Saturday, April 27, 2013

Evaluation of the Program

                The intervention that will be used for the problem of diabetes in the African American community is basically providing residents with the opportunity to purchase healthy foods at grocery stores within. This will happen by use of different participation of certain institutions, mainly grocery stores, hospitals and clinics. In this intervention, patients can be referred to the program where they can trade in certain amounts of money for a certain amount of “healthy money” or vouchers that can be used in designated grocery stores that will participate in the program. In these stores, only certain items will be able to be purchased with the money, which will of course be healthier for the at risk or already diabetic patients. (Maybe patients can rack up points at the cash register that they report back to their doctors)
                To implement this intervention there would have to be cooperation of the hospitals, clinics and grocery stores that I plan to run the program in. For the beginning of the program there won’t be as many participant institutions until we have evaluated the program to ensure that it has been going as planned.  I suppose I would have to approach the heads of the hospitals in order to see if they are on board with the program and if they have to then ask their superiors. In addition to this, grocery stores would need to be approached as well. It would have to be taken into consideration whether the grocery store is public or privately owned. In addition to this, producers of the foods that are planned to be put on the list would have to be approached as well.
                Possible barriers, of course, include the fact that the stakeholders won’t agree to the plans. To overcome this, perhaps there could be incentives in place for the stakeholders so that they want to participate in the program. Also, there could be a barrier in exactly understanding how the regular currency will be traded in for representative money at grocery stores.
                A good way to communicate the program to stakeholders is to hand out pamphlets to residents in the communities to be targeted. It would be beneficial to actually get people who are at risk or already have diabetes within those communities to pass them out because others would be more persuaded rather than have outsiders handing them out. Putting up posters in common, popular spots would be helpful as well. In Baltimore, there are a variety of faiths and religions, so perhaps it would be helpful to hold information sessions or place posters inside of churches for example. To get other stakeholders like grocery stores and hospitals on board, data about the program and how we see the benefits of the program on patients, might persuade them, especially since these places are within the communities where these residents live.
Evaluating the program is next. One way to do this is to record the number of program participants and whether they are actually purchasing items using the vouchers and which items. Also there can be a count of the amount of patients that were recommended to the program and those that actually decided to enroll.  Some outcome measures that can be used are evaluating the patient’s attitude towards healthier food options and towards the program in general. There can also be a survey of patients and residents to see if they actually saw or heard about the program and that will show well the communication of the program’s existence is going. Also, doctors can track the patient’s health from the beginning of the program until a set amount of time enrolled in the program and see if the patient showed improvements over that time.

Saturday, April 20, 2013


A current intervention that addressed my problem that was tested focused on the idea that having one’s peers as a form of social support when dealing with chronic illness will actually improve and influence the behaviors of those who have the illness. For this study, they looked at background information about how this model worked in other situations and in other places, for example, for people with hypertension. The intervention that they implemented was used in west Baltimore city. Basically, they first recruited members of the community to become community health care case managers in their specific communities. They then trained these workers extensively about what the program entailed and about diabetes. These community healthcare workers made weekly in home visits and phone calls with patients. They did everything from helping the patients to keep their appointments to making sure they were taking their medications appropriately to monitoring for signs of complications. The key determinant they addressed was that there were increasing hospitalizations and emergency room visits for patients with diabetes who were on Medicaid.
                A possible strategy that identifies the issue of food deserts is to incorporate more farmers’ markets within these communities. By doing this, residents have more consistent access to quality, healthy foods. Perhaps these farmers markets should also be actively advertised within the communities and hold other attractions so that residents are more likely to attend. Maybe there’s something there for kids, which can then lead to the parent having to take the child to the event and indirectly will be susceptible to purchasing some of the produce.
                Another possible strategy is to provide incentives to patients who come in regularly for their checkups and for physicians who will agree to see these Medicaid patients. Such incentives could be pay bonuses for physicians and healthy meal vouchers at their local grocery store for the patients. This is just a way to get the diabetic patients in the hospital and seen by a professional that can track their progress and analyze if there are any potential complications in the future so that they can be reduced.  This addresses the issue of Baltimore residents being of low socioeconomic status and many are on some type of public health insurance.
                Lastly, because a large majority (over 70%) of residents in Baltimore are associated or affiliated with some type of religious group, perhaps it would be a good idea to get these institutions involved as well. For instances, churches can hold health fairs, sponsored screenings, or day-clinics to get their members to be aware of the statistics. Perhaps health professionals can enter these institutions and provide presentations on the epidemic that is present in the African American community. This is more of a primary method, aiming at educating Baltimoreans about diabetes and how to prevent the illness.


