Friday, October 11, 2013

Hospital Quality Metrics....Did You Know?

Did you know that Medicare releases hospital quality metrics for almost 3,000 facilities? I just learned this last week! Through the Hospital Value-Based Purchasing Program, these scores are available for anyone to see right on the Medicare website. And the list can be sorted (for example, by alphabetical order of hospital name) or filtered (for example, to only show facilities in your state).

70% of the hospital score is based on clinical process of care measures (of which there are 12 measures) and 30% is based on patient experience of care measures. You can look at the scores separately for each measure by scrolling through a few menus, or you can look at the aggregate scores. It goes without saying that these measures provide a limited view of a hospital's total package, so you should really look at what they are specifically measuring before you put too much stock in the rankings, but I do find it pretty cool in concept. I hope that in future, hospital performance metrics will be even more transparent for individuals seeking care. How great would it be to have a single website displaying success rates for specific types of surgeries for many hospitals/surgeons at once (adjusted for level of difficulty, since certain hospitals may attract more challenging cases in the first place)?

In the mean time, perhaps this Medicare website can be a starting point for opening the discussion about quality care. As it stands today, if you get an infection after a surgery and have to go back to the hospital, the hospital gets paid more for the additional services. In many ways, the future of health care is now moving in the direction of paying for quality, not quantity (paying more for an infection-free surgery, for example, instead of paying more for an infection-inducing one), but we need to be able to accurately measure quality first! There are a lot of problems that arise when trying to measure outcomes that are not entirely within the control of the physician; we definitely need innovative leaders to figure out which outcomes are actually worth measuring / reimbursing on the basis of "quality" or "success," and how to do so most equitably.

Anyway, I just thought the very existence of this website was worth sharing. Got ideas? With the ever-changing landscape and need for innovation, maybe now is the time to consider a new career in health care! (My little plug for getting an MPH or just going for a new role with an innovative organization!)

Wednesday, August 28, 2013

Does Wealthy = Healthy When It Comes To Buying Food?

My husband and I have been living on a food budget of approximately $350 per month for the last few years. That's $175 per person per month, a little over $40 per person per week, and just under $6 per person per day. Since we both eat 3 good meals a day, plus snacks, I figure on average, we are spending under $2 per person per meal. But we aren't eating McDonald's. We are eating pot roast with veggies, tuna noodle casserole (and a host of other casseroles), fresh salads, fresh fruit with yogurt, baked chicken, homemade pizza, tacos, tomatoes with basil, lasagna, and so much more.

The reason I really got to thinking about this is that I viewed a few episodes of the television show "Secret Millionaire." The premise of the show is that a wealthy person moves into a poor neighborhood for a week, disguising himself or herself as a new member in the community, and searches for non-profit organizations deserving of large donations. One of the things the participant has to do is buy his or her own food for that week with a handful of cash, representing the amount of money that a typical person on food stamps would receive in the area in which they are staying. Depending on the locale, my experience from a few episodes is that they receive anywhere from $30 to $60 to eat for the week. Of course, they then go grocery shopping and bemoan their need to check prices and inability to eat well. And I'm not talking about not buying more expensive organic or grass-fed options here. I mean the choice to cook any kind of actual meat and produce versus the choice to buy processed or calorie-dense/nutrition-light options.

To be clear, I am not totally sure how I feel about the premise of the show. I mean, giving generously to hard working organizations serving those in need is great (highly recommend it), and even walking in someone else's shoes for a period could certainly be valuable in many situations. But the whole 'flying in from out of town and disguising yourself as an impoverished individual only to suddenly throw money at your new friends and fly right back out of town' thing is a little off to me. Regardless of how I ultimately view the show, however, I still find it interesting to see that these wealthy people typically eat pretty poorly for the week on their cash budget, when my husband and I eat much better for the same weekly amount. And so I got to wondering why? 

Then it dawned on me that to some degree, it is easier to eat healthy for less when you have some capital to begin with. (I am not talking about being extremely wealthy by U.S. standards, but more about being solidly in the middle class and being able to build some savings, rather than living paycheck to paycheck.) How ironic, really, that we can spend less money on food because we have more money. But when I started thinking about how we eat so inexpensively, it really made sense. This is subtly different than the post I wrote about Food Insecurity and Obesity in Children, where I discussed some of the reasons that the poorest in our nation are also more likely to be the heaviest, as I really want to focus in this post on where each dollar goes, rather than taking on overarching systemic issues of hunger. Therefore, I thought it might be helpful to do a thought experiment detailing some of the tools we use to meet our food budget and whether we would have those same tools if the rest of our budget was lower. So here goes:

