Category: Health Communication

PrEP for Life

Reflecting on the models of health discussed previously (part 1 & part 2), a queer man without human immunodeficiency virus (HIV; disregarding other illnesses) would be healthy, whereas a queer man with HIV would be unhealthy within the medical model of health. In the sociocultural model of health, both a queer man with HIV and without HIV would likely be considered healthy. Given current treatments, there would likely be no affect on an individual’s ability to perform the five activities of daily living. Finally, in the psychological model, we have no easy way to estimate beforehand.

However, within the “drugs for life” model, since queer men are identified within the public health discourse as high risk for HIV, they are immediately seen as bodies-at-risk. Within this model, being queer men can become a predisease for HIV. Much like pre-hypertension for hypertension, the predisease becomes an illness to be treated in itself. Here, we treat the predisease with public health interventions, but the predisease is the behavior of men having sex with men. However, with the best intentions, public health interventions and health communications campaigns can exacerbate the stigma within the queer community with regards to HIV and pre-exposure prophylaxis (PrEP).

Within this model, PrEP becomes another “drug for life.” There’s no point at which individuals can stop taking PrEP to prevent HIV. It has to be consistently taken in the same way that one would consistently take drugs after contracting HIV. Hence, the treatment for the disease and the treatment to prevent the disease have the same consequences. Presumably, patients would only stop taking PrEP after finding a long-term partner with whom they are monogamous (also presumably both partners would be HIV negative). However, this assumes compulsory monogamy and perhaps even compulsory matrimony. For queer men who don’t want to become monogomous or get married or who are worried about their partner’s (or partners’) infidelity might still be taking PrEP. This combination of high NNT (especially high NNT when we consider the effectiveness of condoms, which should still be used while taking PrEP, since it isn’t 100% effective) with the endless length of the prescription results in considerable profits for drug companies and a significant economic injustice for queer men.

Recent Data on Obesity Prevalence in the U.S.

The National Center for Health Statistics (NCHS) recently released a data brief on recent estimates for obesity prevalence in the United States. These estimates are from the most recent National Health and Nutrition Examination Survey for 2015-2016. Some key survey findings showed that in 2015-2016, obesity prevalence was 39.8% among adults and 18.5% among youth in the U.S. Additionally, obesity prevalence was found to be 13.9% for children aged 2-5 years, 18.4% for children aged 6-11 years, and 20.6% for children aged 12-19 years.

While there was not a significant change in obesity prevalence among U.S. adults and youth between 2013-2014 and 2015-2016, obesity continues to remain an important public health concern.

Obesity prevalence rates in the U.S. do not currently meet national weight status objectives set forth in Healthy People 2020, a 10-year national agenda for improving public health in the U.S. These objectives are to reduce the proportion of U.S. adults that are obese to 30.5%, as well as reduce the proportion of U.S. children aged 2-5 years, 6-11 years, and 12-19 years that are obese to 9.4%, 15.7%, and 16.1%, respectively, by the year 2020.

Obesity can lead to serious health effects, such as: high blood pressure, heart disease, and even type 2 diabetes. However, maintaining a healthy weight through eating right and staying physically active can prevent these negative health outcomes.

References

Prevalence of Obesity among Adults and Youth: United States, 2015-2016. (2017, October). Retrieved from https://www.cdc.gov/nchs/data/databriefs/db288.pdf

Nutrition and Weight Status. (2017, October 13). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives

Eat Right. (N.d.). Retrieved from https://www.nhlbi.nih.gov/health/educational/lose_wt/eat/index.htm

Be Physically Active. (N.d.) Retrieved from https://www.nhlbi.nih.gov/health/educational/lose_wt/physical.htm

The Newest Style of Sex Education

About a week ago, our class had the pleasure of listening to Alexandra Lightfoot, EdD discuss her involvement in one of the more revolutionary forms of public health circulating the block. As a professional, she has focused on the intersection between the arts and public health and how the two can be combined to create more effective health messages.

The topic of her discussion was the Arts-based, Multiple-component Peer Education (AMP!) Program that first came to UNC from UCLA a few years ago. AMP! utilizes interactive theatre techniques with college students who create scenarios to deliver sex-ed to 9th grade students in a novel way, especially down here in the South.

The critical component of this program is its use of satire, humor and storytelling to disseminate knowledge and start discussions about sexual and reproductive health with high school students and their health teachers. Research has shown that this traditionally complicated conversation is facilitated by this arts-based approach and the AMP! intervention has significantly increased student knowledge about how to prevent HIV and maintain sexual health.

Given that the live performance model of AMP! is delivered by college student “near peers” in locations close to their universities, it has been difficult to scale the program here in North Carolina. However, it has scaled well in the Los Angeles Unified School District, so hopefully that will provide a blueprint for sharing this creative and fun program to more youth in North Carolina. Lightfoot and her partners at the UCLA Art and Global Health Center are currently developing a compendium of video scenarios made by NC-based college students and a manual for teachers so that the intervention can be implemented more widely via digital delivery in classrooms across the state. The team is currently applying for funding to further refine the digital model and pilot and evaluate the implementation process and impact on student outcomes.

