Friday, November 28, 2014

Music Therapy and A Song for the Holidays

For Thanksgiving this year, most of our good friends were out of town. Luckily, we were still able to have three amazing friends over for turkey and stuffing and all sorts of other Thanksgiving goodies. Two of them were brand new friends who moved here only two weeks ago!

There is something special and immediately bonding about chatting over a plate of comfort food on a special occasion. We look forward to many more meals over which we can get to know our new friends better while we continue to grow closer to longtime friends. The more the merrier!

One of our new friends shared that she trained in music therapy, so I took a moment today to read a little bit about how music therapy works. I am a newbie to all of this information, but from what I read, what many of us understand intuitively about music's ability to change our mood and even our whole day has also been proven empirically.

Music can affect both mind and body. Music therapy can change the speed of brain activity, relieve stress, lower blood pressure, and improve sleep. It can even help stroke patients in their movement recovery.

So in honor of our enjoyable Turkey Day and the start of the holiday season, I thought I would share one song that has touched me deeply, provoked emotion, and helped me relax this year.

Pentatonix competed on NBC's The Sing-Off. They, and all contestants on the show, sing a cappella, which means that their music is made with only their voices. That includes drum sounds and all - no accompanying instruments allowed! (Reminds me of my high school choir days!) After my favorite group, Afro Blue (see here and here and here), was voted off the show, I got behind Pentatonix, and they did not disappoint! I was constantly astounded by the innovative and rich sound that this group made with just five mouths. (To see them on the show, check out here and here and here. For some of their incredible a cappella work since, see hereherehere, and here.)!

And without further ado, below is the song I want to share today, Pentatonix' beautiful and touching rendition of a holiday classic, "Mary Did You Know?"


Wednesday, October 29, 2014

California Gold

I seem to be on a media kick with my blog posts lately. Here is another such post!

I have noticed on my Bart rides home that there is a new ad campaign in Berkeley encouraging residents to use their "green bins" to recycle food scraps, as well as soiled paper/cardboard. These can then be composted to enrich the soil, aka "California gold."

Image source: http://www.readysetrecycle.org

Did you know that California produces about half of the nation's fruits and vegetables in our central valley region? For some items, such as artichokes and walnuts, it is as much as 99%! That's why we care about soil.

The ads are produced by Ready Set Recycle, a campaign in Alameda County to help people learn how to properly sort their refuse. They even offer prizes, like gift cards, gardening compost, and fresh  food boxes from local farmers, for engaging in certain activities that support learning to recycle.

Image source: http://www.readysetrecycle.org

One tricky thing is that businesses in Alameda County can contract with private recycling companies, which may not follow the same rules as the curbside program. For example, where I work, a Starbucks coffee cup can be composted (green bin) and the lid can be recycled (blue bin). In other places, the lid may not be recyclable and would go to landfill.

So what does recycling and composting have to do with public health?

As it turns out, the environment affects our health! Things we do to and for the environment can have lasting impacts on our health. For example, according to the EPA, recycling can play a role in reducing GHC emissions, which are associated with chronic illnesses like asthma. For more information on waste disposal and public health, see here, here, and here.

Image source: http://www.readysetrecycle.org

Does your town, county, or region offer large scale composting? How has it changed your thoughts about waste or the environment?


Saturday, October 25, 2014

Health Insurance Changes Behavior: Moral Hazard

This semester, I am a Graduate Student Instructor for the undergraduate course Public Health 150D, Introduction to Health Policy and Management. I am really enjoying working with the students and am having fun helping them learn about the U.S. health care system! Here is something they learn about in our class:

UC Berkeley requires students to have health insurance to enroll in the school. When many of my classmates started graduate school, they had previously been working in settings that did not provide benefits and had therefore gone without some health services for a period. Once they started school and had insurance through the university plan, they got very excited to use those services to the fullest!

New glasses? Check!
Teeth cleaning? Check!
Pap smear? Check!
Flu shot? Check!
Sore throat? Why not get it checked out? Can't hurt! Check!
Ski trip? I'll have to save up to go, but at least if I get hurt on the trip, I know I'm covered!

Did you know? This phenomenon actually has a technical name!


Moral Hazard in health care is the tendency to behave differently when you have health insurance than when you don't. It can include both engaging in riskier behaviors (because you know you have insurance if you get hurt) or using more services (because they are covered fully or in part by your insurance).

Furthermore, it turns out that the better our insurance coverage (lower deductibles, lower copays, lower coinsurance, etc.), the more services (and more expensive services) we are likely to use! (See publications on the RAND Health Experiment and other similar findings.)

The name "moral hazard" makes it sound like this is a series of bad or wrong choices. But that is misleading, in my opinion. Sure, insurance companies dislike it, and in some cases, moral hazard can involve over-use of unnecessary services. But for most of us who just want to take care of our health, it is actually quite logical to weigh the risks and count the costs when we make everyday decisions. If we can afford it, of course we want to get the services that might improve our health!

If you have never heard the term "moral hazard" before, you have just been introduced to one concept from PH150D: Introduction to Health Policy and Management. And now you know!

Monday, October 20, 2014

Disney's Anti-Bullying Campaign #ChooseKindness

October is Bullying Awareness Month.

Image source:
http://citizenship.disney.com/be-inspired
While watching one my favorite ABC shows online recently, I saw an interesting anti-bullying ad put out by Disney, involving many of their stars donning t-shirts with anti-bullying messages and encouraging us to use the hashtag #ChooseKindness. Since bullying is an issue I have addressed on this blog before (read here and here), I looked into it more. As it turns out, Disney is doing an entire campaign this month around the issue. (For details, see their "Be Inspired" website.)

What I found particularly interesting is that they are not only putting out advertisements around the issue; they are also incorporating anti-bullying themes within the scripts of their television shows. Here are some sample clips I found:


Show Name: "Austin & Ally"




Show Name: "Girl Meets World"



I know that public health professionals have varying views on Disney as a whole (for example, some take issue with Disney's employment practices and affiliation with "The Other NRA"), and I am in no way trying to endorse them as a perfect company. And then, of course, there is the general philosophy (and evidence) that TV-viewing is not a particularly healthful behavior. (For more on that, see here, here, and here.)