Our pantry affords us good storage space.
  • Buying in bulk. - This is one of the most common strategies for smart shoppers. Yes, we have a Costco membership that we use for certain items. But that's not really what I am talking about here. What I mean more generally is that when I go to buy canned tomatoes, I purchase a 10-pack at Safeway, because it costs less per can than purchasing them all separately. When we buy potatoes, we usually buy the 10-pound bag and use it in multiple meals. When we buy salsa, we buy enormous containers of it, because the price per ounce is less. And then we eat it all over time. So if we have to pay $9 today to buy a huge jar of salsa, that's better than paying $6 for one half the size and then coming back next week and buying another small one for $6. Buying the smaller size twice means paying $12 for the same amount of salsa as you can get for $9 if you just bought the big one once.
    • The reason this might not work for someone living paycheck to paycheck is that when you only go into the store with $6 to spend, you have no choice but to buy the smaller can today and come back next week with your next $6 to buy another smaller can. This also translates to the "Secret Millionaire" television show experience, since the individuals participating are only buying food for one week and do not have the option to buy in bulk to cover the following week.
    • This method of purchasing food does also require an ability to transport heavy items home and to store them safely. I am thankful to own a car and to have an extra closet that we use as a pantry. It might limit our ability to buy in bulk if we did not have this kind of transportation or storage space.
  • The freezer. - I think this is likely our biggest money saver. When our fruit is about to go bad, we cut it up and put it in the freezer to use for smoothies or muffins or pancakes. When I buy fresh herbs at the store, I freeze whatever I don't need immediately. When I buy certain items with oils that break down quickly (such as flax-seed), I store them in the freezer. But by far the most important thing we put in the freezer is MEAT. We keep chicken in the freezer at all times, which is our most common meat eaten. Occasionally, we buy ground beef at Costco and freeze it in sections. All other meats, such as ground turkey, whole cuts of beef, pork, sausage, bacon, even hot dogs, I purchase almost exclusively when they are "buy one get one free" at Safeway. And I purchase a LOT when these sales happen, which means there is too much for us to eat right away. Therefore, I have to freeze the meats immediately when I get home. So that $20 hunk of pot roast that we ate for 5 days in a row only cost me $10 when you consider that I got the second one free (which comes out to $1 of meat per person per meal, plus the cost of vegetables to finish the meal), and the other one that also cost $10 is in the freezer right now. Both may have been in the freezer for a time before I used either. Sometimes, there are 3 or 4 meats on sale in a given week, and I buy them all and freeze them. Here is why that might be difficult if I were living paycheck to paycheck:
    Two views of our freezer. No, that's not cereal in there.
    My husband likes to organize by packing items into old cereal boxes.
    • First of all, large cuts of meat are an investment and may require a person to have $20 on hand. That $20 may be able to purchase 20 servings of meat at the good price, but if you don't have $20, you are left unable to purchase the good stuff at all. It's the same issue of capital as the buying-in-bulk mentioned above. In addition, I often find that 3 or 4 meats are on sale BOGO the same week, and I will buy all of them to freeze at once, which requires an even greater capital investment in a single week. For me, I am willing to spend this, because I know we will be eating that meat all month (or longer), but I have to have the $100 with me in the first place to make this choice for my family. Since we are not living paycheck to paycheck, I can theoretically "borrow" from our savings account to spend our entire $350 food budget on one day (and then "reimburse" our savings account when we receive a paycheck), or I can space my purchases out over each week. As long as I plan ahead so that whatever food I buy will cover us for the month and so that I stop purchasing once I hit the $350 limit, I am free to use any part of our food budget whenever the deals are out. Without some savings money available, we would not have this flexibility, which would limit us to purchasing foods (especially something as expensive as meat) when we have the cash, rather than when the food is on sale. Relating this back to the "Secret Millionaire" show, it does not make sense for the individual to purchase such huge portions of meat for just one week, and they don't really have the cash on hand to do so anyway. 
    • When I have visited the poorest parts of San Francisco, such as the Tenderloin, I noticed that many people I met were living in long-term "hotels" that resembled renting a dorm room. None of these rooms had their own kitchen. Some of these hotels had a shared kitchen at the end of the hall. Given this living situation, a person would not own a freezer at all and would be lucky to have a mini-refrigerator in his or her rented room. That would make buying meat and certain vegetables in any substantial portion very difficult, and freezing meat would be out of the question.
  • Coupons. - Personally, I do not go too crazy scouring every last corner for coupons, as I have often found that coupons for name-brand items still leave me paying more than just buying the store brand. I find it is easier to get to know one store's system intimately well and to work that system as much as possible, including the use of coupons when helpful. So I look at the weekly circular sales to purchase fruits, veggies, and staple items that are on sale at the store, and I also add all of Safeway's online coupons directly to my Safeway card, which enables me to take advantage of special deals. It usually takes me 30 minutes to add all of the coupons to my card, but a lot of them are very helpful. For example, we get "Just For You" deals that give us discounts on foods that we specifically have a history of purchasing, so instead of paying $0.50 for kiwi's, we get them for $0.25 if I add the coupon to my card.
    • This activity requires us to have access to the internet and 30 minutes of free time. This is by no means impossible for someone who does not have internet at home and is very dedicated to getting it done, as they can take advantage of the library's free internet. But it would certainly be a bigger hassle. And it would be made much more difficult by having to work during the hours of library operation or by having children at home with no other caregiver, which is the situation for many families. I also believe that the Safeway discount card itself requires at least a phone number, which could be a problem if we did not own a phone of any sort.
The kitchen space in our apartment.
  • Cooking. - We cook almost all of our own meals. Very rarely do we buy pre-prepared food at the store, although we do keep a couple of these items in the freezer for busier days, or we may splurge on a special occasion. I try to limit myself mostly to meals which take 30 minutes or less of direct effort to prep and cook (special occasions excluded). If it takes 20 minutes of prep and then goes in the oven for an hour, that's ok, because I do not have to stand watch over the oven for that hour. But if it requires me to stand at the stove-top to get it done, it better cook quickly.
    • Cooking at home usually requires us to have a kitchen in the first place, which may not work for someone renting a room in a long-term "hotel." We usually use our stove, oven, microwave, crock pot, etc. to prepare food. Cooking also requires us to own pots and pans, casserole dishes, a refrigerator and tupper-ware for storing leftovers. I imagine cooking our own meals would be difficult if we did not own such items. We even have a bread-maker that was a present from my husband's parents, which we use to make our own sandwich bread and pizza dough, so that we save money by paying only for the flour, water, yeast, etc. (which is a lot less than buying a loaf at the store). All of these cooking items required an initial investment to purchase, but pay off in the savings they enable us over the long term.
    • Then there is the sheer time it takes to cook (about 30 minutes for a given meal, which often lasts us a few days and will certainly not last as long once we have more mouths to feed). The time it takes to grocery shop can also add up. Although this does not seem like an overwhelming amount of time to me right now, with my one career, I imagine that if I were working two jobs, it would probably sound like a lot more time. And if I had children that I had to supervise while cooking or bring to the store with me, that would be another aspect to arrange.
  • Our garden. - Ok, so this really hasn't been such a big help this year, as most of our plants got eaten by squirrels, rats, and aphids. Beginner's luck? Not in this house. But in theory, if we can do better next year, this may save us some money on produce. It did save us on some herbs, because our basil, thyme, and rosemary all thrived (eventually).
    • The garden requires space. We live in an apartment, but we have a decent sized first floor patio with moderate sun that we were able to utilize. This type of space can be a luxury, especially in an urban setting. In addition, the garden did require an initial investment in pots and potting soil, some of which we can reuse next year and some of which we will need to purchase again.
      From left to right, I have two red pots of arugula that got eaten by rats or squirrels, a rosemary plant that lived,  two rectangular containers in which I am attempting to re-grow lettuce under wiring to protect it from the vermin, and a round tub of carrots, most of which has been eaten by animals or died from lack of sun light.
      The square containers are growing bell peppers (sadly aphid infested), and on the ground, we have a hibiscus plant, surrounded by thyme (herb) ground cover.
These are just some of the initial things that came to mind as I conducted this thought experiment about what really enables us to live within our food budget. I am sure there are many other issues I have not mentioned and also many creative ways to save money that I have not considered. (For an example of a systemic issue, one that jumps to mind is that some people live in "food deserts," where they may not even have full service grocery stores nearby, but they are surrounded by fast food chains and convenience stores filled with snack food. This issue tends to disproportionately affect the poor, such as residents of certain inner city communities.)

I am not saying that it would be impossible to eat healthy outside of having middle class resources, like a stove top and a savings account, but our situation certainly makes it a lot more feasible for us. When circumstances change, creative people can often make a way. But thought experiments like this help me to empathize a little more with families who eat pre-prepared frozen meals or fast food on a regular basis. At less than $2 per meal in the generally expensive San Francisco Bay Area, if you were to add in the assistance cost of free school lunches and other similar programs, I think my husband and I are not spending much more on daily food expenses than some lower income families in this area. But many of the less healthy food options that cost about the same overall do save precious cooking time and allow a person to spend their food budget day to day instead of in bulk.

Since I have only just started this thought experiment, and I am certain that my ideas are incomplete, I am interested to hear what others think. What holes do you see in my initial thoughts? What other factors can you think of that enable you to eat healthy for less? What have you done when you were living paycheck to paycheck? Are there tools that people of any location or socioeconomic situation can utilize? What could be done to make it easier for people in all situations to take advantage of lower cost items, store sales, cooking at home, etc?

