Category: Health Promotion

Research Spotlight: Dr. Noel Brewer

Last week, Upstream Writers were joined by Noel Brewer, PhD, professor of Health Behavior in the UNC Gillings School of Global Public Health and affiliated scholar with UNC’s Interdisciplinary Health Communication program. Dr. Brewer gave an interesting and informative talk about his recent tobacco research involving the effect of cigarette pack messages. His findings showed that pictorial cigarette pack warnings increased smoking quit attempts and 7-day quitting. Additionally, the pictorial warnings were found to work better than text warnings, as they led to more attention, negative affect, social interactions and thinking about the warnings. Finally, because the study’s findings did not fit existing models of health behavior, Dr. Brewer developed the new Tobacco Warnings Model.

Dr. Brewer received his PhD in psychology from Rutgers University and joined the faculty in the Department of Health Behavior at the University of North Carolina at Chapel Hill in 2004. He studies how people make risky health decisions, and he currently directs the UNC Health Cognition & Behavior Lab where he conducts his research. Furthermore, in addition to Dr. Brewer’s tobacco research involving smoking risk communication, his work also focuses on HPV vaccine communication and increasing HPV vaccine uptake, and he currently serves as Chair of the National HPV Vaccination Roundtable. More information about his research can be found here.

In the spirit of Public Health Thank You Day, thank you, Dr. Brewer, for the work that you do to promote and protect public health! 

Using Mass Communication to Curb Obesity

Internationally we continue to see substantial increases in overweight and obesity rates. In 2016, the World Health Organization reported that about 39% of all adults were overweight. Since overnutrition seems to traverse cultures, languages and international waters many people are looking for the most effective and efficient way of promoting positive health behaviors that promote a healthy weight. I believe mass media campaigns could serve as a solution to the problem. Health professionals can use mass media to improve the dietary habits of populations through multimedia-based communication efforts.

Over the past ten years, we have seen considerable changes in mass media communication largely due to increased use of mobile technology, especially social media. As access to mobile technology increases and people use smart-technology at increasing rates, health professionals have increased opportunities to address the importance of nutrition and physical activity. I believe that no other intervention approach has the potential for as wide a reach as mass media. Mass media campaigns that target individual dietary behaviors like increasing vegetable intake or reducing sodium are effective at promoting those behaviors (1). The “5-A-Day” campaign was successful in its efforts to increase fruit and vegetable intake. It was associated with a significant increase in fruit and vegetable consumption and increased awareness of health benefits associated with consuming fruits and vegetables. The success of mass communication in campaigns and interventions is not exclusive to increasing fruit and vegetable intake. This method has also proven effective at promoting folic acid supplementation and the maintenance of weight loss The Community Guide (2). I believe mass media campaigns advance nutrition efforts to reduce overweight and obesity rates because of the extent to which media is incorporated into people’s daily lives. Mobile technology gives health professionals a chance to engage in dialogue with individuals outside of clinical settings. I believe engaging with individuals in spaces they already visit may help people feel more comfortable and make them more receptive to adopting health-promoting behaviors.

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

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

Flu Shot Season

When it comes to the flu shot, I trust in the CDC for their advice and present it as follows. Some vaccines contain inactive virus parts to three types of influenza while others have four. The predicted and included flu strains are educated guesses, so a quadrivalent vaccine might cover more bases. Search for flu shot locations around you and find out which they offer.

If an individual has never gotten the flu or the flu shot, they may not think they need to be vaccinated. This experienced phenomenon is often due to herd immunity, where the surrounding people in a population act as insulation against the flu because they were vaccinated and so not spreading it. Another common myth is that the flu shot will give you the flu though this is not the case. The body takes up to a few weeks after being exposed to the inactivated virus to develop antibodies, and while your immune system is working on this you may not feel at your best for a day or so. If I experience this, I remind myself how much worse the full-fledged flu virus feels. The flu shot may even decrease your risk by half.

October is the time to get it— read up on the flu shot and make a choice that best benefits your health and the health of those around you!

Teal Pumpkin Project: Promoting fun and safe Halloween treats for all

As my little one tries new foods, I pay close attention for any strange reactions that might indicate a food allergy. Food allergies are the result of an immune response to proteins found in food. The immune response can cause mild symptoms such as redness on the skin or an itchy mouth. Or it can cause more serious, life threatening symptoms, known as anaphylaxis, like trouble swallowing, shortness of breath, or loss of consciousness.

While more than 170 foods have been identified to cause allergic reactions, eight allergens are responsible for the majority, and the most severe, reactions in the United States. The ‘big’ eight include: egg, milk, peanut, tree nut, wheat, soy, fish, and shellfish.

It is estimated that upwards of 15 million people in the United States have food allergies, and that number is on the rise. A Centers for Disease Control & Prevention report states there is increasing prevalence of food allergies among children, and a recent media headline shared that insurance claims for anaphylactic (severe) food reactions are going up in adults too.

