Category: Women’s Health

Discrimination and Health Part I: LGBTQ+ Americans

Past research has suggested that discrimination can impact health outcomes – perhaps through vehicles such as stress of daily interactions and negative experiences with the healthcare system. One group whose experiences with discrimination can be linked to negative health outcomes is LGBTQ+ Americans. A study found that over half of LGBTQ people have experience slurs and offensive comments, and over half have been sexually harassed or experienced violence, or had an LGBTQ friend or family member experience such trauma.

We can make the connection between discrimination and trauma through various factors. One is through microaggressions –  seemingly harmless daily interactions with others who express, in this case, homophobic or transphobic views. These have been found to negatively impact health. Another is through discrimination within the healthcare system that lead LGBTQ Americans to seek healthcare less frequently. 18% of this population has avoided necessary medical care. Various forms of discrimination they face at the hands of medical professionals, police, and community members are much worse for those of color and those who are transgender.

Unfortunately, we can already see the health outcomes of discrimination to this population – they have higher rates of psychiatric disorders, substance dependence (including higher tobacco use), and suicide; lesbian women are less likely to get preventative services for cancer, and gay men are at higher risk for certain STIs.

How can we work to eliminate these gaps, even when interpersonal discrimination may take longer to tackle as our culture continues to evolve? HealthyPeople2020 provides several recommendations. First, healthcare providers should discuss sexual orientation and gender identity (SOGI) respectfully with patients, and collect data on it. Medical students should be trained in LGBTQ culturally-responsive care. In addition, we must be spokespeople against legal discrimination of this population in social services such as employment, housing, and health insurance.

Sources:

https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

https://www.npr.org/documents/2017/nov/npr-discrimination-lgbtq-final.pdf

https://www.centerforhealthjournalism.org/2017/11/08/how-racism-and-microaggressions-lead-worse-health

https://www.psychologytoday.com/us/blog/microaggressions-in-everyday-life/201011/microaggressions-more-just-race

http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747726/pdf/nihms134591.pdf

What’s going on with the HPV vaccine?

HPV is the most common STI, and 9 of every 10 people will have an infection at some point in their lives (1).  This virus can cause cancers in the cervix, penis, mouth, and oropharynx (2), and it also causes genital warts (3).  Even though a vaccine exists against HPV, less than half of teens are up to date on all of their doses of these shots (2).

Part of the reason behind these low vaccination rates are due to parents concerns regarding vaccine safety and fear that vaccination will encourage sexual activity (4).  Though all vaccines, including this one, have potential side effects, the HPV vaccine is considered safe (4). Additionally, studies have shown that the HPV vaccine does not make teens more likely to start having sex (4).

The way providers approach talking about the HPV has also influenced vaccine rates, and strong provider endorsement seems to improve vaccinations (5).  On Monday, March 19, Chris Noronha spoke with the Interdisciplinary Health Communications Class about the work he is doing with Noel Brewer on provider communication regarding the HPV vaccine.  They have found that when providers mention the HPV vaccine in the same list as other vaccines that are due at age 11, vaccination rates increase.

If you’re interested in the HPV vaccine, it may not be too late.  You can receive the series through age 26 (1).  Contact your provider if you’re interested.

 

Works Cited
  1. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) Vaccine Safety. Centers for Disease Control and Prevention. [Online] January 30, 2018. https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html.
  2. Aubrey, Allison. This Vaccine Can Prevent Cancer, But Many Teenagers Still Don’t Get It. National Public Radio. [Online] February 19, 2018. https://www.npr.org/sections/health-shots/2018/02/19/586494027/this-vaccine-can-prevent-cancer-but-many-teenagers-still-dont-get-it.
  3. Centers for Disease Control and Prevention. What is HPV. Centers for Disease Control and Prevention. [Online] December 20, 2016. https://www.cdc.gov/hpv/parents/whatishpv.html.
  4. —. Talking to Parents About HPV vaccine. Centers for Disease Control and Prevention. [Online] December 2016. https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf.
  5. Narula, Tara. HPV vaccine: Why aren’t children getting it? CBS News. [Online] July 23, 2017. https://www.cbsnews.com/news/hpv-vaccination-cancer-prevention-dr-tara-narula/.

