Category: Health Promotion

SNAPFresh Without the Fresh

This week the Trump administration released their proposed change to the longstanding SNAP (Supplemental Nutrition Assistance Program) which some would equate to delivery meal services such as HelloFresh, Blue Apron and Purple Carrot. These new delivery meal services have been tremendously popular and my first reaction was this might actually be a good idea. This type of service is more convenient and having groceries delivered without the hassle of going to a grocery store would be a nice perk for program shoppers. I further explored the details of this program and my mind quickly changed when I read about what was included in the boxes and more importantly what was not. These boxes would not contain fresh foods (milk, eggs, fruits and vegetables) and instead would provide canned fruits and vegetables and shelf milk. To be honest I had to do a quick web search to see what was actually shelf milk. Additionally, these Americans would have little to no say over what is included in the boxes versus the current program where they are issued a card and can purchase what they choose to at participating stores. While I could see benefit in this type of service as an OPTION for SNAP shoppers there is a lot of improvements that should be made before bringing this proposed idea into actual implementation particularly thinking about the foods included and would this truly be something that current SNAP shoppers find feasible and/or pragmatic.

References

https://www.npr.org/sections/thesalt/2018/02/12/585130274/trump-administration-wants-to-decide-what-food-snap-recipients-will-get?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social

Just Trust Me (Part II)

“Dr. X, or whoever she was, she must have been experimenting on me…she left a big scar on my neck … I don’t want that lady to ever touch me again. I don’t like her and I don’t trust her.

Last week, I introduced the issue of trust in the medical setting and how it may vary across scenarios and patient characteristics. But to truly understand why some patients don’t trust the healthcare system, we absolutely cannot ignore the history of their oppression by its hands.

The most well-known medical violation under the guise of research in the U.S. is the Tuskegee “study,” a 40-year-long theft of human rights that, brilliantly and viciously, utilized both government and community-level networks to recruit black men in Macon County, AL. Most had syphilis. The participants, many of whom had never seen a physician, were not made aware of the dangers, causes, and treatment options for their disease. They were not offered informed consent, nor the option to leave the study, and many died.

But Tuskegee is only the tip of the iceberg. Henrietta Lacks’ cells were cultured without her consent during her battle with cervical cancer in 1951 and are still widely used today. Gynecologist J. Marion Sims ran “practice runs” of his procedures on enslaved women. A common belief in the 20th century was that those who could not pay for medical care, many of them poor minorities and immigrants, “owed their bodies” to science. Harry Laughlin performed forced sterilizations on “socially inadequate” Puerto Rican women until the 1970s. The list could go on.

Today, this unfathomable history is manifested in mistrust in healthcare and scientific research. Evidence suggests that black patients are less likely to trust physicians, are more worried about medical privacy and experimentation than are white patients, and are less likely to participate in clinical trials. Some patients are not fully aware of the history to their mistrust – it is a cultural feeling that has been passed down through generations. This is called historical trauma. In addition, racism is still rampant in the healthcare system, both intentional and subconscious, which I will delve into in Part III. These features make this issue even more difficult to address.

Crash or DASH- choosing the right diet

February is heart month.  We’re often told that in order to keep our hearts healthy we should maintain a healthy weight.  Many people try to do this by dieting, but do diets really make us healthier?

New research has emerged that meal replacement crash diets (typically consuming only 600 to 800 calories each day) can temporarily worsen heart function [1].  This means that if you have heart problems, these diets could actually make your health worse instead of better.  If you’re looking for a healthy way to lose weight, you may want to check out the National Heart, Lung, and Blood institute’s DASH diet.  In January, U.S. News and World Report ranked the DASH diet as the best overall diet plan for the eighth year in a row [2].  The DASH diet also claimed first place in the healthy eating and heart disease prevention categories.

If you feel like dieting, stop and ask yourself why you’re doing it.  If you’re trying to get your heart in shape, you may want to rethink that overly restrictive diet.

 

References

[1]   European Society of Cardiology (ESC). “Crash diets can cause transient deterioration in heart function.” ScienceDaily. ScienceDaily, 2 February 2018. www.sciencedaily.com/releases/2018/02/180202123836.htm

[2]  National Heart, Lung, and Blood Institute. (2018, January 3). DASH ranked Best Diet Overall for eighth year in a row by U.S. News and World Report. Retrieved from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/news/2018/dash-ranked-best-diet-overall-eighth-year-row-us-news-and-world-report

 

Just Trust Me (Part I)

Well I’m not trained medically, so I’m taking a lot of what they say on faith.”

This was the response of a 47-year-old man, whose interview was part of a study on patients’ trust in hospitals.

There is no universal definition of trust that will apply to every scenario. Physician training, patient’s racial and cultural background, personalities, and expectations all come into play as their relationship evolves. One recurring theme in the study cited above was “sensing that you are in good hands.” Some mentioned that their trust developed from knowing the sheer amount of training required to be a medical provider. Other patients pointed out that being desperate, or having few other options, accelerates the formation of trust.

