Thursday, July 28, 2011

Suicide among middle-aged women

A newly released study from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that middle-aged women's suicide attempts are at what might be an all-time high. (article here).

The majority of these attempts are drug-based, which coincides with most suicide research about gender differences in preferred method of personal dispatch; men are more likely to use firearms, while women are more likely to attempt to kill themselves with drugs or other toxic substances. Not surprisingly, men are generally far more successful, but the incidence of female suicide attempts is significantly higher. I'm not citing this information because I've read so much about suicide and mental health during the past 10 years that I can't even remember where I found all of these facts ... but I'm certain they're out there somewhere. Happy hunting, blog readers.

Anyway, this blog isn't about pointing you to interesting documents and factoids about health (all the time), so today we're going to launch into a discussion about mental health services in this nation and how women's health is grossly neglected. And .... go.

So, middle-aged women make up one of the fastest-growing demographics for newly diagnosed eating disorders. Middle-aged women are also apparently attempting to kill themselves more often. What gives? The linked article talks about hormone problems, "empty nest" syndrome, and other biological/psychological motivators, all of which seem perfectly legitimate. Have we stopped to think, though, that this generation of women might have been left behind by the healthcare system? That we have been carefully ignoring their needs for years?

My mother, for example, has had to practically pull out her doctors' teeth to get them to test her for heart conditions (they run in the family) and hormone problems (yep, I have them, too). These are relatively straightfoward conditions; imagine if my mom was like the woman in the linked article. Schizophrenia? Yep, good luck receiving appropriate treatment for a condition like that.

I imagine that if it's difficult for these women to receive adequate physical care, mental health care must be lacking.

This article is simply another supporting document for the degrading quality of healthcare in our nation (in my opinion). Using carefully collected anectdata (joke), I have found that many of my friends and family members have been ignored, if not flat-out mistreated, by medical professionals at university health centers and specialists' offices alike. Our healthcare system is sick and unable to accommodate physical and mental illness, despite increasing technological power.

This article also states that ONE IN FOUR Americans has a treatable mental illness. That's right. 25% of America is mentally ill (count me in the ranks!). Yet, mental illness is still so heavily stigmatized, and insurance companies are ridiculously hesitant to provide even a small bit of coverage for problems such as eating disorders and depression.

The implications of our social condition contained within this article are just too great to ponder. Gender politics, marginalization of the mentally ill, the cultural traditions of the Baby Boomers .... #head_explosion

I hope you enjoy thinking about these problems, as well. Get back to me when you've come up with a solution.

Thursday, July 21, 2011

It's Junk Food Day ... are you getting yours?

It's National Junk Food Day! I found this out as I was browsing the news sites this morning, here and here.

Now, as a public health professional, I know you're all going to expect me to sit up on my high horse and preach "eat your veg!" and "leave junk food alone!"

But I'm not going to do that. In fact, I find that perspective overly simplistic and frankly more than a little upsetting.

Junk food has a place in your diet. It has a place in my diet. It has a place in everyone's diet!!! *sound of shocked public health professionals everywhere* Yes! Really! It does!

If anyone has ever heard of the Health At Every Size movement (HAES), or Intuitive Eating, you would know that by perpetuating the idea of the "food police" we are just harming our natural drive to eat what our body needs. That's right, we should trust our bodies to tell us what we want to eat. Sometimes I eat chocolate cake for dinner for a week straight. Yes, I admit it. I'm not the strictist dieter, and I don't beat myself up when I want chocolate cake. I don't eat it every day, but there are times in life when you want a sweet or salty treat! It's OK!

After I've eaten all that chocolate cake, though, it's generally not surprising that I reach for oranges, quinoa, spinach, and other delicious alternatives for a long time. When I was going through eating disorder treatment, I ate chicken wings and pie for about 3 weeks straight, because I was finally "allowed" to do so. I haven't had them since. I don't feel guilty about either choice.

I eat what I want, as much as I want, when I want to. Really. Sometimes it's a lot, sometimes it's a little, sometimes it's in the middle. And my life's better for it.

Point being, if you deny yourself junk food when you really want it, I think you're more likely to binge on it later. The whole point of public health is to create normal eating patterns and provide adequate access to reasonable food options ... for everyone. Now, someone tell me that junk food is not part of a normal American diet ...

