What I learned from International Health

At the beginning of the semester, I knew hardly anything about global/international health.  I still think this is much to be learned, but taking International Health and World Food Problems has helped a lot.  I believe the class as a whole agrees that positive deviance is very important.  At least it appeared that way from the last class.  I personally think globalization was one of the most important concepts we talked about.  Globalization needs to be understood or at least thought about.  It has always been around, but we do not think about it.  Globalization has led to many changes around the world both good and bad.  Even if it involves the same people or object, it can have different effects.  Look at what we learned about women and globalization.  It is starting to become more acceptable for women to seek out paid work.  I do not know where this started, but the United States has obviously been supportive of paid women’s work.  The glass ceiling aside, women are allowed to work in developed countries.  Having more women in the work force has uncovered problems that we were not aware of before.  The stress of having to work a paid job, raise a family, and do all other day-to-day tasks is daunting.  Women are strong enough to handle, but societal norms are not making it easy on them.  Finding good childcare and financing it are extremely difficult for many.  Hopefully, we will come up with better solutions in future years.  We have are all capable of being this solution.  I talked about globalization because I found it to be so important.  There were other concepts we learned about that are also significant.  Wherever I end up career wise, I believe I can use the concepts taught from these courses to improve how I address the issues I face. 

Reflection

       As the semester is coming to an end, I reflect on what I have learned in all of my classes and how they all relate to one another. While they all had their specific focus areas, one thing that stuck out to me is the depth that public health interventions must entail in order to be successful. No public health issue can be moved in a positive direction by using a narrow approach. Individual, interpersonal, structural, physiological, and societal factors all have their own impact on one's health. Also noted, that as much as public health professionals believe that an intervention they have created will be successful, they cannot initiate it without proper funding and resources, which is a big obstacle in this field. In addition, policy changes are most often out of our control and policy can be very beneficial or detrimental to a targeted health behavior. Specifically, in regards to global health, I have learned that there is a lot to be done around the world. There are so many alarming health disparities that I was not completely aware of prior to this class. Like all interventions, we must understand what our target population wants and needs what they will respond to. Also, we must make changes that will make it able for these communities to sustain better health once the intervention is over. We cannot put a quick, simple fix on a long, complex problem. While there are many obstacles and challenges in public health, and while some tasks may seem way too out of reach to tackle, we can all make a difference if we put our mind, time, and effort into it. I believe public health is a very rewarding field, and the impacts we have the ability to make on people's lives is worth all of the hard work we will put in as public health professionals.

Preventing Prevention: What's stopping us from using contraceptives?

Contraception is a public health issue with worldwide prevalence, complicated by difficulties with access, proper use, stigma, cost, and more.  Unfortunately, many misconceptions exist that limit use of birth control, whether through public policy or individual choice.  Public policy that restricts birth control access is very difficult to fight, being that it is grounded in social norms and cultural beliefs of the majority or of the governing party.  For example, I have been researching women’s health care access in Italy, where emergency contraception is still prescription-only; this barrier is even more problematic when you consider the time-sensitive nature of emergency contraception.   One study found that some Italian doctors will refuse to write prescriptions because they misunderstand the medical mechanism, considering it to be like an abortion rather than a true prevention of fertilization; this forces women to try clinic after clinic until they can finally get a script for what should be an easily accessed method of pregnancy prevention (Bo, Casagranda, Charrier, & Michela Gianino, 2012).

In addition to public policy challenges, personally- or societally-held misconceptions can limit birth control use in practice, even if it is not limited by policy.  A recent article from Science Daily (“Fear of gaining weight may influence contraception choices,” n.d.) discussed the very real fear that many women have of gaining weight due to oral contraceptives, and how this deters them from using this method.  The study they referred to (Bhuva, Kraschnewski, Lehman, & Chuang, 2016) found that women who were overweight or obese were more likely to use either highly effective forms of birth control (IUD or implant), or minimally effective forms (condom, withdrawal) to none at all, but had lower rates of pill use.  Pill usage has been linked in the public discourse to weight gain, but literature review has shown no true correlation (Gallo, Lopez, Grimes, Schulz, & Helmerhorst, 2006).  I have many friends who have stopped or never started oral contraceptives because a fear of weight gain, but in reality any initial weight gain is usually due to a shift in water weight and normalizes after a few cycles of the pill.  The fact that this study showed that overweight or obese women tended to avoid the pill is concerning, because some of them ended up using less effective to no method of contraception.  Just last week I was reading about factors that influence pregnancy outcome: pregnancy intention leads to better outcomes for mother and baby, but more than half of all pregnancies in the U.S. are unintended (Frayne et al., 2016).  This means we must fight any and all misconceptions about birth control that are preventing women from using it, in addition to access and policy barriers, here and throughout the world.  Proper education about contraception, free of misconception, myth, or stigma, is vital.