Intervention 1:
Food deserts
Intervention 2:

Intervention 3:





Cost effectiveness

Political acceptability

Social will

Potential for unintended risks

Potential for unintended benefits


The best intervention seems to be the first one based on the idea of food deserts. This scored the highest from the decision criteria, which all seemed appropriate for determining the best interventions. 

Friday, April 12, 2013

Possible Stakeholders...

There are several stakeholders that play a role within developing an intervention for diabetes in the African American community. It is important to recognize who the stakeholders are within the area that you plan to implement a program because those are the people who will have to be convinced or approached for support and resources in the event that the program you are implementing will affect them.
        Possible stakeholders include the population that obviously is going to be directly impacted: African Americans. Besides this, there are other organizations and persons to be considered. There can be food suppliers and grocery stores, local/state/government contracting and government budgets (fiscal analysts or those who control the budget of the area), health insurance companies, hospitals and physicians.
The beginnings of some possible interventions for this problem for example could be the development of more efficient grocery stores within urban areas to decrease the amount of food deserts. Stakeholders for this intervention include the local or state governments who have to make room in their budgets to build more grocery stores. They would also have to provide staff and training for these new stores. You would need the cooperation of those individuals who live in the area where the stores are planned to be built, especially in the case that residents might need to be displaced, unless the stores were built on vacant lots or other places. In this case, there may be opposition from the local governments, especially if there budget spending is limited and they would like to put the money they have towards other areas that they deem more necessary. This can be addressed by ensuring some type of payback towards the government for each grocery store that is established.
Another intervention is to provide more fresh and healthy foods for lower prices. Stakeholders in this intervention could be farmers and those who grow the produce, the companies who manufacture the produce, the stores that distribute and sell the produce, and even the government because of the decrease in profits (i.e. taxes) that will be incurred from the lower prices. There may be opposition from farmers because there income will be impacted by the lower costs. Perhaps there could be an incentive for farmers who participate in the intervention over a certain amount of time or how much of their products were purchased in consumer markets.
The stakeholders will obviously have many concerns about what the implementations might mean to them in the long run. For many of the stakeholders, the loss of money is a huge factor in whether they will comply or negotiate with the implementation plans. They may also be concerned about how their participation looks to other groups and organizations that they support. Even more important, they may be concerned about what they may gain from negotiating with the task force.

