Thursday, June 30, 2011

Serving Up Simplicity

At the beginning of June, the US Department of Agriculture released its recent brainchild and announced that the food pyramid that everyone knows (and apparently hated) had been deconstructed and reformed with fewer edges: it's now a plate:
It makes a startling amount of sense. Most people didn't consult the pyramid and use it to create triangle-shaped meals, but with the plate it is much easier to visualize proportions, and if you are a stickler about it and have done some research, the MyPlate also comes with rules, such as avoiding overly large proportions and fatty meats as your proteins.

Humans are visually-minded creatures. As children we look at pictures of things we recognize in order to learn words and then apply that to letters and spelling. In terms of visualization, the food plate fits fabulously into the human brain and will be a superb building block for children. 

However, is it too little too late? Is it enough? Can a new food pyramid - er, plate - change wide-spread poor diet choices? Of course not.

But what the new plate does show is that there is change a-comin'. And thankfully, the changes are not what we've seen in recent history. The blame-the-victim mentality for overweight and obese individuals is being shoved out of the window by many foodie and nutrition groups; there are projects to nurture both food and knowledge; and nutrition labels - that have long resembled the Da Vinci Code for many people - are being redesigned as well (and moved to the front of the package, to satisfy the majority of consumers' three-second attention span):
There is even a contest (it's happening now!) to redesign the nutrition labels. It's a chance to show off your smarts and your arts, as it's being judged both by functionality and design. One of the judges is foodie/intellectual (or foodie intellectual, really - no slash required) Michael Pollan, who is known for his smart but scathing criticisms of the way food functions in the United States, from the soil to your plate (and especially scathing for those foods that didn't even begin in the soil, but in a laboratory). Check out all the information here, even if you don't want to enter, because at the very least, it's interesting. If you click on the "Why it Matters" link on the website, you will see the truth: "this is confusing." Amen. (This statement is backed up by the fact that the FDA has a website devoted solely to explaining the nutrition label.)

In all, it is a relief to see several factions pushing towards simplicity. Hopefully the movement snowballs in this direction. We did not all take advanced algebra and courses on CIA-style decoding to apply towards deciphering nutrition labels. We want to eat, and feel good when we're done. Simple.

If you're curious about some of the pioneers to simplify food:

Check out some of Michael Pollan's books here.

Find out what food did in Kris Carr's life (and why we should maybe be moving faster with healthy foods campaigns).

And a friend from way back when who has since become a one-woman natural foods knowledge bank helps incorporate simple (yay, more simplicity!) ways to improve the way you eat.

Fat women everywhere ... FREAK OUT!

Something my friend posted today on Facebook: Obese girls face tough career climb

Coming from an eating disordered background, I have to admit that this kind of thing hits a raw nerve for me. Weight loss efforts for PRESCHOOLERS?

Are you serious?

Can you imagine how messed up those kids are going to be if they start developing food issues at that age? I mean, I remember having serious body image concerns at about age 5, but I'm in the minority (one would hope). Why would we want to spark this kind of neurosis in a large (no pun intended) population of youngsters?

I understand that obesity is a problem in our nation today. I really do get it. Obesity, diabetes, yadda, yadda, the dethfatz are going to get you!

But I will say (as I always do) that obesity is not simply a function of what you eat or how much you exercise. Women with PCOS (ahem, moi) experience obesity as a symptom of their illness ... and this condition affects as many as 10% of women. Funny that you never hear about it, right? That's because too many of us are supporting bogus and dangerous diet ventures in an effort to eliminate our socially manufactured shortcomings.

Anyway, I would believe that young women face huge obstacles if they are larger. After all, our culture tells us that our size is a reflection of our self-control, our virtue, our ability, our dedication. How many studies have been done that prove that fat people (not just women) get paid less, are hired less frequently, and generally get the short end of the stick?

Arguing against these researchers' suppositions ... I wonder whether anyone noticed that lower-income women from disparaged populations are more likely to be obese, which is probably why they have a harder time graduating from college and becoming gainfully employed. ETA: The article says that the researchers said "It didn't seem as though economic situation was a factor," but I'm not sure how that's quantified. Another case of correlation being confused with causation. I mean, I know it's a tough concept, but it seems like a lot of researchers just can't stop sensationalizing phenomena that kind of coincidentally happen together. It's hard for me to believe that we can blame all of our problems on being fat.

