Category: Uncategorized

Revised Cervical Cancer Screening Guidelines Offer Women More Options

New recommendation guidelines for cervical cancer screening were published this month in the Journal of the American Medical Association (JAMA). These guidelines are an update to the U.S. Preventive Services Task Force (USPSTF) 2012 recommendations on cervical cancer screening. The new screening guidelines now offer women more options and longer screening intervals when it comes to their preventative care. One of the most notable guideline changes is that women aged 30-65 can now get an HPV test alone every 5 years instead of just a Pap smear alone every 3 years, or in combination with a Pap smear every 5 years.

According to the guidelines:

  • Women aged 21-29 years should get a Pap smear every 3 years
  • Women aged 30-65 years can get:
    • A Pap smear alone every 3 years
    • An HPV test alone every 5 years
    • A combination of a Pap smear and HPV test every 5 years

The USPSTF does not recommend screening for women younger than 21 years as well as women older than 65 years who have received adequate screening before and are not at high-risk for cervical cancer.

Cervical cancer was once a major cause of death among women. However, with the advent of screening tests, such as Pap smears, cervical cancer rates have fallen considerably over the years. Still, the American Cancer Society estimates 13,240 women will be diagnosed with cervical cancer in 2018.

Almost all cervical cancers are caused by the human papillomavirus (HPV), a common sexually transmitted infection. There are many types of HPV, some low-risk and some high-risk. Low-risk HPV types can cause warts that can be treated. High-risk types, however, can cause cancer. While the body can often fight off HPV infection, this is not always the case. Some HPV infections can become chronic, and chronic infections with high-risk HPV types can lead to cancer in both men and women if left untreated. However, there are vaccines that can prevent cancers, like cervical cancer in women, caused by HPV. The Centers for Disease Control (CDC) recommends that all children get vaccinated against HPV at age 11 or 12. For young women in particular, the CDC recommends they get vaccinated through age 26.

Because it can take years for cancer caused by HPV to develop and for symptoms to appear, the CDC encourages women to regularly screen for cervical cancer. This includes both women who have and have not vaccinated against HPV, as the HPV vaccine does not protect against all types of HPV that can cause cancer.


U.S. Preventive Services Task Force. (2018). Cervical Cancer Screening. Retrieved from

Centers for Disease Control and Prevention. (2017, December 16). The Link Between HPV and Cancer. Retrieved from

National Institutes of Health. (2018, June 30). Cervical Cancer. Retrieved from

American Cancer Society. (2017, November 1). What Are the Risk Factors for Cervical Cancer? Retrieved from

U.S. Preventive Services Task Force. (2012). Archived: Cervical Cancer: Screening. Retrieved from

Centers for Disease Control and Prevention. (2018, August 23). HPV Vaccines: Vaccinating Your Preteen or Teen. Retrieved from

American Cancer Society. (2015, February 19). HPV and Cancer. Retrieved from

American Cancer Society. (2017, October 9). HPV and Cancer. Retrieved from

Can The Media Solve Climbing Obesity Rates? part 3

Marketing regulations, in addition to mass communication campaigns that promote healthy dietary habits, have the potential to reduce overweight/obesity drastically. Restricting product marketing has been cited as a highly cost-effective method of reducing chronic disease globally (citation) because it involves implementing government-based restrictions on food manufacturers and advertisers. I believe this method has the potential to be highly effective because marketers succeed in convincing populations to desire and purchase their products (be them healthy or unhealthy). They do this though audience targeting strategies like giving celebrities endorsements, using dialects specific to populations an advertisement will be run in and by using popular cartoons on ads that target children. In particular, I believe that when companies advertise to children and caregivers purchase the unhealthy foods they desire, companies play a role in shaping children’s taste preferences. These preferences can follow children into adulthood and place them at a greater risk for overweight/obesity. Marketing regulations could potentially decrease the awareness about and desirability of unhealthy food by limiting the use of certain strategies.

