Wednesday, August 31, 2011

Risky business! Are you a sensation seeker?

Much of my research and professional experience focuses upon ergonomics, workplace hazards, and traffic safety. A major component of improving public health in these realms is compliance. Well, really, that's a problem with any public health program: How do we get people to do what we want them to do? That IS the basis of our course of study, at least in the social and behavioral realm.

We generally try to avoid blaming the individual person for his or her health decisions, rather focusing on the system that fosters such choices. Systemic changes, we think, enable people to naturally make the "right" choice for themselves, or at least a well-informed "wrong" choice.

Some people, though (myself included), are just high-risk folks. I always theorize that certain professions attract social deviants:

  • If police officers weren't cops, they'd be criminals.
  • If chemists weren't working on pharmaceuticals, they would be making meth.
  • If ski patrol wasn't bombing for avalanches, they'd be arsonists.
  • If safety professionals weren't teaching safety, they'd be dead.
Here's a cool link to a self-assessment tool for determining your sensation-seeking rating (goes from "titmouse" to "adrenaline junkie").  I, consequently, fall into the highest category, which makes sense.

I feel as though I am a great public health/safety professional because I'm the most likely person to do stupid stuff. I've skied helmetless in the backcountry, ridden motorcycles at 70mph on the freeway while the driver was drunk, and raced at speeds up to 120mph on San Antonio's roads. I've worked in chemical demil facilities that had gallons of VX nerve agent in the lab hood. I have handled dangerous chemicals without gloves or protective eyewear, and I did the same with urine on more than one occasion. I SCUBA dive, ride in small planes, get on every roller coaster I see ... and yes, I've had unprotected sex. I still run with scissors (don't tell anyone). I've done it all wrong.

I have had (in the past) almost no regard for my own personal safety. Frankly, I hit age 25 and was shocked to still be around. I was lucky. Other people aren't. This is why I appreciate the importance of safety initiatives and messages; people really do get hurt. I just lived long enough to tell my story.

In other words, I am my own target audience. If you can make me change a health behavior, you can probably convince anyone.

This is a great asset, because I'm able to critically evaluate programs' ability to succeed in real life. Is the program inconvenient? Culturally insensitive? Gender-biased? Yep, I'll find any excuse to not be healthy. Which is why I'm perfect for this discipline. If I can save people from one of the horrific deaths that I narrowly avoided, then I must be fulfilling my greater destiny. And I suspect that many public health professionals can say the same.

I hope to see some comments telling me about YOUR sensation-seeking scores! It's really a fun test.

Tuesday, August 30, 2011

CDC's Health Out Loud ... Entertainment and public health belong together

Here at the School of Rural Public Health, we are often encouraged to think about innovative ways of including public health messages in general media. Specifically at our school, because of our proximity to the Mexican border, we often discuss telenovelas, popular soap operas that have previously been used to disseminate information to disadvantaged Hispanic populations. These are very well-received and prompt a significant change (in some cases), when paired with other public health efforts.

I be you didn't know that the exact same thing happens on American television! Check out the CDC's blog today about a new episode of "Army Wives" that addresses the topic of Traumatic Brain Injury (TBI). Link here.

Here's also a link to the actual video clip in which TBI is discussed.

Although this approach is nothing new (I've read documents dating back to the 70's that address public health in the media), it's interesting to see how issues have changed, and how they may have remained the same.

One of the biggest issues we face as public health practitioners is the continued portrayal of illness as:
  • Quickly cured
  • Affecting only white, middle-class patients
  • Exotic and difficult to define (i.e., not diabetes ... instead, amnesia!)
This, frankly, is not what illness is in this nation. We are a group of people with chronic conditions that are fairly common. We have high blood pressure, diabetes, arthritis, heart disease ... none of which are particularly glamorous. Trauma makes for better TV, but it doesn't help Americans understand the health care system.

I have to admit that I am particularly fond of the TLC show that shows true stories from the ER; although some of the ailments are sensationalized, we get a feeling for what might actually happen in an Emergency Department, rather than what Hollywood would have us believe. Teens actually do come in after overdosing on drugs, for example, and car crashes are among the leading causes of preventable deaths for Americans in general. The TLC show portrays these events accurately, in my opinion.