 

 

“The Angelina Effect”

In this day of age celebrities dominate our world. They hold elected office, they are activists, they are social media entrepreneurs, they are everywhere. Whether we like to believe it or not they have influence over our behaviors and how we make decisions. I’m guilty that most of the accounts I follow on Instagram are former Bachelor contestants and catch myself wanting to mimic their fashion and fitness routines. In fact, there has been research that has examined this phenomenon. Back in 2013, esteemed actress Angelina Jolie announced that she carries the a genetic mutation that greatly increases your risk of breast and ovarian cancer (BRCA1). In her New York Times opt ed piece, Jolie reveals that she lost her mom, aunt and grandmother to cancer and that influence her decision to undergo preventive surgery to remove both of her breasts (mastectomy) and ovaries. After this announcement, several researchers explored what came to be known as “The Angelina Effect” and how her decision influenced other women’s decisions about their own health. In a study published in Health Services Research journal, hospital data from both New York and the UK revealed that three months after Jolie’s announcement there was a significant increase in preventive mastectomies prior to the announcement. This trend has been seen with other celebrities after announcements of diagnoses and provides incentives for both public figures and healthcare providers to use these instances as teachable moments and bring awareness to employ preventive healthcare.

To learn more about the BRCA1 gene visit the following site: https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q1

 

 

 

Pollution and Pregnancy: A Match Made in Hell

A recent study in the journal Biological Psychiatry has found that mothers exposed to air pollution during pregnancy have children at higher risk of cognitive health problems, due to brain alteration during fetal development. Such abnormalities resulted in issues such as impulse control and behavioral problems. Researchers believe that long-term impacts could include high-risk activity, such as addiction, as well as mental health disorders and low academic achievement.

Previous research has associated high levels of pollution with poor development in the womb, but this study found that these risks occur even when pregnant mothers were living in places with air pollution levels deemed acceptable. This raises questions of whether our air quality measurement standards are adequate and accurate.

Researchers compare this troubling finding with the field’s existing knowledge of the dangers of smoking during pregnancy – Dr. John Krystal, editor of the journal that published the study, draws the parallel that both scenarios involve “inhaling toxins.” We already know that other environmental factors (like stress, lead exposure, and pesticides) can lead to adverse outcomes during pregnancy, but it seems that regulatory policies for some environmental risks fall short of others. Translating research findings to the public – and focusing on productive solutions instead of instilling fear in those with no choice of residence – are key roles for public health moving forward.

Sources:

https://www.usnews.com/news/national-news/articles/2018-03-14/air-pollution-within-levels-considered-safe-changes-brain-development-leads-to-cognitive-impairment

http://time.com/3757864/air-pollution-babies/

http://www.biologicalpsychiatryjournal.com/article/S0006-3223(18)30064-7/fulltext

How many teens are sexting?

When we go on the internet and listen to stories, we often hear comments about sexting among teens.  With all of this talk, it may sound like this is something that all teens are doing.  However, according to a study published this week by JAMA Pediatrics, only about 14.8% of teens have sent these messages, and approximately 27.4% of teens have received a sext [1].  This means that roughly 17 out of 20 teens have never sent sexually explicit images, videos, or messages.

Though this rate is lower than we may have expected, sexting is becoming more commonplace, and that is cause for concern. Many teens, view sexting as private and therefore safe.  However, approximately 12%, are forwarding sexts without consent of the sender [1]. Additionally, many teens don’t realize that even though some messaging apps that allow video and image sharing appear private, they may not be [2].

Often times, sexting is a normal by-product of teens trying to establish their identities and wanting to explore their sexuality [2].  However, many teens just are not aware of the dangers that can come with sexting.  Along with these concerns, teens just need to be reminded that it’s not OK for them to be pressured to share more of their bodies than they’re comfortable, and that consent is theirs to give.