As societies become more Westernized, overweight and obesity rates rise [1].  This association could exist for a number of reasons, but I believe marketing and mass communication play a large role. Food manufacturers invest millions of dollars into marketing unhealthy food products to populations at large, and there are not enough public health initiatives that promote healthy dietary behaviors using mass communication. We, as public health nutrition professionals, understand the relationship between diet and weight, but to make changes, there must be efforts to reach populations where they are. From what I have observed, people are spending more and more time with the media (especially social media), and this presents an opportunity to communicate with populations about diet innovatively and engagingly. Why not promote healthy dietary behaviors through mediums audiences are currently using?


Can The Media Solve Climbing Obesity Rates? part 2

Mass media campaigns can be used to improve populations’ dietary habits and promote health. Opportunities to utilize mass media, which includes any form of communication that reaches populations (i.e., television, print media, social media), have increased in recent years. We have seen changes and improvements in mass media communication largely due to the increased use of social media and mobile technology. As access to mobile technology and populations’ use of smartphones and social media increase, health communicators have increased opportunities to reach populations through these mass communication mediums. I believe that no other intervention approach to decrease obesity rates has the potential for as wide a reach as mass media, and the literature supports its efficacy. Mass media campaigns that target individual dietary behaviors like increasing vegetable intake or reducing sodium are effective at promoting those behaviors [1]. The 1990s “5-A-Day” campaign, a well-known nutrition education campaign that promoted increasing fruit and vegetable intake to at least five servings per day, used television, radio, and print materials to reach its target audience. This initiative was successful in its efforts. 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 proven effective at promoting folic acid supplementation and the maintenance of weight loss The Community Guide. I believe mass media campaigns advance global nutrition efforts to reduce overweight and obesity rates because of the extent to which media is incorporated into people’s daily lives. Much like mass media campaigns, regulations on marketing through mass communication could also advance global nutrition.

Can The Media Solve Climbing Obesity Rates? part 1

Hunger and malnutrition are major global nutrition issues that affect the health and development of populations. These states can arise from financial disparities as well as natural disasters. For example, when countries experience severe droughts that wipe out crops, famine can result and greatly affect populations at large.  While food aid exists to help alleviate the burden associated with these situations, malnutrition is still a serious public health issue, particularly in overpopulated, low-income and low-resource countries. It is estimated that international hunger rates are rising and that children are largely affected with over 155 million children suffering from stunting [1]. Paradoxically, while malnutrition still exists in many countries, international rates of overweight/obesity are skyrocketing. In 2016, the World Health Organization reported that roughly 39% of adults over the age of 17 were overweight [2]. About 13% of the population is obese. These findings leave public health professionals with two challenges: 1) increasing food access among populations at risk for malnutrition and 2) promoting weight management at a populations level. In addition to these problems, public health professionals encounter the challenge of creating a substantial impact on large populations with limited financial capital and resources. Public health professionals must be intentional about choosing the best approaches to public health issues. I believe the most effective strategy for reducing overweight/obesity involves using media to promoting healthy dietary choices and behaviors. In particular, mass media campaigns and marketing regulations can be used to influence populations’ nutritional behaviors and food purchasing patterns.

Could the Mediterranean Diet Delay Alzheimer’s?

In recent years, the news has constantly covered the health benefits of the Mediterranean diet, a diet characterized by meals that use lots of fruits, vegetables, whole grains and healthy fats like olive oil. The Mediterranean diet is back in the news after a recent study found that it has the potential to delay the onset of Alzheimer’s disease. The study involved two groups of 70 participants. Half highly adhered to the Mediterranean diet for three years and the other participants adhered to a lower extent. After three years, the high adherers presented with fewer Alzheimer’s biomarkers. The researchers estimated that these changes would translate into a delay in Alzheimer’s onset by 1.5 to 3.5 years. These findings could indicate that a large part of Alzheimer’s development is diet-related. Since diet is largely in an individual’s control, we may be able to curtail disease development and help individuals age in a healthy manner through the promotion of a healthful diet.

Congrats to Our Grads!

The Interdisciplinary Health Communications (IHC) program at UNC-Chapel Hill, which houses the Upstream blog, is an inter-departmental initiative in the new science of health communication. This year, several wonderful students are graduating with degrees or certificates through IHC. Let’s recognize them!