In essence, I hope that we see more information dispersal like this clip from Army Wives. Although it wasn't on a major network, I think it portrayed a fairly realistic situation. We have an obligation, as public health professionals, to promote these surreptitious but effective mechanisms for social change.

Monday, August 29, 2011

In defense of innovation

I'm currently reading this excellent book by Gerald M. Weinberg called Becoming a Technical Leader: An organic problem-solving approach. This, along with some recent class experiences, has prompted me to start thinking about the real place that innovation has in the public health care realm.

Public health, unlike computer science and other technical disciplines, is unlikely to be revolutionized by that next great idea; a single spark is unlikely to ignite a flame. That attribute, however, doesn't prevent public health from the need for great and innovative ideas. Ideas that were not forged in a sterile academic test environment ... no, those ideas are inadequate. What we need in this field, what our populace deserves, is a thinking and creative workforce that creates new approaches to old problems.

I was troubled today by a response I received from a teacher during class. I quoted the 1998 book Public Health and Marketing, which asserts that public health practitioners need to adopt strategies and mindsets that exist in the marketing realm. Specifically, we are encouraged to realize that corporate marketing professionals only expect a 2-3% per annum change in purchasing behavior (note the "per annum"). In other words, public health professionals need to set more realistic expectations for mass behavior change. This seems reasonable to me, as someone who does a lot of independent research, because I have yet to see sufficient evidence that behavior change can be achieved through educational efforts.

I was thoroughly trounced, albeit politely, by my professor, who essentially laughed at me, telling me that any proposal that promised a 2-3% change per annum would be swiftly rejected for its inefficiency. Let me bring up the following points, though. For example, in a 5-year program, assuming a 3% change annually, one could effectively change at least 15% of the target market. Perhaps a 2-3% change is warranted because of the characteristics of the health problem; if we're changing 2-3% of the rates of homicide in the U.S., for example, we might have an argument for the program if it's low-cost and efficient. Furthermore, those affected by the change may have the ability to influence their community, effectively changing social norms.

There must be something wrong with me because I have the continuous faith that professors, fellow students, and the public as a whole are as optimistic and revolutionary as I choose to be. Yes, I do my public health research. I read books upon books that have nothing to do with class, but everything to do with actual implementation of public health principles.

Take, for example, the remarkable book Theory in Health Promotion Research and Practice: Thinking outside the box, by Texas A&M's own Patricia Goodson. I won't go into detail about the book (since I'm honestly not done reading it), but the title alone should make us stop and question our motives in this field. Thinking outside the box. Theory does have its applicability, and evidence-based public health practice is important, but our field must also be receptive to the radical and weird ideas that just might change the world.

Why are we stumbling around within our profession when so many questions have been answered by research in other disciplines? We have a problem with our marketing strategy ... why don't we look at marketing research to fix the problem? There's a reason that the big corporations are dwarfing our public health efforts ... they have the resources to hire the best and the smartest campaign development staff. Our field seems to be sinking in stagnation and self-congratulatory angst. I'm kind of not impressed.

I am compelled by Weinberg's leadership model, which calls upon technical leaders to motivate, organize, and innovate. The overall theme of the book calls upon those who have been innovators in the past to stimulate new ideas by creating motivation and organization that supports new ideas.

As a leader in this field (which I hope to be one day), I can only say that I would be remiss if I didn't entertain some wacky approaches to public health; after all, we really have no idea what works in this field, so how can we trust the evidence we have? Goodson says that it's rather insane to think that we can imagine ourselves capable of predicting others' behavior. "Well, I raised his self-efficacy, so there must have been an improvement," we say, without understanding what those catch phrases really mean.

The point of this post, I suppose, is to request that public health academicians step down off their beautiful high pedestals and come join the rest of us in the real world, where things are messy and difficult to define. Allow us to think radically. Allow us to feel empowered to go out into the world and make changes! I don't want to work within the crappy existing framework that public health requires, and by golly, I don't have to.

I want to think critically about problems using a variety of perspectives, and I intend to apply theory from *gasp* other disciplines such as engineering, economics, manufacturing technology, and management. Get it together, folks. Public health is the ultimate conglomeration, the meeting place for all courses of study, and all should be recognized as valid. Who cares if it's theoretically supported if it works?!

