Author: Jenny Fitter

Practice These Morning Habits For A Better Day Ahead

Most of us fail to consistently get a good night’s sleep, BUT there are things you can do the next morning so you won’t feel exhausted throughout the day. The good news is that you can begin feeling better before you even leave the house. While some of these may be obvious, we bet there are some that may shock you.

  • Don’t look at your phone after you awake. Studies reveal the longer you stay in bed, the longer your brain waits to prepare for the day ahead. Electronic devices have contributed to this problem, as people are inclined to check the weather, send emails, read news headlines, or review social media immediately after awakening. The rule of thumb here is, “when you wake up, get up.” The phone can wait.
  • Don’t be discouraged by your fitness tracker. While Fitbits and the like are great for giving us detailed information regarding the quality of our sleep, sources say beginning the day by looking at negative sleep reports can induce stress and get us off on the wrong foot. Folks tend to begin their day with the mindset they should be tired, even when they aren’t.
  • Drink plenty of water. We all know drinking water is good for many reasons, but replenishing our bodies after a long night of sleep gives us the energy we need to begin our day. Water not only helps relieve “morning breath” but it also helps keep from feeling tired and irritable. So while you perk that initial pot of coffee, go ahead and grab a glass of water and get to hydrating yourself ASAP.
  • Shower in the morning. We all love a hot shower just before bed, but studies show this can have a negative effect on our sleep since our core body temperature drops to about 60 degrees before we fall into a deep sleep. Showering before bed can result in a delay in hitting REM or can cause restless sleep since it takes longer for our bodies to cool down. Actually, a warm morning shower can help energize us by raising our body temperatures and helping us to awake quicker than taking cooler showers or not showering at all.
  • Exercising at night keeps us up. It may be difficult to get in an hour workout before work at 8 a.m., but studies reveal the more activity you do during the later hours in the day, the more likely you’ll have a harder time falling asleep at night. In fact, working out in the morning makes us awake quicker and leaves us energized throughout the day, regardless of the amount of sleep we actually got.
  • Get outside! This should be no-brainer, but Vitamin D gives us energy, and reduces the sleep-inducing hormone, melatonin. As soon as you arise, you should open the curtains and let the sunlight in. Go for a morning walk or run if you really want an extra energy boost.
  • Turn on the tunes. If you exercise regularly, chances are that your iPod often helps get you in the mood to get you through your work out. Well, the same theory can be applied to getting out of bed. Turn on something upbeat to help you power through your morning routine – think: Pharrell’s “Happy”, “Walking on Sunshine” by Katrina & The Waves, or “September” by Earth, Wind & Fire.


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Is It A Cold Or Allergies?

With the beautiful trees and flowers in bloom this Spring season, also come the agents that make us cough, sniffle, and sneeze. And while the symptoms are always frustrating, for many of us, it’s sometimes hard to tell if what we’re suffering from is a cold or simply allergies. According to a recent survey conducted by Allegra D, 65% of people didn’t always know if they had one or the other, making it difficult to treat with OTC treatment. So before you head to the pharmacy to pick up meds or Kleenex, consider the following symptoms and see where they fall in the “Cold/Allergy Venn Diagram.


The Brain Controls the Body, But Can the Body Control the Brain?

We all know our moods can affect how active we are, but did you know how much you move can also have an affect on our mood?

That’s right, according to researchers at Harvard Medical School, the connection between your brain and your body is a two-way street. They found that consistent exercise, such as running, cycling, and aerobics can affect your mood by increasing a protein found in the brain called brain-derived neurotrophic factor, or simply BDNF, which aids in the growth of nerve fibers.

Other studies have shown that those with ADHD can reduce their symptoms (although only temporarily) by doing 20-minutes of exercises such as cycling. Afterward, participants were motivated to do tasks that required thought and were less depressed, tired, and confused.

Forms of meditation, such as yoga, qigong, and tai chi were all shown to be helpful at alleviating depression, by allowing people to pay closer attention to their bodies and not on external factors. These changes in posture, breathing, and rhythm have all shown to affect the brain in a positive way. In some cases, people with post-traumatic stress disorder (PTSD) no longer met the qualifications for it once they began practice meditative movement.