The Trust Project at Northwestern emphasizes the role that vulnerability plays in forming trust. Generally, once we come to trust someone, we open up to them; we expose vulnerability. In the healthcare system, it works backwards: being sick, worried, or simply confused by jargon (this is called information asymmetry), the patient often begins her relationship with her provider in a state of vulnerability.

Trust can also vary in different facets of the healthcare system. When we say that a patient has mistrust in the healthcare system, are we referring to his relationship with his provider, institutions like his hospital and insurance company, or the notion of Western medicine to begin with? One study suggests that repeated interactions are a key to building trust, and that patients do not see their providers as interchangeable. These findings suggest that we should enhance continuity, not just access.

Patients with low health literacy may reveal trust in a number of ways. One extreme is blind faith in the expertise of the provider, and another is mistrust and suspicion. One study found that blind trust in physicians was stronger in patients who were older, perceived their prognosis to be uncertain, or sometimes of low SES. Trust in the healthcare system tends to be lower among racial minorities, due to a history of unethical treatment. Could race moderate the relationship between SES and trust? Can these two extremes be reconciled, or even coexist in a single patient?

The air up there: air quality for long-term health

As development and industrialization occurred, international and domestic societies became increasingly dependent on mass-produced products and, unknowingly, the chemicals used in their development. Chemicals are used in the production of everything from household products to organic foods, and many of these man-made compounds have detrimental effects on human, environmental and ecological health. One chemical exposure of greatest significance to human health is ambient and indoor particulate matter. These elements are often overlooked; however, a human health risk assessment can be used to determine the severity of their harm.

Particulate matter (PM) is defined as all hazardous particles (including solids and liquids) that are suspended in the air [1]. These pollutants are generally less than ten µg in diameter and include course, fine and ultrafine elements. PM has many detrimental affects on human health because it is so easily encountered and can be deeply inhaled. PM is known to elicit cardiopulmonary responses and is also a risk factor for cardiovascular disease morbidity and mortality. Atherosclerosis, myocardial infarction, and cardiac arrhythmias are just a few cardiovascular disease states with which PM is associated [2]. PM inhalation is also associated with cancer – the second leading cause of death globally.

All people are exposed to particulate matter because it is dispensed into the air we breathe. There are various sources, including aerosols, mist, and all forms of combustion, that emit particulate matter into the atmosphere many of which individuals encounter frequently throughout the day. To protect oneself from these harmful chemicals, it is important that people engage in protective behaviors. Below are a few that could help you improve your long-term health:

1. Use an air purifier in your home.
2. Avoid using aerosols.
3. Check for proper ventilation and air filtration when using a fireplace.
4. Avoid burning incense.
5. Avoid second-hand smoke and stop smoking.

References:

[1] “Ambient Air Pollution.” World Health Organization. World Health Organization, n.d. Web. 23 Feb. 2017.

[2] Du, Yixing, Xiaohan Xu, Ming Chu, Yan Guo, and Junhong Wang. “Air Particulate Matter and Cardiovascular Disease: The Epidemiological, Biomedical and Clinical Evidence.” Journal of Thoracic Disease. AME Publishing Company, Jan. 2016. Web. 23 Feb. 2017.

Using Behavioral Economics to Combat Antibiotic Resistance

By Elsbeth Sites

Antibiotic-resistant infections affect 2 million people and are associated with 23,000 deaths each year in the United States.1 Physicians link medicines and patients, so prescriptions are a target for reducing unnecessary use of antibiotics in humans. But physicians tend to prioritize the patient in front of them, rather than consider the long-term, societal implications of each prescription. How can we make appropriate prescription of antibiotics the new norm?

Behavioral economics embeds insights from psychology into neoclassical theories of behaviors. It’s hard to see the consequences of antimicrobial resistance in the day to day – discounting and present-bias de-emphasize long-term prevention in favor of immediate gratification. For doctors, discounting might take form in the satisfaction a patient leaving the office with treatment in hand, while discounting the long-term impacts of inappropriate antibiotic usage.

Recently, researchers have begun designing behavior-change programs for healthcare providers. One such “nudge” that has shown promise involves hanging letters of commitment in examination rooms that document the physician’s commitment to the appropriate prescription of antibiotics and explain why they are not useful in many cases 4. This strategy may be doubly effective because it helps make the physician feel accountable for their commitment, and facilitates discussions with patients.

Behavioral interventions at the provider level can be powerful tools to facilitate consideration of the long-term effects of a decision made today. Simple, inexpensive programs like this have enormous potential to stall the progression of antibiotic resistance by decreasing the flow of unnecessary antibiotics from doctors’ offices to patients.

References:

[1] Antibiotic/antimicrobial resistance. https://www.cdc.gov/drugresistance/index.html. Updated 2017. Accessed 11/19/, 2017.

[2] Meeker D, Knight TK, Friedberg MW, et al. Nudging guideline-concordant antibiotic prescribing: A randomized clinical trial. JAMA Internal Medicine. 2014;174(3):425-431. doi: 10.1001/jamainternmed.2013.14191.

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