Friday, August 23, 2013

Berkeley Application Essay #2: Statement of Purpose

Yesterday, I posted my first application essay for the Berkeley Masters of Public Health program in Health and Social Behavior. Today, I want to post the second essay, which is the longer of the two and is called the "Statement of Purpose." I hope that these two essays can give you a sense of where I hope to go in the future and may even inspire you to pursue your own passions and dreams. The prompt for this application essay was as follows:

Your Statement of Purpose should explain what has brought you to pursue graduate training in Public Health. It should also explain your eventual career goals and why you need a degree in your specific program. It may also explain why you are pursuing this degree now, and why at Berkeley. Please be sure to check your program’s page, as some programs have specific prompts they like you to follow. If a prompt is not listed, please follow these guidelines.

My specific program in Health and Social Behavior also added the following:

[We are looking for a] Statement of Purpose that explains why the applicant is interested in HSB versus other areas, and how this program would build on prior experiences (if applicable) and contribute to his or her career goals. 1500 Word Limit.

In reality, I am not 100% certain what I want to do in future, although I hope that it will have something to do with serving people or communities who have been treated with or have otherwise lived with a sense of indignity due to circumstances related to health concerns. However, to write a compelling and concise essay, I felt that I had to focus on one potential career path that I found particularly interesting, so I chose to focus on  mental health as a result of traumatic events. In large part, this was an issue that was on my heart at the time, and I think it is highly likely that my career will take me in this direction in actuality. However, as I enter my two years at Berkeley, I am also very open to learning about other aspects of human health and wellness, and I have open hands for any calling that comes through this learning.

I also want to give a special thanks to the loved ones who read my essays, highlighting the strengths and commenting on areas for improvement, all of whom really helped me hone in on exactly what I wanted and needed to say: my husband Matthew (probably the most prolific reader of my essays), my parents, my in-laws, and especially my dear friend Christine, who helped me see which areas could be cut out and which ones needed to be elaborated, resulting in a work reflecting my own heart and interests in a much better way.

One last note: I had to remove portions of one sentence and alter a couple of other sentences below for the blog-version of this essay, in order to protect the privacy of programs and people mentioned. I included certain details about my experiences in the original essay to highlight my background and exposure to various health topics, but did not reveal personal details about the identities of those involved. However, in this version, I would like to provide further protection for those programs and individuals, since this is a public forum.

So anyway, here it is:


Statement of Purpose: Trauma and Mental Health Justice

Throughout my life, I have had three core parts of my identity that I have actively incorporated into my activities and choices: (1) an intense enjoyment of mathematics and analytical thinking; (2) a love of creative expression; and (3) a profound desire for justice in the world. These aspects of my nature have often come into conflict, vying for my time and attention. After considering how these characteristics might cease competing and instead work together to make me a more effective agent of change, I am confident that attending Berkeley’s prestigious School of Public Health will enable me to harness my wide-ranging experiences and thrive in the promotion of health justice.

During my undergraduate career at Duke University, each of the facets of my identity was manifest in a different area of my life. When I was selecting a major, for example, I had difficulty choosing between the formidable analytical challenge of mathematics and the creative outlet of English. Ultimately, I decided to major in mathematics and minor in English, mirroring the diversity of experience I have intentionally pursued. Furthermore, I engaged these various aspects of my personality through collegiate extracurricular activities. My most meaningful endeavor was membership in a campus ministry, through which I was able to put my desire for justice into action from a spiritual foundation, by guiding a team of students in planning community service events.

In addition to my on-campus activities, I studied abroad in Ecuador. During this time, I explored the social sciences exclusively (all in Spanish) and learned about the application of justice in another society. As I studied Ecuadorian colonialism, I began to recognize how a country’s history and culture can foster pervasive systemic injustice for generations. When I traveled to the Amazon, I saw how the health and livelihoods of entire people groups were disregarded as corporations inappropriately disposed of toxic waste; I learned that virtually no Afro-Ecuadorians attain a university education, largely as a result of ongoing racism, lack of resources, and coastal isolation; I visited Baca Ortiz Children’s Hospital and was shocked that the free public facility not only had few antibiotics or surgical supplies available, but also no hand soap, so that poor families who had traveled great distances had to purchase these items independently or go without treatment. These experiences began to cultivate my passion and desire to alleviate health disparities.

I have now held two roles at Aetna, a national health insurance carrier, most recently as a medical economics consultant. When I began working full time three and a half years ago, I knew that I would develop my analytical skills and business acumen. What I did not anticipate was how my newfound broader understanding of health care would make me increasingly distressed by the gaps in care that plague our world. The injustice I first glimpsed studying abroad has been even more starkly highlighted through my career, as I work in health insurance, volunteer locally and internationally, and conduct research to write my health issues blog (

Although I have enjoyed the challenge and success of my time at Aetna, I now realize that my work is almost exclusively focused on the use of my analytical skills and not on the other aspects of my identity. And more importantly, my current role is many steps removed from the insurance members I am serving, even more isolated from the fifty million Americans without health coverage today (before the landmark health care reform bill takes effect), and still more remote from the billions of people receiving inadequate health care worldwide. I am now certain that many health concerns need to be addressed at the community level. And this is where I would like to be involved.

In particular, I have seen that mental health is a crucial part of overall well-being that is not given the priority it deserves. The Mental Health Parity Act was signed into law in the United States in 1996, yet sadly, recognition of the importance of mental illness is still in the process of gaining traction in our culture; many other parts of the world have no such laws, offer fewer services, and/or lack a conception of mental illness as a public health concern in general. Therefore, my husband and I have a vision to go abroad for at least two years to work with an international non-governmental organization, assisting women who have mental health afflictions as a result of traumatic experiences, such as rape, abuse, war, or trafficking.

On a recent two week trip to Cambodia to work with Agape International Missions on the issue of child sex trafficking, I learned that the Khmer Rouge government of the 1970’s killed one fourth of the population of the country, including nearly all health care professionals. For the last forty years following this traumatic period, Cambodia has had virtually no mental health services and retains many scars from the time of the regime. Children who were once persecuted by the Khmer Rouge, or even those who were recruited to torture and kill, are the parents of today. This backdrop has contributed to a high prevalence of post traumatic stress disorder and to cultural views about human life that feed into the pervasiveness of human trafficking. After my experience in Cambodia, I am confident that community-focused mental health programs have the potential to alter the course of this nation.

Locally, I have volunteered for almost two years as a Court Appointed Special Advocate (CASA) for abused youth in San Mateo County. Through this role, I have spent time mentoring and advocating in court for a child -------[rest of sentence removed for privacy]--------. I have seen the overwhelming consequences of trauma on the mind – and this in the lives of a children receiving intensive health services.

What happens, then, to women who have no such support?

In their book, “Half the Sky,” Nicholas Kristof and Sheryl WuDunn share the stories of women who have endured great tragedy. I was particularly moved by their chapter about obstetric fistula, in which the authors explain how women without access to emergency obstetric care may endure life-altering injuries which they call the modern day leprosy. Many are then rejected by their families and communities, with no access to the surgery necessary to repair their bodies, nor to the mental health services that can mend their unseen wounds. As a first step to end this injustice, I have written about the issue on my health blog to raise awareness. But what I desire more deeply is to develop solutions that can help communities deal with the mental health consequences of child sex trafficking, obstetric fistula, or other such injustices.

A public health degree from Berkeley will equip me to take action that empowers women and communities to heal. Moreover, the health and social behavior concentration will enable me to understand how violent, neglectful, or discriminatory behaviors take root as accepted norms in communities, and to evaluate which interventions are effective in changing these practices or attitudes. I see a dearth of leaders engaging in community need-finding, researching what has worked elsewhere, formulating creative ideas, implementing programs, and analyzing the efficacy of steps taken. I want to stand in that gap.