Additionally, another study has shown that while exercise is beneficial for well being, self-esteem if further improved when moving synchronously with someone else. Moving along with someone else also showed signs of cooperation and charity toward others, as well as improved memory and recall skills.

Ultimately, these findings only stress the close connection held between your brain and body, and show that how much you move can not only help you stay physically fit, but can also affect the way you think and feel. These findings also present an alternative remedy to more traditional treatments for depression, such as psychotherapy and medication.

So next time you find yourself exhausted and completely overwhelmed, put on your sneakers and take a few minutes to get some exercise. You’ll not only sleep better, but in time, you may find yourself feeling more positive about life as well.

Coffee: Foe or Friend?

Coffee has long been debated about whether or not it’s healthy, particularly since most of us drink it on a daily basis. While some reports have linked it to heart disease and cancer, recent developments are showing that coffee, indeed, is good for your health — or at least the benefits outweigh the risks.

So why the reversal? Well, one explanation, is that previous studies failed to consider that high risk behaviors, such as smoking, drinking, or physical inactivity were likely to be more common among coffee drinkers, and those factors could have resulted in the negative beliefs about coffee consumption.

Most studies are now finding an association between coffee consumption and decreased mortality, in particular, reduced cardiovascular mortality. Other studies have shown that coffee is linked with reducing the occurrences of Parkinson’s disease, type II diabetes, breast cancer, and liver disease, while increasing cognitive function and decreasing depression.

Doctors at the Harvard School of Nutrition say coffee works at minimizing depression not only for its caffeine content, but also by controlling inflammation in the brain through its high number of anti-inflammatory polyphenols, which are also found in fruits and vegetables. By reducing the amount of inflammation, the brain can then produce more serotonin, also known as the “feel good” chemical, which is found in antidepressant medications.

However, doctors say not all coffee is the same, and to look for brands with high amounts of polyphenols. Also, if you’re looking for a healthier way to drink coffee, the suggested daily recommendation is 1-2 cups, so anything over may end up being detrimental, especially if your body doesn’t metabolize it as quickly. Over consumption of coffee can also be linked to increased cholesterol levels and heart disease, so it’s important to drink it in moderation. It’s also suggested to consume more mild blends, as opposed to stronger brews like espresso. And finally, the less sweets you add to your cup o’ Joe, the better. Some sweetened coffee drinks can contain up to 500 calories!

Other Dangers of Using Devices at Nighttime

Most of us know that using mobile phones or e-readers before bed can disrupt our sleep cycles, but did you know there are other dangers associated with prolonged exposure to artificial light at night?

Recent research suggests that excess blue light exposure may be doing more than robbing you of a good night’s sleep, and could also increase your risk of cancer, obesity, and depression.

It’s important to understand why the blue light emitted from mobile devices affects your circadian rhythm. Typically, after awaking, people usually open the shades to let in the morning sunlight. Special cells in your eyes detect the natural light and signal your brain to shut off its production of melatonin. The physiological process doesn’t stop there—the morning light also signals cells to increase production of the stress hormone cortisol and a hunger-promoting hormone called ghrelin. The morning light also signals your body temperature and heart rate to rise.

In essence, the morning light allows your body to “reset” itself to prepare for the work ahead, which is exactly what’s supposed to happen in the early hours of the morning. However, this physiological resetting can sometimes occur at night, which is when things can start to go amiss.

Previous research has shown that people who use mobile phones, e-readers, or are exposed to LED lighting have increased appetite, took longer to fall asleep, experienced less restorative REM sleep, and were more tired the following day than those who did not use such devices before bedtime. Another study demonstrated where device users experienced a 55% drop in melatonin after only five days, which can be alarming because in addition to its sleep-inducing powers, melatonin has also been shown to be an anti-cancer agent.

While most of the recent research is too early to determine the true effect of blue light at night, scientists aren’t afraid to suggest that folks burning the midnight oil on their devices are more likely to be obese or suffer from heart disease. Other studies have linked late night workers to higher rates of both breast and prostate cancer.