[1]  Madigan, S., Ly, A., & Rash, C. L. (2018, February 26). Prevalence of Multiple Forms of Sexting Behavior Among Youth. Journal of the American Medical Association Pediatrics. doi:10.1001/jamapediatrics.2017.5314

[2]  Gabriel, E. (2018, February 26). 1 in 4 young people has been sexted, study finds. Retrieved from CNN: https://www.cnn.com/2018/02/26/health/youth-sexting-prevalence-study/index.html

Achieving Health Equity and Justice through the Reproductive Justice Framework: keynote by Monica Raye Simpson

This past Friday marked the 39th annual Minority Health Conference, which is the largest and longest run student-led health conference in the world. This year’s 20th annual William T. Small Jr. keynote speaker was Monica Raye Simpson, who is the executive director of SisterSong Women of Color Reproductive Justice Collective, gave a keynote address titled: “Achieving Health Equity and Justice through the Reproductive Justice Framework”. In the talk, Simpson gave an energetic and powerful where she gave a history of the Reproductive Justice framework, and how her own life experiences shaped how she approaches her work. One of her main points was how the Reproductive Justice Framework’s focus on centering those who are the most marginalized is critical for the field of Public Health, in order to overcome health inequities. In case you were not able to attend the event in person, the keynote speech is available for broadcast in the link below, moderated by yours truly.

Sources: https://sph.unc.edu/sph-webcast/2018-02-23_mhc/

America’s Mothers Dying

By Young Kim-Parker

Baby announcements are generally considered a joyous occasion. Culturally, we celebrate motherhood with baby showers, offering well-wishes and gifts to welcome the arrival of a new life. However, perhaps we should also start exhibiting more concern because in America the number of mothers dying from complications due to pregnancy and childbirth is on the rise.

On November 18th, CNN placed a spotlight on maternal mortality with guest reporter Christy Turlington Burns (yes, the former supermodel) to bring attention to America’s glaring lack of support for mothers [1]. Christy Turlington Burns nearly died after childbirth due to complications during the third stage of labor – after the child is born, women continue to labor to deliver the placenta. Her experience propelled her to form the non-profit, Every Mother Counts, to bring greater awareness to maternal health issues. CNN is airing their newest documentary mini-series, “Giving Birth in America,” to bring greater attention to a very real concern of the growing number of mothers at risk of dying from pregnancy and childbirth despite all of the technological advances of the 21st century [1].

The U.S. has the highest maternal mortality rate among industrialized countries, and maternal deaths cut across socioeconomic status – even those with graduate education and high incomes are at risk [2]. Consider the sudden death of a neo-natal nurse, Lauren Bloomstein, who died within 24 hours of giving birth at the regional health center where she worked (she died from severe pre-eclampsia – pregnancy-related high blood pressure – that was diagnosed too late) [3]. The tragedy lies in how many of these deaths are preventable. Globally, a United Nations commitment to reduce maternal mortality resulted in nearly 30-45% reduction in maternal deaths from 1990 – 2015 [2]. For the U.S., maternal deaths rose an estimated 60% during that period [2].

Individual states have taken action to pay more attention to mothers’ health needs. In the case of California, have successfully reduced their mortality rates by 55% [2]. Four states, Kentucky, Minnesota, Mississippi, and Oregon, have expanded Medicaid perinatal services to cover doulas, individuals uniquely trained to support expecting mothers throughout their pregnancy and after birth [4]. Increasing the training of doulas and insurance coverage of their services could save lives – cities such as Baltimore, New York, Chicago and Tampa have already begun doula training programs for the dual purposes of supporting mothers to have healthier pregnancies and to reduce infant mortality [5]. While doula training may not be sufficient, it seems to be an immediate opportunity to save lives. In time, one can only hope that more states and insurance companies will begin to cover doula services. In the meantime, instead of buying onesies and rattles for the next friend that is expecting, I’ll be contributing to doula services.

