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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.

References:

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839972/

[2] https://www.cdc.gov/ncbddd/folicacid/recommendations.html

[3] https://www.cdc.gov/ncbddd/folicacid/features/folicacid-prevents-ntds.html

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). https://doi.org/10.1371/journal.pmed.1001382

[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. https://doi.org/10.2196/mhealth.6286

[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. https://doi.org/10.1007/s11904-014-0239-3

 

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 https://www.cdc.gov/drugresistance/threat-report-2013/index.html

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

Think like a penguin to stay safe this winter

Groundhog’s day (February 2nd) is almost upon us.  I’m hoping for spring, but I’m counting on six more weeks of winter.  Unfortunately, slippery ice often comes with the cold temperatures of winter.  This ice makes for treacherous conditions, which for many leads to back injuries and broken bones (Smith & Nelson, 1998).  In order to walk safely on ice, the Centers for Disease Control recommends trading your Punxsutawney Phil impression for your best penguin impression.  The penguin waddle is regularly touted as a safer way to navigate across ice.  In order to do this, first, lower your center of gravity by bending slightly and pointing your feet outward.  Then instead of trying to fly across the ice, take small, shuffling steps and remain flat-footed.  If you need a little more balance, put your arms out to your side as well (Centers for Disease Control and Prevention, 2016).  Hopefully the prophetic rodent will give us more sunshine, but in case he doesn’t: Stay safe out there!

 

References

Centers for Disease Control and Prevention. (2016, January 5). Prepared Penguins: Tips for a Safe and Healthy Winter. Retrieved from Public Health Matters Blogs: https://blogs.cdc.gov/publichealthmatters/2016/01/prepared-penguins-tips-for-a-safe-and-healthy-winter/

Smith, R., & Nelson, D. (1998, January). Fractures and Other Injuries from Falls After an Ice Storm. The American Journal of Emergency Medicine, 16(1), 52-55. doi:10.1016/S0735-6757(98)90065-1

 

A Very Vegan Christmas – Pro Tips

The number of American’s participating in a Vegan diet has risen to new heights in the year 2017. In response to this, below is a list of tips to hopefully make that trip home to visit our non-Vegan family easier to handle. The following were adapted from Romesh Ranganathan’s Christmas survival guide for vegans:

  1. Accept you will be asked a lot of questions
    • Veganism is an unusual thing. Regardless of how many celebrities take it up, the fact is, you have chosen an extreme standpoint so be prepared to explain yourself.
  2. Accept that you are a difficult guest
    • The dietary limitations should speak for themselves as to why Vegans are difficult to cook for.
  3. Don’t let anyone touch your food
    • With fewer options comes less food available, protect your food at all costs.
  4. Pretend your food is disgusting
    • This goes for those who bring a Vegan dish to the meal. You love your creation and want to ensure it isn’t wasted by those just going for a taste.
  5. Avoid vegan cheese
    • Basically, cheese cannot be replicated for Vegans while keeping the same taste we grew up on. Save yourself the disappointment.
  6. Take your own dessert
    • This goes without saying, we all love dessert, so make sure you have something tasty there when the time comes.
  7. Be ready for some terrible jokes
    • Brace yourself, the lack-of-protein jokes are coming.
  8. Do not preach 
    • We make the decision to practice Veganism based on many factors. Most people know why we make this choice, so lecturing them during this time of celebration and time with family often does not get far.

I hope these help some of you Vegans out there this holiday season. Let me know if you have any other tips that could complement these listed please share in the comments!

Practicing Mindfulness for the Holidays

In last week’s blog, I shared a series of articles by Kesha, one of which was an essay she wrote regarding how the holidays can be a time of added stress for those living with mental illness. It’s the time of the year we are encouraged to spend with family and friends, surrounding ourselves with people who love us. But in getting caught up with all of the hustle and bustle, with all the lights and gifts, it can be easy to forget about finding time to take care of ourselves in the process.

There have been a number of posts that have appeared this semester on this blog regarding mindfulness, including one from Andrew regarding The Magic of Mindfulness, where he shared some of the benefits of practicing mindfulness meditation.

Below I have some more resources regarding practicing mindfulness, with a specific emphasis on this time of the year. I hope that they can be of some help to all of you for taking some time for some self-care, I know I need it after this semester. With that in mind, I look forward to sharing more posts again starting in January, and wish you all a safe and wonderful holiday season.

Mindfulness Resources –

Huffington Post: The 2 C’s Of Mindfulness For Healthier, Happier Holidays – https://www.huffingtonpost.com/entry/the-4-cs-of-mindfulness-for-healthier-happier-holidays_us_5853eb22e4b0d5f48e164e76

8 Mindfulness Tips During the Holidays – https://www.psychologytoday.com/blog/urban-survival/201612/8-mindfulness-tips-during-the-holidays

5 Mindful Tips for Navigating Holiday Stress – https://www.mindful.org/5-mindful-tips-navigating-holiday-stress/

It’s icing on the cake…and calories

Smaller portions equate to fewer calories. But what sized portions are you serving? If you’re like most people, your portions may be determined by images on food packaging, not by nutrition labels. Most individuals who consider calories while serving food do not take into account added ingredients. Packages may display multiple ingredients, like frosting and the enclosed cake, but often frosting and other added ingredients are not mentioned in the nutrition facts. This means that the nutrition facts denoting 200 calories in a slice of cake fail to mention the additional 200 calories of icing covering the slice. When people understand that nutrition labels do not include added ingredients, they eat smaller portions to account for the increase in calories. Next time you’re buying cake mix you might want to consider what frosting adds outside of taste. It could help you cut a smaller piece.

Brand, J., Wansink, B., & Cohen, A. (2016). Frosting on the cake: pictures on food packaging bias serving size. Public health nutrition, 19(12), 2128-2134.

A generation’s view on HIV

Last week, Josh wrote an informative post on World AID’s Day, in which he brings up a key point about how HIV is perceived, and how stigma and discrimination dissuade an at-risk population from getting testing and treated. This points to a real need to understand how the population understands HIV, and what their attitudes are towards it. Kaiser Family Foundation recently wrapped up a study that could be insightful in this area.

In an article published on Nov 30th, they write ” an entire generation has been born and grown up without ever knowing a time when HIV did not exist” but that “they may be the first to see it end”.  KFF conducted a survey in which they interviewed (online and by telephone, in English) 1,794 18-30 year olds between January 25th and February 16, 2017. Of note, they “oversampled” Black and Latino populations, as these groups are disproportionately affected by HIV.

Here are some key findings from their report:

  • young people of color are more personally concerned about HIV, know more people who have HIV, and  are more worried about getting HIV than are whites
  • most young adults are not super aware of advances in HIV prevention and treatment (13% of respondents knew about PrEP–a pill taken daily as a preventative measure against the disease) and only 10% believe modern treatment is “very effective” in preventing HIV
  • stigma is still real: most young people would be comfortable having a friend or colleague with HIV, but many/most are uncomfortable having a roommate with HIV, having their food prepared by someone with HIV, or having a sexual partner with HIV
  • misconceptions: 38-58% of respondents believe that HIV can be spread through plates, glasses, toilets, spitting, or kissing–none of these are true
  • 54% majority of respondents have never been tested for HIV and 63% have never talked to a health care provider about it

Their results are consistent with other findings that advances in HIV prevention and treatment have not been effectively communicated, at least not to young adults.