But given the reality that kids watch an average of 4 hours of television per day,  I did want to share this one cool instance of public health social messaging making its way into mainstream media. I am thankful they are attempting something worthwhile through this campaign.

Wednesday, October 15, 2014

The Great Shake Out on October 16

Image source: shakeout.org
People across the country will be participating in the Great Shake Out, a nationwide earthquake safety drill, on October 16 at 10:16 am.

What to Do When an Earthquake Starts

According to the Southern California Earthquake Center, the best thing to do when an earthquake starts is:

1. Drop to the ground (before the earthquake knocks you off your feet). Do not try to move!

2. Cover your head and neck with your arms, and duck under a sturdy table if nearby. They say that with modern building design, you are more likely to be injured by falling debris, such as lamps or books, than by a collapsed building, which is why a desk or table is helpful.

3. Hold onto your shelter (desk/table) and be prepared to move with it until shaking stops.


Earthquake Safety Myths

On its website, the Center also dispels some common myths about earthquake safety:

Myth #1: You should go to a door frame, because door frames are the strongest part of the house. 

Although images of earthquakes from 50 years ago may show standing door frames, the Southern California Earthquake Center says that door frames are not stronger than other parts of a building in modern building design. Furthermore, a doorframe will not protect you from falling debris off a shelf or cabinet, which is the greatest risk during an earthquake.

Myth #2: You should try to run outside.

Many earthquakes do not last long enough for you to get outside, and perhaps more importantly, they may knock you off your feet or cause falling debris to hit you on the way. Furthermore, you may be hit by bricks or shingles off buildings if standing near a structure outside. The Center suggests it is better to drop, cover, and hold on where you are.

Myth #3: It is better to stay next to a table than to get under it (as perpetuated by chain emails circulating about the "triangle of life.")

The Southern California Earthquake Center says that this myth is based on multiple false assumptions, including the false beliefs that falling buildings are your primary threat during an earthquake, that buildings that do fall crush all furniture, and that you will be able to anticipate how a building might collapse if it does. According to the Center, while collapsed buildings get a lot of attention in headlines, this is much less likely to happen with modern building design. On the other hand, falling debris, bookshelves, and other items are much more likely to harm you and should be your main concern. This is why they recommend getting under a desk, rather than next to it.

For more information on earthquake safety in a variety of situations, check out their website or this helpful two-page handout!

Are you planning to do anything for The Great Shake Out event?

Saturday, October 11, 2014

Jesus as a Community Organizer?

For my Health Policy Advocacy class a couple weeks ago, we read an essay called, "The Power Tactics of Jesus Christ," by Jay Haley. The essay analyzes the ministry of Jesus as a movement for social change. The article compares Jesus' tactics to community organizers (and even dictators) who amass large followings. The text purports to describe the power dynamics of Jesus' movement-building work, providing lessons about rallying the poor and oppressed for a cause, which we can use in our own efforts to advocate for just health or other policies.


From our class discussion, it seemed like this article may be one of the few encounters many of my friends and classmates have had with Jesus, and it paints a rather disturbing picture. The text speculates on Jesus' ulterior motives and ultimately construes him as a tyrannical schemer who was willing to do anything it took to get his message of social justice out.

I have been hesitating on whether or not to share my thoughts on the essay for weeks, because of course, it is a controversial one to say the least. And then there is the personal temptation to hide who I am and what I believe, because faith is sometimes frowned upon in public health discussions.


But over the last few weeks, I have realized that I can only be who I am. Many of my classmates know that I am a Christian, and yet, I rarely share on a deeper level what that even means. The truth is, it has changed everything about who I am and how I see the world. Everything. I hope that sharing a glimpse into my own experiences of who Jesus is might open the door for others to feel more freedom in being real about who they really are and what defines them at the deepest level. So here goes nothing!

One thing I have in common with Jay Haley, the author of the essay we read, is that I do believe Jesus paved the way for a radically different view of the poor, hurting, and oppressed, and this belief is a large part of the reason that I am back in school to make a career change. I desire to love others through a career in public health.


Yet ultimately, the way I came to love Jesus had very little to do with His view of the world and everything to do with His view of me.


The scriptures taken as a whole, both Old and New Testaments, paint Jesus' motives and primary purpose not as a political campaign or rebellion, nor as a human movement for justice, but as the love-motivated fulfillment of God's plan to save and redeem humanity from separation from God himself. 

The most radical thing Jesus has shown me is that as much as I desire to love others through my own work and service, I cannot earn God's approval or love through these things. For one, my own efforts involve mistakes and mixed motives, many so corrupt that I hide them even from myself at times; as much as I try to be a good person, I shudder to think of what would happen to my reputation and relationships if the full content of my thought life were broadcast to the world on a projector 24/7. I don't know anyone that would fare well under the light of such a deep evaluation. Many of us agree that the world is a messed up place, but the more I examine myself, the more I realize that I am a central part of the problem.

Why is this so radical?

The miracle is that God actually knows all of the intimate details of every thought I have ever had, every motive I have ever held, every action I have ever done, and He loves me deeply.


Like, imagine the most passionate love story you have ever read or seen, multiply that by a million, and that is how God feels about me and you. In fact, He has already demonstrated his unconditional love for me through Christ's death on the cross. Christ lived the life of perfect love that I should live (but am unable to do in my own power) and then willingly out of love for me died the death that I truly deserve. When Jesus died on the cross, the scriptures teach that he actually paid the penalty for every corrupt thing I have ever thought or done, past, present, and future.

This free gift of love, this exchange of Christ's perfect life for my messed up one, is what I believe Christ's ministry was ultimately about. I don't need to keep trying to earn God's love or to save myself. I already have his unconditional love and salvation as a free gift.


It is out of the security of this relationship with God, knowing that He already loves me more than I could ever imagine or earn, that I grow to love Him more and can then serve and love others.