On a longer term basis, I envision myself playing an ongoing role, either locally or internationally, in helping people and communities respond to traumatic mental health problems. I have seen first-hand that there is a continuing mental health crisis in the United States and the world, and I want to be a pioneer in creating solutions.

The health and social behavior program at Berkeley is among the best in the nation, and it is uniquely suited to help me evaluate and intervene in the social climates that contribute to traumatic mental health concerns. I am especially intrigued by the research of Professor Ozer, which spans mental health topics as diverse as maternal depression, relational violence, PTSD, and even “Micro-credit and mental health” in South Africa. I am also impressed by the work of Professors Herd, Corburn, and Holmes. Additionally, attending Berkeley will enable me to continue volunteering as a CASA with abused youth, and the Bay Area offers a plethora of local opportunities to help victims of trauma (such as human trafficking) or others suffering from mental illness.

In the future, I envision programs that acknowledge the importance of both physical and mental health needs. I envision communities that work together to overcome traumatic histories and unite to prevent trauma from afflicting multiple generations. I envision women who are empowered by freedom from the health consequences of traumatic experiences and who are actively engaged in changing the patterns of abuse in their communities. I desire to use my analytical skills, creativity, and heart for justice as catalysts in designing such social interventions. And I believe that my admission to the Berkeley School of Public Health is critical to making this vision a reality.

Thursday, August 22, 2013

Berkeley Application Essay #1: Personal History Statement

I thought it might be fun to post the application essays I submitted for the MPH program at Berkeley to give anyone interested a small glimpse into where I hope to be headed through this degree. (Yes, they let me in!) This first essay I am posting is the shorter of the two and is called the "personal history statement." The prompt was as follows:

Your Personal History Statement gives you an opportunity to add some individuality and depth to the basic information contained in your Statement of Purpose. You may write about who you are as a person, about your family, your ethnicity, and the experiences that make you unique. This essay will play a large role in consideration for fellowships.

There is also a "personal statement guide" that lists other suggestions, such as discussing non-traditional educational backgrounds, cross-cultural experiences, ability to articulate the barriers facing women and minorities, etc. The limit for this essay was 4800 characters (which amounted to 649 words in my essay).

So without further ado, here is my personal history statement for the Health and Social Behavior concentration:


A Cambodian proverb: Men are like gold; women are like white cloth. 

The implication of this axiom is that women have little intrinsic value, and once a woman is “dirty,” there is no way to redeem her. Men, on the other hand, are portrayed as naturally valuable, and their transgressions are easily erased. Some read this proverb and see a concise explanation for gender-based injustice in Cambodia; I perceive a complex set of circumstances, of which this is but a single layer. Recognizing the complexities of a problem, however, falls short of a plan to restore dignity. My passion is to help those regarded as “dirty cloth” realize their infinite worth, and I believe a graduate degree in public health will equip me to develop solutions that change lives. 

I recently had the opportunity to volunteer in Svay Pak, Cambodia, a destination village for pedophiles. Looking into the faces of young children, some of whom were sold nightly for sex, I saw a juxtaposition of beauty and human depravity. While the injustice of trafficking is evident, one of my greatest gifts is an ability to see the hidden complexities in a problem; Cambodia’s challenges are no exception. Let me explain. The issue of child sex trafficking is a mosaic with roots in dictatorial oppression, war, culture, poverty, and a lack of mental health resources. Among other factors, attitudes of disrespect for women (as described in the proverb) have contributed to the prevalence of trafficking in Cambodia, as well as the inability of victims to reintegrate into communities. These attitudes have allowed exploitation to perpetuate as a societal norm, creating a public health crisis. 

A simple-minded approach is to outlaw underage prostitution. But historically this alone has done little to change the environment. I believe a complex problem necessitates a multi-faceted solution, and it gives me hope that an organization such as Agape International Missions (AIM) has fostered change by taking this requisite seriously. Through victim recovery programs, job creation, community-building activities, and even a gym where perpetrators can interact with aid workers, AIM is having a transformative impact in Svay Pak. AIM’s efforts reveal that my eye for complexity need not lead me to despair, but can be a valuable tool as a public health professional in discerning how to assist women in mental health recovery toward becoming advocates of change in their own communities. 

I also recognize that complex situations resulting in disregard for human dignity are not unique to Cambodia. During my time studying in Ecuador, I saw my classmates disrespect their indigenous heritage, and I learned that few Afro-Ecuadorians attend college. In reading “Half the Sky,” I have been deeply troubled by indifference for women’s reproductive rights worldwide, including poor prenatal and emergency obstetric care. Through my job in health insurance, I have become critically aware of the millions with inadequate healthcare here in the United States. Locally, as I have volunteered as a Court Appointed Special Advocate, I have been grieved by the roles of mental illness and poverty in the child welfare system. I have even personally experienced the effects of being a “lesser-viewed” person, as a woman in the male-dominated field of mathematics. 

I believe my diverse experiences are not random, but have coalesced to uniquely shape my heart for all cultures, to open my eyes to intricacy, and to develop my desire to serve. As long as any person is perceived to be lesser than any other, or is held captive to unjust institutions that remain from such views, I feel called to dedicate my life to restoring human dignity through public health justice. Graduate school at Berkeley is a critical step in transforming my eye for complex problems and love for people into an ability to create adaptable solutions. One day, I hope to see the “white cloth” of the world revalued based on the “gold” inherent in every human spirit.

Update: Be sure to check out my second application essay, the "Statement of Purpose."

Wednesday, August 21, 2013

Modern Day Sex Ed: Google

I have not written anything on my blog in a few months. Life has been extremely busy (and on the not-so-busy days, I have opted to just take my down time to rest up). Big changes are coming my way! I am starting a Masters in Public Health at UC Berkeley in about one week, as part of the "Health and Social Behavior" cohort. I am both excited and nervous as I prepare for this next journey! And I am ready to get back at it with the writing!

One topic I have had on my mind lately is internet boundaries for youth. I wrote a few posts that were somewhat tangential to this issue a while back, such as the one about cyber bullying and the one about limiting the content I access personally.

Recently, however, I feel like the topic of sexuality and sexual education via the internet has been swirling all around me. Just a few days ago, I read a very important blog post titled, "Three Things You Don't Know About Your Children and Sex," by Ann Marie Miller. (Note that this post is so popular that you may get an error if you are trying to access it at pique times.) The main point I gleaned from the article is that today, when kids don't know what a word means at school, they simply Google it. And guess what that exposes them to? Pornography. Maybe even pornography showing types of sex you and I have never heard of.

I remember being in 5th grade many years ago when my friends were cracking jokes about "sixty-nine-ing." I pretended like I knew what they were talking about and laughed along. Later, I privately asked a friend what it meant, and she just said, "Think about it. 69. Get it?" My guess is that she did not know either.

But it was not just among my friends where this sort of perplexing situation happened. In 7th grade health class, we were learning about sexually transmitted diseases and other topics of "safe sex." The teacher said in class that "one possible consequence of anal sex is a ripped anus." At that age, I was embarrassed that I did not know what an anus was (note for those wondering - it's your butt), and I never asked a soul. I just made something up in my mind about what it might be (incorrectly) and moved along. Somewhere between then and probably 9th grade, I heard the real meaning in passing, but I know I went quite a while not knowing.

