Category Archives: Public Health

Parental Obesity and New Mentality: Raising the Risk of Child Obesity

Our nation’s most urgent health problem is the disparities in health care. There are stark disparities in health by gender and socioeconomic status. According to Davis et al. (2005), “the social and community environments affect health directly as well as indirectly by influencing behavior”(p. 2168). Which group do we put parents who have a distorted perception of their child’s body size? This phenomenon is most prevalent among low-income women and Hispanic mothers. But regardless of race or socioeconomic background, the obesity epidemic is eroding the general impression of what healthy looks like. What if obese is the new normal? If obese is the new normal, then it will be our failure as Public Health professionals to emphasize the importance of the role of parents and family to combat child obesity. Parents should play a crucial role in influencing children’s food habits and physical activity. Parental obesity may increase the risk of a child becoming obese. Wrotniak et al. (2004) is the first study to examine the incremental effects of parental weight change on child weight change while controlling for variables that influence child weight loss. The study stated that youth benefit the most from parents who lose the most weight in family-based behavioral treatments (Wrotniak et al., 2004, p. 342).

The prevalence of obesity is increasing in all pediatric age groups according to the Health and Nutrition Examination Survey (NHANES). Genetics, environment, metabolism, lifestyle, and eating habits are among the factors believed to play a role in the development of obesity. More than 90% of cases are idiopathic; less than 10% are associated with hormonal or genetic causes. Hirschler et al. (2008) found an association between mothers’ distorted perception of their children’s shape and eating habits and mothers’ obesity and their children’s overweight. The study provides clues for obesity prevention programs. There is a multitude of health problems that are associated with obesity. Without dealing with the new trend of maternally distorted perception of their child’s body size, health problems faced by family care physicians will continue to rise. There will be continued prevalence of obesity associated diseases such as type 2 diabetes and heart disease to hyperlipidemia, asthma, and obstructive sleep apnea. According to Friedman & Schwartz (2008), “A key concept in developing obesity-related policies is creating ‘optimal defaults’17. When there is an optimal default, the health promoting behaviors are those that come most easily, require the least effort or thought, and offer a more healthful option” (p.718).

References

JAMA Network | JAMA Pediatrics | Parent Weight Change as a … (n.d.). Retrieved from http://archpedi.jamanetwork.com/article.aspx?articleid=485676

Hirschler, V., Calcagno M., Clemente A., Aranda C., Gonzalez, C. (2008, July 21). Association between school children’s overweight and maternal obesity and perception of      their children’s weight status. Journal Pediatric Endocrinololgy & Metabolism. 7:641-9.

Cohen, L., Chavez, V., Chehimi, S. (2010). Achieving Health Equity and Social Justice. L. Liburd & W. Giles, Prevention is Primary (pp. 33-53). San Francisco: Jossey-            Bass.

Friedman, R., & Schwartz, M. (2008). Public Policy to Prevent Childhood Obesity, and the Role of Pediatric Endocrinologists.Journal of Pediatric Endocrinology &                    Metabolism, 21, 717-725.

A Health Strategy on the Reduction of Inequalities: Not a Utopian Fantasy

          As social inequalities in health in the U.S. and international evidence continue to increase, disparities in income and wealth widened the gap making social class as a key determinant of population health. The gap is widening between upper-middle-class Americans and middle class Americans. Health and longevity are determined by the access of advances in medicine and disease prevention. These benefits are disproportionately delivered to individuals who have more education, connections, money, and good jobs. They are the ones in the best position to learn new information early, modify their behavior, take advantage of the latest treatments and have the cost covered by insurance. Since 1911, mortality statistics in Britain have consistently shown an inverse relation between measures of socio-economic status and mortality. While social class has been a less popular topic in the United States, this has been a trend in Europe since George III. Socio-economic disparities in mortality statistics have been increasing both in the U.S. and Britain, despite an overall decline in death rates. It is almost universally the case that the social class, the combination of income, education, occupation and wealth, plays a pivotal role in defining an individual’s ability to change their lives and shaped the odds of getting better. In Europe, people in lower economic class have more morbidity and disability and have shorter lives. Like the U.S., European countries’ immigrant workers and long term unemployed are increasingly isolated from the rest of society.  It is not a Utopian fantasy to develop a health strategy that include reduction in inequalities. Health inequalities vary between countries, thereby it is not a fixed magnitude. Marmot et al. study (1997) stated “material deprivation plays an important role in generating inequalities in health. At a threshold above absolute deprivation, other factors may be more important in generating relative differences in health. If we are to appeal to the concept of relative deprivation, this implies the operation of psycho-social factors related to the position in the hierarchy.”

