett, K., Ricks, J. M., & Howell, B. .. (2014). ‘It’s just a way of fitting in:’ Tobacco use and the lived experience of lesbian, gay, and bisexual Appalachians. Journal Of Health Care For The Poor And Underserved25(4), 1646-1666. doi:10.1353/hpu.2014.0186

Impostor Experience: The Advice I Keep Giving Myself in Graduate School

Impostor experience is characterized as having an inability to internalize one’s accomplishments, where those who experience it feel that they are a fraud, that they have somehow deceived others to believe that they are smarter than they actually are. These feelings occur even when contradicted by success, often crediting luck or good timing over their own hard work and effort. And it is quite prevalent in academic spaces.

When I started my graduate career, I was lucky enough to have professors who were well aware of this topic, encouraging students to reach out when they needed to, reminding us that we all have expertise to contribute to the classroom, we all have a space.

As a first generation college student, I still have moments almost daily where I feel like I don’t belong, that this isn’t really the place for me. Sometimes it’s a simple comment, someone in class sharing an experience, like “Oh my dad’s a doctor”. Don’t get me wrong, my parents are two of the hardest working people I know. But there are constantly reminders for me that in pursuing a graduate degree, I’m taking a career path that not many people who knew me as a child could even imagine.

Below I’ve attached some resources that I have found particularly helpful at some low points in my academic career. But what has helped the most for me is opening up to my friends and classmates, and realizing that I am not the only one having these feelings. I’m writing this because I’m not perfect at taking my own advice, I still need to step back and use some of these strategies, and I still need to practice opening up when I’m struggling.

Sources:

APA Cover Story: Feel like a fraud? http://www.apa.org/gradpsych/2013/11/fraud.aspx

The Chronicle of Higher Education: Impostor Syndrome is Definitely a Thing: http://www.chronicle.com/article/Impostor-Syndrome-Is/238418

National Coming Out Day: Empowering, Heteronormative, or somewhere in between?

Tomorrow, on Wednesday, October 11th, the Human Rights Campaign (HRC) will commemorate the 29th annual observance of National Coming Out Day, to “celebrate coming out as lesbian, gay, bisexual, transgender, queer (LGBTQ)”. Many fine this day an opportunity to reflect back on and share their own coming out story, the HRC frames the day “as a reminder that one of our most basic tools is the power of coming out”. While my own process of coming out, at least in the sense mentioned above, I have some issues with this notion that it is a process with a shareable end goal, that I am able conveniently post to social media (based on the privilege I have in society), to remind my friends and family that I am queer, in case how I am living my life did not make that obvious enough.

On one hand, there is something to be said about the need for visibility, simply having a presence of owning your identity can be empowering, and it can help others in their process of finding their identity. But at the same time, I cannot help but wonder if the emphasis placed on coming out only serves to be heteronormative in nature, this need to distinguish yourself as the “other”. I also have issue with the idea that only LGBTQ+ individuals need to take the time to process what their sexual attractions and gender identities are, and more importantly how they define them and their place in the world. Why is it so normalized to own and share this counter narrative, when say, someone who identifies as a cisgender straight man is just accepted and believed in their identity?

Coming out also reinforces this idea that this process has an end goal, you spend some time, realize you’re not straight, share it with your friends and family, and done. This week, I want to encourage everyone to take a moment, think about how you feel with sexual orientation and gender identity, and consider how it positions you in the spaces that you occupy and the world around you, and the think about the ways that it can make it easier or more difficult for those in your circles who are not straight, are not cisgender. Does it give them space, and does it allow others to be open to themselves, and do you use your privilege to challenge that status quo to make that easier?

Straight Skinny, but Gay Fat? Reflections on Pride, the intersection of identity and mental health, and the stigmatization of queer bodies

This past weekend marked the 33rd annual celebration of North Carolina Pride, a time to celebrate the beauty, diversity, and resiliency of the LGBTQ community. The week of October 1-7 is Mental Illness Awareness Week, observed by the National Alliance on Mental Illness, to “fight stigma, provide support, educate the public and advocate for equal care” in regards to mental health. Studies have shown that LGBTQ+ identified individuals are three times more likely to live with a mental health condition than their heterosexual counterparts. This includes, but is not limited to: depression, anxiety, eating disorders, or Body Dysmorphic Disorder, to name a few.

Body Dysmorphic Disorder, or BDD, is classified as a body-image disorder where individuals have persistent and intrusive preoccupations with a defect in their appearance, which can be imagined or slight. Obsessions about appearance can be all consuming, and make it hard for those affected to focus on other areas of their lives. Oftentimes, those living with BDD can perform a compulsive or repetitive behavior, with some examples being: avoiding mirrors, skin picking, excessive grooming, excessive exercise, frequently changing clothes, trying to hide or conceal body parts, or in extreme cases seeking surgery to correct the perceived flaw or flaws. These behaviors can lead to feelings of low self-esteem, resulting in avoiding social situations and having difficulties with work responsibilities and personal life. Individuals suffering with severe BDD are also at a higher risk of having suicidal thoughts or to attempt suicide.

