Category: Men’s Health

Implicit Bias in Prescription of PrEP

African American men who have sex with men (MSM) are disproportionately affected by HIV; however, recent research suggests that medical providers are less likely to prescribe Pre-Exposure Prophylaxis (PrEP), a preventative treatment for HIV, to black MSM (Calebrese et al, 2014). This is a direct result of implicit racial bias, prejudice, and a lack of institutional knowledge on the part of medical providers. Current stereotypes about gay men exist among many medical practitioners, specifically with regard to “Truvada Whores.” It is assumed that MSM who take PrEP will participate in more risky behaviors and thus be at greater risk of HIV, though PrEP is an important measure for reducing risk of HIV. This is further exacerbated by implicit racial bias which corroborates beliefs by providers that black MSM are even more likely than white MSM to partake in risky sexual behaviors if they are prescribed PrEP. As such, medical providers are less likely to prescribe PrEP to black MSM, barring them from access to an important and potentially life-saving measure to prevent HIV, a disease that they are disproportionately affected by.

This research suggests that public health interventions that focus on black MSM might be misplacing their efforts by focusing on changing the behaviors of the individuals or encouraging use of PrEP if they don’t have the necessary support from their doctors. Perhaps, public health interventions should focus on developing additional institutional knowledge to prepare medical providers for caring for black MSM and providing adequate sexual health care.

Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x

Coffee… Good or Bad for Health?

I recently read an article that was published a few days ago in The BMJ regarding coffee consumption and health. I was curious to learn what the findings were, considering that I have heard mixed reviews over the years about the health benefits of coffee.

After conducting an umbrella review of over 200 meta-analyses regarding coffee consumption and health outcomes, Poole et al. (2017) found that drinking three to four cups of coffee a day was associated with lower risk of a variety of health outcomes. According to the article, researchers found that drinking three cups of coffee a day lowered risk for death and cardiovascular disease, compared to non-coffee drinkers. Coffee consumption was also found to lower risk of various cancers, as well as neurological, liver, and metabolic diseases. In women who are pregnant, however, high levels of coffee consumption were associated with higher risk of low birth weight, pregnancy loss, as well as preterm births. Additionally, coffee consumption was found to be associated with an increased risk of fracture in women.

A note that this study mentions is that current evidence on the topic of coffee consumption and health is mainly observational and of lower quality in nature. That said, researchers recommend that randomized controlled trials be used in future research to better understand causal associations between coffee consumption and various health outcomes.

Eliseo Guallar, professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health published an editorial in response to Poole et al. (2017). Dr. Guallar comments that while coffee drinking is generally safe, people should not start drinking coffee for health reasons. Dr. Guallar continues in stating that “some population subgroups may be at higher risk of adverse effects” of coffee consumption. Additionally, Dr. Guallar expressed the importance of the amount of coffee consumption, asserting that there remains uncertainty regarding the effects of higher levels of coffee consumption. However, Dr. Guallar expressed that moderate coffee consumption is safe and can be a part of a healthy diet.

References:

Poole, R., Kennedy, O.J., Roderick, P., Fallowfield, J.A., Hayes, P.C., & Parkes, J. (2017). Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ 2017; 359:j5024. doi: https://doi.org/10.1136/bmj.j5356 

Guallar, E. (2017). Coffee gets a clean bill of health. BMJ 2017; 359:j5356. doi: https://doi.org/10.1136/bmj.j5356 

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

Football and Concussions: Where do we go from here?

October may be my favorite month of the year: sweater weather, changing leaves, and most importantly college football is at its peak. I am a University of Michigan Wolverine fan and every Saturday I look forward to watching the game. Even though I live and breath for college football, as a public health student I still have many concerns about the health implications of this game on players.

CTE (chronic traumatic encephalopathy) is a degenerative brain disease caused by multiple blows/hits to the head. This disease is seen in many former football players; however, the catch is that it is only diagnosable after a person has died through an autopsy. Symptoms of this disease include impulsive behavior, depression, memory loss, substance abuse, emotional instability and suicidal thoughts or behaviors.

CTE has affected many former NFL players such as Mike Webster, Ken Stabler, Kevin Turner, Bubba Smith and Dave Duerson. A study published in JAMA this past July found that out of the 202 deceased football players 177 had CTE (87%) while of the 111 former NFL players 110 of them had CTE (99%). The high prevalence of this disease is a call for action on better treatment and care for these players by these franchises especially since these franchises are not running low on cash.

To learn more about CTE check out the Concussion Legacy Foundation’s website: https://concussionfoundation.org/CTE-resources/what-is-CTE

Lady Gaga Reveals Battle with Fibromyalgia

This past week, music sensation Lady Gaga revealed on her Twitter account that she has been battling fibromyalgia, and was recently taken to the hospital for severe pain, leading her to cancel one of her performances. While it may not have been easy to do, Lady Gaga’s decision to open up about her condition sheds an important light on the debilitating condition that is fibromyalgia.

