Tag: Public Health

9/11, Hurricane Season, and disaster-related Secondary Traumatic Stress

Yesterday was the 16th anniversary of the 9/11 Terror Attack, and like many Americans I can easily recount where I was at when I saw the coverage of the attack. The event dominated news media for weeks after the events unfolded, and became enshrined as a defining moment of 21st century America.

I cannot even begin to fathom the first hand experiences of people who directly impacted from the attack, but for many, the day is a permanent memory of the way they felt, perceived, and witnessed everything unfold.

Secondary Traumatic Stress occurs when an individual hears the recounting of another’s traumatic life event. Often, the symptoms are similar to that of the more commonly known Post Traumatic Stress Disorder, or PTSD. In recent years, there has been more research being done to see the effects of disasters that affect those beyond those immediately experiencing an event.

In the wake of the recent disasters of Hurricane Harvey and Irma, we have seen coverage of their destruction everywhere from major news sources to the social media that we consume for updates from loved ones. A recent New York Times piece noted that the Weather Channel, being the only network to provide 24/7 access to coverage of the recent Hurricanes, had seen its audience increase nearly tenfold. The coverage of these storms has been vast, because the scale of the destruction of these storms has been unprecedented.

Covering these events is vital, it is important that we do not sensor the news that we receive just because of the harmful effects that it may have on us. But, by being more aware, and staying informed, we can acknowledge the way that having information so freely available can help us to cope, and hopefully heal, together.

 

Sources –

New York Times Piece: https://www.nytimes.com/2017/09/09/business/media/weather-channel-hurricane-irma.html?_r=0

Secondary Traumatic Stress: http://www.nctsn.org/resources/topics/secondary-traumatic-stress

The Voice of Public Health

People get in to public health because they want to help others. They want to share their wealth of knowledge in a way that makes a difference.

So then why don’t people hear public health messages?

Jim Garrow offers a fun, yet thoughtful read about why public health is boring.

One reason, messages go unnoticed is that public health has relied heavily on data and presenting rational arguments in an effort to persuade people to change behavior. Facts are important, I’m not denying that. But what really speaks to people?

Matthews and colleagues offer up the notion of speaking to deeper, moral values that connect us. Some practical, if not obvious, suggestions include:

  • Avoiding that intrinsic tendency of self-righteousness
  • Find common ground or at least empathy
  • Foster personal relationships, particularly with those who have different values than you
  • Tell stories that incorporate 6 moral foundational values (Care, Liberty, Fairness, Loyalty, Authority, and Sanctity)
  • Understand your target community

People are more than numbers, and life is constantly going on around them. A wise teacher once told me we need to see people, know people, and care about people. We need to communicate, and then try again in different ways, over and over.

Dr. Anoop Kumar has a provocative post claiming “…this historic time is when your (public health) voice is most needed…You are being called to a higher purpose – to say what you know, to speak up for the good of our communities and our country…”

How will your voice be heard?

 

Sources:             

Garrow, Jim. Public Health is Boring. May 13, 2015. https://medium.com/rebel-public-health/public-health-is-boring-d7c9b9792787

Kumar, Anoop. A Clarion Call to Publich Health Mavens. May 19, 2014. https://medium.com/healthcare-and-public-health/a-clarion-call-to-public-health-mavens-c9775456ea7

Matthews G, Burris S, Ledford SL, Baker E. Advocacy for leaders: crafting richer stories for public health. J Public Health Manag Pract. 2016;22(3):311-315.

 

Hate Crime as a Public Health Concern

Unless you have been living under a rock the past few months you are well aware of the social tension amongst citizens of the United States. Don’t get me wrong, it has never been ideal, but since the election of President Trump, we have been a country far from united.

In the first month following the 2016 election, there were over 1,000 race-related incidents. While the monthly rates have decreased, the overall occurrence of these incidents continues daily. I’m not here to take sides or point fingers, but instead, look at hate crimes from an often overlooked perspective.

The psychological and physiological damage accumulated by those who face routine discrimination is now considered by many as a public health concern in and of itself. Data from the American Psychological Association shows the impact of discrimination and racism can increase rates of chronic stress, depression, and anxiety; while a meta-analysis compiled by Cambridge University has shown it increases rates of the common cold, hypertension, cardiovascular disease and breast cancer.

While data continues to develop, it is now obvious how snide remarks and hateful actions do much more than simply hurt feelings. In times like these, it’s important to take an introspective look and ask what we are doing in response to this climate of hate.