         There are four major models used to describe social class in health. Life-course, psycho-social, and materialist model are the models that could best explain the relationship of social class and the health outcome of early medical care. Life-course model explains social class inequalities rooted from what happened to a child in-utero and early childhood. Poor home condition overtime is the predominant causation of occupational disadvantage. Psycho-social model explains the effect of social inequality to body chemistry. Stressful social circumstances produce emotional responses which bring about biological changes, thereby increasing the risk of heart disease. Plethora of socio-economic challenges tends to discourage individual to seek early medical intervention.  Materialist model pertains to economic factors in relation to the individual’s environment, such as air-pollution and substandard housing conditions. Studies show a higher rate of childhood respiratory disease in damp housing. Bartley & Blane (2008) noted the fourth model-behavioral model in reference to the Whitehall 1967 study.  The Whitehall study found that differences in health behavior explain only one-third of social class differences in mortality. Evaluations of interventions that seek to change health behaviors have rarely found clear-cut improvements in health.

References

Poverty, Ill Health and Health Care Expenditure – Scribd. (n.d.). Retrieved from http://www.scribd.com/doc/42351361/Poverty-Ill-Health-and-Health-Care-Expenditure

Inequalities in the distribution of health and health care … (n.d.). Retrieved from http://healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-ec

onomics/4c-equality-equity-policy/inequalities-distribution

A Focus on Resilience: Children during Marital Transition

Resilience is very important in order to establish positive adaptation during marital transition. Divorce and remarriage involve a complex series of changes that can affect all aspects of family relationships. In attempts to recapture normalcy after marital separation, the feelings of hurt and pain, sadness and anger are particularly intense among children and parents. Counselling will provide the basic foundation needed and the ability to face adversity or risks, easing the challenges confronting members of families in transition.  Based on the significant body of research, most children adequately adjust to dramatic changes such as emotional distress, psychological confusion, and relationship strain. The experience of children of divorce eventually meets the criteria of Garmezy’s definition of resilience “the maintenance of competent functioning despite an interfering emotionality” (1991, p. 466).

Discussion

          Longitudinal research on prevention shows that communication problems and destructive marital conflict are among the leading risk factors for future divorce and marital distress. The effects of divorce and marital distress caused by destructive conflict are passed on to spouses and children. According to Stanley et al. (1995), longitudinal studies have found that destructive patterns such as invalidation, withdrawal, pursuit-withdrawal and negative interpretation undermine marital happiness.   The success of marriage is undermined by the active erosion of love, sexual attraction, friendship, trust, and commitment. Over 6 million children of divorce are growing up, and the study of specific mental health issue should be encouraged among current and future public health practitioners. The study will be instrumental in the development of variety of approaches that will deal with both normal and disturbed children, focusing on the immediate and future impact.

Conclusion

          Many children hold inappropriate feelings of responsibility for their parents’ continuing relationship, and misunderstandings about the reasons for divorce. Children’s relationship to nonresidential parents, most commonly their fathers, often grow distant and inconsistent after separation and overtime. Parents should realize that the victims of marital transition are the children. A source of chronic distress for children are anger and conflict before, during and after the divorce. Single or joint parenting can become unstable as one or both parents struggle with their own burdens such as the adverse economic consequences of divorce.

References

Garmezy, N. (1991). Resilience in children’s adaptation to negative life events and stressed environments.  Pediatric Annals, 20, 459–466.

Haggerty, R., Sherrod, L. & Garmezy, N. (1996). Parenting divorce and children’s wellbeing: A focus on resilience. Stress, Risks, and Resilience in Children and Adolescents:     Processes, Mechanisms, and Interventions. Cambridge, United Kingdom: Cambridge University Press.

Stanley, S., Markman, H, St. Peters, M & Leber, B. (1995). Strengthening Marriages and Preventing Divorce-New Directions in Prevention Research.  Family Relations, 44, 392-401.