So, in a world driven by technology, what can we do to ensure we’re getting the proper kind of sleep? Fortunately, there are several steps we can take that won’t require us to toss out our smartphones and computers. With a proper balance, we can have both!

The best advice public health gives us in this department is to power down those devices at a normal hour, or at least an hour before you go to bed (of course, the earlier the better).

Next, try reading an actual paper book before bed. Foregoing the artificial light from a phone or e-reader will signal your brain to begin producing melatonin at a decent hour to prepare your body for sleep.

Also, try purchasing energy-efficient light bulbs. Certain companies now produce bulbs that automatically change their hue depending on the time of day.

Finally, if you must use an electronic device before bed, purchase an app that allows your laptop or phone to emit blue light during the day and shifts to warmer wavelengths by evening. While this option isn’t as healthy as reading a traditional paper book, it should help your body to still produce some amounts of melatonin.

Sweet dreams!

Breaking Rural Health Barriers

For those of us that are fortunate to live near hospitals and primary care clinics, that question of rural vs. urban care is unlikely to even cross our minds. But for those living in remote locations, lack of access is a common issue. Unfortunately, what many of us take for granted is another person’s struggle, especially if they are plagued with chronic conditions, such as asthma or diabetes. And in many cases, most folks in this situation often go without treatment.

The National Rural Health Association reports that while a quarter of the U.S. population lives in rural areas, only one-tenth of our nation’s physicians choose to practice in these areas. And while only a third of automobile crashes occur in rural locations, two-thirds of deaths attributed to those accidents occur on rural roads, indicating a shortage in acute trauma care.

These figures certainly give rise to the need for increased access to care within rural communities. Another factor that contributes to this issue is that Medicare reimburses rural hospitals at a lower rate than urban hospitals, resulting in fewer physicians choosing to practice in such locations. Over the last 25 years, nearly 500 hospitals have closed, many of which were located in rural communities.

Fortunately, this is the age of digital know-how. Technology is king, and health care is one of the leading industries taking advantage of such innovation and wisdom. General Electric (GE) is doing its part to improve women’s health in remote areas like Wyoming, where the average woman has to commute 70 miles just to receive a mammogram.

In 2014, the company started the GE healthymagination program, to expedite cancer innovation and improve cancer care to 10 million patients, over the next six years (until 2020). One of the program’s most influential aspects is the GE Mammovan, equipped with mammography technology to provide free mammograms to all women living in remote areas.

GE chose to pilot the program in Wyoming, which has the lowest number of citizens and lowest population density (after Alaska). Many of the women using the van cited it was their first time having ever received a mammogram, stating that travel time or insurance requirements had precluded them from being screened for breast cancer. GE’s website reports that because of Wyoming’s uneven population distribution, a third of women living in that state over age 40 never receive a mammogram.

Since nearly two years ago, the mobile unit has traveled throughout the state, setting up in locations where women can receive a mammogram within an hour, allowing them to avoid the hassles of taking off from work and/or driving long distances. In many ways, the van serves a dual purpose—by eliminating the barriers rural residents previously faced and improving access to preventative care. By detecting breast cancer as early as possible saves the health care industry billions and ultimately, saves lives.

While North Carolina isn’t as rural as Wyoming, you might be surprised to learn that 85 percent of our state’s counties are, in fact, considered to be rural. And with nearly 2 million people receiving Medicaid, access to care is certainly an issue of interest among health care workers and lawmakers. And while mobile units are pricey to create and maintain, the progress the GE Mammovan has made in Wyoming is a good example of how health information technology can work to address some of our most pressing issues that impede quality health for everyone.


Mike Newton-Ward, MSW, MPH, of the Gillings School of Global Public Health, at the University of North Carolina at Chapel Hill (UNC), spoke with the Upstream writing team recently to share his lifelong experiences working with social marketing and how this form of communication is effective in public health.

Newton-Ward, an adjunct professor, received both a Masters in Social Work and a Masters in Public Health from UNC, and spent many years working with the N.C. Division of Public Health and the N.C. Department of Health and Human Services helping to create and implement various social marketing campaigns aimed at populations across the state. He retired in 2015 and is now an independent consultant with RTI International.