Now imagine if this had happened to me today. Imagine that as a 5th grader I searched for the meanings of those words on the internet. What would almost certainly come up first would be pornography depicting these acts, and I would be exposed to graphic content by no intent of my own. Hopefully, you get the picture.

Am I saying that anal sex or the 69 sex position are inherently wrong or "dirty?" Absolutely not! I believe that in the context of a consensual adult relationship, two people can discuss between themselves what is safe, respectful, and pleasurable, and no two relationships will look exactly the same on that front. What I do think is wrong, however, is a child searching the internet with little other context in which to discuss or understand sex, and coming to believe that various sex acts or attitudes they encounter are the norm for all couples. Or a child becoming addicted to the online images they see, such that they become desensitized to real future partners. Especially during the extremely formative developmental years, children may come to believe that they should "expect" certain acts, responses, grooming habits, etc. from future partners, and that can be extremely damaging to real life relationships, where very rarely does a partner fulfill every imaginable fantasy on demand.

I want to preface the rest of this post by saying that I am aware that many of the opinions expressed in this post are informed by my faith as an evangelical Christian and by my identity as a woman, through which I have come to believe that pornography is damaging to the sexual and emotional health of any person, regardless of age. I am also aware that intelligent, loving people may disagree with me when it comes to adult consumption of adult content. However, I hope that we can put aside our differences about the more controversial topic of adult viewership and still agree that consumption of adult content by young children is of actual consequence to their social, emotional, sexual, mental, and physical well-being. Young brains and bodies are just not at the same stages of development as those of an adult.

Although any type of pornography can be scary, confusing, or damaging to a child, I think it is worthwhile to point out that pornography today may be different than what you thought of twenty years ago when you came across your friend's dad's magazine in his basement. Some of the main differences are (1) an endless and constantly available supply, (2) an ability to search for any type of pornography until a person finds exactly what he/she is looking for, (3) the anonymity of viewing internet pornography (versus purchasing it in a store), and (4) perhaps most importantly, the content available and popular today, which often includes violent or fetishist acts. Although there have not been many studies to date directly addressing childhood pornography viewing, many psychologists will talk about their own clinical experiences of the types of damage done to their young clients, as discussed in this article from ABCnews. Additional information can be found on this page by, this fact sheet by the Coalition to Prevent Child Sexual Abuse and Exploitation, and many other informative sites that you will encounter with a simple Google search of "Damage of Pornography to Kids." Among the short-term and long-term concerns listed are impairment in developing real-life friendships and romantic relationships, unrealistic depictions of sex in a real relationship, unrealistic views of body image, violent images leading to violent in-person gender relations, a psychological separation of sex from emotional intimacy, expectations of fetishist acts from real life future partners, a sense of pressure to perform sexual acts that are uncomfortable or unwanted, addiction, acting out sexual acts on other children or generally engaging in sexualized behavior at a young age, normalizing sexually abusive scenarios, and normalizing adult/child sexual relations (if a child stumbles across pornography involving minors), among many other possible negative outcomes.

So how do we protect our children?

My mom did have a few sex talks with me, and my parents tried to be open and available for me when I needed them. I really believe that I grew up in a great household with wonderful, loving, supportive parents. But even so, my young mind thought I should be afraid to ask them what terms like "69" and "anal sex" meant (and maybe they would not have even known themselves about some of the terms I heard floating around the halls of school.) In her post, Ann Marie Miller talks about how children and parents need to have an ongoing dialogue about sex, not just a single moment of discussion. (Unfortunately, many parents do not even have that one talk.) There is no guarantee that your child will open up to you, of course, but starting those discussions early, as children become aware of their sexuality over time, raises the chances that if something does happen, be it around them, to them, or by them, they are more likely to feel safe confiding in you (or talking with another trusted adult), should they feel they need to.

Ann Marie Miller also points out that many parents think their child is the exception, but Miller says that parents just need to get that out of their heads. You may have great internet controls at home, and you may not provide internet access without parental involvement yourself, but chances are, some (maybe a large) proportion of your child's friends have smart phones, tablets, etc. that they carry around without those same protections. Even when I was growing up without any of that technology around, I had heard a surprisingly wide array of sexual information on the elementary playground, often completely unsolicited. Any child, of any age, of any race, of any socioeconomic background, of any religious upbringing can hear confusing words at school, can be exposed to pornography, can be molested by a trusted adult or stranger, can end up with deep sexual secrets that they are afraid to tell you or that may affect them for years to come.

A few months ago, I read a book about pornography addiction called, "The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography," by Larry and Wendy Maltz. The book is very educational and talks about the personal damage, relational havoc, professional embarrassment, and other trials that pornography can escort into our lives. It also talks about steps to seek help and to get out of the addiction. I wanted to read about the topic, because I personally know a LOT of people (mostly Christians who have confided in me), both male and female, who have struggled with secret pornography obsessions at one point or another. I myself had viewed it for a period of several months in college, at a time which I would describe as the last step in a series of escalating issues I was handling poorly. I would say my own experiences were addictive to some extent, as it is difficult not to get addicted to something that releases so many pleasurable hormones into your system. At the height of my viewership habit, I found myself actually getting annoyed with good friends when our social plans interfered with my desire to view pornography. As it turns out, this is a very common experience! Yet thankfully, I believe God intervened when I had a life-changing moment during which I decided to put it away forever and never turned back. Sometimes I wonder how deeply I would be entrenched today if that change never happened. In reading the Maltzs' book, I wanted to understand more about the psychological underpinnings of pornography addiction and the best ways to respond to and support the recovery of my friends who are in the middle of it right now.

Does everyone who views pornography get addicted? No. But it is still a very real concern. Consider this: According to the National Institute on Drug Abuse, of those who use heroine, it is estimated that 23% become dependent. That means 77% of people who try heroine have no problem with addiction, yet I would never recommend it to anyone I know. One might consider pornography in a similar light. The risk of addiction is real, and the relational risks, even apart from addiction, are also very real. Will everyone who looks at porn experience negative consequences? Maybe not. But do you want to leave that to chance with young children, who are particularly vulnerable? According to many surveys, children ages 11-17 are the biggest viewers of pornography, and about 70% of people say their pornography viewing is a secret. For more specific information about how pornography can actually be not just psychologically, but actually physiologically (body chemistry) addicting, check out this video series about the brain on pornography.

One of the most interesting (and scary) things I learned from "The Porn Trap" is that most people who do develop pornography addictions had their first exposure in elementary school, often times accidentally. And the exact age of first exposure is getting younger and younger with the widespread availability of internet access.

Couple this with the evidence presented in "Cinderella Ate My Daughter," by Peggy Orenstein, that we live in a culture which is sexualizing children in advertising all around us (for a recent example, read about the controversy over Victoria's Secret tween advertising), and you have a recipe for a generation of children experiencing sexuality in ways that you and I hardly had to worry about until our teen years or adulthood.