Maybe I'm just a starry-eyed optimist, but so are others who really make a difference.

Monday, August 22, 2011

Here's your infected speculum ... yum.

So this is pretty much the most horrifying public health lapse that I've heard of recently in our nation ... and guess what? It happened right here in Texas.

Apparently the Parkland Memorial Hospital incorrectly sterilized not just a few, but at least 70 speculums.
A March 2010 letter to clinic patients said, "We would like to let you know that you may have been exposed to a speculum"—a vaginal examination instrument—"that may not have been properly sterilized." Although the infection risk was very low, the letter added, "we would like to evaluate you in our OB/Gyn Intermediate Care Center as soon as possible to offer you preventive medications."
Two days later, another letter told clinic patients they needed to also alert them to the possibility of infecting a sexual partner. "We would recommend that you abstain from sexual intercourse or use condoms until notified of negative results after your six month follow up," the letter said.
A third letter soon went out to a different group of women that warned of another possible failure to sterilize instruments. This time the problem had occurred in Parkland’s labor and delivery department, one of the nation’s busiest.
Yep, so this information is just now coming to light because of freedom of information inquiries. Can you imagine being one of these women? Getting letters like this out of the blue, telling you that some rotten and unclean speculum has been used during your exam? I just threw up a little bit.

Hospitals are supposed to be bastions of professionalism and cleanliness, and yet we hear about events like this all the time. Infections that kill patients, botched operations, ineffective medication management. Mistakes like these, if made in other industries, wouldn't be such a big deal; the auditor catches the misplaced decimal point, the copy editor corrects the grammar error, the janitor cleans up your spill. But in the medical community, we can't just write off errors such as these to human nature.

We have to wonder, also, whether this hospital possesses the correct financial and administrative resources to serve the needs of its surrounding community. I'm not familiar with the demographics of the nearby region, but the hospital may primarily serve underprivileged individuals; if this is the case, perhaps more government funding is necessary to ensure the availability of equipment and staff to guarantee patient safety.

I think many hospitals lack the financial or managerial resources to institute proper systematic controls that would prevent errors such as these. Why would a system allow technicians to retrieve dirty speculums? Shouldn't there be a mechanical safeguard to stop such an event? Further, what kind of managerial pressures are being exerted on technicians to sterilize quickly without regard to process quality?

In short, the hospital has pledged to fix this problem through increased monitoring, but I don't think that's the problem. An environment that encourages productivity over safety, regardless of the product, is unsafe for everyone. This is true of manufacturing environments, hospitals, and even office workplaces.

I think a careful analysis of the organization's culture will reveal far greater problems than dirty speculums. Perhaps the hospital, under threat of lost Medicaid and Medicare funding, will learn to clean up its act.

Thursday, August 18, 2011

Let's encourage little girls to diet! Brilliant!

Although I pilfer most of my links from Jezebel, and I'm trying very hard to stop doing this, I found this GEM through my daily reading of that site.

The book, which ostensibly encourages youngsters to eat appropriately and exercise, is ... well ... appalling.

I remember when I was in my early teens ... yeah, that's right, that's when my eating disorder started. Let's remember that environmental factors are not the only components to eating disorder development, but I can guarantee you that books like this would have just made things worse for me (and the other, what, 1/3 of girls who have disordered eating patterns). I had problems just going to the doctor and finding out I was "overweight," even though I played 3 sports.

Furthermore, let's remember that a large percentage of our nation's young women would rather be hit by a truck than be fat. Information here.

So, what about those girls who play sports, like Maggie did (and I did), and still don't lose weight? This book implies that it's their fault ... although they might just be sturdy little soccer players like me! What about those of us who remain physically fit, yet straddle the clinical definitions of overweight/obese?

I just can't see this book as anything but a mortifying and appalling excuse for a "positive health message." Read a health marketing book, lady. Guilt doesn't work to change behavior, and you're expecting kids to have the cognition to understand the concepts in this book without adopting harmful strategies. #facepalm

If people like this keep dominating the health communications marketplace, we're all doomed.

Wednesday, August 10, 2011

National Health Center Week!

How do I keep missing these awesome commemorations?

It's apparently National Health Center Week, an effort supported by Aetna, Sharing the Care, and other corporate and government-based entities.