According to the Centers for Disease Control, fibromyalgia affects about 4 million US adults. It is a chronic condition characterized by widespread pain and can include symptoms of fatigue, depression, and headaches that can negatively affect quality of life. While it is unclear what causes fibromyalgia,  some possible risk factors include age, stressful or traumatic experiences, family history, and sex. According to the Centers for Disease Control, women are twice as likely to have fibromyalgia as men.

Treatment for fibromyalgia often involves a team of different health professionals, and can be effectively managed with a combination of medication, exercise, and stress management techniques.

Check out the following resources for more information about fibromyalgia and how you can get involved in raising awareness of this condition:

The National Fibromyalgia Association

The American Fibromyalgia Syndrome Association, Inc.

Fibromyalgia | Centers for Disease Control and Prevention

Questions and Answers about Fibromyalgia | National Institute of Arthritis and Musculoskeletal and Skin Diseases  

Note: Lady Gaga has been working on a documentary entitled “Lady Gaga: Five Foot Two,” in which she discusses her battle with fibromyalgia. This film will be available on Netflix on September 22.  

References:

Fibromyalgia. (2017, September 6). Retrieved from https://www.cdc.gov/arthritis/basics/fibromyalgia.htm

Park, Andrea. (2017, September 13). Lady Gaga opens up about having fibromyalgia. https://www.cbsnews.com/news/lady-gaga-opens-up-on-fibromyalgia-on-twitter/

Questions and Answers about Fibromyalgia. (2014, July). Retrieved from https://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp#c

PrEP for HIV Prevention? Here’s what you need to know

Pre-Exposure Prophylaxis, or PrEP, has changed the way in which we talk about HIV Prevention. After being approved for preventive use by the FDA in 2012, there has been a sharp increase in PrEP prescriptions in the U.S. over the past several years. Currently, the only prescription available for PrEP is Truvada, which also serves as a treatment drug for those who are HIV positive.

Truvada is a nucleoside reverse transcriptase inhibitor, or an NRTI. When exposed to HIV, a NRTI works by masking itself as a building block of the virus’s genetic structure. While our own cells are able to recognize and correct for this coding mistake, HIV cannot, and as a result is unable to replicate and mount a widespread infection.

A quick distinction: Truvada as a drug is a form of PrEP, PrEP is a general class of preventive measures. Birth control can be thought of as a form of PrEP, preventing a pregnancy before it occurs. Even sunscreen is a form for PrEP. You apply lotion to prevent sunburn before it occurs.

But PrEP only works if you take it. According to recent findings from the Centers for Disease Control and Prevention, the majority of uptake of PrEP in the United States has been among middle-aged, white, gay men. But the HIV epidemic has shifted, with the CDC noting continuous inequalities in the southern states and among young African Americans.

More concentrated efforts need to happen to ensure that those who can benefit from PrEP are able to access and receive it. Gilead, the company that produces Truvada, has a copay card available, where they pay up to $3600 a year in copays for those living under 500% of the national poverty level. For more information on PrEP, UNC campus health also serves as a great resource on campus, and students can get more information by making a free appointment with Student Wellness by emailing LetsTalkAboutIt@unc.edu or by calling (919) 962-WELL(9355).

For additional Resources on what to know about PrEP, and how to have a conversation with your provider, please see the resources below for information from the CDC. For those looking for a PrEP friendly provider, here is a list of providers in the State of North Carolina who actively prescribe PrEP.

Sources –

Gilead Copay Card: https://www.gileadadvancingaccess.com/copay-coupon-card

Centers for Disease Control and Prevention PrEP Resources: https://www.cdc.gov/hiv/risk/prep/index.html

Centers for Disease Control and Prevention PrEP Information: https://www.cdc.gov/hiv/basics/prep.html

List of PrEP Providers: https://www.med.unc.edu/ncaidstraining/files/PrEPProvidersforDownload.pdf/view

September is National Prostate Cancer Awareness Month

Did you know that prostate cancer is one of the most common types of cancer in men, and is the second leading cause of death from cancer in men? This year, the National Cancer Institute estimates that 161,360 new cases of prostate cancer will appear, and the lives of 26,730 men will have been claimed by prostate cancer alone.

There are several factors that can increase men’s risk of prostate cancer, such as age, race, and family history. Older men, African-American men, and men with a family history of prostate cancer have an increased risk for having prostate cancer. Prostate cancer is often asymptomatic in its early stages, and typically grows slowly. When it comes to screening for this disease, it’s important to be as informed as possible. There is no standard screening test for prostate cancer, and scientists are still studying certain screening tests used to detect this disease. Men, particularly those at an increased risk, may want to have a conversation with their health care provider about prostate cancer and the potential harms and benefits of prostate cancer screening.