References:

[1] Burns, C. T. (2017, November 18). Maternal mortality is the shame of US health care. Retrieved from http://www.cnn.com/2017/11/15/opinions/op-ed-christy-turlington-burns-every-mother-counts-2017/index.html

[2] Merelli, A. (2017, October 29). What’s killing America’s new mothers? Retrieved from QUARTZ: https://qz.com/1108193/whats-killing-americas-new-mothers/

[3] Martin, N., & Montagne, R. (2017, May 12). Focus on Infants During Childbirth Leaves U.S. Moms in Danger. Retrieved from National Public Radio, Inc.: https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger

[4] Gifford, K., Walls, J., Ranji, U., Salganicoff, A., & Gomez, I. (2017, April 27). Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey. Retrieved from Kaiser Family Foundation: https://www.kff.org/womens-health-policy/report/medicaid-coverage-of-pregnancy-and-perinatal-benefits-results-from-a-state-survey/

[5] Ollove, M. (2017, September 25). Cities turn to doulas to give black babies a better chance at survival. Retrieved from The Washington Post: https://www.washingtonpost.com/national/health-science/cities-turn-to-doulas-to-give-black-babies-a-better-chance-at-survival/2017/09/22/07420956-8363-11e7-ab27-1a21a8e006ab_story.html?utm_term=.8d953053d40c

#FreeCyntoiaBrown

“If I can keep one child from going down the path that I went down, it will be worth it.” Words spoken by twenty-nine-year-old Cyntoia Brown. The path she embarked on as a child was not one she chose. Brown was forced into prostitution as a child during which time she was abused and raped until the age of 16 when she was arrested for murdering one of her solicitors.

Brown’s story has garnered a lot of media attention recently with a number of high profile celebrities including Rihanna and Kim Kardashian sharing her story on social media outlets and calling for her release from a life prison sentence. Brown has served 13 years thus far and is ineligible for until she has served at least 53 years.

Cyntoia Brown’s story brings to light both the legal and health-related problems associated with sex trafficking. After having their human rights violated, victims who comply with their abusers’ demands are often jailed for prostitution. Those who fight back against their violators often face legal prosecution and serve jail sentences. Is this how we should treat victims of human trafficking?

Not only do victims face legal ramifications they also endure health consequences of their physical and emotional abuse. Women are often subjected to unwanted, unplanned pregnancies because they do not have access to birth control methods including condoms (1). This also places them at risk for gynecological problems including sexually transmitted diseases and infections. According to Stop Violence Against Women, rates of abortion, infertility, and sterilization are higher among female prostitutes. Victims are also subject to long-term mental health issues including depression, suicidal ideation, substance abuse and post-traumatic stress disorder.

Brown’s story is not unique. According to the Human Trafficking Hotline, in 2015 over 5,500 cases of human trafficking were reported (2). This number rose in the following year. Over 7,600 cases were reported in 2016. The challenges that victims of human trafficking face need our attention. Their struggles with physical and emotional abuse do not belong only to themselves. They are public health issues that affect us all.

(1) http://www.stopvaw.org/health_consequences_of_trafficking

(2) https://humantraffickinghotline.org/states

Image: https://www.fbi.gov/news/stories/human-trafficking-prevention-month-raising-awareness-of-a-devastating-crime

 

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 

#MeToo: Personal Stories of Assault Flood Social Media

As I scrolled through my phone through my various social media applications (as part of my slow Monday morning routine) I noticed the phrase “Me Too” flooding my streams. At first I was puzzled by this reoccurring status, but did a quick google search and came to astonishing realization: all of these people have experienced some sort of harassment or assault. It took a second to fully comprehend how many of my friends and followers have had this traumatic experience. As I continued scrolling through my feeds, I discovered that this campaign was kick started by a tweet by actress Alyssa Milano. Soon after many public figures came out responding with a “Me Too” including Viola Davis, Debra Messing, Rosario Dawson, Lady Gaga and Sheryl Crow just to name a few. By Monday afternoon, Twitter announced that the “Me Too” had been used in half million tweets and Facebook released “Me Too” was referenced by 8.7 million users.

This campaign comes out shortly after the New York times published a tell-all article about the alleged sexual harassment incidents by movie mogul Harvey Weinstein. In the wrath of the article, Weinstein has been fired from his own company and the company will formally change their name. Let’s hope that that these events will ignite the conversation about harassment and assault and that social media will release these numbers to help change societal norms around harassment and assault!

Sources:

http://people.com/movies/me-too-alyssa-milano-heads-twitter-campaign-against-sexual-harassment-assault/

 

http://www.rollingstone.com/culture/news/harvey-weinstein-what-you-need-to-know-w508162

 

https://www.recode.net/2017/10/16/16482410/me-too-social-media-protest-facebook-twitter-instagram