He spoke to the class to highlight the importance of social marketing campaigns in public health and discussed what steps are needed to ensure optimal effectiveness with selected target audiences.

One of the most valuable aspects of social marketing is that it takes feedback generated from the target audience (the group the campaign is intended for) and uses that data to help determine the layout of the campaign itself. Using this approach is key for garnering participant interest and ensuring improved outcomes.

Newton-Ward also discussed other aspects of social marketing, such as its interdisciplinary approach, and how the input of several fields is effective at campaign development, as well social marketing’s unique ability to influence behaviors in all directions. Since public health is primarily geared toward prevention at the population level, social marketing can be used to influence behaviors upstream through social or policy change. Likewise, it can also be used to produce changes downstream (hence, the name of our blog!), by treating or educating populations to change negative behaviors. Finally, social marketing can work sidestream, by allowing partner organizations to collaborate for promoting the best environment possible to ensure a continuum of positive outcomes.

Newton-Ward concluded his talk by answering questions from the audience and discussing the “simplified elicitation methodology,” a strategy used in many public health campaigns, which seeks to identify determinants of behavior by asking three pairs of questions, including:

  • “What makes a behavior harder or easier to do?”
  • “What are the good things and bad things that happen when one does the behavior?”
  • “Who would approve or disapprove of the behavior?”

 The answers generated from these questions are strong indicators for discovering and learning about target audience reactions, and are key drivers for developing successful campaigns.

Is Health Advertising Worth the Cost? You Be the Judge.

From a small printed flyer to a 30-second T.V. spot during the Super Bowl, there’s no question that advertising is expensive. And while there are many different forms of getting the word out, there are different reasons we advertise as well. It’s safe to say most advertising or marketing, particularly on a large scale, is done for competitive reasons—to boost sales and detract potential customers from going someplace else. But what about when the product being advertised isn’t actually for sale? What’s the goal of marketing something if you aren’t going to profit financially?

In the health communication field, organizations choose to advertise as a means of communicating something to the general public. This could be a health message to get tested for HIV or a celebrity testimonial to stop domestic violence. Either way, in health communication, the the “seller” or advertiser doesn’t stand to gain a profit on their effort in the financial sense, but rather, to promote healthy behaviors that in the long term, save lives. But these ads aren’t cheap. As health communicators, how do we know when the message we’re promoting is effective at producing change for the better?

That’s just what research economist Paul Shafer is trying to determine. A doctoral student in health policy and management, Shafer is working to determine the effectiveness of tobacco cessation advertisements from the Tips From Former Smokers campaign. The ads aired from March 4 to June 21, 2013. To determine effectiveness, Shafer and his colleagues looked at web traffic and determined the number of unique visitors the site had during the time the ads were aired.

The federally funded national tobacco education campaign resulted in the Centers for Disease Control’s (CDC) campaign website having over 900,000 total visits and nearly 1.4 million page views. There were an additional 660,000 unique visitors, meaning users returned to the site after their initial visit.

In his paper, published online Feb. 17, in the Journal of Medical Internet Research, Shafer seeks to demonstrate the relationship between the amount of advertising and the resulting numbers in web traffic. He attempts to show that by increased advertising leads to increased traffic, for both new and returning visitors, thus, implying the advertisements are effective at least getting people’s attention.

Shafer explains the uniqueness of his study is that he and his researchers were able to record the variation of media dose over time and across markets, as opposed to comparing aggregated traffic before, during, and after the campaign.

In addition, he and his team were able to determine fluctuation between the two types of ads, both aimed at providing resources to smokers desiring to quit. The ads used different tagging methods, such as a URL or a telephone hotline number, with results showing that the URL ads were more effective at driving users to the website, but that the hotline ads were also effective at increasing web views.

While Shafer’s study makes it difficult to determine the number of individuals who quit smoking as a direct result of the ads, the study does imply that such campaigns not only serve as a call to action, but also are effective at linking people to resources they would otherwise likely not know about. Finally, the results of the study imply the potential researchers have at more accurately forecasting the impact such ads will have at increasing web usage and interest in online resources that promote healthy behaviors.