I highly recommend that you read Ann Marie Miller's entire post about the "Three Things You Don't Know About Your Children and Sex," as you may be surprised by what you read. Personally, I believe that even those of us without children need to be aware of what youth face today, as we may find ourselves mentoring youth who want to talk to us, or we may even know people in our adult lives who have had some of these experiences and need help to deal with them.

We definitely need to protect children from things that their young minds were not meant to process, so I am in no way saying that we should intentionally introduce our children to words or acts that are beyond their years. But no matter how hard we try, we simply cannot protect them from everything and everyone out there. They are highly susceptible to seeing, hearing, or personally experiencing something that you would never have wanted them to know at their age. The question is, to whom will they be ready to turn when this happens? Personally speaking, I would rather a child ask me what "anal sex" is than be so afraid of my reaction that they believe an internet search is their only option. For many children, if a loving and non-condemning adult does not listen and/or answer their questions, someone or something will, and it may be a frightening or inappropriate experience for them. In an age when more kids know how to use a smart phone than know how to tie their shoes, let's commit to being as educated and as open as possible, so that when youth do have questions or confusing experiences, they know that we (as parents, grandparents, friends, mentors, pastors, teachers, counselors, etc.) are there to listen and to help.

Thursday, April 11, 2013

Funny Statistics

One of the things on the internet that often sends me into a minor rage (because, you know, there are just so few offensive things out there that I had to find something, anything to be annoyed at) is misuse of statistics. It is so easy for a manipulative writer to "deceive the masses" with numbers (myself often included), and then there are those who unintentionally misuse statistics in their articles and go about their merry days guilt free. That is among the reasons I wrote a post a while back about the benefits and limits of statistics. The point was really to encourage readers to think critically. Interestingly enough, that is my most popular post ever, so maybe I am onto something!

I seem to encounter statistically infuriating writing in the news or other websites on a near weekly basis, often written by "experts." Yikes! But this week, I found something statistically hilarious on "The 10 Most Bizarre Correlations." Ok, I know I have a dorky sense of humor. But come on people, these are funny!

This is one of my favorites, because it realistically portrays what I actually see in articles on a regular basis:

For those still scratching their heads about why this is absurd, notice that the two graphs are presented in total counts (total sales and total diagnoses), not as proportions of the total population represented by the graph. My best guess is that the population growth curve would match up very closely to these two metrics or that the population growth curve plus other factors would do so, but without that information specifically provided, we cannot know. It really doesn't mean that much statistically to say that there were four times as many disease diagnoses counted in 2008 compared to 1998 if there were also four times as many people alive in general (or if the methods for diagnoses became better, such that the disease was simply identified with greater ease). If that were the case, the rate of disease may have stayed constant. The same is true with the purchase or organic produce - it could be an increase based solely on having a larger population (or another possibility is that the number of organic produce purchases remained constant, with the price of the organic produce quadrupling, thus increasing total dollar sales). With this graph, we really have no way of knowing what this data really means, as it has no reference to how many people were in the population each year, nor do we have information on many other associated metrics. Without asking critical thinking questions, some might look at this and automatically conclude that there is a link between organic food and autism. Gotta love the misuse of science! I'll stick with my pesticide fruit, thank you very much!

This also reminds me of a funny xkcd comic:
As the comic author writes in the sub-text (when you hold your mouse cursor for a couple of seconds over the comic on their website), "There are also a lot of global versions of this map showing traffic to English-language websites which are indistinguishable from maps of the location of internet users who are native English speakers." Yes!

Another one of my favorites from the buzzfeed article is a 1960's study demonstrating that countries with slower growing economies have men with longer "male organs."

Or, as a slightly different, but more recent study showed:
I knew there was a silver lining to the recession! Ok, but seriously now - can you think of other factors that might create this effect, beyond the economic growth of a country? This is a test of your analytic prowess!

To see the rest of the odd examples of correlation, check out this awesome article:

Monday, April 8, 2013

Guatemala Support-Raising Update

Update! With one week left to go before the balance is due on the Guatemala well-drilling trip, here is where I stand on my support goals:

  • My prayer team is rapidly growing, and I am so thankful for everyone who is willing to support me in this way! Prayer is the most important thing I need going into this trip!
  • With regards to fundraising, the latest figure I have received from our trip coordinator is $425 raised out of a total of $1900 needed.
If you are interested in joining my prayer team, please call/email me directly or message me below. For financial donations, please make checks payable to Living Water International and mail with the remittance slip at this link to make sure it gets attributed to my trip! You can also make donations via credit card by calling our Living Water trip coordinator, Sarah Evans, at (281) 207-7814. The organization will give me the names of all who donate, so that I can thank you!

Mailing address:

Living Water International
Attn: Mission Trips Department
4001 Greenbriar Drive
Stafford, TX  77477

Don't forget to include the remittance slip in the envelope.

Thanks again to all who have already joined my team, either financially or in prayer. Your support means so much!

Tuesday, March 26, 2013

Bringing Clean Water to Guatemala

"But whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life." -John 4:14

Dear Friends,

Greetings from the San Francisco Bay Area! As you may already know, a lot has happened in the last year or so. Last summer, Matthew and I went to Cambodia for two weeks to volunteer with Agape International Missions by serving children who have been trafficked for sex or who are vulnerable to trafficking. It was a very meaningful trip that opened our eyes to the horrors of child sex trafficking and that further confirmed our calling to serve abroad for a more extended period in a couple of years. On a slightly different note, I also recently found out that I was accepted into the Masters of Public Health program at UC Berkeley, so I will be leaving my job at Aetna and starting a two-year program in health and social behavior this coming fall. I am hoping that God will use this time to prepare me for a career change that enables me to exercise my passion for health justice.

On the theme of health justice, one of the major global health crises of our day is that 783 million people lack access to safe drinking water. Many of these individuals are part of the billion people on our planet who live on less than a dollar a day. Communities without a reliable source of clean drinking water are often plagued by water-related diseases or parasites, and some people risk their safety to travel miles every day to gather water from the nearest source.

I recently learned of an opportunity to bring clean water to one such community, and this is the main purpose of my letter today. One of my friends was awarded a volunteer grant by his tech company, which pays for him and one other individual to go on a well-drilling trip to Guatemala. The only catch was that he needed to assemble the rest of his drilling team quickly! As Matthew and I were reflecting on whether another missions trip was in the cards for this summer, God placed this need directly in our laps. Matthew will unfortunately be out of town on another trip that week, but we decided it would still be a great opportunity for me to go and serve the Guatemalan community alongside our friends.

So in less than two months, May 18-25, I will be headed to Guatemala with Living Water International! This is an organization that seeks to demonstrate God’s love by implementing participatory, community-based water solutions in developing countries. They recognize that meeting physical needs is an important testament to the true “living water”—the gospel of Jesus Christ—which alone satisfies the soul’s deepest thirst.

In order to attend this trip, I need to assemble a team of people committed to praying for me before, during, and after my time in Guatemala. In addition, I need to raise approximately $1900 to cover the participation cost. Due to the short timeline between when God provided this opportunity and the date on which the full cost of the trip is due, I am left with about two weeks to raise full funding. I am trusting that God will provide! I would be honored if you would consider partnering with me on this mission to bring clean water and the love of Christ to those in need.