References 

Bhuva, K., Kraschnewski, J. L., Lehman, E. B., & Chuang, C. H. (2016). Does body mass index or weight perception affect contraceptive use? Contraception.

Bo, M., Casagranda, I., Charrier, L., & Michela Gianino, M. (2012). Availability of emergency contraception: A survey of hospital emergency department gynaecologists and emergency physicians in Piedmont, Italy. The European Journal of Contraception & Reproductive Health Care, 17(5), 373–382.

Fear of gaining weight may influence contraception choices. (n.d.). Retrieved December 3, 2016, from https://www.sciencedaily.com/releases/2016/11/161117101728.htm

Frayne, D. J., Verbiest, S., Chelmow, D., Clarke, H., Dunlop, A., Hosmer, J., … Zephyrin, L. (2016). Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative. Obstetrics & Gynecology, 127(5), 863–872.

Gallo, M. F., Lopez, L. M., Grimes, D. A., Schulz, K. F., & Helmerhorst, F. M. (2006). Combination contraceptives: effects on weight. The Cochrane Database of Systematic Reviews, (1), CD003987.

Social Media & Health Promotion

Social Media & Health Promotion

In an age of globalization and the rapid growth of technology, developing countries are increasing their use of social media and have gained access to technologies including cell phones and internet. As a result, many health interventions have utilized social media as a communication tool in order to change health behaviors due to its ability to increase information access as well the ability for such programs to be customizable to a population (Levac & O’Sullivan, 2016).

However, as a relatively new medium, I have questioned the unintended consequences of such an outlet on a variety of factors. For instance, what impact does this have on social skills and potential it has on limiting physical activity among a given population. Also, with the reliance of such interventions on the internet and technologies, are they effective and reliable in global health initiatives? How may we as health professionals experience the benefit of social media as an effective tool and at the same time, have little negative impacts on the population we are targeting. Also, researchers such as Levac and Sullivan (2016) question the long-term effectiveness of such strategies as the nature of technologies is one that is in constant change and fluctuation. Social media sites also are sensitive to the nature of information and the ability for unreliable information to be published and referred to in at-risk communities. This lack of control increased the need to educate the public on ways to effectively utilize such social media tools for it to be effective.

As I read this article, I was interested in your thoughts as public health professionals from various fields and how you think social media may or may not have unintended consequences in utilizing it as a strategy in global health initiatives? Should we continue to use this as a reliable communication tool?

Reference

Levac, J. J., & O’Sullivan, T. (2016). Social Media and its Use in Health Promotion. Revue Interdisciplinaire Des Sciences de La Santé - Interdisciplinary Journal of Health Sciences, 1(1), 47–53. https://doi.org/10.18192/riss-ijhs.v1i1.1534

'Tis the Season for Test Anxiety

            As we are heading into finals, my personal thoughts are constantly being about final projects, exams, and presentations.  I do not know about you all, but even though we are in graduate school, I experience peak anxiety during this time.  While for some classes we might not have written final exams, we continue to have finals that determine large parts of our overall grades.  Test anxiety is a curious thing.  Why do some people feel it so harshly while others are hardly affected?  What is the science behind this?  Test anxiety is correlated negatively with academic examination performance (Aysan et al., 2001).  Salehi and Marefat categorized anxiety as trait and state anxiety.  Trait anxiety is a tendency towards anxiety on a relatively stable scale.  This type anxiety is basically a personality trait.  These are people that tend to also have some level of anxiety.  State anxiety is situation-based anxiety.  State anxiety is also considered part of trait anxiety, but will arise during situations that cause individuals stress.  The researchers have found that test taking while experiencing a language barrier is even worse (2014).  Aysan et al. discussed different methods for dealing with test anxiety.  Their sample population was Turkish MA postgraduate students.  They recommended practicing yoga and meditation to deal with everyday anxiety.  The researchers’ main focus was to look into performing pranayama or a type of Hindu yoga.  Pranayama is regulation of breathing that has been shown to control and reduce anxiety during test taking (2001).  I chose this topic to write about not to get everyone down with thoughts of finals, but to give at least an understanding of test anxiety.  Hopefully, this blog makes you realize that everyone has the potential for test anxiety.  Good luck on all of your finals whether they are exams, presentations, projects, etc.  You can do it!