Here's the crux of the whole thing for me: This kind of article perpetuates the "if only I was skinny" myth that so many eating disordered folks hear playing in their head ALL DAY EVERY DAY.

"If only I was skinny, I would get a better job."
"If only I was skinny, I would have more friends, and maybe even a partner."
"If only I was skinny, I could feel good about wearing a size ____ "
"If only I was skinny, everything would be better."

This is a dialogue that none of us deserves to hear. It's a bunch of baloney. Being skinny doesn't make your life easier if all you think about is remaining thin. In the case of folks like me, the push to be super thin can endanger your life.

It won't be until we, especially as public health practitioners, start to respect all types of bodies (including those that are naturally thin, fat, whatever) that we will truly begin to find a solution to the obesity problem. Treat these people with dignity, for heaven's sake.

One final thing: "He himself has studied the connection between body image satisfaction, and obesity and anorexia. People who have poor self esteem have difficulty controlling their eating habits, he said."

Yes, because obesity is analogous to an eating disorder? (WRONG ... not everyone who binge eats is fat, and not everyone who is fat binge eats). And the last time I checked, eating disorders weren't because of a lack of control over your eating habits, they're about a need to control something ... so you exert more control over your eating (i.e., not eating anything!). I'm really not impressed with this particular piece.

For more information on fat advocacy, visit:

More smoking, more eating = less economic burden?

Smokers, obese save us money!

So, in addition to the above picture of the ubiquitous headless fatty, I bring you one of the most controversial articles I've read all year. I tell all kinds of people about this study, but no one seems to believe me, and they also think I've lost my mind and/or soul when I bring up this important point:

Healthy people cost the healthcare system more money than chubbies/smokers do.

"How can this be?" you might ask. I was with you at first. I used to vilify people for making bad health decisions because I thought I'd end up paying thousands of dollars to fix their medical problems. I resented diabetes, lung cancer, hypertension, COPD and the whole panoply of medical conditions that accompany obesity and smoking. 

Consider this ... if you're eating healthy, exercising, and living to a ripe old age of, say, 90, you're ruining it for the rest of us. Would you rather pay for 2 years of cancer treatment (and die at, what, 65?), or 15 years of Medicare-sponsored assisted living expenses?

Our profession ostensibly strives to overcome health problems to improve the quality of life rather than simply its duration, which is the only argument I really have against allowing people to kill themselves earlier so we can reap economic gain. That, in itself, should be the fundamental tenet of public health, not saving the almighty dollar. Still, information like this is hard to ignore; again, as public health professionals, how are we supposed to "sell" improvements in health when they might actually harm society? Great question.

Articles like the link above provide us with stimulating information that ought to fuel our continuous debate about how to best spend our public health dollars. When it comes down to it, we really do have to think in economic terms; although it may seem cold, would you rather save 400 people with a guardrail (for example) or one child who needs a liver transplant (thus condemning 400 people to death)?

Economically, I'd go for the former, despite the plight of the kid tugging at my heart strings. But then everyone looks at you as though you shot their dog, accuses you of being heartless, and spends the money on the sick child anyway.

I feel very clinical and almost ... Third Reich-ish ... when speaking like this, but this is just another example of humans failing to examine facts and make decisions based on reality. I'm guilty of choosing with my gut more often than not, but when we're dealing with population-based health measures, that's a dangerous way of doing things.

Our responsibility is to serve the best interests of the general populace; can we do this best by saving money, or by lengthening lives?

Wednesday, June 29, 2011

Chores as Exercise

The Huffington Post brought us this nifty article on chores and calorie counts. A staple of Men's Health and women's fashion mags for years (carrying your groceries burns 90 calories an hour! curling your hair burns 5 calories a second!), they bring up an important aspect of being a part of the bi-pedal homo sapien sapien mammal clan: we are built to move, and the more we move throughout our day, the better for our health. If you want to fight off disease, keep everything tickin', and feel and act better, move. As grad students we enjoy moving from class to class to library to bar, and our brains are the better for it.

My favorite ways to move during the day:

1) Get up from desk and do wall pushups in the bathroom. Yes, it's dorky. Looking like Michelle Obama in a tank top is not.

2) Walk around the block. Power walk if shoes and outfit allow.

3) When you're on the computer, sit up straight and engage your core muscles. Ripped abs are not brought on by crunches so much as active muscle engagement.