Yep, didn't think so.

Let's acknowledge junk food, celebrate its importance in satisfying our sweet tooth, and stop vilifying everyone who cracks open a package of Oreos every once in a while. Isn't our overall health a little more important than maintaining a perfect weight all the time?

I'm overweight. I eat junk food. I'm a vegetarian. I'm also pretty darn healthy (mentally and physically). So Happy Junk Food Day! Throw back some Lay's, Twix, Skittles, SnoCaps, Milk Duds ... you get the picture.

You're not a bad person for wanting some junk food. Don't beat yourself up endlessly about it.

For more, see what The Fat Nutritionist has to say.

Tuesday, July 19, 2011

Should obese children be removed from their homes?

The most recent post at our friend Dances With Fat deals with a controversial JAMA article that asserts that grossly obese youngsters should be taken away from their parents. Ragen pretty much nailed the main points that I wanted to discuss, and she's kind of an expert on this one, so I'm ceding to her opinion.

One thing I would like to add, however, is my never-ending argument that obesity is sometimes a symptom of a more serious illness; individual with certain mental disabilities, for example, overeat because of malfunctions with their brain structure. Similarly, hormone conditions, endocrine disorders, brain tumors, and other conditions all pose as simply "eat less, exercise more," and they are commonly dismissed (in my opinion) by the medical establishment.

It's easy for us to put the onus of this problem on the parents of obese children instead of accepting that, as a society, we may all be the ones to blame. In fact, children's food choices are not totally dependent upon their parents, and studies have shown that more parental control over children's diet = higher likelihood of obesity. Here is an interesting study that discusses the complex nature of children's food intake and their relationships with their parents.

Ultimately, the question here is whether the community or the individual family unit is more responsible for children's welfare. Although it takes a village to raise a child, I wonder how much intervention our children should face from the government. Also, the costs associated with such an effort would be immense, and I find it hard to believe that health savings would outweigh the bureaucratic losses and legal implications involved with this action.

I see this study as a radical ploy to open discussion about this topic, instead of a realistic proposition for intervention. In that context, it is a useful, if culturally irrelevant, piece. Americans don't want the government in their refrigerator, and they frankly shouldn't.

In other words, just all public health problems, there is no easy fix for this quandary. Taking kids away from their parents for being fat is just an overly reactionary strategy with little basis in public health theory ... it's not an appropriate intervention. Behavior change is not fast or simple, and sometimes we need to allow our social programs time to work before we release such incindiary information into the public sphere.

Saturday, July 16, 2011

MSN tells us valuable things about our mental health!

Actually, that's not sarcasm. Here's an interesting point that was made by recent research that's striving to clarify youngsters' depressive symptoms: Kids' mental health paradigm

The most interesting thing to me about this article, though was the headline. You would think that the depressive symptoms are prompted by some genetic component related to maternal heredity; rather, almost the entire article addresses implications for new measurement of depressive symptoms in children.

Isn't it interesting how the media is able to frame things differently by simply changing a headline? Those of us who aren't willing to click to the actual article would be poorly informed in an important public health matter because some lazy copy editor didn't bother to read the text. (This is coming from personal experience ... I was a copy editor many moons before, and I would have been heavily punished for something like this).

Anyway, what I'm trying to get at is this: We need to stop pinning kids' mental illness on their mothers, for genetic reasons or otherwise! I am so tired of mothers shouldering the blame for everything from anorexia to depression and bipolar disorder. The fact of the matter? Mental illness has behavioral and medical components, few of which can be attributed to (non-abusive) parents.

It's unfair for us, as health professionals, to buy into the baloney perpetuated in the media like this. A critical eye is a requirement in this business, and I would encourage all of us to dig deeper than just the headlines.

Tuesday, July 12, 2011

Did you know ... political groups try to frame public health issues FOR you?

I have been researching common advertising themes that are effective among younger populations, and I came upon this Web site today. The Center for Consumer Freedom is an industry-funded site that purports to tell "the truth" about obesity ...