What do you think? Is this something you feel is appropriate for NC high school students? What do you think are the barriers and challenges such a program might encounter here? What are the positives about this kind of approach to sex education? Let us know below in the comments.

Are You Healthy? (Part 2)

Previously, I discussed changes to our model of health due to randomized control trials and the pharmaceutical industry, as discussed in Joseph Dumit’s Drugs for Life. Here are the three primary models of health as discussed by Donald A. Barr in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health. 

The first model is the medical model or physical health model that focuses on the absence of symptoms or other signs of disease or illness. However, Barr mentions several issues with this model of health, noting “that this approach to defining health tells us what the concept of health is not. . .It does not tell us what health is” (2014, pp. 15). He expands on this later:

“What are we to make of a condition that has no abnormal symptoms? An important example of this is high blood pressure, also referred to as hypertension; persons with hypertension develop symptoms only after a number of years. Should we consider a person with somewhat elevated blood pressure to be unhealthy based on our knowledge that his blood pressure will eventually lead to further problems? What might be the consequences of labeling such a person as ‘unhealthy,’ even if he feels fine?” (Barr, 2014, p. 16)

These are the questions that Joe Dumit attempts to answer, looking beyond hypertension to guidelines about pre-hypertension and the prescriptions of statins with no understanding of when patients can stop taking them.

The second model is the sociocultural model or the model of health as functioning at a normal level. Barr looks at it in contrast to the medical model, which looks at absence, because the sociocultural model looks at the presence of an ability to function at a level that has been deemed normal (2014, p. 17). The ability to functional normally is defined in regards to one’s ability to completed five “activities of daily living (ADLs),” which are roughly, (1) eating, (2) bathing, (3) dressing, (4) using the bathroom, and (5) moving on one’s own (2014, p. 17). Of course, the entire premise of “normal functioning” is subjectively predicated on societal ideas of self-sufficiency that might vary from culture to culture or community to community.

The third model is the psychological model or the model of health as a feeling of well-being. In this model, individuals are able to assess themselves and their own health with the help of several developed measures (Barr, 2014, p. 18). However, Barr notes that these tests are often “time-specific” (Barr, 2014, p. 18). I would argue that health is always time specific and temporal. I may be healthy today, but I can quickly develop a health problem or injure myself, perhaps even resulting in a temporary or life-long disability, reaffirming the temporality of both health and disability.

According to Barr, these models can be combined to create a multidimensional model of health that presents a better picture of the health of an individual.

Reverse Type 2 Diabetes?

Yes, you read the title correctly. Researchers from the UK published a report in the British Medical Journal (BMJ) a couple weeks ago revealing they have had success with patients Beating Type 2 Diabetes into Remission.  Dr. Mike Lean, who co-authored the publication, spoke with an editor at the BMJ about the study which can be heard here.

Type 2 diabetes mainly stems from having excess body fat but once diagnosed, treatment usually ends at a tablet you take for the rest of your life to control your blood sugar. Very rarely do treatments take into effect the vascular issues or decreased life expectancy also experienced by those with diabetes.

So what is the miracle cure? Well as is the case for most chronic diseases, the cure is not locked inside a pill, rather within the contexts of a healthy lifestyle. A consistent exercise regimen coupled with a diet strategic to losing weight is the secret. Put simply, if you can lose weight and keep it off long enough remission can be possible.

Shockingly, they said reaching a healthy weight wasn’t the hardest part, but that maintaining a healthy weight is where people usually fail when striving to beat diabetes into remission.

So what do you think about this? As an optimistic health professional, this gives me hope for the future of our nation and globally in dealing with this chronic disease. Do you have any tips for maintaining a healthy weight? If so, share below!

 

AB

 

Emerging Emojis–the fight for a seat at the table

Do you sometimes feel like an emoji is the only way to perfectly embody the message, or the face, you are trying to convey?

It’s no secret that emojis are changing the way we communicate. They don’t just appear on our phones, either. Popularized emojis are iconic, appearing on clothing, in advertisements, and other outlets. They allow for a creation of meaning and personalization, as a readily accessible tool with which to join a dialogue.

Marla Shaivitz, a communication specialist at Johns Hopkins University’s Bloomberg School of Public Health, and Jeff Chertack, a malaria expert with the Bill & Melinda Gates Foundation, are appealing to the Unicode Consortium–an organizing body that approves characters an emojis for standardized usage–to consider adding a female mosquito to the list of emojis that will be added to smartphones next year. Apparently, the mosquito is among a list of 67 finalists that will be further considered.

Anticipated uses of the emoji include pairing the image with other symbols–a rain cloud, for instance, to encourage people to stay dry indoors and to encourage insecticide application–or to indicate that eradication efforts are under progress. As mosquitoes are key in infectious disease transmission (for viruses including dengue, Zika, malaria, and yellow fever), a recognizable symbol might encourage more dialogue about preventative behaviors or information-seeking behaviors.