Saturday, April 6, 2013

All About Key Determinants

There has been increased prevalence of Diabetes among African Americans 18 years and older in the United States between 2002 -2010. There are a variety of key determinants that factor into this diabetes epidemic on many levels. Biological determinants include race,  gender, physical activity, and previous health-related problems such as obesity and hypertension.  Social and Cultural factors are things such as ethnicity, socioeconomic status, group norms (soul food, curvy women), daily lifestyle habits (working multiple jobs, not enough time to cook), education (being aware of healthier options), media influence, and social support. In addition to these are environmental determinants such as the distance to grocery stores, access to gyms, and quality of neighborhoods. Economic factors include the price of foods, medication costs, and employment status. There are also political determinants such as access to healthcare/quality of healthcare and even medication costs.
To analyze these determinants and see how much they contributed to the development of diabetes, many studies were done. The Food, Identity, and African-American Women With Type 2 Diabetes: An Anthropological Perspective analyzed the importance of food in African American culture and relationships, predominantly among women. They found that food was sort of a way to welcome others, and to show gratitude those who the food was given too felt they had to eat plenty. One interviewee stated that, “The old people that I work around, they show me they love me and really care for me, they feed me. They feed me a lot. They feed me like five times a day, not thinking, well, this child needs a balanced nutrition meal so he won’t get fat.” Other research was done on another basis as noted in Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration. Researchers interviewed African Americans in a systematic way which included questions from several different categories of ecological levels such as individual, relational, and environmental. As a result of these interview responses, they put together possible determinants of health. This included lack of social capital, political cronyism, poverty, racism, and local economy. Although this study does not particularly identify diabetes determinants, they can also be applied to this disease. Another study, Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention, focused on diabetes in the population of African Americans in Detroit, Michigan. Something they found was that the city had a higher rate of mortality from the disease than the state itself, (note: Detroit is predominantly African American).  They also identified that African American women were the least active and the most overweight among many groups and bridged a link between this and the development of type 2 diabetes. The researchers suggest that race-based residential segregation is one of the overarching issues that have a trickling effect down to the health disparities seen in the US.
There are many key determinants that contribute to the prevalence of diabetes among the African American community. I intend to identify those that relate to my problem definition through more research.
Liburd, Leandris C. "Diabetes Spectrum." Food, Identity, and African-American Women With Type 2 Diabetes: An Anthropological Perspective. American Diabetes Association, n.d. Web. 01 Apr. 2013.
Scott AJ, Wilson RF.  Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration. Rural and Remote Health 11: 1634. (Online) 2011.
Schulz, Amy J., Shannon Zenk, and Angela Odoms-Young. "Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention." PMC. American Journal of Public Health, Apr. 2005. Web. 01 Apr. 2013.

Friday, March 29, 2013

Diabetes in African American Communities

There has been increased prevalence of Diabetes among African Americans 18 year and older in the United States between 2002 -2010. Diabetes among the America is an important topic of discussion because it is predicted that the rates of the disease will increase as it is evident that more Americans are becoming obese. This disease is even more of an issue within the African American community being that despite being a minority within the US, the rates of diabetes within this group are almost 2 times more likely than non-Hispanic whites (Disease and African Americans).  Diabetes is 7th leading cause of death in Americans and the cause of major issues such as heart disease and stroke. Diabetes also is a contributing factor to other health problems like hypertension, kidney disease, blindness, and even limb amputations. The cost of diabetes related care is also reason to address this public health issue as healthcare spending is an important topic within US politics.
There are various avenues that can be assessed to determine why this health issue is occurring. Indicators, both indirect and direct, contribute to understanding the factors that play a role in diabetes among this group. According to the CDC’s 2003 National Fact Sheet, in 2002, “11.4% of all non-Hispanic blacks aged twenty years or older have diabetes.” In addition to this, the United States’ Diabetes Crisis among African Americans: Today and Future Trends reports that 5,547,700 of 40, 951, 000 (roughly 13.5%) African Americans had diabetes in 2010 and projected a growth to about 20% in 2025. From this data it is apparent that the trend of this disease is definitely increasing.  This data is strong evidence in that it also gives future predictions if actions are not taken against combating this disease.
In today’s American society and culture, life is moving by fast. It’s no doubt that there is only so much time in the day, and with adults having such busy lives they may have to make decisions that can later on impact their health. There are many players that can greatly affect the non-healthy choices that are made that can cause diabetes. Social culture and education all indicate the trend of diabetes in the African American community. The idea of “Soul Food” has long been embedded in the lifestyles of many African Americans. This food, although is just a heavenly taste, is not particularly nutritious because of the way that it may be prepared. A study of African Americans in California showed that fast food restaurants were most preferred among eat out dining options at 29% (Cowling 2). Although the data is a strong inclination of poor diet options, the data was self-reported and may have included bias. Not only does food choice factor into the big picture, but education levels perhaps. In a press release by the CDC, it was noted that, “2007-2010, women 25 years of age and over with less than a bachelor’s degree were more likely to be obese (39 percent-43 percent)” (Press Release). This is just one statistic that shows that those who are less educated are more likely to be obese. Obesity is on the road to diabetes. Other factors that can be evaluated include socioeconomic status, fast food restaurant density within urban communities, unemployment rates, food deserts, obesity, prices of healthy food versus unhealthy food, family history and access to healthcare prior to diagnosis.
"Press Release." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 May 2012. Web. 28 Mar. 2013
"2003 National Diabetes Fact Sheet." Centers for Disease Control and Prevention. N.p., 20 May 2011. Web. 27 Mar. 2013.
"Diabetes and African Americans." The Office of Minority Health. US Department of Health and Human Services, 28 Aug. 2012. Web. 30 Mar. 2013.