Dr. Martin Luther King Jr. said it best, “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

What’s culture got to do with it?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

What happens when a cultural and political sociologist teams up with health researchers? Answer: some really fascinating work and advancement of how we think about the influence of culture on health.

Meet Andrew Perrin, Ph.D. He is a professor in the Department of Sociology at the University of North Carolina in Chapel Hill.

perrin

While his work focuses mostly on “what people need to know, be and do to make democracy work”, his family has opened up the opportunity to share his expertise with the public health arena. Does culture influence health? If so, how, and to what extent?

Dr. Perrin suggests that although the public health and health communication world may be able to measure certain aspects of culture well, there is a lack of breadth and depth of conceptualizing culture. This could mean we, public health and communication groups, are missing or misinterpreting a big piece of the health puzzle. He offered context of the contemporary synthesis of culture as presented by Johnson-Hanks and colleagues. A cyclical interaction between culture in the world and culture in our mind influences our individual and collective decisions and actions, but how can we robustly measure this?

culture

Fortunately, Dr. Perrin and an interdisciplinary crew are working to develop tools to measure culture in the world and culture in the mind within the context of obesity. Once measured, they will work to interpret the effects of culture on health. One project looks to explain variations and health outcomes in a county in North Carolina using a combination of geocoded photographs (culture in the world) and focus groups (culture in the mind). Results for this are forthcoming. Another project looked at obesogenic behaviors and stigma in children’s movies. You may or may not be surprised to learn that unhealthy behaviors are represented more than healthy behaviors, and movies contain messages that encourage weight-related teasing or bullying. For more information and results about this, review the paper on Pass the Popcorn.

Thanks to Dr. Perrin for sharing his time and expertise with our class! He highlighted the value interdisciplinary teams bring to thinking about problems in a more holistic manner that could ultimately benefit the public’s health.

 You can learn more about Dr. Perrin’s work at his website.

You are what you Tweet?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

Are you someone who puts your mood, food, or physical activity on social media? If so, you may be helping researchers develop and test new ways of tracking health behaviors.

funny-food-house-quote-sweet

 

It is known that the places where we live, work, play, and learn positively and negatively influence our health. But due to the time and other resources necessary to gather and update information about neighborhood characteristics, there is a lack of information to really understand how characteristics influence our health or why those effects might differ across town or the U.S.

As an alternative, a group of researchers explored the usefulness of using geotagged tweets to generate neighborhood level information to characterize happiness, food, and physical activity. By linking tweets to census tract level information, investigators found correlations (relationships) between happiness, food, and physical activity information and health behaviors, chronic diseases, death, and self-rated health.

And although this wasn’t the intention of the study, you might be interested to know the top 5 most tweeted about foods and forms of physical activity in the 1% random sample of publicly available tweets from April 2015 – March 2016:

Foods

  1. Coffee
  2. Beer
  3. Pizza
  4. Starbucks
  5. IPA (beer)

Physical Activity

  1. Walk/walking
  2. Dance/dancing
  3. Running
  4. Workout
  5. Golf

Any chance your tweets over the last year included one of those words?

This study, like all others, has limitations, and it is important to remember this is a first look at the usefulness of geocoded Twitter information. Having said that, these results show promise that Twitter or other social media data could be a useful and cheaper, more efficient way to create neighborhood profiles. More information about our neighborhoods could provide insight about important targets for change to improve the health of our communities. Now that is something to #tweet about!

 

Resources:

Cara, E. Top 10 Food Tweets Reveal Diet and Physical Activity Patterns of Twitter Users. Medical Daily. October 16, 2016. http://www.medicaldaily.com/heres-top-10-tweeted-about-foods-and-what-they-mean-our-health-401413

Nguyen QC, Li D, Meng HW, Kath S, Nsoesie E, Li F, Wen M. Building a National Neighborhood Dataset From Geotagged Twitter Data for Indicators of Happiness, Diet, and Physical Activity. JMIR Public Health Surveill. 2016;2(2):e158. DOI: 10.2196/publichealth.5869. PMID: 27751984

Are you prepared?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

Zika virus. Flooding. Hurricanes. Wildfires. Earthquakes. What do these have in common? They are all examples of public health emergencies that have impacted our nation and world in just the last few months. While not all emergencies can be predicted, we can take steps to have an emergency response plan in place.

The Centers for Disease Control and Prevention is promoting National Preparedness Month this September.

preparedness_month_2016_infographic

 

Preparedness is important not only for the international, national, regional, and local agencies and organizations that help people overcome disasters, but also for individuals and the communities they are part of.