Health centers are critical to the public health efforts we work for every day. Why? Because they are often located in impoverished, disparaged neighborhoods with few other resources. They are the tie we have, as public health professionals in our towers on high, to the actual populations who need our help. They are the front line defenders against maladies associated with homelessness, poverty, and inaccessible medical care.

National health centers also provide care to immigrant and nomadic workers, populations that are also medically vulnerable.

Now, before I start hearing all of the "they're taking our jobs!" arguments and other such nonsense, I'd like to point out that one of the basic tenets of public health is as follows:

A healthy nation is a happy, productive nation.

If we support the health of everyone who's in this nation, we are not only being decent human beings, but furthering the interests of all Americans (and people who just happen to be here). Now I'm the farthest thing from a "bleeding-heart liberal," but that's an ethical foundation I can stand upon. Sick people, logically, cost us more than healthy people in most cases, right? So, duh, let's keep everyone well.

We might argue that immigrants and others who use the national health center system are draining our resources. Oh, contraire, though, my friends. If they're using the health center system, then they likely are visiting the appropriate medical facility for their needs, rather than congesting local emergency rooms with minor ailments. This is a good thing.

So, enough with the minor tangent.

Did you know that we have a community health center right here in Brazos County? Yep, it's there! It provides low-cost medical care to lower-income individuals in our area (*cough, cough, GRADUATE STUDENTS). I've been to the health department to receive low-cost immunizations that even the campus health center couldn't provide. Gardasil for $30 instead of $150? Yes, please!

Anyway, let's take some time this week to consider the contributions that these little-known facilities make to the overall health in our nation. They don't have glamorous jobs, and they sure aren't famous people, but they are out there making a difference, and I am so grateful for their presence.

Shout out for the shout out!

Check us out on Regan's blog roll here:

She's been super helpful in getting our blog off the ground! Here's to awesome women in health! Now go visit her kickass Dances with Fat site.

Tuesday, August 9, 2011

Public health theory links ... helpful for social and behavioral students (and everyone else!)

I'm a big advocate of using theory to create public health programs, instead of just trusting your "gut." Too many public health practitioners, who are poorly trained in theory and evidence-based approaches, put together programs like this: FocusDriven that are largely designed to appeal to our emotions and fear of physical injury. Although I suppose these worked at one time, campaigns such as these slip out of our conciousness the minute we navigate to a different page.

With that in mind, I've found some really awesome articles that summarize public health theories relating to behavior change, and I'm going to share them here! Get stoked!
  • This article from the National Institutes of Health relates specifically to cancer, but the information can be generalized to most public health practice. This is probably the most practically applicable document I've seen that relates to public health theory.
  • Here is a file that summarizes public health theory nicely, including some that you usually don't see, such as Protection Motivation Theory and the Elaboration Likelihood Model.
  • Finally, it's important to recognize that different populations require different theoretical models to inspire interventions. Children are a particularly relevant group because their cognitive abilities differ greatly from those of adults. This article explains a child-specific model that can be used to spark behavior change.
Again, it's important that public health professionals adhere to existing scientific knowledge in crafting campaigns and interventions. Otherwise, taxpayer money and funds from private enterprise are essentially discarded as they are applied to feel-good efforts that really don't fix anything.

I'm continually shocked at the inability of our health community to lay proper foundations for research and intervention. Perhaps this is because many of us in this field are poorly educated about public health, considering the current clinical focus of medical technology today. It's clear that a paradigm shift must occur that stresses true evidence basis instead of self-serving, happiness-inducing, ineffective programming.

This means that we, as public health professionals, must acquire enough knowledge to recognize when something is a bunch of horse hockey. Learn your statistical measures. Understand what total crap looks like. Sources will tell you that D.A.R.E. is an effective program, for example ... but if you actually READ the studies, the evidence for this suddenly vanishes.

Think critically, people.

Monday, August 8, 2011

Man denied breast cancer treatment ... because he's a man. Really?

Check out the link here about a man who was denied Medicaid coverage for his breast cancer treatment because he is not a female.