First is Arshya Gurbani, who has earned her MA in Media and Communication:

Next is Matty Johnson, MS in Library Science and IHC Certificate, who will be going on to pursue his PhD:

Hannah Tuttle, MPH, IHC Certificate:

Casey Evans, MPH and Registered Dietitian, IHC Certificate:

Josh Boegner, MPH, IHC Certificate:

Congrats to our wonderful 2018 graduates, who will be using their health communication knowledge for great things!

Supplement to Save Lives

“Having a baby changes everything.” Most parents can relate to this once popular Johnson and Johnson montage; however, no one quite understands the changes that take place as much as mothers.  During pregnancy, women undergo both physical and cognitive changes.  Elevated prolactin levels promote lactation and memory disturbances do in fact occur [1]. To facilitate these changes while promoting the growth and development of infants, expecting mothers’ actions are strictly monitored.  Women are expected to visit the doctor frequently and their diets are drastically altered.  One dietary change that is vital for fetal maturation is the incorporation of folic acid supplements.

Folic acid is a vitamin that promotes healthy nervous system development. It is recommended that women who are pregnant or might become pregnant consume 400 micrograms of folic acid per day. Forgoing this recommendation can result in serious birth defects including spina bifida and anencephaly which can increase infant mortality [2].  Folic acid naturally occurs in various fruits and vegetables, and in the United States, many cereal and bread products are fortified with folic acid.  Although we practice measures to prevent neural tube defects many populations are still at risk particularly Hispanic women [3]. Findings such as these highlight the importance of increased efforts to decrease NTDs in populations of greater need.





HIV Medication Adherence Apps: Challenges Faced

By Chunyan Li

The success of HIV medications has changed HIV from a fatal disease to a chronic illness. However, like other chronic diseases that require lifetime medication (at least for now), maintaining good adherence to antiretroviral therapy is not easy for HIV-positive people for reasons such as the complex drug regimens, strict requirements on the time of daily medication, and sometimes intolerable side effects. Having a mobile phone-based application to remind patients of daily medication is a good way out, but the effectiveness of such medication adherence apps remains less studied.

One significant challenge that such apps often face is a lack of behavioral science in design. Some experts described the development of many healthcare apps as a “black box”[1], blaming that app developers often focus too much on technology while neglecting behavior change theories or research evidence. One 2016 research study [2] reviewed all health apps on Google Play, Apple App Store and Windows Phone Store, and found that the reviewed 28 eligible health apps only used 5.6 out of the total 37 behavioral change principles on average. Among the four categories of behavior change principles proposed by the researchers (task support, dialogue support, system credibility and social support), the most used principles were about “system credibility” and “task support”, including features like surface credibility, expertise, authority, and providing general information and function of self-monitoring.  The two categories “dialogue support” and “social support”, which require higher user-provider interactivity and more constructive design based on behavioral science, are somehow neglected.

In another systematic review [3] that reviewed all eHealth-based HIV intervention studies (including smartphone-, Web- and general Internet-based interventions), 10 out of the 14 studies that had a component of adherence improvement were smartphone-based. As HIV patients are usually required to take medicines on quite a strict daily schedule, and sometimes even to be in private if HIV/AIDS is heavily stigmatized, smartphone-based apps are better for portability and privacy protection. However, it could also be challenged when people feel unsafe to disclose HIV status or worry about leaving digital footprints on such apps. In lower-income settings where cell phones are shared with family members, using apps to keep track of medication adherence might not be an ideal option for HIV-positive people.

In a qualitative research study about the HIV treatment continuum that I’m recently working on, a frequently-mentioned desired feature of app-based interventions by HIV-positive people is having communication with human counselors. Many adherence apps may have functions of knowledge education, tracking medications and pushing reminders, but lack an emotional support. Living with HIV is a chronic and multidimensional (physical, psychological and cultural) stress, and a successful coping with such a stress requires consistent support from families, friends and health professionals. Though the advantages of health apps include its mass-reach to users and increasing access to care in limited-resource settings, we should never ignore the needs for human caring and support. How to incorporate human support into HIV medication adherence apps could be one of the future research directions.