4) Can we say dance party in the lunchroom?

5) If you can get away with it, slip your shoes off under your desk and stretch out your feet. Shoes can cramp your muscles and nothing is more relaxing than a good stretch.

6) Park your car at the end of the lot and walk.

7) Lift heavy things. Be the guy who refills the water cooler, everyone likes that fella and it's a great mini workout.

8) Throw your kids around (nicely). Piggy backs and swings make Fun Mom/Fun Dad/Fun UncleAuntieCousinGodmomma and give kids great memories of good times and you the benefit of a workout.

9) Get up from your desk at least once an hour and move. It adds up!

What are your some of favorite ways to slip a little more activity into your day?

Tuesday, June 28, 2011

National Safety Month!

I am 100% embarrassed to admit that I did not know it was National Safety Month in June. This is somewhat mortifying considering that I was the president of the A&M chapter of ASSE ... so here's a post that I am making with much chagrin, but also much enthusiasm!

What do we mean when we talk about "Safety" ... it's such a broad term! We can talk about workplace safety, which generally conjures up OSHA, but occupational safety is so much more than that. OSHA is the regulatory agency that oversees workplace safety rules, but the professionals who enforce these laws within industry play an important role as well.

With the time and space allotted here, it would be hard to totally describe occupational safety, so it appears that we might have to wait until next year rolls around to do this month justice. In the meantime, why don't you check out these cool sites?

Pro Act Safety (behavior-based strategies)
American Society of Safety Engineers (100th anniversary!)
National Safety Council
Utah Safety Council (a great example of a state-run program)
National Association of Safety Professionals

Monday, June 27, 2011

Distracted driving bill introduced!

NY Rep. McCarthy introduced this new bill on June 23, 2011:

Safe Drivers Act of 2011

It's one of the first federal bills that would affect state highway funding if cell phone bans are not enacted.

It's widely accepted that cell phone bans don't work, though, and they might actually make crash risks worse:

HDLI texting bulletin

This is sure to be a continuing saga. What do you think about cell phone bans? (I'm personally on the fence ...)

Bringing it back to the basics

We'll bring back a discussion of Men's Health Week later today, but this morning I wanted to talk a little bit about the use of conceptual models in behavioral health interventions.

I, like many other public health students (I assume), memorize the constructs of a whole bunch of behavioral models during the introductory Social and Behavioral Health class. We have the Trans-Theoretical Model, the Theory of Planned Behavior, Social Cognitive Theory, Health Belief, Risk Perception ... the list goes on (and on and on).

I, also like many other public health students, learn the models, categorize them within my brain, and then promptly forget to actually apply their messages to any of my work. I found this out this morning during my practicum work; my preceptor came to me and said, "Well, you have all this information about distracted driving, and you have this fancy model ... are they related?" And the light bulb went on. Although I had created an outline for my paper that seemed to make sense, it was only loosely related to the theoretical basis I had chosen. *headdesk

This is why I'm happy that they give us preceptors to give us feedback and input about our duties. Otherwise, I'd be making silly mistakes like this for the rest of my career.

It's so important that, as we go down the empirical research path, we consider our theoretical basis. That is, we can't just do a literature review without relating each piece back to its fundamental theory. Drawing conclusions about empirical research is useless unless we can determine how to apply our learning.

Just a little advice for all my fellow PH students out there. Stay tuned for more fun information this afternoon!

Sunday, June 26, 2011

Men's health, part II

So, since we're still in June, let's talk a little bit about how Men's Health Month actually does a pretty good job of reaching out to one specific disadvantaged population: Gay men. This population, has struggled with not only communicable disease issues such as AIDS, but more recently, mental health issues such as higher suicide rates. Gay men, then, are obvious targets for this kind of initiative.

What have I learned about in class this year concerning gay men? The study that sticks out in my mind is the Wyoming Rural Aids Prevention Project (WRAPP), which was an Internet-based intervention for gay men in rural communities. You can visit the page here: WRAPP.

You can also check out the program evaluation journal article here: WRAPP program eval

As Internet availability increases in rural communities, we need to consider these non-traditional groups in our intervention schemes. Before attending SRPH, I would have never really thought about intervening in a rural setting with gay men; ignorant me, I assumed that was primarily an urban problem. The fact of the matter is, though, that gay male (and female) populations still need our public health support regardless of whether they live in San Francisco, Santa Fe, or Steamboat Springs ... although the setting may be different, the health issues are largely the same.