I am not interested in public health based on feelings of guilt or trying to earn God's approval with my chosen field.

On the contrary, because I understand at a deep level what selfless love is, based on what Jesus has already done for me and based on His unshakable love for me, regardless of what I do, I am overwhelmed with gratitude and have begun to be changed from the inside out. God's demonstrated love and his Holy Spirit guiding me are ultimately what help me pursue a world of greater equity, improved health, and justice for all.

When I was very young, I remember a few kids on the playground seemed to know something about God, and I had no idea who He was, having never gone to church at that time. I asked God to please show me who He was, and somehow He prompted my family to start attending the closest church to our house. Twenty years later, I am still leaning into new questions and asking God to show Himself to me, to help me figure out why I am responding to Him in any given way on any given day. And He is working on my heart from the inside out, revealing new aspects of His love in every season.

This is who I am. This is what shapes me.


My encouragement to those who have first encountered Jesus (or re-encountered him) through "The Power Tactics of Jesus Christ," would be to actually turn to God and ask Him your tough questions. Cry out to Him! If you find the essay intriguing, ask God to reveal Himself to you in other ways. If you find the essay disturbing, tell Him why and ask Him to help you in the search for answers. If you find yourself indifferent to it all, ask God why you feel this way. Maybe He will answer.

One great place to start in getting a glimpse into the life of Jesus is the book of John, the fourth book in the New Testament. If you are wondering who Jesus is, try reading it with an open mind, and see if God speaks to your heart through it. What events, characteristics, and statements stand out to you? What troubles you? What encourages you? God is not afraid of your questions; He already knows what they are before you speak them aloud, and He understands them. He loves you.




To learn more about the gospel of Jesus Christ, check out this resource about God's Plan of Salvation. https://bible.org/article/gods-plan-salvation


Not sure which translation of the bible to read? I enjoy the NLT, NIV, or ESV translations for modern language translated closely to the historical texts or The Message for a modern paraphrase / interpretation. (Note that The Message is NOT a translation.) All of these are available to read for free on biblegateway.com.






Friday, October 10, 2014

Jennifer Garner's Baby Bump

I saw this video posted recently, and I really appreciated it! I have not had children yet, but I hope to some day, and this just made my day. (And no, it's not what you think. Just watch!)



Thank you, Jennifer Garner, for your honesty and body positivity. So refreshing!

Tuesday, October 7, 2014

Colbie Caillat's "Try"

I hear this song on the radio a lot these days, but I feel like the video really enhanced my understanding of the meaning on a deeper level. So for those of you out there who are visual learners, I wanted to share.  It seems like so many of us struggle with image in one way or another, and this really spoke to my heart. I hope you too enjoy Colbie Caillat's new song, "Try."





Thursday, October 2, 2014

The Lost Art of Listening

Discourse over social and political issues (and thus health issues) today is fraught with fighting, name-calling, finger-pointing, and a general lack of cooperation. It is no wonder that approval ratings for Congress hit an all-time historic low this summer.

In part as a response to this tumultuous state of affairs, some of my college friends recently started an organization called Listen First Project. Their mission is simple:
"Listen First Project seeks to facilitate greater understanding, respect and cooperation by encouraging the timeless but abandoned practice of listening to each other, regardless of politics, religion, race, ethnicity, gender, sexual orientation, socioeconomic status, education or any other distinction. We believe in the power of listening to transform our discourse and change the world."
Image source: http://www.listenfirstproject.org

My dad loves to tell a story from my toddler years about the time I was chattering away on a long car trip, when suddenly it grew very quiet. Wondering why I made such an abrupt end to my soliloquy, my parents turned around to ask if I was ok. My response: "My mouth is tired."

And thus kicked off my illustrious career as a talker.

Listening has always been a challenge for me. It is not that I am uninterested in what others have to say. Quite the opposite! I get so enthusiastic, however, that I feel the need to jump in and respond to every....single....thing someone shares. When someone makes a statement, I often feel compelled to pose the arguments for the alternative position just to see if they can find any common ground with the opposition and to understand better what they think. I love engaging others and being engaged at what I perceive to be a fun and challenging level.

(Note to others: it turns out that not everyone enjoys this or feels respected and heard through this type of dialogue. Who'd'a thunk it?)

Despite my loquacious tendencies, Listen First Project has really struck a chord with me. When I think about the state of American politics, I sense that common decency has been lost somewhere along the way and is needed to bring us back on track.

Although I recognize the imperative for listening in the broader political realm, as I reflect on the above stories and personal traits embodied by my everyday experiences, I am realizing more and more that the first place listening needs to start is with me.

One thing I tried earlier this year was one week without expressing opinions - just to see if I could do it and come out alive. Most days, I failed at least once, but it made me much more aware of my own talking instincts and habits. Why do I feel the need to be heard on anything and everything? Will the world stop or people go on perpetually uneducated if I do not inform them of my views? As it turns out, the world kept turning and people kept learning and growing that week! In many ways, holding back my own voice made me more aware of the power that voice has when I do use it.

I was also called out by a friend for interrupting during a group project meeting last semester, and I really took it to heart to try to adjust this bad habit. I still struggle with interrupting, but being more conscious of it has meant that I now catch myself in the act more often, apologize, and ask the other person to please continue expressing their thoughts, because I do care.

Other places that learning to listen well has been making an appearance in my life include learning how to teach well (pedagogy) by facilitating other students in having discussions of their ideas, administering surveys with Best Babies Zone in East Oakland to understand community members' perceptions of their experiences,  and even learning in my prayer life how to sit quietly with God, rather than simply listing my requests.

Listening is one of the most important things I can do, both for my personal relationships and my professional success. In public health, understanding health concerns from the perspectives of the communities they affect, listening to community ideas for solutions, and investing in solutions that have community buy-in are often significantly more important to community thriving and successful interventions than any expertise or ideas I bring to an issue.

Learning to listen well will undoubtedly be a lifelong process for me.

I am excited to see where Listen First Project goes. To learn more about their efforts, check out the Listen First websiteFacebook page, and Twitter feed @ListenFirstProj.