This September, let us observe National Prostate Cancer Awareness Month by raising awareness of and educating our communities about prostate cancer and its risk factors, empowering men to take an active role in their health, supporting prostate cancer research and advocacy, as well as supporting those individuals currently battling prostate cancer. Together, we can end this disease.

Check out ZERO Prostate Cancer Run/Walk, sponsored by ZERO – The End of Prostate Cancer, a prominent national non-profit organization fighting to end prostate cancer, to find a run/walk near you. Additionally, the UNC Pardee Hospital will be hosting a FREE “ABC’s of Screening for Prostate Cancer” event with Dr. Glover Little on Thursday, September 14, 2017, from 6:00-7:00 pm, at the Cancer Center at Pardee in Hendersonville, NC.

Finally, below are some helpful online resources for more information about prostate cancer:

References

Cancer Stat Facts: Prostate Cancer. (N.d.) Retrieved from https://seer.cancer.gov/statfacts/html/prost.html

Prostate Cancer. (2016, November 14). Retrieved from http://www.pardeehospital.org/patients-visitors/health-library/document-viewer/?id=hw78220

Prostate Cancer—Patient Version. (N.d.) Retrieved from https://www.cancer.gov/types/prostate

Prostate Cancer Risk Factors. (2017). Retrieved from https://www.cancer.org/cancer/prostate-cancer/early-detection/risk-factors-for-prostate-cancer.html

Prostate Cancer Screening (PDQ®)-Patient Version. (2017, February 17). Retrieved from https://www.cancer.gov/types/prostate/patient/prostate-screening-pdq#section/_13

Prostate Cancer Screening Draft Recommendations. (2017). Retrieved from https://screeningforprostatecancer.org/

Race Locations. (2017). Retrieved from https://secure3.convio.net/zero/site/SPageNavigator/RunWalk17_RaceLocations?_ga=2.133389517.2131034159.1503848578-1067309688.1503848578

What’s the Deal with Male Birth Control?

By: Aria Gray MPH: Maternal and Child Health candidate 2017

I have been on many different types of birth control in the past 10+ years, all with varying levels of success and each with a new set of side effects including migraines. It has never been a question of if I should try a new method since no there is no effective reversible male birth control available.

Recently, it has made headlines that a male birth control shot has been found to effectively prevent pregnancy in a newly published study. Unfortunately, participants in the study reported adverse side effects including mood changes, depression, and increased and 20 participants dropped out of the study leading researchers to stop the study earlier than planned.

These reports come very soon after another recently published study that was in the news, which cited that hormonal birth control can cause depression in women.

While this particular study was cut short, it is my hope that research continues to search for a safe and effective method of male birth control. Over 80% of the male participants in the study responded that they would use this method of contraception outside of the study, which is hopeful for the future, and a sign that this method is very much wanted and needed. Both women and men deserve to have reproductive freedom without having to jeopardize their health or mental health.

But for now, until male birth control that is safe and effective is developed and approved, women must bear an unequal burden to prevent unwanted pregnancies.

Read more about this interesting topic here.

October is Domestic Violence Awareness Month

By: Aria Gray MPH: Maternal and Child Health candidate 2017

What is Domestic Violence? Domestic violence is the willful intimidation, physical assault, battery, sexual assault, or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It can include physical violence, sexual violence, psychological violence, and emotional abuse. Domestic violence affects individuals in every community regardless of age, economic status, sexual orientation, gender, or other demographic factors. However, domestic violence is most commonly experienced by  women between the ages of 18-24.

Domestic violence is preventable. Part of domestic violence prevention includes talking about this issue and reducing the stigma associated with it as a community. While all of October is Domestic Violence Awareness Month, the National Network to End Domestic Violence is hosting a week of action from October 16-October 22.

Here are some ways that you can get involved during the week of action and throughout all of October. You can also search for events that may be happening in your community with local organizations.

  • Wear purple for #PurpleThursday on Thursday October 20
  • Speak Out: Talk with a friend, family member, or colleague about domestic violence to help eliminate stigma and show survivors that they are supported.
  • Follow the National Network to End Domestic Violence on social media (Facebook, Twitter, and Instagram and change

For anonymous, confidential help available 24/7, call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE) or 1-800-787-3224 (TTY) now.

Spotlight on Men’s Health [infographic]

Guest Blogger: John Rehm

According to cancer.org, cancer is the second leading cause of death in men and that 1 in 7 will be diagnosed with prostate cancer. However, prostate cancer survival rates increases significantly if detected and treated early.

To increase public understanding of the disease, prevention tips, treatment options, and encourage men to proactively manage their health, the American Cancer Society has dubbed September as National Prostate Cancer Awareness Month.

The graphic below created by Nursing@Georgetown, Georgetown University’s online FNP program, breaks down the U.S Department of Health and Human Services health guidelines for men to improve overall health and wellness throughout their lifespan.

menshealth_infographic