The great thing about June is that it's also Pride Month, so we as public health professionals are uniquely positioned to use both of these initiatives to improve the sexual and general health of gay men. Contrary to popular opinion, AIDS isn't going away in this group, and neither are many other maladies. Stay tuned for a discussion of other innovative programs for gay male communities, which are on the docket for this week.

Friday, June 24, 2011

June's almost over, but ...

Did you know that June is both Prevention and Wellness Month, as well as Men's Health Month?

Since we are probably all familiar with at least some basic components of Prevention and Wellness (a kind of nebulous term, don't you think?), I thought it would be good to bring up health problems that are specific to men. As a woman, this is something that isn't exactly on my radar, so we'll be learning together!

The Agency for Healthcare Research and Quality has created a site called Healthy Men that provides educational information for men's health issues. There's no denying that health concerns differ between the genders. The site tells us:
  • Men are 24 percent less likely than women to have visited a doctor within the past year and are 22 percent more likely to have neglected their cholesterol tests.
  • Men are 28 percent more likely than women to be hospitalized for congestive heart failure.
  • Men are 32 percent more likely than women to be hospitalized for long-term complications of diabetes and are more than twice as likely than women to have a leg or foot amputated due to complications related to diabetes.
  • Men are 24 percent more likely than women to be hospitalized for pneumonia that could have been prevented by getting an immunization.
Honestly, when I think of men's health, my mind goes right to low testosterone and prostate cancer, not diabetes and cholesterol. I believe that even though men are more likely to have congestive heart failure, more women have heart attacks. It's kind of late at night, so I'm not going to check that fact, but I would never have thought of these specific health concerns as gender-based.

Think of how often we see campaigns to increase screening and awareness about cervical cancer, breast cancer, and other women's issues. Heck, the pink ribbon overtakes our entire society every October. But when was the last time that you heard someone speak candidly about prostate cancer, amputation, or even ED (although that was quite a phase when Bob Dole started discussing it)?

As a card-carrying feminist, I believe I have the right to assert that everyone's health issues should be considered equal; although we ought to acknowledge that men have certain advantages because of their gender (and women have other advantages), we should also recognize that the patriarchy works against some men, as well. I doubt that many have access to appropriate screening or medical care results in poorer urban and rural areas

... and yet, in my public health curriculum, I hear almost nothing about interventions involving grown men. Women and children, yes, or the entire population of an area. But when was the last time we read an article for class, or discussed a program, that was targeted toward men's health? Again, although we may have this concept that the patriarchy allows all men to access all available resources, nothing could be farther from the truth.

Strangely enough, maybe it is time for us to start acknowledging the unique health problems faced by men, which are often exacerbated by their refusal to visit doctors. Let's not forget that public health is here for all of us. Even the feminists can rally around that.

We're on the map!

So, we just got a nod from the Disruptive Women in Health Care blog! They put us on the blog roll. Do us a favor and go visit their awesome site!

Thursday, June 23, 2011

Graphic cigarette labels ... really?

Take a look at these:

Pretty pictures of new warnings that will be included on cigarette packs per 2009 legislation.

Now, take a look at any of the following:
Ineffectiveness of fear appeals in youth
How to use fear appeals
Fear appeals in traffic safety

When a person believes that he is not vulnerable to a risk, his behaviour will not be affected by information about the serious consequences and the recommendations for effective behaviour.
In other words ... now, stay with me ... fear appeals are largely ineffective, especially among younger populations. In simple terms, this is because young people don't understand how to effectively estimate risk. This is the root of the common "it won't happen to me" phenomenon, and the reason that many teenagers are drawn to risky behavior. Their brains are quite literally unable to process the seriousness of the danger inherent in many behaviors and situations.

Also, we've tried stuff like this before, when the tobacco companies were required to advertise to prevent youngsters from initiating smoking: Evaluation of youth response to tobacco-company sponsored messages.
Not surprisingly, these companies crafted their messages to appeal to adults who needed a warm, fuzzy feeling ... but the teen smoking rate increased. That's right, the public health ads that were supposed to prevent kids from smoking actually prompted more young people to light up. Brilliant!

What makes us think, then, that young people won't just discount these messages, ridiculing them in a defensive response? My prediction is that is exactly what's going to happen. These messages will be, at best (in younger populations), completely ineffective because they're mocked by kids for being entirely too graphic.