"United States’ Diabetes Crisis among African Americans: Today and Future Trends."Institute for Alternative Futures. Institute for Alternative Futures, 2011. Web. 30 Mar. 2013.

Cowling, Linda L. Health and Dietary Issues Affecting African AmericansCalifornia Food Guide: Fulfilling the Dietary Guidelines for Americans. N.p.: n.p., n.d. 1-2.California Department of Healthcare Services. California Department of Healthcare Services, 20 Sept. 2006. Web. 25 Mar. 2013.

Friday, March 8, 2013

Problem Definition: Childhood Depression

Children and teenagers face many new changes throughout their lives during those times of growth and exploration. In the United States there has been an increase in rates of depression in teenagers between 12-17 years old from 2004-2009.
                Childhood depression is an especially relevant problem. For one, these children eventually grow up to become adults that have to live and be able to function in a fast-paced world. Therefore, it is important to address mental health problems such as this in children early so that they can be treated. In addition, depression can also be the cause of or go hand in hand with other health problems. Children with depression can suffer socially as well as physically and mentally. Socially, children who suffer from depression tend to withdraw from situations and people. They also may become moody or indulge in negative behaviors such as drugs and risky behaviors. It may also be difficult for them to express their feelings or emotions. One of the correlations is that depression is also linked to suicide. Depressed children may begin having thoughts related to death because of their low-self-esteem and may often seem hopeless and alone. Relating this to public health, prevention of mental health diseases can ultimately help prevent these unfortunate and untimely deaths.
                This topic is very interesting because depression in children can sometimes go by under the radar. It is important for parents to observe their children and be able to see symptoms and act on them promptly. I would like to investigate how depression even begins and how it is diagnosed. I would also like to understand why it is occurring at faster rates and due to what factors whether it be because of the media, school pressures, or things like sudden life changes and being immersed in different environments. Because depression in children once was not seen as common place, or the children’s behaviors was just disregarded as being moody, seeing how depression was actually expanded to including children is also really interesting.
                Childhood depression is socially relevant in that it affects a very important and vulnerable part of the population. As a child it may be difficult to cope with everything that it is occurring in your life. When others understand and respond appropriately, they can make the situation better instead of making it worse. In addition to this, the mindset of society, with the media, name brands, and the notion that it’s better to be cool and popular, feeds into behaviors such as bullying. If I remember correctly, in school kids were relentless, but they are not fully aware that their behavior can impact someone else so negatively. Treatment and pressures like this are taxing on adults, much less on the minds of children who are constantly learning and trying to find themselves.
                All in all, it is essential that the cause of this trend is identified so that measures can be taken to sufficiently decrease these cases of depression. Seeing that depression can cause other health problems, preventing this mental illness can then aid in the prevention of others perhaps.