Aysan, F., Thompson, D., & Hamarat, E. (2001). Test anxiety, coping strategies, and perceived

health in a group of high school students: A turkish sample. The Journal of Genetic Psychology, 162(4), 402-11. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/228397512?accountid=13360

Salehi, M., & Marefat, F. (2014). The effects of foreign language anxiety and test anxiety on

foreign language test performance. Theory and Practice in Language Studies, 4(5), 931-940. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/1527307504?accountid=13360

Public Health as Global Health

Education informs the public about health and unhealthy behavior choices and it is up to the public to decide whether they are going to change their behavior based upon evidence.  One would think that when someone is informed of negative health effects and the benefits of pursuing one course of action over the other that they would always make the correct choice but that is not how we operate as human.  Also, we do not always have the tools necessary to make the correct decision.  Also even with the correct tools we may not have the means or mode to make those corrective changes.  It takes more than just education, even regulation is not a cure all because some of the same problems that I just spoke of will still exist.  When we look at the cause of death and disease that are plaguing the population we would be incline to say that people choose their own health, but I beg the differ.

The top three cause of death are smoking, poor diet and physical inactivity followed by alcohol consumption.  Behind each of these cause of death is an underlying problem that we may be able to see or fix with changes in health behavior.  Some of the causes of why people drinks, smoke, overeat, etc., are systematic and physiological. Without looking at the root of these issues can we treat the problem or are we only putting on a band aid?  I would say in order for people to change their behavior and move towards better health we must look at the underlying causes and address those as well. People living in food deserts and in poverty are not overweight because they may just love to eat, but because they are not eating the appropriate things or because their body has stored fat due to many days of lack of food. When these people do eat they are not thinking about nutrition, but survival.  The idea of survival overrides the knowledge of health. Also what we eat does make a difference.

In today’s society we are encourage to eat better, eat healthier, however the foods that are affordable are not healthier food.  Organic food, cost about twice that of regular food.  Buying junk food could cost a dollar, whereas fruit and vegetables could range from $1/lb to $4/lb according to the season. So yes, education does work, but survival is necessary.  With education should also come measures to reduce consumer cost at the grocery stores! Many of the fruit and vegetables when not bought would be thrown away, but this does not make national new nor does it come into account when making statements regarding the health of a nation.  There are many factors that go into why people are unhealthy, and some of those are income inequality, access and means.

In conclusion, No, I do not believe that people choose their own health.  Many factors go into this equation along with what is in the environment, additives in the food etc.

Global Effects of the Tobacco Industry

As I was driving home one evening, I noticed a construction worker carrying one of my favorite things: coffee; and, one of my least favorite things: a cigarette.  I have always been curious about the global numbers of smoking and the effect of the tobacco industry in developing countries, so I decided to do a little more research for my blog post this week.

            In a study by Jha & Peto (2014), researchers look to an interesting ratio to measure the success of tobacco control.  In developed worlds (USA, Europe, etc.) among men and women 45-64 years old, there are about as many current smokers as there are former smokers.  In contrast, in developing countries, among in this same age category, there are much fewer former smokers than current smokers.  This shows that while smoking in the developed worlds has plateaued or even decreased, it has increased in developing worlds (Table 1).

            Why the decrease in developed countries and not developing countries?  Some point fingers at the effects of advertising – according to WHO (2013), one third of cigarette use that starts in youths occurs as a result of tobacco promotion and advertisement.  Attracting new users is the main reason tobacco companies spend tens of billions of dollars on advertising, promotion, and sponsorship (WHO, 2013).  The effects of advertisement bans are especially visible in Australia, where already existing bans have been strengthened by the introduction of “plain packaging” in 2011 (Jha & Peto, 2014).  Out of curiosity, I investigated these effects a little further and found Figure 1 on the Australian Government’s website (2016).

