Tag 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

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.

Preventive and Curative Health Care Services: Integrating Cultural Health Capital

Critical to improving the health of the US population is expanding the role of primary care in the prevention and treatment of childhood obesity. Providers can improve prevention and treatment through efforts in clinical and community setting, healthy lifestyle promotion, community health education, policy advocacy, weight status assessment and monitoring, clinic infrastructure development, and multi sector community initiatives. Coordinated and collective efforts in multiple sectors and settings are needed to address high prevalence of childhood obesity. There is a recognized need to expand the role of primary care to include advocacy in addition to traditional measurement of patients’ heights and weights to assess growth. It is important to identify successful models that integrate primary care, public health, and community-based efforts to accelerate progress in childhood obesity prevention. Vine, Hargreaves, Briefel & Orfield (2013) stated that based on 96 peer-reviewed articles published between 2005 to 2012, primary care providers (PCPs) are increasingly being included in childhood obesity interventions which is consistent with current recommendations from scientific and professional organizations. Being the critical stages of growth and healthy lifestyle development, prenatal and childhood periods need new strategies that encompass more than individual-level behavior change and post-assessment treatment. Well-child visits is the best timing to counsel parents about healthy lifestyle, mold healthy behaviors and refer families to community resources. It is necessary to stress the importance of PCPs to take on the role as educators, promoters of healthy lifestyle practices, and advocates in the broader community on treatment and intervention initiatives. Incorporating curative health services into broader population health is in essence within the scope of universal health coverage (UHC). Built on the 1978 Declaration of Alma Ata, Rodin (2013) stated that UHC movement reaffirmed that health is a human right and identified primary healthcare as the means for attaining “health for all” (p. 710). Transitioning towards UHC, it is necessary for government leaders and policy makers to take into consideration the unique health needs of women. It is important for policy makers to understand the biological and gender-based differences to successfully incorporate women’s needs into UHC schemes. The social protection schemes that cover women’s preventive services and curative services should seek to eliminate or at least reduce out-of-pocket spending on health and to remove the formidable financial barriers that prevent more women than men from accessing needed services (Rodin, 2013). The success or the efficient performance of UHC systems will be dependent upon the stakeholders’ focus on persistent differences between men and women’s health risks, health status, and access to service. Systematically including women’s health needs during the planning process of UHC will not only improve women’s empowerment, but also economic development.

Linguistic facility is a cultural health capital element that could be improved in order to understand, recognized and increase access to care for cultural and linguistic minorities utilizing ethnicity-specific subsystems of care. To create an organizational development model for ethnicity-specific health care organizations and infrastructures, it is useful to consider the historical experiences of the Chinese community in San Francisco. This model includes the development and recruitment of bicultural and bilingual healthcare workforce which will induce satisfying engagements between the target population and health professionals. The other stages in the development of this model are structuring health care resources for maximum accessibility, expanding health care organizations, and integrating ethnicity-specific health care resources into the mainstream health care system (Yang & Kagawa-Singer, 2007). This study further stated: “moving forward from the documentation of racial and ethnic disparities in health care toward long-term solutions that ameliorate disparities, ethnicity-specific health care organizations have untapped potential as a source for a strategy that addresses the structure of health systems that inhibit full access to quality health care for cultural and linguistic minorities” (p. 546). Ethnicity-specific health care systems can contribute to greater equity, comprehensive, and accessible quality care by greater expansion and integration of this health system into the mainstream. Delivering quality health care in culturally appropriate way, and opening the access which was impeded by cultural and linguistic characteristics could be efficiently implemented by matching of patients and providers. Integration of this system to the mainstream will need monitoring of discriminatory practices, and appropriate action to ensure fair competition among provider groups.

References

Baum, F. E., Legge, D. G., Freeman, T., Lawless, A., Labonté, R., & Jolley, G. M. (2013). The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints. BMC public health13(1), 460.

Rodin, J. (2013). Accelerating action towards universal health coverage by applying a gender lens. Bulletin of the World Health Organization91(9), 710-711.

Shim, J. K. (2010). Cultural Health Capital A Theoretical Approach to Understanding Health Care Interactions and the Dynamics of Unequal Treatment. Journal of Health and Social Behavior51(1), 1-15.

Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic-and Community-Based Recommendations and Interventions. Journal of obesity2013.

Yang, J. S., & Kagawa-Singer, M. (2007). Increasing access to care for cultural and linguistic minorities: ethnicity-specific health care organizations and infrastructure. Journal of Health Care for the Poor and Underserved18(3), 532-549.