Although the reason(s) or cause(s) for these increases is unknown, what is known is that food allergies impact quality of life. Holidays can be a particularly challenging time for people with food allergies, but Food Allergy Research & Education (FARE) has initiated a worldwide movement to create a safer, happier Halloween for all. To support the movement, all you have to do is offer non-food treats, like bubbles or stickers, and place a teal pumpkin on your doorstep as a way to let families know you are safe for children with food allergies or other health concerns.

If Halloween is one of your favorite celebrations during the year, think about how a small change in what you hand out can allow others to experience the fun and tradition of trick-or-treating.

The TEAL PUMPKIN PROJECT and the Teal Pumpkin Image are trademarks of Food Allergy Research & Education (FARE)

 

Sources:                     

NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010; 126(6):S1-58

Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS data brief, no 121. Hyattsville, MD: National Center for Health Statistics. 2013. Retrieved from http://www.cdc.gov/nchs/products/databriefs/db121.htm.

National Institute of Allergy and Infectious Diseases, National Institutes of Health. Report of the NIH Expert Panel on Food Allergy Research. 2006. Retrieved from www.niaid.nih.gov/topics/foodallergy/research/pages/reportfoodallergy.aspx

United States Census Bureau Quick Facts (2015 estimates).

Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M, Chuang K, Sicherer M, Sicherer S. Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics 2013; 131:e10-e17.

Herbert L, Shemesh E, Bender B. Clinical management of psychosocial concerns related to food allergy. J Allergy Clin Immunol Pract. 2016; 4(2):205-213.

Bollinger ME; Dahlquist LM, Mudd K; Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006; 96:415-421.

Food Allergy Research & Education. Teal Pumpkin Project. https://www.foodallergy.org/education-awareness/teal-pumpkin-project

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

Breathe in… breathe out…

Feeling anxious or stressed? Consider diaphragmatic or “deep breathing” exercises! Deep breathing can be a helpful technique for relaxing both mind and body, as well as stress and anxiety management. It can even improve our energy levels!

With deep breathing, we are able to consciously control our breathing, lower our blood pressure and heart rate, and relax our muscles. During normal breathing, we typically breathe shallow breaths using our chest and not our bellies. However, with deep breathing, we breathe with our bellies, taking in slow, deep breaths.

One key muscle involved in the process of deep breathing is our diaphragm, located between our chest and abdomen. When we inhale, we contract our diaphragm, expanding our abdomen, which then pushes air into our lungs. We then exhale, relaxing our diaphragm, and air is pushed out of our lungs.

Interested in trying deep breathing? Click here for a step-by-step guide!

Happy stress relief!

References:

Diaphragmatic Breathing [PDF file]. (2016, September). Retrieved from https://www.uncmedicalcenter.org/app/files/public/196/pdf-medctr-rehab-diaphbreathing.pdf

Patel, S. (N.d.) Retrieved from http://www.chopra.com/articles/breathing-for-life-the-mind-body-healing-benefits-of-pranayama#sm.00019xogqb4t2eoex3f1a17fb6wn4

Rakal, D. (2016). Learning Deep Breathing. Psych Central. Retrieved from https://psychcentral.com/lib/learning-deep-breathing/

Wong, C. (2017, April 30). Retrieved from https://www.verywell.com/how-to-breathe-with-your-belly-89853

 

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/

Helping Out After Natural Disasters

In recent weeks, there have been several catastrophic natural disasters. Arshya recently wrote about the public health aftermath of such disasters. Recovery from natural disasters must be comprehensive in that the safety, sanitation, and welfare of the people, animals, infrastructure, and environment of the affected communities must be addressed.

It is likely that you or someone you know has been impacted by the hurricanes or earthquake, which might leave you wondering how you can help. If you cannot provide time, many local, national, international, and online organizations will accept your donations. Before committing your resources, take a few minutes to do a little research to check whether a charity is legit. Charity Navigator is a trusted source for identifying organizations responding to natural disasters.

The Federal Trade Commission (FTC) offers additional tips for wise giving after natural disasters:

  • Be wary of charities that seem to have appeared overnight.
  • Stick to charities that have a proven track record for dealing with disasters.
  • Designate the disaster so that your funds will be used directly instead of going in to a general fund.
  • When texting to donate, confirm the number with the source. Charges will show up on your phone bill but donations may not be immediate.

The FTC also offers tips for those affected by natural disasters:

  • Be skeptical of people or groups promising immediate clean-up or debris removal. Some may offer overly priced quotes for work, demand payment before ever doing work, or lack the necessary licenses or skills to complete the work.
  • Be on the lookout for rental listing scams that ask for sending money before actually visiting the property.
  • You may need to share personal information to gain access to resources, so make sure you know exactly who you are dealing with before sharing your social security number or financial information.

 

Sources:             

Federal Trade Commission. FTC Advise for Helping Hurricane Harvey Victims. August 28, 2017. https://www.ftc.gov/news-events/press-releases/2017/08/ftc-advice-helping-hurricane-harvey-victims