Monday, December 14, 2015

Witness Misidentification: Exonerated by DNA Evidence After 11 Years for a Rape He Didn't Commit

I recently had the pleasure of talking to a lifelong friend who now works for The Innocence Project. The organization seeks to exonerate wrongfully convicted individuals through DNA testing. They also work to change criminal justice policies that contribute to such wrongful convictions. Since their founding, they have already exonerated 334 individuals; their clients have served an average of 14 years before being released. Many of the crimes they investigate are sexual assaults.
I have countless public health colleagues who are passionate about ending sexual violence. They are advocating for a culture of consent, fighting to change sexist notions and skewed views of masculinity, campaigning against the shame and stigma that many experience when they come forward about an assault, and working to help victims heal from the trauma of sexual violence. They are rightly angry that anyone has to experience this form of violence and that those who do may be deprived of the respect, care, and justice they deserve. This is an extremely important public health topic.

But what happens when a real crime has been committed, yet the wrong perpetrator is identified?

Approximately 82% of rapes are committed by an individual known to the victim. In these cases, witness misidentification is typically not an issue. But in the other 18% of cases, the assault may be the only instance when the victim sees their attacker, and they must rely on their memory of the traumatic event if and when there is an opportunity to identify the perpetrator.

My friend shared with me the story of Ronald Cotton and Jennifer Thompson. Thompson mistakenly identified Cotton in a 1984 lineup, feeling certain that his was the face of her rapist, a face she had painstakingly studied during the commission of the crime in the hopes of catching the man if she lived through the experience. In 1995, however, new DNA technology showed that Cotton was innocent and identified the real perpetrator, Bobby Poole. At that time, Poole was already in prison at the same facility as Cotton for other crimes he had committed. Thompson was shocked; she had been so sure.

Cotton                                            Poole

After Ronald Cotton's release, Cotton and Thompson became friends and have worked together to educate the public about wrongful conviction and to advocate for criminal justice reform. They even wrote a book together called, "Picking Cotton: Our Memoir of Injustice and Redemption."

My friend's passion for the issue and recanting of this true story piqued my interest, and I later watched the 60 Minutes episode about their experience. It is truly powerful.

This is not a story about false accusation due to a made-up story. Jennifer Thompson was raped. And it is not that Thompson was intentionally misidentifying her attacker. Rather, in a way, her memory was tricked when she initially saw a photo lineup that included Cotton and not Poole and noticed some key similar features, such as the angle of Cotton's eyebrows. (Cotton says that other inmates even sometimes confused he and Poole and called one by the other's name.) When Thompson picked Cotton out again in an in-person lineup a short time later, his face was cemented in her memory. Even at Cotton's re-trial in 1987 (before the DNA evidence surfaced), when Poole was in the court room due to a fellow convict's testimony that Poole had admitted to the rape, Thompson did not recognize Poole's face; she was still convinced Cotton was the perpetrator, and he was convicted a second time.

One of the most interesting and telling quotes in the 60 Minutes segment comes from the detective in the case. "Law enforcement wasn't schooled on memory. We weren't schooled in protecting memory, treating it like a crime scene, where you're very careful and methodical about what you do and how you use it. We weren't taught that in those days." (6:40 into the Part 2 video below)

I highly recommend watching the below 60 minutes episode. Not only does it tell the story of Cotton and Thompson, but it also goes into some very interesting scientific experiments on memory that will change the way you view eyewitness testimony.

60 Minutes "Eyewitness Testimony" Part 1

60 Minutes "Eyewitness Testimony" Part 2

While public health seeks to prevent sexual violence in the first place and fights for changes in the public discourse to create a culture of believing and empowering victims, my hope is that we not forget to promote true justice for both the Jennifer Thompsons and the Ronald Cottons of the world.

Thursday, December 10, 2015

Get a Breast Pump with no Copay!

Doctors, early childhood specialists, and public health professionals have shown that there are many benefits to breastfeeding for moms and babies who are able to do so. And a breast pump can help a mom continue providing milk for a baby even when she cannot feed him or her directly. For example, many working moms use breast pumps during the work day to express milk for day care the following day.