Interestingly, the article points out that the man applied for aid through a breast cancer and cervical screening program that only serves women; that is, the defined mission of the organization is to assist WOMEN with these problems, not men. I find it difficult to swallow that this organization is to blame for his lack of coverage. This is also mentioned in the Jezebel article, so kudos to them.

For example, the Juvenile Diabetes Research Foundation primarily deals with Type 1, or early onset, diabetes in child populations. Suppose the JDRF provided charitable support for individuals with this condition. Now, imagine that someone with Type 2 diabetes, or gestational diabetes, applies for financial assistance from JDRF. The organization is dedicated to a different population, however, and so denies the request. There's really no difference between that and the breast cancer situation described above.

Organizations exist to serve specific populations, and that's OK. The flaw isn't with the breast and cervical cancer screening programs, as the Jezebel article points out. Rather, our system is failing because of its inability to provide comprehensive care to everyone. If the American healthcare system was fortified with more safety nets for populations with health disparities, impoverished men with breast cancer would be less likely to fall through the cracks.

We need to allow organizations to focus on their self-defined mission rather than attempting to dictate morality to them; a women's group doesn't have to provide healthcare to men (just like a fathers' support group doesn't have to allow mothers to join). I'm glad that the editorial attacks the general healthcare structure instead of vilifying the women's health organization.

If those groups weren't allowed to set boundaries, I think it would be a slippery slope into chaotic public health practice. I can see the nature of these conversations:
"You have an AIDS foundation? Give us money to help cancer patients!"
"Um ... no?"

It's not that we shouldn't care about groups with different health problems. Rather, we need to acknowledge and realistically assess the independent ability of non-profit groups to support specific populations, strengthening our overall infrastructure to support these efforts.

Monday, August 1, 2011

Borderline personality disorder ... mental health in sports news? Yes, we're excited!

So, I'm hanging out with my S.O. yesterday, and I see him reading some sports news. Meh, no big deal, I think ... I'm not usually excited by A&M's football prospects or which hitter has the best RBI. But then, out of the blue ... a public health article sprouts up in the sporting world that has nothing to do with performance-enhancing drugs or nasty ACL injuries. Yep, it made for a great Sunday.

Here's the scoop: Miami Dolphins wide receiver Brandon Marshall went public with his diagnosis of Borderline Personality Disorder (article here). For those of you who aren't mental health experts, Borderline Personality Disorder (BPD) is characterized by the following:

1) frantic efforts to avoid real or imagined abandonment

2) a pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3) identity disturbance: markedly and persistent unstable self-image or sense of self

4) impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

5) recurrent suicidal behavior, gestures or threats, or self-mutilating behavior

6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

7) chronic feelings of emptiness

8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9) transient, stress related paranoia or severe dissociative symptoms

(More information from a DSM summary here)

The most important part of this whole situation is that Marshall is making his struggles with BPD public. BPD may not be on many people's radars as far as important mental health issues go, but that doesn't matter. What excites me abot this article is that a ridiculously successful (Pro Bowl anyone?) professional athlete is unabashedly admitting to a relatively severe mental illness.

The message? It can happen to anyone.

As more and more people come forward to share their struggles with mental illness, the stigma and hype surrounding such conditions will begin to wane. This is why I am always so forward about my struggles with depression and an eating disorder; by making these things a secret, I would be playing into the social expectations of guilt and embarrassment about my mental health. I'm so happy to see high-profile folks like this coming forward to help fight for the cause.

I do feel terribly sorry for Marshall; even with practically unlimited resources, he's continued to struggle with this difficult condition. This article, however, highlights another important point about mental illness that we can scarcely afford to forget:

A man with nearly unlimited resources at his disposal still struggled immensely with mental illness.

Not only do mental illnesses not discriminate ... they also require specific, individualized treatment plans and a lot of dedication to overcome.

This is particularly salient in light of the recent health care reforms, which have re-opened the debate about insurers' responsibility to those of us who suffer from mental illness. If recovery is even difficult for a man with access to so much care, what can we expect for those with health disparities? The dearth of mental health services for all Americans is inexcusable; although the physical maladies may present themselves with more clarity, mental illnesses are also fatal diseases. We can't ignore the implications that mental illnesses have for overall improvement of care.

So, a big THANK YOU to Brandon Marshall for "coming out" as someone with a mental illness! Here's to shattering more norms!