Now, I would love to hear your ideas! How have you fostered the practice of listening well in public discourse, and perhaps more importantly, in your own day-to-day life?



Note: Another resource I have found helpful on this topic for those interested in the intersection of listening and faith is Richard Mouw's book, "Uncommon Decency: Christian Civility in an Uncivil World."



Sunday, September 28, 2014

BART Food Waste Advertisements

Recently, I have been noticing these advertisements on my morning and evening BART (Bay Area Mass Transit) commutes.





Food Shift, the organization responsible for these ads, is on a mission to eliminate food waste. Since California is currently experiencing a serious drought, these ads definitely caught my attention. That's a lot of water wasted! As I checked out Food Shift's website, I learned that wasting food has environmental, social, and financial impacts.

According to Food Shift's website, that average American family of four throws out $1,600 of food each year, or 20 pounds of food per person per month.

This got me thinking about how we can waste less food. Of course, Food Shift is interested in making changes at the systemic level of food supply chains, which has the potential to make a huge impact. At the same time, I think we can and should recognize that a lot of individuals making small changes can also make a difference.

One thing we do in our household is to freeze items before they go bad. For example, when our fruit is getting on the over-ripe side, we freeze it for use in future smoothies. We also freeze a portion of our leftovers when we cook large batches of food, so that it does not go bad before we finish enough of it (or get bored of it).

Food Shift has a list of recommendations on their site, such as planning ahead, keeping stock of your pantry (and using what you already have), and learning about proper food storage.

What systemic changes do you think would decrease food waste? What personal steps do you take to waste less food?

Monday, August 4, 2014

Hilarious "Girl In a County Song" Calls Out Sexism in Country Music

Everyone who knows me well knows I love country music!

However, in the last five years or so, I have been lamenting many of the latest songs that I perceive as degrading to women. The songs that bother me tend to be about the male fantasy of a woman or women who exist solely to please and serve the man or men in the story. Sexism in song.

When I cringe at these songs, it is not coming from a prudish mentality. I love that my husband is attracted to me, and yes, I sometimes get dressed up just because I know he likes it. The flirtation and attraction are fun and exciting and even a part of human nature. I have read a number of pieces by those who criticize every country lyrical reference to physical attraction as if it were an affront to women, and I am not one of those. I am thankful for physical attraction! I also love doing nice things for my husband that show I care. I might even consider bringing him a glass of sweet tea (if we drank that stuff). Both my husband and I believe that real love involves a commitment to serve one another, so we both make the choice to lovingly serve each other daily. So to be clear, I believe that both physical attraction and serving one another are wonderful things.

What makes me cringe is when wonderful things get twisted into expectations, obsessions, and idols. And when those twisted things are portrayed as romantic. Because they're just not.

One of the most endearing things about country music is the long list of amazing love songs, ranging from fun to deeply romantic, that have come out over the years. It is hard to turn on the radio now and feel like I need to flip the station every few songs just to avoid feeling seriously disrespected by this same genre!

So when I heard this awesome song recently, I was happy to see that I am not the only one bothered by this music trend! Maddie & Tae are right on point. Check it out!


Some of the songs (and a sampling of those song's lyrics) that Maddie & Tae call out with specific references are:
  • "My Kinda Party," by Jason Aldean - "You can find me in the back of a jacked up tailgate sittin' round watching all these pretty things get down in that Georgia clay....You can be my tan-legged Juliet. I'll be your redneck Romeo."
  • "That's My Kinda Night," by Luke Bryan - "Waiting on you to look my way and scoot your little hot self over here."
  • "Take a Little Ride," by Jason Aldean - "Well I'm just ready to ride this Chevy, ride this Chevy down a little back road. Slide your pretty little self on over. Get a little closer, turn up the radio....Sweet tan, little thing with nothing to do, I wanna take a little ride with you. I hope you're wearing those frayed out cut-offs..."
  • "Drunk on You," by Luke Bryan - "Girl, you make my speakers go boom boom, dancin' on the tailgate in a full moon. That kinda thing makes a man go mmm hmmm. You're lookin' so good in what's left of those blue jeans. Drip of honey on the money maker gotta be the best buzz I'm ever gonna find. Hey, I'm a little drunk on you and high on summertime. If you ain't a 10 you're a 9.9, tippin' n' spillin' that home-made wine on your tied up T-shirt..."
  • "Get Your Shine On," by Florida Georgia Line - "Slide that little sugar-shaker over here."
  • "Boys 'Round Here," by Blake Shelton - "Yea, the girls 'round here, they all deserve a whistle, shakin' that sugar, sweet as Dixie crystal.....Red red red red red red redneck"
  • "Redneck Crazy," by Tyler Farr (or what I like to call the "You're romanticizing scary illegal stalking song") - "Gonna drive like hell through your neighborhood, park this Silverado on your front lawn, crank up a little Hank, sit on the hood and drink. I'm about to get my pissed off on. I'm gonna lean my headlights into your bedroom windows. Throw empty beer cans at both of your shadows. I didn't come here to start a fight, but I'm up for anything tonight. You know you broke the wrong heart, baby, and drove me redneck crazy."
  • "Get Me Some of That," by Thomas Rhett - "You're shakin' that money maker, like a heart breaker, like your college major was twistin' and tearin' up Friday nights. Love the way you're wearin' those jeans so tight..." (To be fair, this is not the only country song to have ever used the term "money-maker," including Trace Adkins' song, "Honky Tonk Badonkadonk" several years back.)
  • "Hey Girl," by Billy Currington - "Hey girl, what's your name girl? I've been lookin' at you and every guy here's doin' the same girl. It'd be a shame girl if I let you just walk on by, 'cause I'm all caught up in your sweet smile. A girl like you comes around once in a while. So hot, gotta give it a shot, gotta get get a little bit of what you got."
One of the worst offenders that I don't think they mention specifically (so I will) is:
  • "Country Girl (Shake it for Me)," by Luke Bryan - "Gonna stomp my boots in the Georgia mud. Gonna watch you make me fall in love. Get up on the hood of my daddy's tractor. Up on the tool box, it don't matter. Down on the tailgate, girl I can't wait to watch you do your thing. Shake it for the young bucks sittin' in the honky-tonks, for the rednecks rockin' 'til the break of dawn, for the DJ spinnin' that country song. Come on, come on, come on. Shake it for the birds, shake it for the bees, shake it for the catfish swimming down deep in the creek, for the crickets and the critters and the squirrels. Shake it to the moon. Shake it for me girl. Country girl, shake it for me girl,shake it for me girl, shake it for me....."
The point is, their song is not a critique of an isolated rogue artist. The genre is now choc full of seriously sexist lyrics. And even when the song lyrics aren't so bad, the music videos often make up the difference.