One simple step you can take is to create a preparedness kit. Basics of an emergency kit include:

  • At least a 3-day supply of food and water
  • Health supplies
  • Personal care items
  • Safety supplies
  • Electronics
  • Documents
  • Extra cash
  • Extra house and car keys

infographic-are-you-prepared

 

You can learn more about being prepared for all kinds of situations through a Twitter chat Tuesday, September 27th at 1pm EST with @CDCemergency. And by checking out the resources below.

 

Resources:

ASPCA. General Pet Care. http://www.aspca.org/pet-care/general-pet-care/disaster-preparedness

Boehrer, Katherine. 10 Disaster Preparedness Tips You Can Really Use. Huffington Post. http://www.huffingtonpost.com/2014/09/10/disaster-prep-month_n_5790278.html

Prepare. Plan. Stay Informed. https://www.ready.gov/

 

Celebrating Freedom from Disease

Happy 4th of July!

Today is the day that we celebrate freedom in the U.S. However, most of us don’t think about, or we simply take for granted, the successes that have been achieved and the continued fight being waged to be free from disease.

Through public health initiatives like improved sanitation, the initiatives and infrastructure to ensure clean drinking water, and the use of medical advances such as vaccinations and antibiotics, the US is now free, or well on its way to becoming free, from numerous pathogens and infectious diseases.

The most recent data from the CDC concerning reported cases of infectious diseases showed that there were zero reported cases of smallpox, polio, diphtheria, and yellow fever in the U.S., along with staggeringly low numbers of several other diseases, like cholera, that were previously responsible for thousands of deaths.

 

So this Independence Day, enjoy all of your freedoms and have a happy and healthy celebration!

Disease Chart

Data taken from Summary of Notifiable Infectious Diseases and Conditions — United States, 2013

 

Other Dangers of Using Devices at Nighttime

Most of us know that using mobile phones or e-readers before bed can disrupt our sleep cycles, but did you know there are other dangers associated with prolonged exposure to artificial light at night?

Recent research suggests that excess blue light exposure may be doing more than robbing you of a good night’s sleep, and could also increase your risk of cancer, obesity, and depression.

It’s important to understand why the blue light emitted from mobile devices affects your circadian rhythm. Typically, after awaking, people usually open the shades to let in the morning sunlight. Special cells in your eyes detect the natural light and signal your brain to shut off its production of melatonin. The physiological process doesn’t stop there—the morning light also signals cells to increase production of the stress hormone cortisol and a hunger-promoting hormone called ghrelin. The morning light also signals your body temperature and heart rate to rise.

In essence, the morning light allows your body to “reset” itself to prepare for the work ahead, which is exactly what’s supposed to happen in the early hours of the morning. However, this physiological resetting can sometimes occur at night, which is when things can start to go amiss.

Previous research has shown that people who use mobile phones, e-readers, or are exposed to LED lighting have increased appetite, took longer to fall asleep, experienced less restorative REM sleep, and were more tired the following day than those who did not use such devices before bedtime. Another study demonstrated where device users experienced a 55% drop in melatonin after only five days, which can be alarming because in addition to its sleep-inducing powers, melatonin has also been shown to be an anti-cancer agent.

While most of the recent research is too early to determine the true effect of blue light at night, scientists aren’t afraid to suggest that folks burning the midnight oil on their devices are more likely to be obese or suffer from heart disease. Other studies have linked late night workers to higher rates of both breast and prostate cancer.

So, in a world driven by technology, what can we do to ensure we’re getting the proper kind of sleep? Fortunately, there are several steps we can take that won’t require us to toss out our smartphones and computers. With a proper balance, we can have both!

The best advice public health gives us in this department is to power down those devices at a normal hour, or at least an hour before you go to bed (of course, the earlier the better).

Next, try reading an actual paper book before bed. Foregoing the artificial light from a phone or e-reader will signal your brain to begin producing melatonin at a decent hour to prepare your body for sleep.

Also, try purchasing energy-efficient light bulbs. Certain companies now produce bulbs that automatically change their hue depending on the time of day.

Finally, if you must use an electronic device before bed, purchase an app that allows your laptop or phone to emit blue light during the day and shifts to warmer wavelengths by evening. While this option isn’t as healthy as reading a traditional paper book, it should help your body to still produce some amounts of melatonin.

Sweet dreams!

Breaking Rural Health Barriers

For those of us that are fortunate to live near hospitals and primary care clinics, that question of rural vs. urban care is unlikely to even cross our minds. But for those living in remote locations, lack of access is a common issue. Unfortunately, what many of us take for granted is another person’s struggle, especially if they are plagued with chronic conditions, such as asthma or diabetes. And in many cases, most folks in this situation often go without treatment.