So, aside from the fact that health campaigns can be quite expensive to implement, and there are no guarantees of success, with careful formative research and a targeted approach, such campaigns are valuable for the potential they have at impacting populations on a large scale at changing behaviors for good.

When (and Will) We Have A Zika Vaccine?

President Obama has requested that $1.8 billion in emergency funding be put toward the development of a Zika vaccine, but that doesn’t mean we’ll have a quick fix to one of the world’s most alarming threats to public health.

Although government funding is likely to be soon secured, and several companies are working expeditiously to develop a potential vaccine, experts say we’re at least 18 months away from having a vaccine that’s ready for widespread dissemination.

Unfortunately, the development of vaccines is often a slow process, largely due to federal regulations that prevent testing on human subjects in the early stages of the formation process. Obviously, such regulations are intended to keep subjects safe, but this standard wasn’t always the case. Since the 1940s, scientists tested vaccines on themselves and their family members during their trial and error processes. Remarkably, most cases were a success; however, in 1955, the federal government intervened after a clinical trial left 11 test subjects dead and hundreds more paralyzed. Since then, new rules were created that involve benchmarks that must be followed before pharmaceutical companies can sell vaccines for public use.

This process can (and usually does) take several years of research before scientists can determine a virus’ specific antigen. The vaccine then goes through three stages of testing to determine specifics, such as potential side effects, correct dosage amounts, and whether or not it would be effective among large numbers of people. Obviously, it’s a lengthy process, which, in most cases, is still ongoing when an outbreak’s peak has passed.

It’s a tricky situation, because public health calls for the promotion of health for all, primarily through the prevention of unhealthy outcomes. This makes the speedy development of vaccines seem like a tremendous positive for attacking viruses and disease. However, safety always comes first, thus, preventing a vaccine from causing more harm than good.

So, while the jury is still out on if and when we’ll see a Zika vaccine, we can at least be sure not to see anything for quite some time.

What’s NC Doing to Prevent Zika?

As Americans grow increasingly concerned about the threat of the Zika virus, it’s important to know what measures are being taken in North Carolina to prevent its spread locally.

Although there have been travel-associated cases in the U.S., the Centers for Disease Control and Prevention (CDC) has found no reported mosquito-borne cases, and state departments of public health nationwide are doing what they can to ensure the virus is kept at bay.

However, those efforts are being challenged in North Carolina. The first step in controlling the spread of Zika is to control the mosquito population, but since 2010, budget shortfalls in North Carolina have resulted in limited funding allotted to mosquito surveillance. Formerly, money was appropriated to localities to control mosquitos, but that money is no longer available. Funding for local governments through control grants was eliminated in 2014.

And while little attention was placed on such cutbacks in the past, the recent threat of Zika has caused some N.C. lawmakers to emphasize the need to restructure the state’s budget to allow funding for more consistent mosquito control. Although reports have shown the virus can be transmitted through sexual contact, mosquitos are thought to be the primary means of transmission.

The state’s most common mosquito — known as a “backyard breeder,” isn’t thought to be susceptible to wide-area spraying programs, making this form of eradication an unlikely option for successfully ridding the state of mosquitos carrying Zika. Epidemiologists say the best solution is to call in experts well versed in the mosquito life cycle, as they would have the ability to properly identify problematic mosquitos and have the best solution for eradicating them.

Viruses like Zika can be particularly alarming since its symptoms aren’t usually apparent in those who contract it. However, the virus has been liked to several cases of microcephaly, a condition where babies are born with smaller-than-average heads. The virus has also been linked to babies suffering from brain damage. The state’s most recent data shows there are around 140,000 N.C. women who are currently pregnant, implying the need to increase prevention efforts, particularly before the summer months — when mosquitos are most rampant in the state.

While funding for mosquito control remains unclear — the legislature won’t reconvene until April 25 — the state is ramping up its ability to test for the virus and is providing education materials to distribute to women who currently are and are planning to become pregnant.


Photo credit: University of Washington