Others may point a finger at tobacco pricing – doubling the price of cigarettes in developed countries and tripling the price in developing countries has the potential to reduce smoking worldwide by a third.  In the US and UK, cigarette consumption has taken nearly 30 years to reduce by half.  In contrast, with the use of large tax increases, France and South Africa reduced tobacco consumption by half in just 15 years (Jha & Peto, 2014).

 How do we reduce tobacco use while respecting the rights of a TNC?  What are some unforeseen consequences of some of these interventions (ban on advertisement, increased taxation, etc.)?  What other global effects do you see?  Think about positive deviance that we learned about this past week, what are the areas with low numbers doing right?

References

Australian Government Department of Health. (2016, June 29). Tobacco Control key facts and figures. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-kff

Jha, P., & Peto, R. (2014). Global effects of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine, 370(1), 60-68.

World Health Organization. (2013). WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship. World Health Organization.

Pediatric Dental Caries and Food Insecurity

Dental caries is a major public health problem. It is considered to be the most prevalent chronic disease worldwide. Pediatric dental caries not only causes pain and eating difficulties, it also affects speech, esthetics, sleep, growth pattern, social communications, self-esteem, academic performance, and quality of life.  In some conditions, untreated oral infections maybe so severe to the extent of causing systemic manifestations and consequently threatening children lives.

Low socio-economic status (SES) has been identified as a strong determinant of dental caries among children. As low SES is strongly linked to food insecurity, it is worthy to ask whether food insecurity can be a potential risk factor for this global threat.

Families that suffer from the food insecurity tend to prioritize quantity rather than quality in making their food-purchasing decisions. For example, they may go for sugar sweetened beverages that are less expensive and more accessible, however, in the same time, has a damaging effect on their children teeth.  Food insecure households may also live in food desserts which limit their food choices to processed food and snakes especially in the era of globalization where transnational corporations (TNCs) find such places as easy markets for a guaranteed high profit. Such types of food subject children to highly refined carbohydrates which are strong predictors of dental caries. Additionally, children living in food insecure houses, especially in the developing world, may take the responsibility of managing their food resources and options. In most cases, such management usually take the form of increasing the frequency of small non-healthy snakes that increase the periods of exposing their teeth to cariogenic food resulting in ideal conditions for oral bacteria to produce cariogenic acids that further potentiate caries risk.

Nowadays, most interventions tackling the global threat of dental caries focus mainly on preventive oral health behaviors such as teeth brushing, flossing, fluoride application, dental sealants, …etc. Although, such issues are extremely important, they can be potentiated by taking into consideration the social determinants of the threat and by addressing food insecurity especially within vulnerable populations who struggle under harsh structural and financial conditions.

Reference:

Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008. Am J Public Health. 2014 May;104(5):860-4

Health Benefits of Pet Ownership

            When talking to people before heading home for break, I discovered that most students were really excited to see their pets at home.  This got me thinking about what having pets does for us.  The health benefits of pet ownership have been shown as contradictory in previous studies (Utz, 2014).  These studies have used inconsistent methods and biased samples, so the results have been inconclusive.  Utz reported on a study done to address the previous studies problems (2014).  This recent study showed that pet ownership does appear to have a positive effect on health.  Owners of pets are less likely to be diagnosed with congestive heart failure, report arthritis, or be obese.  People with pets also report and are physician assessed to have excellent or very good health ratings.  This is true for overall health except for allergies and asthma.  Pet owners have been documented to having more prevalence of allergies and asthma than non-pet owners.  This could be an artificial increase because pet owners have more contact with animals and are more likely to be aware of asthma and allergies (Utz, 2014).

            A further study done in China proved that dogs have some benefits on their owner’s health.  Owning a dog is positively associated with feeling healthier.  Dog owners in this Chinese demographic are also less likely to miss work and have fewer nights of bad sleep.  This means that it is possible for pet dogs to contribute to considerable health care savings (Headey et al., 2008).  Other studies have also been done in the United States, Australia, and Great Britain on pet cat and dog ownership and health benefits.  The results of these studies showed that having a cat or dog relieves feelings of loneliness.  The presence of a pet in home is also good for a friendly atmosphere and putting people at ease.  The results of these studies make me happy and appreciate my pets even more.