Even more importantly, sometimes fear appeals such as these can have an iatrogenic effect; that is, the intervention worsens the problem. Fear appeals provoke a defensive mechanism that prompts target audiences to engage in dangerous behavior simply to prove that they're immune to the behavior's negative health effects. In other words, people might start smoking more as a proverbial "middle finger" to the public health campaign. "See, I can do it, and I won't die!" ... or, they'll rationalize their behavior by pointing to anecdata that supports their behavior. Ex: "My grandpa smoked a pack a day for 80 years, and he lived forever."

Anyway, way to go, FDA, for being completely unoriginal and refusing to acknowledge the massive body of research that indicates the complete worthlessness of fear appeals. This legislation passed because we have a bunch of uneducated, self-righteous politicians who want to make themselves feel better because they're doing something. Well, they did something before, involving the tobacco companies, and they succeeded in making the problem worse instead of lowering smoking rates among our nation's youth.

Only time will tell whether this intervention will follow the same path.

ETA: Does anyone else think this is going to cause an increase in the sales of cigarette cases? I would rather have my smokes in a stylish vintage box instead of one of these horrifying boxes. People really can circumvent any intervention.

UPDATE: Check out this awesome editorial, which proves my point --- Smokers unmoved by graphic ads

The Theory of Planned Behavior, operationalized

This may seem rudimentary, but did you know that the Theory of Planned Behavior, a critical behavioral model for public health interventions, can actually be operationalized with mathematical measures?

Theory of Planned Behavior ... with math!

For those of you who aren't completely familiar with this model, I've included a diagram above. Now, I have always been a little wary of simplistic models such as this, because you have to wonder whether intention directly leads to behavior; however, I like that this model includes perceived behavioral control as a factor that influences behavior as well.

At any rate, when we consider this model, we're interested in measuring how attitudes, subjective norms, and perceived behavioral control influence intention, which in turn should influence behaviors. What do all of these terms mean?

Attitude: individual evaluation of a behavior. Operationalized (measured) by considering:
- personal beliefs that a behavior will result in a specific outcome
- evaluation of the outcome
- number of beliefs relevant to the behavior

Subjective norm: how society or environment contributes to behavior. Includes:
- probability that the subject believes the behavior is appropriate
- motivation to comply with this reference point
- number of reference points

Perceived behavioral control: the extent to which the individual believes he or she can control behavior. Includes:
- beliefs about whether factors that will affect the difficulty of the behavior
- perceived power of these factors
- number of factors

Yeah, I had no idea that this model was so ... scientific. It's hard sometimes to conceptualize these models as anything except the brainchild of some doctoral student in a think tank far, far away. And I really do wonder about their ability to predict behavior with such ease. There are so many variables that play into predictors of behavior ... I have to admit, a lot of the times I have intentions to change my behavior, but something prevents me from doing so. (Ex: I can NEVER seem to eat enough vegetables. Grrrr.) I am not 100% convinced that my inability to transfer my good intentions to behavior is a factor of only perceived behavioral control. I believe I can eat more vegetables. I really do.

Anyway, the point is that we need to critically evaluate these commonly accepted models. Although I admit I'm not an expert, I hesitate to just swallow these theoretical constructs that claim to distill human behavior to such simplistic terms. Also, the models' developers are often loath to disclose limitations that they might anticipate with their constructs ... did they honestly not forsee these problems, or were they hoping to fly under the radar, hoping other scientists wouldn't notice the models' inherent shortcomings?

I wouldn't put such nefarious measures past members of our scientific community, but when our entire understanding of human behavior is built on such shifting sands, it sure does humble a student in this field. Our comprehension of ourselves and the world around us is still so ... rudimentary. For all of our happy diagrams and well-articulated arguments, we really aren't close to understanding motivation, faith, or any other nebulous human attribute.

Without this fundamental knowledge, how are we expected to facilitate change?