The National Rural Health Association reports that while a quarter of the U.S. population lives in rural areas, only one-tenth of our nation’s physicians choose to practice in these areas. And while only a third of automobile crashes occur in rural locations, two-thirds of deaths attributed to those accidents occur on rural roads, indicating a shortage in acute trauma care.

These figures certainly give rise to the need for increased access to care within rural communities. Another factor that contributes to this issue is that Medicare reimburses rural hospitals at a lower rate than urban hospitals, resulting in fewer physicians choosing to practice in such locations. Over the last 25 years, nearly 500 hospitals have closed, many of which were located in rural communities.

Fortunately, this is the age of digital know-how. Technology is king, and health care is one of the leading industries taking advantage of such innovation and wisdom. General Electric (GE) is doing its part to improve women’s health in remote areas like Wyoming, where the average woman has to commute 70 miles just to receive a mammogram.

In 2014, the company started the GE healthymagination program, to expedite cancer innovation and improve cancer care to 10 million patients, over the next six years (until 2020). One of the program’s most influential aspects is the GE Mammovan, equipped with mammography technology to provide free mammograms to all women living in remote areas.

GE chose to pilot the program in Wyoming, which has the lowest number of citizens and lowest population density (after Alaska). Many of the women using the van cited it was their first time having ever received a mammogram, stating that travel time or insurance requirements had precluded them from being screened for breast cancer. GE’s website reports that because of Wyoming’s uneven population distribution, a third of women living in that state over age 40 never receive a mammogram.

Since nearly two years ago, the mobile unit has traveled throughout the state, setting up in locations where women can receive a mammogram within an hour, allowing them to avoid the hassles of taking off from work and/or driving long distances. In many ways, the van serves a dual purpose—by eliminating the barriers rural residents previously faced and improving access to preventative care. By detecting breast cancer as early as possible saves the health care industry billions and ultimately, saves lives.

While North Carolina isn’t as rural as Wyoming, you might be surprised to learn that 85 percent of our state’s counties are, in fact, considered to be rural. And with nearly 2 million people receiving Medicaid, access to care is certainly an issue of interest among health care workers and lawmakers. And while mobile units are pricey to create and maintain, the progress the GE Mammovan has made in Wyoming is a good example of how health information technology can work to address some of our most pressing issues that impede quality health for everyone.

RESEARCH SPOTLIGHT: MIKE NEWTON-WARD

Mike Newton-Ward, MSW, MPH, of the Gillings School of Global Public Health, at the University of North Carolina at Chapel Hill (UNC), spoke with the Upstream writing team recently to share his lifelong experiences working with social marketing and how this form of communication is effective in public health.

Newton-Ward, an adjunct professor, received both a Masters in Social Work and a Masters in Public Health from UNC, and spent many years working with the N.C. Division of Public Health and the N.C. Department of Health and Human Services helping to create and implement various social marketing campaigns aimed at populations across the state. He retired in 2015 and is now an independent consultant with RTI International.

He spoke to the class to highlight the importance of social marketing campaigns in public health and discussed what steps are needed to ensure optimal effectiveness with selected target audiences.

One of the most valuable aspects of social marketing is that it takes feedback generated from the target audience (the group the campaign is intended for) and uses that data to help determine the layout of the campaign itself. Using this approach is key for garnering participant interest and ensuring improved outcomes.

Newton-Ward also discussed other aspects of social marketing, such as its interdisciplinary approach, and how the input of several fields is effective at campaign development, as well social marketing’s unique ability to influence behaviors in all directions. Since public health is primarily geared toward prevention at the population level, social marketing can be used to influence behaviors upstream through social or policy change. Likewise, it can also be used to produce changes downstream (hence, the name of our blog!), by treating or educating populations to change negative behaviors. Finally, social marketing can work sidestream, by allowing partner organizations to collaborate for promoting the best environment possible to ensure a continuum of positive outcomes.

Newton-Ward concluded his talk by answering questions from the audience and discussing the “simplified elicitation methodology,” a strategy used in many public health campaigns, which seeks to identify determinants of behavior by asking three pairs of questions, including:

  • “What makes a behavior harder or easier to do?”
  • “What are the good things and bad things that happen when one does the behavior?”
  • “Who would approve or disapprove of the behavior?”

 The answers generated from these questions are strong indicators for discovering and learning about target audience reactions, and are key drivers for developing successful campaigns.