Friday, March 1, 2013


                The movie Contagion is about a pandemic that began at one source and then quickly spread to other people in many countries. The movie covers an array of topics about what could happen if a situation like this was made a reality. Many people were quarantined and dying because the disease was spreading quicker than the CDC and other medical personnel could develop a vaccine to combat it. As the outbreak continues to spread and a drug was developed that could contain the virus, human civilization begins to break down as people were driven to loot and riot. Vaccines are given out via lottery and slowly civilization returns. At the end we realize that the virus came originally came from a bat which transferred it to a pig, then to a chef who then gave it to Beth where it all began. In relation to public health, I feel like this movie captures in its allotted time, the essence of what the goal of public health is. Prevention of diseases and containing them, among other things, is the purpose of the field and if something as drastic as what occurred in the movie happens, I suppose we can expect to see everything and every aspect in full action.
                Many concepts from class relate to and are shown in the movie. Outbreaks are defined as a disease that occurs in great numbers than expected within a community. An outbreak can occur and spread just as rapidly as it happened in the movie. It depends on the disease that you are dealing with. The outbreak investigation involved tracking down where the pandemic started and projecting the amounts of people that may become infected and over what period of time can it be expected to see these occur. Also, developing a solution for the virus and then approximating the amount of time that it can be expected for the vaccination to be verified and then ready for disbursement to the public is also important. Isolation involves separating sick people from others in the case that they may spread the illness to others. This occurs in the movie when many of those who had the illness were placed together. Also, many people in the public isolated themselves from others in order to protect their own health. The concept of quarantine is different in that it separates those people who may have been exposed to a disease, but have not yet showed symptoms of being ill. This also relates to the movie in the sense that everyone who was thought to be infected was purposely set apart from the rest of the population. Quarantine is essential in taking preventative measures against increasing infections and death toll rates.
                Since 9/11 the possibilities for non-conventional ways to spread terrorism has become a realization. The use of biological weapons has become a factor in the way the U.S. prepares for future threats. In the movie, public health agencies could have been better prepared if they had better communication, not only between them, but with how they informed the public. I understand that they did not want to cause panic, but the people also deserve to know what they are up against and how to protect themselves. Also, because the world had never seen anything like the pandemic in the movie, they weren't prepared to effectively prevent the spread of the disease and identify it and its origins. There also should have been better protocols in place for worst case scenarios where a disease spreads uncontrollably.

Friday, February 22, 2013

Affordable and Quality Health Care in the U.S.: Is it Possible?

This week’s assignment was to watch a documentary called US Health Care: The Good News. The documentary highlighted the problems within the U.S. Health Care System. Despite the United States being the richest and most industrialized country, it still has not provided health care for all of its citizens like other countries. The documentary focused on the Dartmouth Atlas Project that sought to provide examples in various towns and places in the U.S. like Seattle and Colorado that adapted practices within the medical system that developed affordable and quality health care by using innovative techniques. They found what worked in each of the towns and believed that these places ultimately could be models for the U.S. Health Care System.
I believe access to health care should be a right because everyone’s health is essential. In the country where you live I think it is a community duty to provide health care to everyone in that community. I do agree that, yes, people should be responsible for their own health, but also that others should play a role in the health of those people who are not qualified or as well versed and can’t provide that care for themselves. It just seems wrong to neglect or deny others health care just because they are poor or have some other inconvenience, especially because they may actually need it the most. I just believe there should be some type of balance within the system that lowers prices so that everyone has the same opportunity for quality health care.
During the video, a variety of towns were visited where the health care in those towns were not only affordable, but quality. Grand Junction, Colorado was revered as a model for the U.S. Health Care System. The town was one where it had 100,000 of the lowest medical cost in the United States. I thought it was really interesting how some of the doctors’ pay would be withheld until the end of the year and depending on whether they performed well would determine if they received a portion or all of that pay back. It takes some really dedicated doctors and self-responsibility to be able to limit one’s personal gain for the betterment of others. In addition to this, in Seattle, Washington, it was interesting how the hospital was consumer owned. They were very innovative in using electronic records instead of files which allowed patients to have more access to their own medical records. In the town of Everett, Washington, they began to use generic drugs to help cut down on overall costs. That was very important because these drugs basically contained the same ingredients. Lastly, in Hitchcock, Dartmouth, it was really innovative to allow the patients to be a part of their treatment choices because, after all, they will be the ones having to live with the surgeries and medications they undergo.
The medical care models in the video could be duplicated in my neighborhood and town. I just think there just needs to be the right people to initiate it and then diligent, dedicated physicians to follow through with it. There are many reasons why it has not happened yet. Perhaps physicians may want to continue earning the pay that they currently make and don’t want to see a dive. In addition to that, there just needs to be cooperation from all aspects. Getting many people to agree can be highly difficult because everyone has different motives and agendas, personal or otherwise. 