[1] Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2).

[2] Geuens, J., Swinnen, T. W., Westhovens, R., de Vlam, K., Geurts, L., & Vanden Abeele, V. (2016). A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement. JMIR mHealth and uHealth, 4(4), e118.

[3] Muessig, K. E., Nekkanti, M., Bauermeister, J., Bull, S., & Hightow-Weidman, L. B. (2015). A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care. Current HIV/AIDS Reports.


39th Minority Health Conference – 23 Feb

The 39th Minority Health Conference will be held at the Friday Center in Chapel Hill next week (Friday, February 23, 2018). According to the conference website, “This year’s theme, Reclaiming the Narrative, is based in the recognition that the world is organized by the stories we tell. Stories have the power to influence the way we view ourselves and others and have the power to shape our actions. Given this sometimes unacknowledged influence, we must ask who are the storytellers, and who benefits from these narratives. The answers to these questions can offer an understanding of how we as public health professionals can progress and push public health agendas forward in a meaningful way. This year’s theme challenges us to end perpetuation of damaging rhetoric against marginalized communities. It highlights how resilient communities have fought to speak truth to power and refused to have their voices silenced and how public health practitioners can join such efforts. By reclaiming the narrative, communities and public health practitioners can reconcile the past and present and take agency in the future to promote health for all people.”

The event will feature keynote lectures from Monica Raye Simpson, Executive Director of SisterSong Women of Color Reproductive Justice Collective, and Vann R. Newkirk II, MSPH, a staff writer at The Atlantic.

Information about registering for the event in person is available here, but there is also an option to watch a live webcast of the event.

Fore more information about the event, visit their website.

Funding AMR Research Straight from the Source: Agriculture

By Raj Topiwala

Alexander Fleming’s discovery of Penicillin in 1928 is undoubtedly one of history’s crowning achievements in medicine. In the 89 years that have since followed, antibiotics have saved countless lives and reduced once fatal maladies to easily treatable diseases. However, with the list of antimicrobial resistant pathogens growing at an alarming rate, we risk soon encountering diseases that are resistant to every available method of treatment, regressing us back into the pre-antibiotic age (and its diminished life outcomes).

With that in mind, one would expect research and development (R&D) into antimicrobial resistance (AMR) to be a major objective in the pharmaceutical industry. However, it turns out that AMR innovation is a rather unattractive option for pharmaceutical firms. Because patents for new pharmaceuticals expire quickly, there is a narrow window of time for firms to make up the massive costs of R&D and turn a profit, a near-impossible task for new antibiotics. With the plethora of inexpensive generics already on the market, why would a consumer choose the new expensive antibiotic when they could get a generic for nearly free? To offset this lack of profitability, a prize-system that rewards new AMR innovation has been proposed. In searching for a way to fund the prize, I propose we focus our gaze on what is arguably the biggest contributor to AMR there is: the agriculture industry.

The largest consumer – and waster – of antibiotics is the agriculture industry. More drugs are used for animals that produce food than the people that eat them (CDC, 2013) and an estimated 75-90% of antibiotics used in feed is excreted from livestock completely unmetabolized (O’neil 2016). The industry is routinely exposing pathogens to antibiotics without killing them – directly fostering the development of drug resistance. Taxing this practice presents a win-win scenario for the health sector. If the industry opts to continue using antibiotics at such

a dangerous rate, the tax revenue generated would be more than sufficient to fund the prize. If instead, the industry responds to the tax by decreasing antibiotic use in feed, then an entirely different, but equally beneficial, victory in reducing the dangerous practice will have been achieved. On some level, it is fitting to have the very practices that are creating AMR enable to solving of it. Though the agriculture industry is clearly unequipped to “clean up their own mess” in this case, having them pay for the AMR prize comes in at a close second – one that is both feasible and effective.

Works Cited

CDC: Centers for Disease Control and Prevention. (2013). Antibiotic / Antimicrobial Resistance. Retrieved November 19, 2017, from

O’Neil, J. (May 2016). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. The Review on Antimicrobial Resistance.