·         Headey, B. (1999). Health benefits and health cost savings due to pets: Preliminary

estimates from an australian national survey. Social Indicators Research, 47(2), 233-243. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/197667607?accountid=13360

·         Headey, B., Na, F., & Zheng, R. (2008). Pet dogs benefit owners' health: A 'natural

experiment' in china. Social Indicators Research, 87(3), 481-493. doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1007/s11205-007-9142-2

·         Utz, R. L. (2014). Walking the dog: The effect of pet ownership on human health and

health behaviors. Social Indicators Research, 116(2), 327-339.

doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1007/s11205-013-0299-6

The year was 1621

Thanksgiving 1621

The year was 1621 when many believe the first thanksgiving meal was celebrated with the abundant harvest that had ended the famine that resulted in many deaths across the pilgrim population. This is what Americans have been celebrating this weekend! Not being American myself, I was curious as to why such a holiday was celebrated more so here than in Canada. The history of how this holiday was a triumph over an epidemic of famine among a population brings hopeful light onto many global health concerns we have today of food insecurity and diseases associated with such. It is each year that we are given this rebirth of hope needing to be cherished as well as reflected upon in how we can use this new-found hope to address our current health situations across the world. By learning through historical events, we can identify ways to reduce food insecurity, create bountiful harvests and agricultural practices.

There is a much needed movement needing to be had to detach ourselves from the marketing holiday that it has come to be towards one of humbleness, a moment to reflect on what the history books would say about the year 2016 and thanksgiving. Perhaps it is time to create a new holiday that celebrates a new day of health, a new solution to a problem we currently have. For example, as we sit in traffic jams this weekend to reach many different destinations for that thanksgiving feast, the stress thousands of vehicles have on our climate that impact our current health concern of warming temperatures. Or even perhaps once we finally get to our destination, reflecting on where our food has come from and the trickling down effect on the small scale farmers of where the brussel sprouts, potatoes, and ingredients in the pumpkin pie have come from. How can we address these issues? How can we create a movement away from such a heavily market-created holiday towards one of reflection and inspiration in order to address many global health concerns we have today? 

Complementary Feeding, Globalization and Child Health

Per the WHO, Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The transition from exclusive breastfeeding to family foods is referred to as complementary feeding. Formerly, the ideal age of this transition was at the age of 4 months. However; recently, based on the new WHO recommendations, exclusive breastfeeding is found to be of maximum benefit to the child health when it continues till the age 6 months. Starting from 6 – 24 months of age, complimentary feeding should continue side by side with breastfeeding which should continue through this period. This period is critical for child growth during which, nutrient and micro-nutrient deficiencies contribute globally to higher rates of child malnutrition which is the underlying cause for multiple diseases that account for high child mortality rates of children under five worldwide. Apart from timing, adequacy, appropriateness, and cleanliness are crucial with the transition to complimentary food.

In the developing countries, the problem is complicated. Women in the era of globalization are forced to go to labor market to afford money for themselves, babies, and families. The work conditions are not suitable to maintain the exclusive breastfeeding till the age of 6 months and mothers tend to either shift to formula and/or complimentary feeding earlier. In most of the developing countries this carries disastrous influences on child health. These countries mostly lack access to clean and safe water and/or refrigeration. Hence; the risk of illness dramatically increases when babies start solids and/or formula especially that they did not get their sufficient immunity from their mothers’ breast milk. With introducing solid foods and or/formula to babies, potential exposure to pathogens from contaminated food, water, or utensils will significantly increase. Additionally, the solid food introduced to the child is mostly dependent on availability of food in households rather than adequacy and appropriateness to the child age which could expose the child health to further complications.

Tackling the problems of exclusive breastfeeding and complimentary feeding practices is crucial due to their global influence on child health and mortality rates. However; interventions in the developing world is very complicated. Although lack of knowledge is a major factor, I believe that it is neither enough nor successful in such communities. In my opinion, these problems should be tackled from multi-perspectives, taking into consideration the individual level along with the structural barriers and the social suffering of the mothers in the globalized world.

Reference:

http://www.who.int/nutrition/topics/complementary_feeding/en/

What if the World went Vegan?

What if the World went Vegan?

Vegetarianism and Veganism have been discussed in our class a minimal amount in terms of global health; however, rising popularity of this lifestyle in North America has flourished with numerous research studies and documentaries on its impact on health (i.e.: Before the Flood) and its relation to climate change (also a topic of concern on how it too can impact the global health environment). Recently, I came across an article hypothesising the effects of a scenario in which the world went vegan.  