McDermott, J. (1970). Divorce and its psychiatric sequelae in Children. Arch Gen Psychiatry, 23 (5), 421-427. : 10.1001/archpsyc.1970.01750050037006.

Prostate Cancer Screening for Early Detection and Treatment

 

Prostate Cancer Screening for Early Detection and Treatment.

Prostate Cancer Screening for Early Detection and Treatment

In 2003, there were approximately 220,900 diagnosed cases and 28,900 recorded deaths from prostate cancer in the United States. These statistics shows that prostate cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer death. The public health importance of cancer prevention and treatment will rise as they increasingly contribute to the overall cancer burden. Prostate cancer is the second leading cause of male cancer-related death in the United States. The etiology of the prostate cancer is still unknown despite the substantial studies on morbidity and mortality. Despite the current belief that the prevalence of latent microscopic prostate tumors in most populations is similar, several epidemiologic observation shows very large differences in incidence rates among racial/ethnic groups. The 2001 study of Hsing & Devesa suggested that dietary fats, obesity, and sexual factors may be associated with increased prostate cancer risk in certain population. Continued monitoring of prostate cancer incidence and trends will encourage prostate cancer screening for early detection and treatment.

Reference

Bradley, L. A., Palomaki, G., Gutman, S., Samson, D. J., & Aronson, N. (2013). PCA3 Testing for the Diagnosis and Management of Prostate Cancer.

Hsing, A. W., & Devesa, S. S. (2001). Trends and patterns of prostate cancer: what do they suggest? Epidemiologic reviews23(1), 3-13.

Labilles, U. (2013). “Bone Metastases in Prostate Cancer” A Cross-Sectional Study. (Unpublished, PUBH-8155-3. Research in Public Health. 2013 Fall Qtr. WK11Assgn) Walden University, Minneapolis.

Li, J., Djenaba, J. A., Soman, A., Rim, S. H., & Master, V. A. (2012). Recent Trends in Prostate Cancer Incidence by Age, Cancer Stage, and Grade, the United States, 2001–2007. Prostate cancer2012.

O.N.E.—One Nation’s Echo | One

Community-based Participatory Research (CBPR) and Campaign on Early Prostate Cancer Screening

prostate health

Integral to a community organization and community building is community-based participatory research (CBPR) that gives researchers the opportunity to identify and address health policy questions at the local level. The theory which is relevant in my campaign for early screening of prostate cancer is ecological system perspective that will focus on the organization and technological forces that could help educate the target population on the management and development of the disease. Globally, cancer is the second leading cause of death, and it is essential for public health oncology to develop interventions to combat mortality and case burden successfully. In addition to the CBPR’s mechanism to increase the ability of health service researchers to impact health by motivating and supporting community partners to participate directly in the research process, and gives academic researchers access to local data. It also enhances interpretation of research findings through understanding of local context, and provides a natural infrastructure for affecting local policy through its community partners. Bridging partnership between academic researchers and community members will help identify the best approach to educate the target population on the potential benefits of early screening. Rimer, Briss, Zeller, Chan & Woolf (2004) stated that considering the complexity of issues regarding prostate cancer screening, experts recommend that men receive support in making informed decisions. This 2004 study of Rimer et al. further noted that competing clinical demands and the challenge of providing sufficient information to support decision making present important barriers to having this decision.

How far can we go to maximize the population’s uptake of screening? Woloshin, Schwartz, Black & Kramer, B. S. (2012) noted that one obvious approach was to use powerful tools of persuasion such as fear, guilt, and a sense of personal responsibility. Vulnerability can be induced by emphasizing the risk of the target population by framing statistics to provoke alarm, and then introduce hope by exaggerating the benefit of the intervention. These said, it is important for public health professionals to stay within the ethical boundary of the information campaign by increasing the awareness of screening’s benefits and risks so as to encourage informed personal decisions. Early prostate cancer screening with prostate-specific antigen (PSA) is controversial because it is not clear whether it reduces mortality and whether the potential benefits of screening and early detection outweigh the risks (Chan et al., 2003). The study added that a public health campaign could begin with a rationale for informed decision making by highlighting that regular prostate cancer screening with PSA may or will not reduce mortality. It is important to develop different strategies for different cultures and educational levels. Increased participation of patients may be required in informed decision making as technology improves in the detection of the disease at an earlier stage. This argument includes public health genomics, and the future of personalized prevention. Pashayan et al. (2013) stated that a risk-tailored screening program should first address the organizational and ethical, legal and social issues and commit to public engagement and education and to work with the health professionals delivering the program.