I am excited that Maddie and Tae's song, "Girl in a County Song," came along at this moment to garner attention about the sexist trend. And with good humor, too! I would love to hear more songs like theirs on my radio. Turn it up!

Wednesday, June 18, 2014

Street Level Health Project's 20 Barriers to Health Care

This past school year, I had the privilege of interning as a Health Navigator once a week at Street Level Health Project in the Fruitvale neighborhood of Oakland. Street Level Health Project is an Oakland-based grassroots organization dedicated to improving the health and wellbeing of underserved urban immigrant communities in the Bay Area. They are working to address health from many different angles, from offering care at their free clinic, to distributing food bags from the food bank, to providing community lunches, to engaging in community organizing and occupational health education through the Oakland Workers' Collective.

As a Health Navigator, I had the opportunity to build relationships with community members and to help them find the right resources to advocate for their own health and wellbeing. Recognizing that health is not just about treating illness, people came to Street Level for legal, food, housing, educational, relational, and other information. For me, the role required practicing active listening (often in Spanish), learning a lot about the resources in the neighborhood, and constantly struggling to find the balance in doing versus supporting. Although my summer internship has pulled me away from working at Street Level, I often find myself thinking of and praying for them as I pass through the Fruitvale BART station on my morning ride to work.

One thing I appreciated about Street Level was that my first week, my supervisor gave me a document explaining some of the barriers to health that many community members face. The list is in many ways common sense, but at the same time, it is easy to be blind to the obstacles that I do not personally experience on a daily basis. I thought I would share a sample of the items in the document, and I would encourage you to read the whole thing here to learn more about some barriers to health care access and to health in general experienced by many immigrants and other local residents.

Image source: streetlevelhealth.org

Examples of common barriers for clients at Street Level:

1. No current/valid identification with photo.
2. No proof of income, due to cash payments for work.
3. No proof of address (homeless, squatting, living with friends/relatives, bills and leases are in other people’s names, no contact with primary renter, in recovery/rehab home, etc.)
4. Lack of transportation or funds for transportation.
5. Fear of ending up with a bill for services.
6. Already have a bill and are too embarrassed to go back or think they won’t be seen.
7. In another city working when they finally get a follow-up call for an appointment (seasonal farm workers or other migrant workers).
8. Inability to miss a day of work for medical care.
9. Language barriers, such as limited English, limited literacy, and/or unfamiliarity with the phone tree menu system.
10. Cultural norms about accepting advice from health care providers without asking questions.
11. Different ways of understanding wellness and illness that conflict with Western medicine.
12. Working and supporting the family is valued over self-care.
13. Fear of immigration detention or deportation.
14. The professional, dressed up, or formal atmosphere of clinics and hospitals can be intimidating.
15. Racism and classism encountered in health care settings.
16. Multiple confusing steps (find out if you’re eligible, call to get on a waitlist, make an appointment for program registration, go to registration appointment, make doctor’s appointment, go to separate location for labs and medications, etc.)
17. Difficulty planning ahead for appointments due to the often unscheduled nature of day laborer jobs.
18. Limited communication between multiple different health care providers.
19. Long wait times (all-day waits or long waitlists) for appointments in public clinics and hospitals.
20. Significant documentation or bureaucracy required to maintain coverage for care when circumstances change frequently.

This is not to say that all immigrants or clients experience all or any of these barriers. But many of the people I worked with did experience some of these, and understanding cultural, structural, and other practical barriers to trusting, consistent, and affordable medical care helped me value the perseverance and strength of the people I met and informed the way I responded. Read Street Level’s full list here.

Friday, May 23, 2014

Patio Garden!

Last year, I decided that growing edible plants would be fun. Unfortunately, the aphids, spider mites, whiteflies, and squirrels decided that eating my plants would be equally fun. This year, with my mind set on defeating the evil squirrels and aphids, I put in a bit more effort, and so far, it seems to be paying off!

Bottom left: you can just barely see the black flower barrel and next to it the green leaves of our hibiscus coming back. Middle left: vegetable cage. Top middle: hanging tomato plant. Top right: fusia basket. Bottom right: some of the herbs on our patio table. 

Firstly, I read up on aphids and other bugs. As it turns out, a natural way to control the bug populations in your plants is to plant a variety of edibles and flowers that create a sort of habitat. Rather than attracting a single bug (such as aphids), this habitat can also attract beneficial insects that prey on the harmful ones. Monoculture (planting only one plant) is a recipe for disease and bug infestation. Of course, not all plants love growing next to all others, so I used some helpful online sites to make choices. One of the predator-attracting flowers that has grown easiest for me this year is alyssum, a small white flower. Many brightly colored flowers attract other bugs, as well. And bonus: my fusia has attracted hummingbirds, which are just plain fun to watch! For lists of predator attracting flowers, read more here and here.

Top left: herbs and flowers on our patio table. Bottom left: flower barrel
with alyssum and snap dragons. Right: fusia flowers.