Since the passage of the Affordable Care Act - also known as Obamacare - many insurance plans now cover breast pumps at $0 copay. The law requires it! Since I have not seen this new benefit widely publicized, I thought I should share with others. (It is important to note that some plans may be grandfathered, meaning they do not have to comply with all of the new rules yet, and some public plans may not be required to offer this benefit at all. But there is a good chance that your insurance does cover it, so why not check?) If you are pregnant and wanting to use a breast pump, even occasionally, I definitely recommend at least looking into it - all it takes to verify is a quick phone call or email!

And the great part is many stores that sell breast pumps will do the work for you to find out what your insurance covers.

For example, Target has a breast pump program. You can either call the phone number listed on their program website or email them at with the following information:

- full name
- date of birth
- expected due date or delivery date
- address
- phone number
- insurance name
- insurance member ID (including any letters)
- insurance group ID
- insurance phone number
- first and last name of your OBGYN or midwife
- doctor's phone number

They will then contact your insurance company on your behalf and email you back with information about which breast pumps are covered in full by your plan. They will also let you know how much it would cost to purchase an upgrade, for example, to get a bag that can hold all of the parts. Then you email back about which breast pump you want, they handle the insurance transaction behind the scenes, and you simply go pick it up at the location they tell you (a Target store near you).

I was amazed at how simple it was to acquire my breast pump. Now it is hard to imagine life without it! I was able to leave enough breast milk in the freezer for my husband to feed our eight-week-old son when I left them alone together for a long weekend. And I was able to enjoy participating in a friend's wedding across the country knowing that our baby would be well fed back at home!

Friday, December 4, 2015

8 Tips to Get the Most out of Marriage Counseling

Relationships affect our physical, mental, emotional, and spiritual health tremendously, and for those who are married, our relationships with our spouses can be some of the most impactful and life-giving ones we have. Yet even good relationships have areas or seasons of conflict.

Recently, I have had several conversations with friends and family about marriage counseling. Matthew and I have been married for five years now. About two years into our marriage, we decided to go to counseling for several months to help us work out some areas of conflict that we felt were not improving through our own efforts.

Our marriage was not in a state of crisis. We were mostly happy, enjoyed each other's company, and felt secure in our commitment. But there were certain topics that we were unable to discuss without tears being shed due to events and discussions that had happened in our dating relationship and early marriage. We felt that we would be stronger in twenty years if we dealt with these topics in year two, instead of waiting for our challenges to devolve into something more.  So we asked our church for a list of counselors, picked one, and jumped into unknown relational territory for us!

Our Wedding Day, August 2010
(photo take by Anna Wu)

As my friends and family know, after our experience, I became a huge proponent of marriage counseling. It is not as if I now see counseling as a panacea for all relational problems. Just like the rest of marriage, counseling was hard work, and that's coming from someone who did not feel on the brink of disaster going in and was on board with change from the get-go. So no, counseling is not a silver bullet.

So what did counseling do for us? It gave us new frameworks and tools to break out of our thought patterns, communication habits, and actions around certain topics. Although we have always been very strong in communication (you kind of have to be when you date long distance, as we did for two years), counseling helped us reframe one particular challenge from a you-versus-me issue to an us-versus-the-problem one. The new ways of thinking about the issue that we learned eventually changed the way we interacted around it completely.

I am by no means a relationship expert, nor would I claim to know what works for everyone. (That's why I needed a counselor!) However, having had a positive experience with marriage counseling, I wanted to share a few things we learned  through our time on the couch about how to get the most out of counseling, in case it helps another individual or couple in need of some extra support.