Researchers at the University of Oxford used a data set from the UN Food and Agriculture Association and WHO and compared the effects across global health.

Fact:

ü  Greenhouse gas emissions would fall by 50% by 2050

ü  Health costs due to the decrease in noncommunicable diseases world wide per year= $735 billion US (following international guidelines of a healthy diet), $973 billion (vegetarian diet), $1 trillion (vegan diet)

ü  Decrease in deaths= 5.1 million (healthy diet), 7.3 million (vegetarian), 8.1 million (vegan)

ü  75% of these benefits occurring in developing countries

Developing countries are in deed where many of the global health concerns we have discussed are present and a lot of these benefits would be seen there. Many pro meat consumption arguments include the livestock’s capacity to generate business for small and local farmers, being a way of life, health benefits, as well as the cultural symbolism that meat consumption is often associated with. However, these concerns have supporting counterarguments mentioned above including the health benefits. It is also interesting to note that “the world’s agricultural system would need to produce 25% more fruits and vegetables, and 56% less red meat” (DeWeerdt, 2016). This production can be shifted towards local farmers who would otherwise be farming for meat consumption with strategic processes in place to identify which crops can be best grown in certain countries due to their climate.

I certainly am not suggesting everyone goes vegan, simply considering the alternative of even reducing meat consumption to the international dietary standards would be a desirable change. Presenting the evidence in this light that is supported by data is worthy of consideration. Perhaps efforts should be weighed more heavily on adopting a global lens towards diet and food consumption (including increased donor funding towards planning and implementation) that a significant impact on many global health concerns we have today will be addressed.

I would love to hear your thoughts on this as I know many of you do consume meat and animal products and are public health professionals! 

Reference

DeWeerdt (2016). What if the Whole World Went Vegan? Conservation. University of Washington. http://conservationmagazine.org/2016/03/can-vegans-really-save-planet/

At the Mercy of our Environment: Epigenetic Influences Have Complex Impact

Last week I attended a talk by Dr. Valerie Knopik, a genetic biologist, entitled "Genes + Environment = behavior?" The concept of nature and nurture both coming together to affect our biology and behavior is nothing new, but Knopik challenged the assumption that some sort of linear model could sufficiently describe the relationship.  Rather than genes and environment each contributing separately to our behavior, she eloquently displayed the complex web of factors relating the two.  Not only do nature and nurture influence us, but they also influence each other in complex ways, sometimes even before they affect us.  What does this mean for international health?  I feel we often talk about how cultural, political, historic, and geographic factors have effects on people's health to no fault of their own, and that not everyone has equal access to health.  However, Knopik's talk shows how this can go beyond social factors to influence our actual biology in serious and lasting ways.

Dr. Knopik discussed her work with smoking during pregnancy (SDP) and how that relates to ADHD in children.  First she described some of the variables that can predict for smoking during pregnancy, most notable of which is, as could be expected, chronic smoking abuse.  However, this behavior is also linked to a variety of other circumstances, such as social phobia and depression, and church attendance actually had a protective effect against it.  Ultimately this research into related variables to smoking during pregnancy found that this behavior was also a proxy for other behaviors, and that it was also genetically influenced.  When we turn our attention to children who faced SDP in utero, children are at highest risk for developing ADHD when they have genetically inherited the risky allele for the nicotinic receptor AND are exposed to SDP.  If the children ONLY have the risky allele OR are exposed to SDP, but not both, risk of ADHD is much lower.  

This information has obvious application in the field of public health, and international health.  When we seek to promote healthy behavior change, or even just to understand the root causes of a health problem in a given community, it is vital to remember that there is more at play than the choices people make.  I think it is quite common for public health professionals to understand that environmental limitations such as socioeconomic status and education can negatively impact health behaviors, but biology must not be counted out.  The unfortunate thing is that this can be hard to change; as epigenetics research shows, we are not entirely in control of our gene expression but are at the mercy of environmental exposure, prenatal care, and even behavior of the generations that came before us.  Ideally, we need to be able to communicate to people that their behaviors are not only affecting them but also their descendants for generations to come.  More realistically, we can recognize that genetics and environment do not only independently impact our health but also influence each other, so any particular health concern we seek to attend to as international health officials requires careful analysis and deep understanding of all contributing factors.