I also found out that certain plants are known to repel aphids (such as chives, green onions, mint, and marigolds), which I planted near the edibles I wanted to protect this year. I also tried some of the tricks I read about that may or may not be old wives tales (such as burying pieces of banana peel around affected plants). And finally, I made sure to plant everything in places where I could easily reach them this year, because physically wiping off aphids with gardening gloves when the population is small helps to prevent them from multiplying rapidly. I also read that the scent of smashed aphid warns other aphids to stay away. And smash the aphids that have dared to enter my planters I have done! I also occasionally spray the plants with an organic pesticide (made of plant oils), if it looks like there have been too many aphids on my lastest bug-smashing expedition. I try to avoid using sprays as much as possible, because I do not want to harm any of the beneficial bugs. (Plus, I found that the oils alone did very little to get rid of the aphids last year. However, combined with this year's multi-pronged attack strategy, I figured it wouldn't hurt on occasion.)

All in all, we have significantly fewer aphids this year.

Vegetable cage with a tomato, bell peppers, chives, green onion, arugula, and several types of flowers.

As for the squirrels, I designed a cage-like contraption with swinging doors, and so far, I have not had any whole heads of lettuce go missing. (Yes, that happened last year, when the heads were still too tiny for a human to want to eat; they were just pulled completely out of the pots, with nothing but a hole where a lettuce once had grown!) For the cage, I simply drew a rudimentary design on a piece of paper, and my husband and I wrote in some measurements. We bought the wood, metal brackets for the corners, wire fencing material, and other supplies and went to work! This was a three-weekend project for us between the shopping, building the frame, attaching the wiring, attaching the doors, etc. It was more work than I thought it would be (especially for my husband, as he did some of the heavier lifting), but I am very happy with the result!

Constructing the vegetable cage. I love drills! (Not!)

Our plants are looking great so far! This year, we have tomatoes, bell peppers, chives, green onions, arugula, basil, parsley, lovage, thyme, and rosemary, in addition to several species of flowers, such as marigolds, alyssum, pansies, snap dragons, Shasta daisies, a fusia basket, and the perennial hibiscus I planted last year (which is just starting to grow new leaves, so hopefully the flowers will come in again soon!) The veggie plants are getting quite large, and I hope that we get actual tomatoes and peppers in the near future. Hopefully I can post more pictures when we do.

Another angle showing most of the garden.


Wednesday, May 14, 2014

Automatic Action Tendencies (or Using Magical Mind Games and a Joystick to Change Implicit Alcohol Associations)

In the fall semester for my Theories of Health Behavior class, we spent some time talking about implicit associations. These are preferences or biases that we hold that we may not even know we hold and that have the potential to affect our choices and behaviors. One really interesting experiment we discussed involves the approach bias for alcohol (e.g. the tendency to either automatically approach/prefer or not prefer alcohol).

In one study, participants' approach bias for alcohol was measured both before and after an intervention. The intervention involved asking alcoholics in recovery to use a joystick to either pull pictures towards themselves or to push them away. Four different groups were assigned to four different levels of intervention, with two being experimental groups and two acting as control groups.

The first experimental group was directly told to push the joystick away when an image of alcohol came on the screen and to pull the joystick when a soft drink was displayed. All images were exactly square.

The second experimental group was told to push the joystick for pictures in landscape format (horizontal) and to pull the joystick for pictures in portrait format (vertical). Most of the images of alcohol appeared in landscape format, whereas most pictures of soft drinks appeared in portrait format. However, participants were not told about the alcohol versus soft drink distinction and were merely told to react based on the layout orientation of the picture on the screen.


Image source

Image source
As for the control groups, one group received no intervention at all. A second control group was told to push the joystick for pictures in landscape format (horizontal) and to pull pictures in portrait format (vertical). In this case, pictures of alcohol and soft drinks were evenly distributed between the landscape and portrait images, so that participants were pulling alcohol images the same number of times as they were pushing them away.

Image source


The results of the study showed that for both experimental groups, alcohol approach bias was changed to a strong avoidance bias immediately after the intervention. The control groups, on the only hand, averaged only a mild decrease in approach bias. Note that this was equally true in the case of individuals in the second experimental group, who were unaware that they were specifically pushing images of alcohol or that the exercise was meant to affect alcohol preferences in the first place. Furthermore, in a one-year follow-up, fewer of the experimental group participants had alcoholism relapses than the control group participants.

On the downside, the experimental groups ended up showing an increased approach bias for soft drinks!

A similar study was conducted among high-drinking students, who then taste-tested alcoholic and soft drink beverages after engaging in the joystick/image exercises. This study showed that those who had been assigned to unconsciously push away the images of alcohol and who also showed a change in their Approach Avoidance Test score, ended up drinking one full glass of beer less during the taste-testing time than those whose Approach Avoidance Test scores had not changed significantly.

While these studies certainly raise some ethical concerns about unconscious brain manipulation, they also have the potential to affect addiction treatments.

In addition to the health intervention reasons why these studies are interesting, I also found them interesting from a marketing perspective. Surely many companies who want to sell me something are also aware of the power of implicit associations and use these to their advantage. It has definitely got me wondering how my implicit preferences affect my food decisions and other consumer choices. In fact, some firms even use neuro-marketing to create the most compelling advertisements. These firms pay people to view advertisements while having their brain activity monitored, in order to predict whether the ads are likely to affect consumer preferences and behavior.....more on that in a later post!

What do you think of the joystick activity as a potential alcohol intervention? What potential benefits or downsides seem most relevant or important to you?


Saturday, April 12, 2014

Epigenetics: Are Nature and Nurture Really So Different?

Image from: http://robbiestudent.com/
the-doctor-opines-nature-vs-nurture-
part-1/
This semester, I am taking a class called "Biological Embedding of Social Factors." The premise of the class is that we have spent so many years arguing whether health conditions are the result of nature or nurture, without considering that our lived experiences (and those of our ancestors) can actually affect our biology! Sometimes nurture is nature and vice versa. Often, this debate takes place in the context of determining whether a disease is caused by genetic factors or environmental factors. Or if by both, how much is caused by one or the other? As I am learning in class, however, the study of genetics has not turned out to be the panacea it was originally thought to be, and many processes are more complicated than an either/or categorization of genetic versus environmental effects. Sometimes, we may have an identical gene or set of genes that does completely different things depending on context and experience!