8 Tips

1. You don't have to wait until you are in crisis to go. (My husband says you shouldn't wait until crisis.) Most people can and should learn to resolve minor conflicts in healthy ways between themselves, so I am not suggesting you drag your spouse before a conflict arbiter for every disagreement. But I also don't think we have to experience catastrophe level conflict to seek support. Some conflicts (like ours) come up every few months for years without any progress seeming to be made. These conflicts don't need to be earth shattering to slowly erode your trust and joy. Some very common conflict areas in marriage - money, in-laws, children, sex, etc. - can take a toll over time, and my hunch is that the majority of couples could benefit from some improved communication in at least one nagging area. I was so thankful that our friend group had a positive culture around counseling, because we experienced no stigma in the decision to go. In fact, most of our married friends had been at one point or another. It did not mean that our relationship was worse than other folks'. It meant that we were so committed to each other that we were willing to go to great lengths to work on ourselves.

2. Before you start counseling, talk about what you want to get out of it. This was hugely important for us. Counseling can be expensive and time consuming. Matthew and I decided that we wanted to learn new tools to handle a specific area of conflict, and we told our counselor up front that we would attend counseling until we felt we could continue on a positive trajectory on our own in that area. We didn't feel like we had to be perfect or talk through every detail of that conflict, and we didn't feel like we needed to address every single other type of conflict in our marriage. Rather, we wanted to be confident in our healthy ability to resolve the new challenges that inevitably arise in any relationship. After a few months, we felt like we were on a steady path to healing and growth in our particular area of focus, so we ended our professional counseling while continuing to implement on our own the tools and techniques we had learned. Setting a goal from the outset helped us to stay focused throughout counseling and to know when and how to make the transition out of it.

3. Not every counselor will click with you. It is ok to try out more than one. It helps if their general philosophy is in line with your personal beliefs and goals. Although we stuck with the first counselor we tried, many of our friends told us beforehand that they had tried two or three different counselors until they met someone who they respected, who they felt understood both spouses, and who gave truly helpful advice. It is ok to shop around if you need to. My biggest fear going into counseling was that our counselor would "take his side." I was relieved when she heard us both out. At times, she did speak hard truths to one or the other of us, but because we trusted her perspective, we were more receptive to her counsel.

4. Go in with an open mind; consider that you may be (probably are at least in part) the one who has to change. Don't get me wrong. Even one spouse changing for the better can have a huge impact in a marriage. But the opportunity for growth and healing is multiplied by that much more if both spouses are willing to make adjustments. There are two sides to every story, and the reality is that you cannot force another person to change. You can only change your own attitudes and behaviors and pray that the other person follows suit. Some conflicts are more one-sided than others, but we all have room to grow. Going in with a positive attitude and willingness to change personally makes all the difference.

Engagement Photo, 2010
(photo taken by Anna Wu)

5. But you also don't have to agree with everything the counselor says. When the counselor judges a situation in a way that does not ring true for you, after honestly considering what they have to say, it is ok to disagree. That person may hold some different spiritual views, cultural norms, relational expectations, etc. than you and your spouse. Just because you may need to change some things for your marriage to thrive does not mean you have to do everything the counselor's way. When you disagree with the counselor, this is a good opportunity to find out what your spouse thinks. If they agree with the counselor, you may need to go back to number four and see if it applies. But sometimes a counseling session can spur good conversation when you get home precisely because you did not agree with everything said, opening the door to affirming what you and your spouse do believe.

6. Not every session (or even any one session) will be life changing. Take the long view. Sometimes, we left counseling feeling like we did not learn anything new or like we discussed a topic that didn't quite seem relevant to our overall goal for counseling. On those days, we wondered whether we had just wasted an hour of our lives and a chunk of change. (And maybe we had sometimes - more on that in point seven.) Other sessions, we saw the value of the conversation but didn't leave suddenly feeling like different people. Rarely did specific and measurable change come after a single counseling session. Rather, it was something like a year later, when the previous area of conflict came up, and I didn't feel defensive or angry or sad or even like there really was a conflict anymore, that I realized counseling had worked for us. When we had a calm conversation about the topic and each trusted what the other was saying, my husband and I just looked at each other and said, "Wow, we are in a really different (great) place right now! How did we get here without even realizing it?" It happened through gradual (but intentional) change that we could not always see in the day to day slog. Now, several years later, we recognize how different we are for having applied those new ways of thinking over an extended period. It is easier to maintain perspective throughout counseling if you go into it having a realistic long-term view of relational growth.