- The government is controlling you by calling out food manufacturers about their shoddy labeling;
- The government is interfering in your basic rights to be an American;
- Obesity is not caused by fatty foods;
- Exercise will cure all obesity;
- Sugary sodas are good for you because they help the performance of elite athletes (seriously, this is their argument. See study here and "unbiased" interpretation here).

I must admit that their ad campaign is incredibly clever, appealing to basic American principles such as freedom of choice, independence, liberty, etc., etc. However, it's important to recognize that this is all a sham, at least from a public health perspective.

The food lobby is using the same arguments that the tobacco companies used in the past few decades: Our product isn't dangerous for you because we say it isn't! Your freedom to eat (smoke) is being infringed upon! NO MORE BIG GOVERNMENT!!! BLAHHH!!!!

Have you ever wondered why they're using these outdated and ridiculous arguments? Maybe it's because many food giants are actually owned by tobacco companies (as you might find in this awesome article about marketing food to children). For example, Philip Morris, under its alias Altria, owns both Nabisco and Kraft foods. Are we surprised that they're using the same detrimental marketing and social influence techniques to make sure their products remain on the market?

I'm all about supporting individuals' right to choose, but I'm also all about them receiving accurate information about what they're putting in their bodies. If I know that my food is chock full of chemicals, and I understand the ramifications of eating that food, then I assume responsibility for my consumption patterns. If, however, I am coerced into believing that the food I eat is NOT HARMFUL, how can I be expected to make reasonable decisions about my diet?

Again, I think Twinkies and Ding Dongs have their place (i.e., occasionally on my plate), but I understand the risk associated with those products. I wonder whether the rest of the nation really "gets" what's going on ... or whether they're being manipulated by the same crappy companies that used to market cigarettes to kids and the urban poor.

Also, let's not forget that industry-sponsored initiatives often prompt the "boomerang" effect, encouraging people to engage in the negative behavior instead of preventing illness. Ex: The tobacco industry's anti-smoking ads actually encouraged more kids to smoke (as we addressed in an an earlier post on this blog). Do you think McDonald's or Coke's fitness initiatives are really going to promote health? Or are they a surreptitious way to promote inactivity?

Looks like a job for The Public Health Models. We'll keep you updated on this topic.

Monday, July 11, 2011

Interpersonal communication with your doctor ... improvements on the way?

Today's New York Times featured a front-page article about a new interview process that is being used in medical schools throughout the nation, most notably the newest in Roanoake, VA:

Medical schools require people skills

The interview process involves an increased emphasis on patient-doctor interaction. This approach attempts to minimize the number of ranking medical professionals who inappropriately bully their staff or surpress patient interaction. Instead, a new focus is emerging that will ostensibly prevent patient injury by improving the population of doctors with developed communications skills.

In other words, your doctor won't be a jackass who orders nurses around and refuses to listen to your complaints.

This is a concept that I have been championing informally for the past several years after a series of difficult interactions with medical professionals. I understand that the technical side of medicine is important; after all, if you don't know what kind of medication to prescribe for a specific ailment, you're unlikely to be a good physician. On the other hand, though, I think it's important for doctors to realize that suffering from an illness is a very scary and emotional time for most people. Even a minor injury or condition can cause significant emotional stress because of the uncertainty and lack of control the patient experiences.

It is imperative that our modern medical establishment transition from the "doctor-on-high" perspective to a system that promotes team-based cures; that is, we should involve the patients in their own recovery instead of only dictating their courses of action. This is likely to encourage better compliance because the patients feel invested in their own health plan.

I think this new interviewing method is a fantastic concept. However, I wonder how many people will simply attempt to "study" their way around the interview by training on specific ethical questions instead of learning how to truly communicate. I believe that might be a significant problem, especially considering the characteristics of many students who are interested in applying to medical school. Potential physicians may see this test as simply another barrier to prepare for, instead of understanding the true value of communication in the healthcare setting.

I truly hope that this approach is a harbinger of a new direction for the healthcare establishment.

Thursday, July 7, 2011

Did you know ...?

... that out of every 2,000 drunk drivers on the road at any time, only 1 will be arrested?

That translates to about a 1/300 chance for heavily policed area, and a 1/1,000 chance for areas with less enforcement.

Furthermore, most drunk drivers have driven drunk at least 30 times before they were caught (according to self reports).