Consider first the human body and its parts. Each part has the same set of genes as all other parts, but each part looks completely different from others. The cells in your skin have the exact same genetic makeup as the cells in your bone marrow, and yet one set of cells creates more skin and the other set produces blood cells. How do these two genetically identical cells do completely different things? In scientific terms, we say that the genes are being "expressed" differently in the two cells. Clearly, it is not just the genetic makeup of the cell that determines what the cell does. Something outside of the genome is interpreting what a particular gene means and then translating that into what they cell should do!

This is the type of question being studied by the field of epigenetics, which literally translates to "outside of genetics."

I am not going to get into all of the details of how these processes work (and many processes are still unknown), but rather, I just want to share a few particularly interesting findings to get your juices flowing about how the environment can actually affect outcomes that we often think of as being predetermined by genetics. I find it helpful to imagine a gene or set of genes that, rather than telling the body to "Make X happen," actually tell the body, "If you encounter situation A, make X happen, and if you encounter situation B, make Y happen."

Animals

One interesting example is that even though there are genes known to determine the coat color of  mice, the diet of pregnant mice can still affect the coat color of their offspring. Scientists are able purchase inbred mice strains in order to get genetically identical mice and then feed them different diets to isolate the effects of the dietary supplements. As it turns out, among mice who have the gene for yellow fur coats, mice fed a high-methyl diet are more likely to have gray offspring, whereas those not fed this diet tend to have yellow offspring. The methyl diet effectively "turns off" the yellow coat genes in the offspring! Interestingly enough, the yellow-coated mice are also known to experience increased risk of other health problems. (Wolff, Kodell, Moore, & Cooney, 1998;  Begley, 2009)

Another example that I found to be fascinating is that of the minute parasitic wasp. This wasp actually lays its eggs inside a host insect, either a butterfly or an alder. Wasps bread in butterflies develop wings, whereas wasps bread in alders do not develop wings. One might think that having wings or not having wings would be genetically determined, and in many ways, it is, because wasps have genes that allow them to develop wings in the right conditions. Yet the gene is able to be expressed in a completely different phenotype (visible outcome), depending on the growing conditions of the egg (Gottlieb, 1998)! We might infer that there is some sort of hormone, diet, or other chemical environment in the host insect that actually tells the genes for wings whether or not to be expressed.

Yet one more example is that of the water flea. Offspring are born with a "helmet" for protection if the mother has ever encountered a predator and no helmet if the mother has lived a care-free bug life (Begley, 2009).

There are many such examples of this phenomenon in nature, revealing that animals with identical genes can actually adapt, such that the genes remain the same, but get expressed very differently in response to environmental stimuli.

Humans

In the human realm, scientists are currently asking questions about whether traumatic or prolonged stress exposures (which are known to alter brain chemistry, hormone production, etc. for some individuals who experience them) may also affect the offspring of individuals who experience these exposures. There is already evidence that individuals who experience PTSD have lower levels of cortisol, and children born to these parents may also have lower levels of cortisol throughout their lives, without ever having been traumatized themselves (Yehuda, Halligan, Bierer, 2002). This in turn may make these offspring more susceptible to PTSD if they do encounter a trauma in later life and may also be passed down to their offspring.

Likewise, there is evidence that maternal stress exposure in utero, or even before conception, affects the brain development of offspring, and thus the ability of offspring to handle stress "appropriately" for the rest of their lives (Matter, 2014). While children almost certainly learn many stress coping techniques, either adaptive or maladaptive, from watching their parents and peers, the biological effects of parental stress before birth are of special epigenetic interest. It is not just that children learn from observation after being born, but also that during fetal development, the child's biological abilities to produce and regulate stress hormones, to interpret stressful experiences, to grow certain regions of the brain that control stress response, etc. are being formed. The mother's lived experience is reflected in her hormone levels and other biological traits, which may then affect the way that developmental genes are expressed in the fetus. This fetal development, in turn, informs the specific way the individual will be able to either learn or not learn from their surroundings after they are born. Although these developmental traits are not completely deterministic of behavior or future health outcomes, they can act as a major hurdle or point of susceptibility for those affected and thus make it more difficult for individuals and populations to achieve good mental and physical health.

On another topic, studies show that children of mothers who were pregnant with them during times of famine experience significantly higher rates of obesity, diabetes, and schizophrenia as adults (Lumey, Stein, & Susser, 2011). So while the underlying genes for how to develop a healthy digestive system or a healthy brain may not change due to famine, something about famine affects the way these genes get expressed in development. Similar questions are being asked about a variety of mental illnesses, heart disease, personality, sexual development, and many other human health outcomes for which human biology might be affected by exposure to violence, historical traumas (like slavery), pesticides, household chemicals, and many other experiences.

The question is no longer solely about whether genes predispose a person to a certain health outcome, but also about whether the experiences of our parents, grandparents, and even more distant ancestors are affecting the way our genes are being expressed.


For more information, check out:



References:




Wednesday, February 26, 2014

Anti-Smoking Advertisements

A few days ago, I posted about a handful of recent smoking policies that have come up in discussions with friends and family, in new campus rules, and in laws around town. As promised, today I want to talk about some interesting anti-smoking advertisements.

In my "theories of health and social behavior" class last semester, we talked about various advertising campaigns and what has made them successful (or not). Interestingly enough, studies show that some anti-smoking (and anti-drug, anti-drinking, etc.) campaigns actually increase propensities for engaging in those activities, while others effectively work to reduce them.