Friday, February 15, 2013

Vaccinations- Beneficial or Unnecessary

The video was about the ongoing controversy about the importance of vaccinations. Many people, mainly parents, are apprehensive about vaccinations and are also concerned that they may cause diseases and are actually more harmful than they are helpful. There are advocates and health care professionals who push the idea that vaccines are one of the best conventions of the modern world. They marvel at the idea and the ability to prevent diseases and epidemics that were once commonplace. On the other hand, there are people who view vaccinations as a threat. The public has become concerned with the side effects of these vaccines. One proposed side effect is Autism. There were many cases of parents who claimed that the MMR shot caused their children to regress and become Autistic. The health community argues that there was no evidence to support this claim, and yet people still believe it.  Older physicians know firsthand about the diseases that modern medicine has cured and think that the younger generations don’t appreciate these advances in medicine because they have not lived to experience them, nor do they know how quickly these diseases can spread.
Personally, I have never thought that vaccinations were harmful. I’ve always thought that the benefits outweighed the hazards. There were times when the thought might have come up that, “what if this shot will actually do me more harm than good?” I understand how parents can be concerned about the side effects of the vaccines, but I also think that they should keep in mind that the physicians and other health care professionals have the public’s best interest in mind. These people may also have children, so they have two reasons to try and fight these diseases that have caused epidemics in the past.
Herd Immunity is the notion that the more people in an area that have been vaccinated and therefore immune to a disease in a community, the less likely an outbreak will occur and spread in the case that there is an infectious person. This is directly related to the public health notion of vaccinations because the only way to get a community of immune people is for those people to actually have been vaccinated. Vaccinations are different from other personal health decisions because without them, a person has the ability and potential to infect an entire population. With the possibility to eradicate diseases, the cooperation of the public is necessary. With behaviors like exercise or diet, a person is only effecting themselves. In addition, I think the child’s parents are responsible for the health of their children. But I also strongly agree that they should recognize the risks that go along with their choices not to vaccinate. They should understand that they are not only putting their children at risk, but other people’s children as well. And as a parent who deeply cares for the health of your child, how could you not relate to the woes and concerns of other parents as well?
                There are many reasons why a child might not receive their recommended amount of immunizations. The parents are concerned that these vaccines contain harmful chemicals. With the internet, parents have access to cases where the vaccines have gone wrong. Parents also may think that physicians don’t offer them a choice to be vaccinated and view it as routine and necessary. Parents don’t understand the facts and the research that goes into prevention of epidemics, so they don’t have that information to base their decisions on because they aren't scientists.
                To increase vaccination rates I would present more evidence to the population that shows that these vaccinations do indeed do more good than harm. I would explain that there are rare cases where things may go wrong. Show them that yes it can happen, but the likelihood of that occurrence is less than if one does not get the shot at all and is vulnerable to disease. I think it would also be good to push the fact that world and international travel has reached highs like never before. With other countries less fortunate than the U.S., these diseases are actually a reality and a regular occurrence.  If people know that there are always people traveling and the ease with which it is to spread germs, they will be more aware that just because they think they are safe within their neighborhood or town, that doesn't mean others can’t come in. It would also be a good idea for the health care system not to seem so demanding or insensitive despite the good intentions of their measures. Perhaps there also may need to better policies in place as well.

Saturday, February 9, 2013

Non-smoking Wives and Lung Cancer

The effects of second-hand smoke on the development of lung cancer have long been a topic of interest in the health field. A study, Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan, by Takeshi Hirayama, interviewed and followed over 250, 000 adults in 29 health centers and 6 prefectures across Japan. Of these, 91, 540 wives were followed for 14 years. Throughout this time the wives and their husbands were asked independently about their daily lifestyle habits. In the study they also categorized the participants by age and how many cigarettes they smoked a day. They also tested if the husbands'other habits impacted the wives' health such as alcohol and found that they did not. They also identified other variables that could have an impact on the development of the disease such as urban and agricultural factors. The study found that mortality increased up to twofold and those couples who lived in rural areas were more likely to have lung cancer because they were more likely to be around each other more often.

This study was very interesting because Japan seemed like an ideal place to do the study seeing that only 15% of the women smoke while 73% of the men did.  Accurate results could be expected because the study was conducted over an extended amount of time because the researchers actually followed these people for 14 years. This study proved significant because it proposed a link between non-smokers and lung cancer rather than what might have been expected which is that direct smokers would have lung cancer. It also produced evidence that supported their claim. I think it was interesting that they defined the category of non-smokers by breaking them into groups of rural and urban couples to further analyze. I thought it was important that they also tried to find links between smoking and other diseases that others might propose to counteract their findings.