In other words ... it's scary out there, and drunk driving is still a HUGE problem. I'm working on a review of effective media and interpersonal interventions to limit drunk driving, and it's hugely discouraging. I'm thinking that legislative and behavioral interventions are unlikely to seriously affect this problem; however, environmental interventions such as interlocks might be more effective.

(This is my theory, despite the fact that a drunk driver could just have their sober friend blow into the interlock to start the car).

In my opinion, the best decision would be to increase availability of taxis and public transportation to encourage safe journeys home at the end of the night. Either that, or encourage people to live closer to their favorite bars. That's exactly what I've done, along with many of my friends, and I'm rarely tempted to drive after imbibing.

Does anyone have thoughts on how to stem the tide of drunk driving accidents? Or are we all going to be perpetually at risk?

Wednesday, July 6, 2011

The four types of risk-based decision-makers

Traffic safety has long relied upon the theory of deterrence to maintain positive public health outcomes. That is, we have assumed the following:

(1) The human being is a rational actor,
(2) Rationality involves an end/means calculation,
(3) People (freely) choose all behavior, both conforming and deviant, based on their rational calculations,
(4) The central element of calculation involves a cost benefit analysis: Pleasure versus Pain,
(5) Choice, with all other conditions equal, will be directed towards the maximization of individual pleasure, (6) Choice can be controlled through the perception and understanding of the potential pain or punishment that will follow an act judged to be in violation of the social good, the social contract,
(7) The state is responsible for maintaining order and preserving the common good through a system of laws (this system is the embodiment of the social contract),
(8) The Swiftness, Severity, and Certainty of punishment are the key elements in understanding a law's ability to control human behavior.
(taken from Robert Keel's article here)

Examining these ideas, however, launches us into a whole mess of social issues, particularly those dealing with behavior. I don't believe that the deterrence theory actually describes individuals' likelihood of risky driving; people are not inherently rational, and so threat of punishment is not always the most effective way to initiate change.

Rather, I would argue that these guys have a much more compelling viewpoint concerning individual risk assessment and driving behavior. (Bear with me, I know it's an article about deranged world leaders, but it really does apply ...)

Lebow & Stein argue that four types of risk-based decision-makers exist:

-          Risk-prone gain maximizers: Likely to drive distracted because they gain something.
-          Risk-prone loss minimizers: Likely to drive distracted because they are afraid of losing something.
-          Risk-averse gain maximizers: Less likely to drive distracted because not doing so brings benefits.
-          Risk-averse loss minimizers: Less likely to drive distracted because they are afraid of losing something.

They also argue that the most dangerous among these are the risk-prone loss minimizers, because they have the proverbial something to lose.

I would contend that this is also the case. People don't want to put their cell phones down in the car because they're afraid of missing an important communique; an inflated sense of self-importance has encouraged us to imagine that the actions of the whole world hinge upon our ability to answer our phones. Imagine having that ability ripped from your grasp.

Just another theory in the toolbox of effective public health promotion .... Today's lesson? Identify and target your audience.

Tuesday, July 5, 2011

Child Sex Trafficking

A petition was recently started on to help curb Wyndham hotels' (which includes Days Inn, Super 8s, Microtels, Howard Johnsons, and more) support of child sex trafficking and prostitution. 

The issue of hotels being used as prostitution hubs is certainly not new, but with the economy as it is, and travel and leisure venues having been hit extra hard, it has been easier for hotels to turn a blind eye to suspicious activity. Why? Because their rooms get filled. 

From my work in the field with prostitute populations, it's been clear that the economy has also forced more women into the sexy trade business. Motels and hotels are common rendezvous points for a hooker and her John. While I certainly do not support the business, conducting these ventures in a hotel room is safer than being on the streets, or in the back of a stranger's car.

The economy has also forced women out of the business, as even they are making less money, just like the rest of us, and to seek social services, often putting a strain on non-profit social service agencies. 

Yes, a movement to encourage hotels to allow less illicit activity is a good cause. But if you're going to spend time and money on a prostitution issue, help local non-profits deal with the actual issues at hand. Prostitution will occur whether or not Wyndham hotels continues to "support" it.

Friday, July 1, 2011