For example, after a major industry lawsuit in 1998/1999, some cigarette companies agreed to run anti-teen smoking advertising campaigns. The messaging in these ads may have conveyed with words that smoking was bad for you on the one hand, but the way that was done was often ineffective or even subversively promotional of smoking. Whether this was intentional or simply misguided, I cannot say, but it is definitely interesting. For example, by showing a single brave student resisting the peer pressure of everyone else smoking, the real messages interpreted by teens may have been, "You're the only one who doesn't smoke," and, "Your parents are trying to tell you what to do." Or by directly mentioning companies' brand names as the funders of the messages, the companies may have actually built more positive brand association. Especially for a target audience like teenagers, perceptions about how many other people are doing an activity, how cool/desirable those other people are, how trustworthy an industry is, and whether the teen is being "told what to do" by an adult (as compared to being given greater independence), can actively affect decisions to start or continue a behavior. This is an important reminder as a public health professional that we need to be careful with our interventions and take as much precaution as possible to prevent unintended harm. Here is an example of an ad that was evaluated to have actually produced an increase in intention to smoke among teens:


A totally different type of advertisement that we studied, which was evaluated to be more effective, involved off-beat messaging that cast the tobacco industry in a negative light. This was without ever directly telling people what to do or even mentioning the negative consequences of smoking. Check out this innovative ad:


The reason I started thinking about this topic again so recently is that I saw a series of newer anti-smoking advertisements circulating online. For example, this one has gone viral and boasts the YouTube tagline, "perhaps one of the best anti-smoking ads ever created." I am still skeptical, but it is definitely interesting. Judge for yourself:


And then there is this super  hilarious new series about people who self identify as "social smokers," comparing them to social farters, social nibblers, and social ear wax pickers. To see all three videos, click here, and to check out the campaign's facebook page, click here. Below is one of the videos:



Click here for some other creative anti-smoking print advertisements. What do you think? Will these latest ads achieve their goals to decrease smoking? Are there any unintended messages here? What are your opinions on any of the policies mentioned in my last post, or the anti-smoking movement in general?

Friday, February 21, 2014

Smoking Policies

For whatever reason, smoking has been the topic of many conversations, viral videos, and policies popping up in my life lately, and I wanted to share some of the interesting things that have been coming up. Feel free to leave a comment letting me know what you think about any or all of these issues!

Berkeley Campus Smoking Ban

U.C. Berkeley recently became a smoke-free campus, meaning that you have to physically leave campus to smoke a cigarette. My prior workplace implemented a similar policy during my first year there, while at the same time offering increased smoking cessation support. As an asthmatic with lots of allergies who does not smoke, I personally feel in favor of the ban. Cigarette smoke has often been a trigger for me. 


At the same time, I know that some of my peers have expressed "feeling judged" by the campus administration and fellow students. Whether you believe this judgment is ultimately a bad thing or not, they obviously perceive it as injurious in some way. Having never been a smoker, I cannot say that I personally know how hard it is to quit. Based on what I do understand, however, it seems that for many people, the relaxation associated with smoking, the reflexive association of cigarettes with certain experiences, the reduced appetite that makes weight management easier for some smokers, and especially the addictive power of nicotine, make it difficult for many to stop. In my prior work place, the smoking ban did serve as an added motivation for some people who were on the verge of deciding to quit, and I heard many stories of people who had made the change through smoking cessation programs shortly after the ban went into effect. On the flip side, I also recall that as a result of that smoking ban, instead of smoking in front of our building, many people simply crossed the street and smoked in front of other businesses, thus exposing other employees and customers to more second hand smoke. And since our company no longer provided ash trays on site, many people threw their cigarette butts in the street outside of said other businesses. Suffice it to say, we received some complaints. I am not sure if this will be the case near our campus or not. It seems that only time will tell. All in all, I appreciate and support the policy, but I recognize that for some, it remains controversial.

City of Berkeley Residential Smoking Bans

Then there have been even more controversial smoking bans, such as the City of Berkeley's law against smoking in apartments or condos, where neighbors may presumably suffer the effects of second hand smoke. And more recently, there is a more restrictive proposal on the table to ban smoking inside single family homes where children, seniors, or lodgers are present. (I'm not sure what the law says about seniors who are smokers.) When I first learned of the latest proposal, I felt outraged at the heavy-handedness and immediately concluded it was going too far. But after sitting on it for a couple months, I cannot help but wonder why I jump to so adamantly defend the "right" to expose others to potent known toxins, including allowing a person to expose their kids, just because they are their kids. We do have plenty of laws in place mandating that you send your kids to school, seek medical care when your child has a serious illness, and do not abuse your child, so it is not as if our society as a whole believes parents can simply raise their kids in literally any fashion. While these cigarette laws are certainly paternalistic, I believe there is room for debate about where we draw the line between necessary paternalism and going too far, especially when it comes to exposing kids to things we know to be poisonous carcinogens. Right now, I find myself in the void on this particular issue and still trying to make up my mind.

Hiring Practices

Also related to the topic of smoking, I recently had a conversation about employers who do not hire smokers at all (e.g. Cleveland Clinic). On the one hand, I always found it hypocritical for healthcare professionals to smoke while telling their patients to quit. On the other hand, as a general hiring policy, one could argue that this is discriminatory, especially as we were discussing whether this standard might be applied to other fields not directly related to health. The other people with whom I was discussing the policy emphasized that smoking is a choice, unlike many other personal characteristics that should not be used as reasons for not hiring. I am personally not swayed to their side and will cautiously say that I still see this policy as discriminatory. However, I was clearly in the minority in the discussion I was having, and I am open to having my opinion changed by a compelling argument in future.

CVS to Stop Selling Cigarettes

CVS Caremark recently announced that it will stop selling cigarettes in retail locations by October 14. The CEO stated, "The sale of tobacco products is inconsistent with our purpose." (See this article on the CVS site.) As pharmacies are playing a greater role in not only dispensing drugs, but also providing a certain level of patient care (such as walk-in clinic sites), it seems to be even more off-mission to continue to sell a product known to cause so many illnesses and deaths. CVS Caremark specifically is branding itself as a "pharmacy innovation company" that is "working to make health care better." According to their website, they also aim to exercise ethics, abide by principles of corporate social responsibility, and influence health policy. With regards to this latest decision, I have to say that I am impressed at their willingness to lose a portion of their revenue to maintain integrity. Bold move, CVS Caremark. Bold move!


In my next post, I plan to share about some interesting anti-smoking commercials, both old and new. In the meantime, what do you think about the above policies? Which ones are good ideas and which ones go too far?