Category: Health Communication

Pop Up Museums: Public Health Edition

Pop ups are the newest trend today whether it’s a Game of Thrones bar in Washington D.C. or a boutique clothing pop-up in Chapel Hill. Now the pop-up concept has entered the public health realm in the form of pop up museums. This month in London, there is a pop up museum all about global drug policy. The Museum of Drug Policy is a free museum located in the heart of London that is only open for three days. This exhibit has been featured in other cities such as Montreal and New York City in accordance with the UN Assembly and the Harm Reduction Conference. The museum exhibit is a cultural focus on how drug policies impact local communities and the harmful side effects of these policies. The exhibit has a global focus and will transform you to different parts of the world to understand how drug policies differ based on region and country in the world. While many museums/exhibits leave you feeling negative and powerless, this exhibit is different in terms of learning about new approaches to address this problem that would eliminate the community problems and be more mindful to human rights. London

If you are in the London area this week, check out this exhibit and hopefully we will begin to see this exhibit in future cities and other similar exhibits like this!

Health Literacy: The final healthcare barrier?

How can health professionals support and serve our most vulnerable populations? When discussing access to health care, income and location are generally agreed upon barriers to access. Populations who live just above the poverty line often do not qualify for government assistance; however, without it, they often cannot afford coverage. Similarly, populations that live in rural areas often have less lack access to health services. One barrier that accompanies these and is often overlooked is health literacy.

Literacy is not only an education issue it affects access to healthcare as well. When populations have difficulty reading, they may misunderstand health brochures or worse take medication incorrectly. According to Kelly Warnock, Program Manager at the Durham County Health Department, health professionals have a responsibility to reach populations where they are. After working for over 10 years with lower-income, low literacy populations, Ms. Warnock believes that it is possible to increase all communities’ access to healthcare and health information. For health professionals, that means being creative with communication techniques organizing information clearly, using visuals, and non-technical language. If you’re interested in learning more about health literacy and communication, check out this resource from the Food Research and Action Center.

Photo: https://communicatehealth.com/2014/07/frequently-asked-question-can-i-measure-a-patients-health-literacy/

FOP-FTW

You’ve probably seen front-of-package (FOP) nutrition labeling systems.

From ASPE Policy Research for Front of Package Nutrition Labeling: Environmental Scan and Literature Review http://aspe.hhs.gov/sp/reports/2011/FOPNutritionLabelingLitRev/

Next time you stroll through the grocery store, count how many different labeling systems you see in a single aisle. To summarize, the different systems are:

  • Nutrient-specific – to display select nutrients from the Nutrition Facts Panel
  • Summary indicator – to offer a single symbol or score to summarize the nutritional value
  • Food group information – to offer symbols based on the presence of a food group or ingredient

In spite of the different looks, the modified labeling systems have similar intentions, which include:

  • Providing consumers select nutrition information for nutrients to limit (e.g., sodium or added sugars) or nutrients to increase (e.g., vitamin D or calcium)
  • Making it easier to compare similar foods
  • Giving an overall impression about the nutritional value or food group composition of a food

While each type of system has demonstrated success in altering purchase patterns, no system has been deemed superior to another. A major assumption about these systems is that consumers receive and understand the information they are receiving. Although data show this is not the case, there is evidence that simple labeling systems can be effective, including for consumers who have low literacy and may be at nutritional risk.

The committee assembled by the Institute of Medicine was charged with reviewing evidence and providing recommendations for a system redesign that will encourage healthier food choices and purchase behaviors. Highlights include:

  • Develop a single, standardized system that translates information from the Nutrition Facts label
  • Display calories in common household measure serving sizes and 0-3 “points” for nutrients to limit
  • Appear on all grocery products and in consistent locations across products
  • Providing a nonproprietary, transparent translation of nutrition information into health meaning

More information is not always better, and the committee references the Environmental Protection Agency and Department of Energy’s Energy Star® program as a successful model that has altered consumer purchase patterns for household appliances and electronics.

What are your thoughts about FOP labeling systems? Are they helpful? Confusing? What do you want to know from looking at the front of a package?

front-of-package labeling for-the-win (FOP-FTW)

Sources:                     

Institute of Medicine. 2012. Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices. Washington, DC: The National Academies Press. https://doi.org/10.17226/13221.

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

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/