People living with BDD often also suffer from other anxiety and mental health disorders, such as social anxiety disorder, depression, eating disorders, or obsessive compulsive disorder (OCD). Because of similarities and overlap of symptoms, BDD can be misdiagnosed as one of these other mental health disorders, specifically with similarities to OCD, being distinguished when behaviors focus specifically on appearance. According the American Psychiatric Association, between 2.2-2.5% of people in the US experience BDD, and it usually begins to occur around the age of 12-13.

As someone living with BDD, I spent years of my life not having words to describe what I was feeling, being hyper aware of my body and the way I see it as being perceived by others. Most of the time, these are internal conflicts, rarely do they manifest in ways that are visible for others. On Saturday night, I was waiting in line to get into a gay night club to celebrate Pride with friends. When it was time to pay the cover to enter, the thought of people looking at my body, of people touching parts of my body that I find unsightly, resulted in a panic attack where I ended up leaving and going home. This isn’t the first time I’ve felt uncomfortable in a space like this, but I can’t shake the feeling of letting my friends down, of allowing my insecurities to get in the way of what was supposed to be a fun night out.

My bigger concern is that my experience isn’t unique, that others have also struggled to feel accepted in places that are supposed to be welcoming to then. The unrealistic standards around body image in queer spaces foster an environment of self-doubt, generate feelings of insecurity, and further reinforce the heteronormative narrative that is already placed on us by larger society as a whole.

But issues around unrealistic body issues aren’t the only problem facing the LGBTQ community. Blatant and covert racism, misogyny, and the policing of how others live their lives are also major hurdles that we need to overcome. And many of our spaces aren’t accessible to a number of people due to cost.

On top of all of this, we don’t give each other spaces to talk about the ways we are struggling, whether that be with our mental health, our interpersonal relationships, or how we are handling navigating a society that simply is not designed for us. My hope is that by sharing, it will open up a space for others to acknowledge what they are feeling, to finally have words to define those feelings, or to simply be aware of the struggles that others are going through.

Below are some sources if you are interested in learning more about the topics that I discussed here. If you feel that you need to reach out, talking with a mental health professional can be a great place to start. If you are a student here at UNC, CAPS offers a variety of mental health services, more information can be found below.

For CAPS Walk-In Services:

Go to the 3rd floor of the Campus Health Services Building

MON-THURS: 9 am – noon or 1 pm – 4 pm

FRI: 9:30 am – noon or 1 pm – 4 pm

Sources –

National Alliance on Mental Illness Awareness Week – https://www.nami.org/Get-Involved/Awareness-Events/Mental-Illness-Awareness-Week

National Alliance on Mental Illness LGBTQ – https://www.nami.org/Find-Support/LGBTQ

Anxiety and Depression Association of America: Body Dysmorphic Disorder – https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd

CVS and the role of Pharmacies in the Opioid Crisis

This past week, CVS pharmacy announced another step in their response to the country’s ongoing opioid epidemic. They are expanding medication disposal options, by adding over 700 in store disposal units across the country. They also announced an expanded pharmacist counseling session for those prescribed opioids for the first time, to highlight the risks of addiction and dependence, while answering any patient questions. The CVS Health Foundation has additionally pledged $2 million to support federally qualified community health centers that deliver medication-assisted treatment.

On top of all of this, they have announced that they are limiting the prescription of opioids to seven days for acute prescriptions, limiting daily dose strengths, and requiring that immediate-release formulations of opioids to be used before prescribing extended release options. Not only does this make their practices consistent with recent CDC guidelines, but also as the largest pharmacy in the United States, CVS taking a stronger stance to limit the excess prescribing of opioids could set a precedent in the role that pharmacies play in the opioid crisis.

To combat this epidemic, we need buy in from facets of the medical industry, from individual doctors to health care systems, insurance companies and pharmacies, medication manufacturers and government officials. I commend CVS on their stance to address their role in this crisis, and hope that it serves as a moment of recognizing responsibility for this crisis. If we use evidence based interventions, and partnerships from behavioral health, to medicine, and governmental agencies, we can begin to reduce opioid dependence and addiction, and see a decrease in those lost to overdose.

Sources –

CVS Health Press Release – https://cvshealth.com/thought-leadership/cvs-health-enterprise-response-opioid-epidemic/cvs-health-responds-to-nations-opioid-crisis

CDC Opioid Prescribing Guidelines – https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Farm Health and Safety Awareness

September 17-23 marks National Farm Health and Safety Week 2017. As someone who grew up on a Dairy and Crop Farm, I am all too familiar with the dangers that come along with a life in agriculture. From close calls, to the injuries of family members, to the tragic passing and near death experiences of neighbors and others in the community, the risk of injury and death was always in the back of my mind. My parents still operate our family farm together, juggling the responsibilities of keeping the farm going, raising grandchildren, and navigating health issues that someone who has grandchildren often begin to deal with (sorry mom and dad!).