Wednesday, June 22, 2011

Polling accuracy: NY Times doesn't have it

Granted, this is kind of old news, but it makes you stop and think about the sources of "news" we're subjected to in relation to public health concerns:

During my research today at work, I came across this article that expresses Americans' general distaste for cell phone usage in vehicles: Many in U.S. Want Texting at the Wheel to Be Illegal

What's interesting about this poll, you might ask? Well, just read through the methodology here: How the poll was conducted

Does anyone else find it absolutely ridiculous that you would poll only land lines when asking questions about cell phone usage? Perhaps we should consider for a moment the 25% of Americans who don't have access to traditional telephony ... 1 in 4 have no landline. I bet their opinions about cell phone usage might be just a little different. Did anyone stop to consider that people in landline-friendly homes (or even homes with *gasp* no cell phone at all) might be a little biased against cell phone usage? They might have some kind of ideological beef against cell phones. They might be the ones yelling at the young whippersnappers to "Get Off My Lawn!!!"

So ... don't believe everything that you read. That's clearly an established idiom, but I'm consistently surprised at how organizations are allowed to get away with stuff like this.

ETA: Also, shouldn't we be thinking about how this is going to affect public health polling in general? What's our demographic shift if we are only considering those with hard-wired houses? We will be discounting impoverished communities, as well as renters and some minority groups. This is just another factor that's contributing to the continued fragmentation of efforts within the public health community; we must develop new ways of soliciting accurate information so we can take action. If even our basic premises are flawed because our methods are outdated, are we really doing our jobs at all?

Tuesday, June 21, 2011

Perry: Everything's better in Texas! Except for traffic safety!

Texas Governor Rick Perry vetoed legislation Friday that would have outlawed texting and driving. In doing so, he has put a damper on a rather serious education and enforcement effort that Texas public health officials are trying to promote.

Hmm, this seems like a smart plan!
Perry vetoes texting ban

It's well-known that enforcement is an important component when considering behavior change. Educational messages, when presented on their own, rarely result in behavior modification. This is especially true in traffic safety situations, including drowsy driving and drunk driving scenarios. Governor Perry, in vetoing this bill, is ignoring one of the most valuable tenets of public health: Policy must support advocacy.

Check out this site from the Insurance Institute of Highway Safety: IIHS Q&A's about alcohol enforcement

This is a great resource for the layperson who's interested in learning about general principles of traffic enforcement.

The only way you're going to get drunk drivers to sober up is through (a) increased enforcement and (b) the perception of increased enforcement. If people think they're more likely to get caught, they're less likely to engage in the behavior. This is reinforced by the basic concept of risk management, which balances the likelihood of an event with the severity of its consequences. We are far more interested in risky behavior if adverse consequences are infrequent.

Some might argue that, since enforcement for texting laws is so low in other states, having such a law on the books is irrelevant and wasteful. Again, however, the actual enforcement itself can be supplemented by efforts to increase the perception of risk. "If you text and drive, you'll be caught and get in huge trouble," would be an effective message if accompanied by even minimal increases in police officer vigilance.

The level of permissiveness that this veto demonstrates is boggling. Perry calls texting laws "micro-management of adult behavior." Well, if that's micro-managing, then we should all have the freedom to drive completely blitzed, because We're AMERICAN, dammit! Perhaps allowing blind people to drive would be wise, too, by this logic, because we wouldn't want to impede anyone's basic rights.

Not only that, but did Perry consider the impact that this law will have on individuals who populate our state's crosswalks and bike lanes? This law isn't just about protecting drivers; it's about protecting all of us.

And, on a final note, is driving a vehicle a basic right? Although many environments (particularly those of the rural persuasion) are conducive to individual vehicle ownership, a lot of people get by every day without using a car. It's hard for me to believe that, if the Founding Fathers lived today, they would include the Right to Private Transportation in the Constitution.

Ultimately, Perry is pandering to his political constitutents to further anti-government sentiment and strengthen his bid for the White House. It's infuriating that the people making these very important decisions are so obviously poorly informed ... and poorly motivated.

ETA 6/27/11:
Reading a JAMA article today about distracted driving, and the author brought up the topic of Constitutionality ... that is, can the government interfere with what drivers do inside their vehicles to improve highway safety. The answer is a resounding "Yes!"

Courts have consistently upheld mandates on drivers (eg, seat belts and motorcycle helments), and would surely find that the government's interests in protecting the population from distracted drivers outweigh individual liberties. The Supreme Court has similarly upheld congressional requirements for states to adopt safety standards as a condition of federal funding.

(Jacobson & Gostin, 2010).

Just another reason for Perry to get his act together ... although I suppose Texas, as the only state that was once its own country, has a tendency to ignore the whole concept of federal authority.