References

Braddock III, C. H., Edwards, K. A., Hasenberg, N. M., Laidley, T. L., & Levinson, W. (1999). Informed decision making in outpatient practice. JAMA: The Journal of the American Medical Association282(24), 2313-2320.

Chan, E. C., Vernon, S. W., O’Donnell, F. T., Ahn, C., Greisinger, A., & Aga, D. W. (2003). Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message? American Journal of Public Health, 93(5), 779-785.

Glanz, K., Rimer, B., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice, 4th Edition, 4th Edition. Jossey-Bass, VitalBook.

Hoffman, R. M. (2011). Screening for prostate cancer. New England Journal of Medicine365(21), 2013-2019.

Love, R. R., Ginsburg, O. M., & Coleman, C. N. (2012). Public health oncology: a framework for progress in low-and middle-income countries. Annals of oncology, 23(12), 3040-3045.

O’Brien, M. J., & Whitaker, R. C. (2011). The role of community-based participatory research to inform local health policy: A case study. Journal of general internal medicine26(12), 1498-1501.

Pashayan, N., Hall, A., Chowdhury, S., Dent, T., Pharoah, P. D. P., & Burton, H. (2013). Public health genomics and personalized prevention: lessons from the COGS project. Journal of internal medicine274(5), 451-456.

Rimer, B. K., Briss, P. A., Zeller, P. K., Chan, E. C., & Woolf, S. H. (2004). Informed decision making: what is its role in cancer screening? Cancer, 101(S5), 1214-1228.

Woloshin, S., Schwartz, L. M., Black, W. C., & Kramer, B. S. (2012). Cancer screening campaigns—getting past uninformative persuasion. New England Journal of Medicine367(18), 1677-1679.

 

Early Prostate Cancer Screening

Prostate cancer is the second leading cause of male cancer-related death in the United States. The etiology of the prostate cancer is still unknown, and according to the 2001 study of Hsing & Devesa suggested that dietary fats, obesity, and sexual factors may be associated with increased prostate cancer risk in certain population. Increased risk to develop PCa morbidity are found to be common among a large group of men who delayed re-screening for seven or eight years. There should be continued dissemination of information regarding early screening and its association with the reduce mortality from PCa. Prostate specific antigen (PSA) concentration can predict long term risk of PCa metastasis or death.

Tweet the Fight on “Childhood Obesity” Hashtag #onechobesity

Reversing the childhood obesity epidemic will not be achieved until there is a change in societal norms which may require a new approach to improve child health. The progress toward the goal of effective, sustainable child obesity prevention strategies are dependent upon strengthening current approaches to add a component that addresses pregnancy onward. It is essential to alter early-life systems that promote intergenerational transmission of obesity that will intercept or stop the continuing cycle of the obesity epidemic. It was widely understood that the epidemic was caused by changes in children’s environments, Whitaker (2011) found that the expression of obesity genes can be altered by the environment. The study also found that obesity is caused by both overeating and inactivity. Other causes of obesity which are complimentary are the amount and type of food people eat, individual and group behavior, household and community factors, free choice and constraints on those choices, and poverty and affluence. Multiple causes of social origin are increasingly recognized to be related in childhood obesity which needs to be addressed with collective actions. Innovative multifactorial approach such as the “Let’s Move” campaign unveiled almost four years ago by First Lady Michelle Obama has the potential for altering the course of childhood obesity. Early intervention programs have higher overall impact on reversing the childhood obesity epidemic than health services focusing on health conditions associated with the disease. “Let’s Move” and “One Nation’s Echo (O.N.E.)” are examples of innovative strategies that will promote behavioral and social change.
References
Nader, P. R., Huang, T. T. K., Gahagan, S., Kumanyika, S., Hammond, R. A., & Christoffel, K. K. (2012). Next steps in obesity prevention: altering early life systems to support healthy parents, infants, and toddlers. Childhood Obesity (Formerly Obesity and Weight Management), 8(3), 195-204.
Whitaker, R. C. (2011). The childhood obesity epidemic: lessons for preventing socially determined health conditions. Archives of pediatrics & adolescent medicine, 165(11), 973.