Tag: Public Health

SNAPFresh Without the Fresh

This week the Trump administration released their proposed change to the longstanding SNAP (Supplemental Nutrition Assistance Program) which some would equate to delivery meal services such as HelloFresh, Blue Apron and Purple Carrot. These new delivery meal services have been tremendously popular and my first reaction was this might actually be a good idea. This type of service is more convenient and having groceries delivered without the hassle of going to a grocery store would be a nice perk for program shoppers. I further explored the details of this program and my mind quickly changed when I read about what was included in the boxes and more importantly what was not. These boxes would not contain fresh foods (milk, eggs, fruits and vegetables) and instead would provide canned fruits and vegetables and shelf milk. To be honest I had to do a quick web search to see what was actually shelf milk. Additionally, these Americans would have little to no say over what is included in the boxes versus the current program where they are issued a card and can purchase what they choose to at participating stores. While I could see benefit in this type of service as an OPTION for SNAP shoppers there is a lot of improvements that should be made before bringing this proposed idea into actual implementation particularly thinking about the foods included and would this truly be something that current SNAP shoppers find feasible and/or pragmatic.

References

https://www.npr.org/sections/thesalt/2018/02/12/585130274/trump-administration-wants-to-decide-what-food-snap-recipients-will-get?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social

A Multi-Level Analysis of Barriers to Care: Micro Level (Individual)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men).

At the individual level (the micro level), queer men are skeptical of medication for healthy individuals and wary of the potential side effects caused by these medications (Philbin et al., 2016). These ideas seem to go hand-in-hand. If you don’t want to take medication as a healthy person, you’d be worried about the potential side effects that would ultimately make a health person sick in order to prevent something that you might or might not contract. In this sense, it might be important to make people recognize the real possibility of contract the disease. We’re treating risk here, but preventing the disease is important. Further, the side effects of PrEP are fairly uncommon.

Queer men might think that this medication would be useful for others but not for them. Here, we have to think about assessing the individual patient to decide whether or not PrEP is right for them (Philbin et al., 2016). We’re not treating someone because they’re black and queer, and black queer men have the highest rates of HIV. It’s obviously possible for black queer men to have low associated risk of HIV. Treating high risk means treating patients with high risk factors not treating everyone from a population that has high rates of the disease. However, this presents an added barrier for providers to convince patients with high risks that this is the right drug for them.

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

 

 

Public Health & Epistemologies of Ignorance

The field of public health has primarily thought about improving health by making changes for individuals. We try to get individual people to quit smoking, make dietary changes to combat obesity, and start using condoms or other safer sex practices to limit exposure to sexually transmitted infections (STIs). However, all of these interventions focus only on changes that individual people are supposed to make. They don’t think about barriers that impact an individuals ability to make these changes or other factors that could be affecting, positively or negatively, the health of individuals.

In thinking about public health interventions, we should think about a multi level analysis, including the micro level (individual), the meso level (interactional, community), and the macro level (institutional, structural). Factors at each of these levels can positively and negatively impact health; however, by only looking at the individual (the micro level), we miss a significant portion of the picture in terms of health, especially when we start thinking about health disparities.

Lisa Bowleg (2017) argues that this represents an epistemology of ignorance, specifically that the focus on the individual and on health as a characteristic solely of the individual (a very neoliberal position), “obscure[s] the role of social–structural factors (e.g., political, economic, institutional discrimination) that constrain the health of historically marginalized individuals, communities, and societies” (678). She continues to argue that “[e]pistemologies of ignorance illustrate that willful ignorance is functional (Alcoff, 2007; Mills, 1997, 2007). Neglecting the historical legacy of how race (as well as the other marginalized social positions that intersect with race) has structured social inequality for people of color in the United States serves to center the health experiences of White people as normative, “color blinds” White privilege to highlight positive health outcomes among White people as the product of their individual actions, and reifies negative stereotypes about the “irresponsible” health behaviors of people of color (Bowleg et al., 2017).” From a political perspective, she argues that this focus on the individual in public health, and in other spheres, limits the political imperative and pressure to conduct research and enact laws that would address the social-structural factors in order to alleviate health disparities.

Bowleg, L. (2017). Towards a Critical Health Equity Research Stance: Why Epistemology and Methodology Matter More Than Qualitative Methods. Health Educ Behav, 44(5), 677-684. doi:10.1177/1090198117728760

Research Spotlight: Dr. Noel Brewer

Last week, Upstream Writers were joined by Noel Brewer, PhD, professor of Health Behavior in the UNC Gillings School of Global Public Health and affiliated scholar with UNC’s Interdisciplinary Health Communication program. Dr. Brewer gave an interesting and informative talk about his recent tobacco research involving the effect of cigarette pack messages. His findings showed that pictorial cigarette pack warnings increased smoking quit attempts and 7-day quitting. Additionally, the pictorial warnings were found to work better than text warnings, as they led to more attention, negative affect, social interactions and thinking about the warnings. Finally, because the study’s findings did not fit existing models of health behavior, Dr. Brewer developed the new Tobacco Warnings Model.

Dr. Brewer received his PhD in psychology from Rutgers University and joined the faculty in the Department of Health Behavior at the University of North Carolina at Chapel Hill in 2004. He studies how people make risky health decisions, and he currently directs the UNC Health Cognition & Behavior Lab where he conducts his research. Furthermore, in addition to Dr. Brewer’s tobacco research involving smoking risk communication, his work also focuses on HPV vaccine communication and increasing HPV vaccine uptake, and he currently serves as Chair of the National HPV Vaccination Roundtable. More information about his research can be found here.

In the spirit of Public Health Thank You Day, thank you, Dr. Brewer, for the work that you do to promote and protect public health! 

The Newest Style of Sex Education

About a week ago, our class had the pleasure of listening to Alexandra Lightfoot, EdD discuss her involvement in one of the more revolutionary forms of public health circulating the block. As a professional, she has focused on the intersection between the arts and public health and how the two can be combined to create more effective health messages.

The topic of her discussion was the Arts-based, Multiple-component Peer Education (AMP!) Program that first came to UNC from UCLA a few years ago. AMP! utilizes interactive theatre techniques with college students who create scenarios to deliver sex-ed to 9th grade students in a novel way, especially down here in the South.

The critical component of this program is its use of satire, humor and storytelling to disseminate knowledge and start discussions about sexual and reproductive health with high school students and their health teachers. Research has shown that this traditionally complicated conversation is facilitated by this arts-based approach and the AMP! intervention has significantly increased student knowledge about how to prevent HIV and maintain sexual health.

Given that the live performance model of AMP! is delivered by college student “near peers” in locations close to their universities, it has been difficult to scale the program here in North Carolina. However, it has scaled well in the Los Angeles Unified School District, so hopefully that will provide a blueprint for sharing this creative and fun program to more youth in North Carolina. Lightfoot and her partners at the UCLA Art and Global Health Center are currently developing a compendium of video scenarios made by NC-based college students and a manual for teachers so that the intervention can be implemented more widely via digital delivery in classrooms across the state. The team is currently applying for funding to further refine the digital model and pilot and evaluate the implementation process and impact on student outcomes.

What do you think? Is this something you feel is appropriate for NC high school students? What do you think are the barriers and challenges such a program might encounter here? What are the positives about this kind of approach to sex education? Let us know below in the comments.

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