Shaivitz and Chertack make their case by estimating seven times more usage of the mosquito emoji than of the beetle emoji on Twitter. In fact, they claim there is a pretty high demand for it.

When you think about the truly random emojis that do exist, it would seem far-fetched not to include one that has the potential to actually make a  positive change. Time will tell if Unicode bites.

Sources:

http://www.latimes.com/science/sciencenow/la-sci-sn-moquito-emoji-health-20170922-story.html

hhtps://ccp.jhu.edu/2017/09/18/creating-buzz-proposing-mosquito-emoji-public-health/

 

Kyla Garrett Wagner: First Amendment and Health

First amendment, media law, health communication and sexual health advocate describe Kyla Garrett Wagner’s research in a nut shell. Her spunk and passion make her the perfect storm to facilitate the way we should communicate about women’s health options and fighting the regulations through informing through social science research.

Her story starts from her hometown in rural Indiana (think Parks and Recreation and Leslie Knope). Her academic journey began at Purdue University where she earned her B.A. in Communications and Women’s Studies. After receiving her bachelor’s degree, she continued her academic journey to the University of North Carolina’s School of Media and Journalism to pursue a MA in Health Communication. During her time at UNC she fostered her interest in communication of emergency contraception to college students but stumbled on to regulations that restricted her ability to develop a campaign to do so. From this setback made her reconsider her career path into health communication which ultimately led her to pursue her Ph.D. in First Amendment Law. Her research interests now intersect at how law intersects with health communication and public health. Keep your eye out for her name since we are definitely will hear more about her research and passion in the future!

The Realest Statistic on Opioids

Earlier this week the CDC released a study that shined light upon the real impact the opioid epidemic has had on the American population. According to their study published in the Journal of the American Medical Association (JAMA), the average life expectancy of American’s has gone down for the first time in a quite a while. This kind of statistical anomaly has not been seen since the early 90’s when the AIDS epidemic was at its peak.

The number of deaths from opioid overdose has nearly doubled between 2009-2015. Dr. Deborah Dowell, Senior Medical Advisor in the Division of Unintentional Injury at the CDC,  analyzed the data and found that opioid overdose contributed to decreased life expectancy more than Alzheimer’s, chronic liver disease, and unintentional accidents (which included car accidents) combined.

I knew the opioid epidemic, was, well, an epidemic, but this definitely put it into perspective for me. Do you know someone who has suffered from the opioid epidemic? Or maybe know someone who knows someone? Odds are, you do. Regardless, spreading the word can only help.

What resources do you know of that are dedicated solving this problem? The more information we spread the greater impact we can have!

 

AB

 

Guest Speaker: Dr. Allison Lazard talks about eHealth Design

The UpstreamDownstream Health Communication blog is run by students enrolled in a seminar class within the Interdisciplinary Health Communication program at UNC Chapel Hill. A core aspect of this class is the opportunity provided studentes to hear about the work and the journey of leaders and leaders-to-be in the field. Dr. Allison Lazard, an Assistant Professor at the School of Media and Journalism at UNC, started off our semester of guest speakers with an engaging and informative presentation on the importance of communicable materials in interactive interventions.

Dr. Lazard sees opportunities in the world to use design manipulation to create a subjective experience for individuals with needs and wants, in order to influence better health outcomes. To prioritize the user experience, she asks specific questions about aesthetics, usability and content. She has found that tone matters, users respond well to interactive design features, and that the importance of images that match a health message cannot be understated. Her research findings also indicate that responsive websites (that automatically react to be readable for a phone screen vs a computer or tablet screen) are increasingly valuable, and that there is a clear preference for classical aesthetics when it comes to delivery of health information.

As more and more people turn to web or app-based sources of information, designing effective information sources is central to effective health communication. eHealth is a new but quickly expanding field, informed by the innovative work of researchers like Dr. Lazard. We loved hearing from her, and are excited for a semester of inspiring talks!

An Appetite for Adjectives

How can healthy foods be rebranded to garner interest and uptake, without the use of a master chef? A study this summer looked at the effects of descriptive food labels on the amount of vegetables self-served at lunch. The researchers categorized four different labeling groups:

  1. Basic description (i.e. carrots)
  2. Healthy restrictive (reduced-sodium carrots)
  3. Healthy positive (vitamin-rich carrots)
  4. Indulgent (caramelized carrots)

The vegetables and their recipes remained unchanged regardless of the label type. However, the indulgently labeled vegetables had 25% more people select the vegetable than the basic description, 41% more than in the healthy restrictive, and 35% more than the healthy positive. And when the indulgent label vegetables were selected, the portion size selected was greater than when the vegetable was a basic or healthy positive label.

These findings suggest that how we talk about a food impacts how we interact with it. Once the self-service containers were weighed and paid for, we don’t know how much of that food the individuals ate. Perception seems to play a large role in intent, though, and I am curious to see how health communicators can turn that intent into sustainable action through reframing the perceptions of vegetables and other recommended healthy foods.

http://www.cnn.com/2017/06/19/health/vegetables-indulgent-names-study/index.html