Would you be willing to join my prayer team and/or to support this mission trip financially? Donations are tax deductible, and any amount you are able to contribute is significant in helping to reach my fundraising goal. You can make donations via credit card by calling our Living Water International trip coordinator, Sarah Evans, at (281) 207-7814, or by mailing a check with the remittance form at this link to Living Water International (address listed at the bottom of the remittance form). All donations must be received by Living Water International no later than April 15. If you would like to join my prayer team, please comment below or contact me directly.

Please do not hesitate to contact me with any questions you may have. I look forward to hearing from you soon!

Kristen Campbell

Update: For those on my prayer team - my prayer requests right now are for the Lord to provide spiritually and financially by raising up a team to support the trip. The other major request I have is for my neck. I have been experiencing a lot of pain in the last couple of years and have (finally) started physical therapy recently. Please pray for healing, strength, and also to stay safe on the trip, especially because there will be manual labor involved, and I need to plan for it to protect myself from further injury. There may be opportunities for me to take some breaks from manual labor by conducting hygiene lessons in the community (as the organization usually does this at some points anyway). Please pray for God's protection over my neck/back and for Him to be watching over all of the logistics of the schedule to create the best environment for that. Thanks!

Monday, March 18, 2013

Obstetric Fistula: What Can I Do?

A while ago, I wrote a post about obstetric fistula. For those who do not know already, obstetric fistula is a hole between the vagina and bladder or between the vagina and rectum, which can be one of the most tragic and humiliating effects of obstructed labor. (I highly recommend reading my older post that includes moving personal stories of fistula, if you have not already.) This is one of the most heart-wrenching issues I have ever encountered, and it has been on my mind throughout the last year. I have been looking for ways to get the word out about fistula to those who are not already aware.

Along those lines, I am very excited to report that last week, I helped to organize a "lunch and learn" presentation at my workplace. About a dozen people attended the event (out of ~70 employees in the office), received a free hot lunch (homemade by myself and other wonderful women of our office volunteer committee), and listened to a presentation about fistula. The attendees asked a lot of great questions, and many seemed interested in getting involved or spreading the word themselves. If nothing else, I am so excited to know that this important global health issue has gained even a fraction of greater visibility, with this handful of newly educated individuals.

This is the type of event that you can organize to touch your own places of influence, be that your office, church, friend group, family, professional organization, or another circle of people you know.

Other ideas to help women with fistula:

  • Purchase Mothers' Day gifts that support women with fistula.
  • Play this facebook game to earn points that Johnson & Johnson will convert into an actual cash donation.
  • Donate to an organization helping women with fistula, such as the Fistula Foundation.
  • Give the book "Half the Sky" to friends for special occasions.
  • Screen a fistula documentary for friends and family at your home, church, office, or other location.

Tuesday, March 12, 2013

Ultimate Treadmill Fails

Ok, so I know it is sort of messed up that we humans can find it funny to watch videos of people getting hurt. But laughing is good for your health, and I can't help but say that this compilation of "The Ultimate Treadmill Fails" is pretty much hilarious. Some of these workout catastrophes do look plain old painful (and not so funny). Others look like bad ideas gone wrong, or perhaps it would be more accurate to say bad ideas gone even worse than planned. But in my opinion, the clip 50 seconds in makes the whole thing worth watching. I laughed out loud, both the first time I saw it and when re-watching it. So go ahead and treat yourself to a good laugh!

Tuesday, March 5, 2013

Neck Pain, Trapezius Hypertrophy, and Ergonomic Adventures

Today, I wanted to share a little tidbit of what I have been learning in physical therapy. Between surviving the rigors of late-night paper-writing back in college, attempting to exercise in various ways (like African Dance), and getting in a car accident on the freeway a couple years ago, I have had all sorts of neck pain for the last several years. Thankfully, I finally got my butt to a doctor a few weeks ago, in large part due to the encouragement of my wonderful and persistent friends and husband. (Seriously, after a lovely lunch date, one of my concerned friends suggested she not leave my house until I had called the doctor in front of her. And it worked!) Now, I am working on the getting better part!

One of the most interesting things I have learned is that my upper trapezius muscles are hypertrophied. In normal-person speak, this means that those big muscles that connect my shoulders to my neck - the ones I use to shrug - are being over-worked and over-firmed. Hence the reason my neck feels like a rock all the time. I find this cool, because it means I have at least one strong muscle in my body! Win! (Unfortunately for me, I actually need to make this muscle smaller.) As it turns out, some of the hypertrophy may be due to injury, but working on a computer all day can contribute to the problem significantly and/or prevent it from healing. And according to my physical therapist, this is a common occurrence for those of us with desk jobs.
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So what does the computer have to do with a person's neck muscles? As it turns out, the positioning of each item in your workstation setup can make a major difference!

For example, when the keyboard or mouse is too high, you will have a tendency to raise your shoulders in order to use them. The keyboard and mouse should be at a level that allows your arms to stay down and your elbows to bend at approximately a ninety-degree angle. This is typically accomplished with the use of a keyboard tray; having the keyboard or mouse up on your desk surface is generally not recommended. 

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Additionally, if the computer screen is too low (as often is the case with a laptop placed on a desk surface), you may strain your muscles looking down all day. If the screen is too high, you may cantilever your neck out as you look up to read. My physical therapist recommends having the top of the computer screen at eye-brow level, so that you are looking straight to read the top line of text or very slightly down to read the rest of the screen. Most monitors can be adjusted to fit the right height, or if a laptop is your only option, consider getting a stand to raise it to the right eye level.

Similarly, if the arm rests of your chair are too high, they can force your neck muscles into that upward shrugging position, or if they are too low, you may have a tendency to lean against one arm (again resulting in a shrugging neck position on one side, which uses those trapezius muscles). Next thing you know, you will end up in hypertrophied trapezius land with me!

If you have neck or back pain, you should of course consult your doctor. He or she may recommend various tests, exercises, therapies, or medications to meet your specific needs. However, I can guarantee that if you work with computers with any regularity, your doctor will also tell you to fix your setup as part of the healing process. At the very least, there is no harm to be done in making sure your work station is ergonomic. Your employer may have ergonomic consultants already available to assist you, or you can read more about what makes a workstation ergonomic online!

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And remember to be conscious of keeping those upper trapezius muscles down and relaxed! Even the best setup will not necessarily help if you continue to lean forward in your chair, place your elbows on your desk, hunch your back, or keep up all of those other pesky sitting habits that I am working so hard to kick!

I hope to have good news about my neck pain after correcting my computer setup and working hard on my other back/core muscles in physical therapy for the next few weeks. I am thankful that I am getting back on the right track with my new ergonomic positioning. Best of luck to all in your own ergonomic adventures, and feel free to share any tips you have learned!

Saturday, March 2, 2013

Cyber Bullying: Beyond the Edges of the Computer Screen

I mentioned cyber bullying briefly in my last post on teen dating violence. Coincidentally, I have seen a number of articles on bullying since then, so I want to add my thoughts with a bit more depth to the bullying conversation.

One of the particularly challenging aspects of bullying today is cyber-bullying, in part because it was not even around when many of the parents of today attended school. For the sake of this discussion, I will more broadly define cyber bullying as harassment or humiliation involving the use of modern technologies, such as cell phones (including text messages, photos, or phone calls) or computers (including email, websites, or social media).