The National Education Center for Agricultural Safety uses each day this week to highlight a different issue that faces those who work in the agricultural industry, and today marks farmer health. Where I’m from in the Thumb of Michigan, many of the local farms are operated by an aging population, who along with the risks involved with a farming lifestyle, are also coping with diseases associated with aging, such as arthritis and cancer. I encourage you to take the time to learn more about the Health of Farmers, and to appreciate the unique challenges that accompany the large scale agricultural work, and the impact that farming has on a national and global scale. More information is sourced below!

 

Sources –

National Education Center for Agricultural Safety National Farm Health and Safety Week 2017 – http://www.necasag.org/nationalfarmsafetyandhealthweek/

9/11, Hurricane Season, and disaster-related Secondary Traumatic Stress

Yesterday was the 16th anniversary of the 9/11 Terror Attack, and like many Americans I can easily recount where I was at when I saw the coverage of the attack. The event dominated news media for weeks after the events unfolded, and became enshrined as a defining moment of 21st century America.

I cannot even begin to fathom the first hand experiences of people who directly impacted from the attack, but for many, the day is a permanent memory of the way they felt, perceived, and witnessed everything unfold.

Secondary Traumatic Stress occurs when an individual hears the recounting of another’s traumatic life event. Often, the symptoms are similar to that of the more commonly known Post Traumatic Stress Disorder, or PTSD. In recent years, there has been more research being done to see the effects of disasters that affect those beyond those immediately experiencing an event.

In the wake of the recent disasters of Hurricane Harvey and Irma, we have seen coverage of their destruction everywhere from major news sources to the social media that we consume for updates from loved ones. A recent New York Times piece noted that the Weather Channel, being the only network to provide 24/7 access to coverage of the recent Hurricanes, had seen its audience increase nearly tenfold. The coverage of these storms has been vast, because the scale of the destruction of these storms has been unprecedented.

Covering these events is vital, it is important that we do not sensor the news that we receive just because of the harmful effects that it may have on us. But, by being more aware, and staying informed, we can acknowledge the way that having information so freely available can help us to cope, and hopefully heal, together.

 

Sources –

New York Times Piece: https://www.nytimes.com/2017/09/09/business/media/weather-channel-hurricane-irma.html?_r=0

Secondary Traumatic Stress: http://www.nctsn.org/resources/topics/secondary-traumatic-stress

PrEP for HIV Prevention? Here’s what you need to know

Pre-Exposure Prophylaxis, or PrEP, has changed the way in which we talk about HIV Prevention. After being approved for preventive use by the FDA in 2012, there has been a sharp increase in PrEP prescriptions in the U.S. over the past several years. Currently, the only prescription available for PrEP is Truvada, which also serves as a treatment drug for those who are HIV positive.

Truvada is a nucleoside reverse transcriptase inhibitor, or an NRTI. When exposed to HIV, a NRTI works by masking itself as a building block of the virus’s genetic structure. While our own cells are able to recognize and correct for this coding mistake, HIV cannot, and as a result is unable to replicate and mount a widespread infection.

A quick distinction: Truvada as a drug is a form of PrEP, PrEP is a general class of preventive measures. Birth control can be thought of as a form of PrEP, preventing a pregnancy before it occurs. Even sunscreen is a form for PrEP. You apply lotion to prevent sunburn before it occurs.

But PrEP only works if you take it. According to recent findings from the Centers for Disease Control and Prevention, the majority of uptake of PrEP in the United States has been among middle-aged, white, gay men. But the HIV epidemic has shifted, with the CDC noting continuous inequalities in the southern states and among young African Americans.

More concentrated efforts need to happen to ensure that those who can benefit from PrEP are able to access and receive it. Gilead, the company that produces Truvada, has a copay card available, where they pay up to $3600 a year in copays for those living under 500% of the national poverty level. For more information on PrEP, UNC campus health also serves as a great resource on campus, and students can get more information by making a free appointment with Student Wellness by emailing LetsTalkAboutIt@unc.edu or by calling (919) 962-WELL(9355).

For additional Resources on what to know about PrEP, and how to have a conversation with your provider, please see the resources below for information from the CDC. For those looking for a PrEP friendly provider, here is a list of providers in the State of North Carolina who actively prescribe PrEP.

Sources –

Gilead Copay Card: https://www.gileadadvancingaccess.com/copay-coupon-card

Centers for Disease Control and Prevention PrEP Resources: https://www.cdc.gov/hiv/risk/prep/index.html

Centers for Disease Control and Prevention PrEP Information: https://www.cdc.gov/hiv/basics/prep.html

List of PrEP Providers: https://www.med.unc.edu/ncaidstraining/files/PrEPProvidersforDownload.pdf/view