Perceived Barriers and Facilitators to Mental Health Help-Seeking

I am pleasantly surprised at how exposed I have been to mental health issues in public health this semester; it is a topic that we have discussed almost every class, Lala’s point of interest, my group’s final paper project, and an area I will soon be working in.  I think a large part of why we discuss mental health in public health is because there are a lot of perceived barriers to seeking mental health care due to stigma that varies from country to country and even town to town. 

Gulliver, Griffiths, and Christensen (2010) looked at perceived barrier and facilitators to mental health help-seeking in young people globally.  The statistics they found are not surprising to what we already know: only 18% of 12-17 year olds in Germany with diagnosable anxiety disorders utilized mental health care; only 34% of 15-16 year olds in Norway with high levels of depression and anxiety symptoms sought professional mental health care in the previous year; and only 25% of children 4-17 with a diagnosable mental disorder had utilized mental health services six months prior to the survey.  Key barriers that they found in their review included the following: stigma surrounding mental illness (10 studies); confidentiality/trust (6); unable to identify symptoms of mental illness (5); concerns about the mental health provider (5); and reliance on self/do not want help (5); among others (see Table 1 of reference).  I have included a picture of the top rated barriers they found in quantitative studies (Table 3).  Curiously, they also looked at key facilitator themes to seeking mental health services: positive past experiences with help-seeking, social support/help from others, confidentiality/trust in mental health provider, among others (see Table 2 in reference).

            Studies like this are crucial because they help health care professionals fix the right problems: the first step to solving an issue is to (1) talk with the people your intervention affects and (2) ask questions ask questions ask questions.  I also think that Lala’s article on reflexivity that we read a few weeks could come into play perfectly with this topic.  Stigma has unfortunately portrayed mental illnesses harshly and creates judgements in all of us.  With mental health especially it is important to address your own judgements and thoughts, put them aside, and focus on the issue and people.  On a global scale, these judgements can vary widely.  Again, before we plan an intervention it is important to talk with the people of the area we are working in, and realize that what worked for one country/town may not work for another.  Slowly but surely, I think we can defeat the barriers to mental health help-seeking.

Reference

Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BioMed Central Psychiatry, 10(1), 1.

Personality Traits and Health

Personality traits and health have long had an interesting and complex relationship.  Physicians and researchers have looked at how one influences the other.  The most common study is how personalities affect health.  It could be argued that health status can change personality as well, but there is little to no research done on this yet.  Shifren and Bauserman make the connection between personality traits leading to lifestyle choices (1996).  Individuals who have high scores in expressive and instrumental traits are more likely to have better health behaviors.  These include the use of more safety precautions and are less likely to smoke tobacco products.  It has also been shown that people who do not ask for medical assistance during ailments or injury are more likely to be susceptible to preventable illness and death.

In a more recent article, Bogg and Roberts evaluated personality traits as a psychological construct (2013).  Much of their research showed conscientiousness as an influential personality trait on health.  Conscientiousness is the personality trait related to being vigilant or careful.  People ranked with more conscientiousness personalities lived longer and had less disease risk.  These include indicators of pathology for diabetes, ulcers, strokes, high blood pressure, tuberculosis, and skin problems.  The most recent studies have been focusing on conscientiousness personalities and the handling of stress (Bogg & Roberts, 2013).  As we have discussed in previous conversations, stress can cause a tremendous number of health problems.  More conscientiousness leads to better coping and adaptive strategies for stress.  Because this is a fairly recent line of research, the correlation between health-related outcomes and conscientiousness for stress is lacking.  This being said, the initial findings warrant further attention.

The future of health and personality traits, at least according to Bogg and Roberts, is to co-develop health behaviors and conscientiousness.  The researchers believe that this will reduce the amount of morbidity and eventually mortality experienced by populations.

References:

• Bogg, T., & Roberts, B. W. (2013). The case for conscientiousness: Evidence and implications for a personality trait marker of health and longevity. Annals of Behavioral Medicine, 45(3), 278-88. doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1007/s12160-012-9454-6
• Shifren, K., & Bauserman, R. L. (1996). The relationship between instrumental and expressive traits, health behaviors, and perceived physical health. Sex Roles, 34(11-12), 841-864. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/225375107?accountid=13360