The advantage of using the type of study design used here is that the data was based on real people’s lifestyles and not simulations. Also, because one is following around the same couples for an extended period of time, the data collected is coherent and consistent. They did not require the participants to alter their behaviors which lessened the likelihood that they would drop out or alter their responses.

The study seemed effective because it made use of a population where the amount of male smokers in Japan greatly overcomes the population of female smokers. The fact that the lung cancer rates in both groups were similar showed that some other factor besides direct smoking could have impacted the women’s chances of developing the disease. Of course, there could be other factors that could have been observed like food and family history and housing and working environments. The study included a large number of participants, one of the ways to ensure a cause and effect relationship. A problem that could be presented is that although this was cohort study, and they did not make people change their lifestyle behaviors, they still could have received false information as a result of recall and report bias. For instance, a husband might not report exactly how many cigarettes they have had in a day because they do not want to seem like too much of a heavy smoker. In addition to this, they had to make sure there was an absence of confounding variables by trying to relate other habits to lung cancer.  I think the study overall was a good study because it was like a foundation for future findings that we know of today that allow us to be more careful of the habits of people we are around and the environments we are in.

Saturday, February 2, 2013

Binge Drinking Among Adult Women and Underage Girls

The article titled, “Vital Signs: Binge Drinking Among Women and High School Girls — United States, 2011”, provides information and statistics about female alcohol users and binge drinkers. There were two surveys conducted that focused on either adult women or high school girls. The first is CDC’s telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) and the second is CDC’s Youth Risk Behavior Surveillance System (YRBS). Both methods include all 50 states and DC and produce results that quantify the number of those who participate in binge drinking, the frequency at which they drank, and the intensity of the drinking on those occasions. Each group was also analyzed further by categorizing them based on age and ethnicity. The BRFSS reported that binge drinking was most common among women between the ages of 18-24 with 24.2% of the 12.5% that was found to be the prevalence of binge drinking. The YRBS reported that the prevalence among high school girls was 37.9%. Overall, binge drinking was more common among adult women who also drank more frequently and more on those occasions. It was also concluded that the wealthier a person was ($75,000 or more) the more likely they were to binge drink. So, if someone binge drank they are likely to do so more often and consume a large amount at that time. Factors that make women more subject to alcohol exposure are the pricing, marketing, and availability of alcohol. Even more, the article states five limitations in the report that could skew the outcome of the data such as bias as a result of self-reported data, underrepresented portions of the population, low response rates, youth who do not attend school, and the definition of how many drinks actually count as binge drinking. Furthermore, the article presented advice for decreasing the prevalence of alcohol use in women.
Public Health has everything to do with preventing and controlling disease. Binge drinking and excessive alcohol use does, in fact, affect the health of the population. The risk factors of binge drinking such as unintended pregnancies, deaths, diseases, and injuries directly relate to the mission of public health. It is important for people in this profession to understand alcohol use and analyze data to be able to successfully prevent diseases and health problems associated with this behavior such as liver disease and hypertension. It is important to recognize the harmful effects of alcohol despite the fact that it is glorified in the media.
It was surprising that the statistics for alcohol use in women was similar for underage girls despite the age difference. In addition to this, it never appeared to me that underage girls were more exposed to alcohol relative to women than for underage boys relative to men. I just assumed that men and boys would be heavier alcohol consumers in today’s society. An issue with the accuracy of the self-report data may be that some people may falsify some information they provide on the survey because they do not want to appear to be heavy drinkers.
            The prevalence of binge drinking among high school and college students can be reduced by taking certain measures. Encouraging parents to monitor their children’s actions and developing alcohol education programs inside and outside of schools can greatly impact the choices that they make. Also, stricter policies can be put in place that discourage excessive alcohol consumption. In the incident that the laws are violated, tougher consequences can also be put in place for those who commit misdemeanors.