In particular, I want to address one of the main themes I have seen in the comments after the bullying articles I have read lately. Many adults have responded to this outcry against bullying with comments about America "going soft." These posters say things like, "students need to hit bullies back," and simply "shut off the computer." One poster, who called himself or herself "Pork Earmarks" went so far as to respond to someone's personal testimony about cyber bullying by saying, "You can't be cyberbullied. Period." This skeptical individual continued to explain that comments made on facebook are not worth anything, because they are not verbal and may not even be sent directly to the individual being insulted; therefore, in this person's opinion, they are not part of "real life."

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There are so many things that immediately jump out at me when I read comments like this. Here are a few:
  • The first is that I believe responses like this one are most likely to be made by those who did not grow up with the pervasive influence of technology in their childhoods and who do not understand how far-reaching its effects can be. A lot has changed in the last twenty years. The online world becomes increasingly intertwined with "the real world" with every day that passes. As you may know from previous posts, I do advocate for keeping oneself away from sites that trigger negativity (and I practice this personally). But when it comes to bullying, many individuals, both child and adult, who have experienced cyber-harassment will know that simply turning off the machine will not fix everything. This can be true even if the bully is a complete stranger and may be even more true if the cyber bully is a person also known personally outside of the cyber experience.
  • Secondly, comments like the one above perpetuate the myth that verbal and emotional abuse are not truly hurtful. This person erroneously assumes that because someone is not being physically assaulted, there is no damage done. Remarks made in writing or online, as well as those delivered in person, can cut to the heart emotionally, elicit genuine fear in the victim, and leave a lasting psychological imprint. Get with the times and acknowledge that verbal abuse is real abuse.
  • Thirdly, for those who advocate physical retaliation against bullies, even though I am not a proponent of violence, I am not going to say that there is categorically no instance where that can work. But at the very least, I can name many situations where it is not effective. First of all, if the identity of the online harasser is unknown, there is no one to attack. Furthermore, bullies often prey on those who they perceive as weaker and therefore unable to fight back (or they may work in packs). Additionally, even if further cyber activity is halted by punching a bully in the school hallways, the genius of the internet is that once something is put out there, it usually cannot be taken back. If an embarrassing photo is circulating the internet, for example, even if the original photo is taken down, copies of that image can continue multiplying through cyberspace and are nearly impossible to track and remove. Once the damage is done, it can continue indefinitely. Furthermore, as stated in point two, physically assaulting a bully to prevent future attacks does not remove the ongoing psychological effects of past verbal abuse or rumors circulating the school.
  • Additionally, the social experiences of children and teens are extremely important and formative, and young brains are simply not wired to handle pressures the same way as adult brains. Asking a twelve year old to respond to bullying as if their sense of self was as developed as that of a forty-two year old simply does not make sense or align with the real experiences of that child.
  • Beyond that, even adults handle social challenges in a variety of ways, depending on personality and life experience. I know that I personally would love to shrug off every naysayer I meet, and I have worked hard to develop a thicker skin over the years, but even so, I have had tremendously damaging and emotional interactions with people who took hurtful comments too far (both in person and through email). In general, I think that suggesting every single person should be able to "ignore" harassment in the same way one person does shows a profound lack of empathy for those who experience the world differently than the individual prescribing this course of action.
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Even as an adult, I notice that I encounter negative and what I would call "bullying" remarks in the comment threads of reputable news organizations on a near daily basis. This tells me that bullying behavior is a pervasive part of our online culture. Luckily, I have a more mature hold on my feelings and greater security in my relationships than I did when I was 14, and perhaps more importantly, I don't have to go to school the next day with the posters of these insulting remarks. But especially for children and teens who have to face their online tormentors in person, the bullying doesn't stop at the edge of the computer screen.

I remember in high school (ten+ years ago), one of my best friends received an email containing song lyrics from another girl, with really mean words and phrases highlighted in bold. Sure, my friend was able to delete the email, but those words were etched in her mind, and she still had to see the sender every day in class and on her sports team. I also dated an extremely nice guy who was called a "fag" on internet message boards by "popular" people he barely knew. Of course, he was confident that his friends all loved him, and he generally did not have to hang out with the jerks around school, but it was still emotionally hurtful and personally shocking to know that those messages were being broadcast about him. I myself was the subject of speculation about my sexual experiences as a freshman in high school, because, as one person put it, "What else would you be doing when you go to someone's house after school?" I was also criticized behind my back for being open about my Christian faith throughout high school. Sure, those things didn't change the reality of who I was or what I did, but they still hurt. And truth be told, my twelve year old self probably made some comments through AOL instant messenger that were more hurtful than I ever would have said in person.

As prevalent as these behaviors were when the internet was just gaining popularity in my teen years, unfortunately, these types of experiences are becoming even more common today. My family got our first home computer when I was in middle school; flip phones were the new cool thing to get when I started driving as a teenager (yep, my first cell phone at 16); and facebook only came out during my senior year of high school and required a college email address to join at that time. Students today have smart phones, internet access, social media profiles, etc. available to them nearly all the time and from a very young age. Even if your child doesn't have those things, chances are, a number of their peers do. The below chart of teen technology usage is based on a 2010 study of over 4000 teenagers in the southern United States. A 2011 Pew Research study showed that 95% of teenagers use the internet and a full 80% of those online participated in social media sites. These numbers continue to rise rapidly, as has the switch in the last two years from standard cell phones to smart phones, which provide 24/7 internet access (with more than half of cell phones in the U.S. being smart phones as of May 2012). All that is to say, these 2010 numbers are a good guide post and show the prevalent use of technology among teens, but keep in mind that almost all of the below values are undoubtedly markedly higher today in 2013.

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In many of the articles I have seen this week, students tell stories of other students creating fake profile pages on social media sites, where they use the pages to spread lies or make malicious comments. This is a completely new form of bullying that very few parents today would have experienced. In these instances, the victim does not even have to be involved with an online presence at all, yet rumors and negativity can follow the student to school in ways beyond their control. Telling the victim of this type of bullying to simply "keep away from the computer" is like telling your child to just "cover their ears" when a bully is insulting them in person. Sure, the sound will be a lot quieter, but it doesn't change the child's internal knowledge that someone is hurling insults his or her way and that other peers are well aware of what is being said.

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As you can see from the above charts, studies differ on the exact frequency of cyber bullying experiences. Yet all paint the picture that cyber bullying is all too common. The growth of cyber bullying has added many new layers to the childhood social experience, enabling attackers to spread gossip, inappropriate pictures, and threats to a much wider audience than in past. Cyber bullying can also help attackers maintain a level of anonymity not previously available, and even when not anonymous, technology can provide a certain "distance" from the comments being made (since the bully doesn't have to directly confront the victim to his or her face.) The psychological scars of cyber harassment are just as real as those that come from being slammed against a locker, and I am truly alarmed by the lack of understanding around the effects of verbal/emotional abuse in our culture.

Let's start a conversation about bullying where we come to the table acknowledging that our childhood experiences were different than those of children today. Let's listen and show empathy for the experiences of those who have been victimized and those who have bullied others (often the same children). Then we may have a real chance at understanding what cyber bullying is doing in our schools today.

For more information on teen internet usage, check out the Pew Research Center. For more information on cyber bullying, visit the websites of the Cyber Bullying Research Center or STOP Cyberbullying.