7. But you can feel more like you are making direct progress each week if you prepare for each session and are intentional about the topics of discussion. Ok, so you may not experience major life change in one week, but at the same time, there are more and less effective ways to spend your time in counseling. If you have something you want to discuss, make a game plan to bring it up as soon as you start the session. We found that sometimes, one of us was having a bad day at work when we showed up to counseling, or we had a minor disagreement in the car ride over, and that ended up being what we talked about for our whole session! Although dealing with our work hangups and resolving what we were having for dinner were certainly important to us, we didn't want to pay someone else to help us in those areas at that time. We found that by having a brief discussion the day before (or even five minutes before) we went to the counselor, we were able to isolate some topics that would be useful for discussion, such as new successes in our relationship, important conversations that had come up in the last few weeks around our area of conflict, questions we had about the tools we had previously learned, etc. It really helped to ask ourselves what we thought we needed to take the next step forward in our relationship based on the specific goal we had set up for counseling as a whole. And our counselor seemed to appreciate our directness about what we wanted to get out of the process, as well!

8. Sometimes one or both spouses also need to seek individual counseling. This is something we have mainly learned from some of our friends who have gone to marriage counseling. There may be some situations where deep individual challenges are affecting your relationship (or just yourself), and it can be hugely beneficial for one spouse to seek additional guidance. For example, if one of you is dealing with depression, a history of abuse or abandonment, addiction, unfaithfulness, or any number of other challenges, counseling with your spouse may not be the best space (or the only space) to unpack all of the ways this is affecting you.

5 years married, 38 weeks pregnant, 2015
(photo taken by Jen and Jason Ko)

While the above tips will not necessarily work for everyone, these are the things that we found most helpful or that stuck out from what our friends have shared about their own experiences in couples counseling.

With the birth of our first child, we have had yet another opportunity to reflect on what marriage counseling meant for us. And we both agree that the emotional growth of the first five years of our marriage - including those months in counseling - prepared us to be completely different spouses and parents than we would have been otherwise. I can look back and see how God was working in that time, and for that, I am supremely grateful. I would not hesitate to go to marriage counseling again for some guidance on a particular issue or even a marriage "check-in" or "tune-up" should we feel the need.

Wednesday, June 24, 2015

Body Image During Pregnancy

A while back, I posted an awesome video of Jennifer Garner commenting about her latest "baby bump." I felt thankful to see a woman being proud of her body for the amazing feat of bearing children. In a culture that judges women based on appearances so much, it was a breath of fresh air!

I have heard so many pregnant women comment about feeling overweight and unattractive, and I've always thought, "Stop being dramatic. You're pregnant! You're supposed to look like that!"

Little did I expect that when I experienced pregnancy myself, my feelings about my body would be so mixed. Realizing that I am about to surpass my husband in body weight is hard, even though I know that weight is what's healthy for my baby. Seeing so many other parts of my body change beyond just the weight is hard, too. Things leak and sag and ache in ways they did not before. I need my husband to tie my shoes when we go on a walk (and I still have 12 weeks of getting rounder left to go!) Amidst these changes, I sometimes struggle to keep a positive attitude.

Some days, when I look in the mirror, I think my bump is pretty cute, I feel excited about what is to come, and I have joy about the ways my body was made for this purpose. Other days, I walk around calling myself "pudge muffin" or using any number of names that I know in my heart are not helpful or uplifting; I would never say those things about another woman, and yet I feel ok thinking them about myself.

Me at 26 weeks (left) and my friend
Lillian who is due a few weeks later.
Further complicating the pregnant body experience is the way it affects my interactions with others. During the first trimester, I wrote about how lonely it felt to be pregnant and feel sick, with almost no one else knowing. Now, I find the opposite is challenging. Something that began with the most intimate expression of love is now on public display to every stranger on the street; whether I want to share or not, my pregnancy is being carried with me on my physical body everywhere I go.

One particularly trying aspect of this is attempting to graciously listen and respond to others' comments and opinions about this body. (These comments are on top of all the opinions about breastfeeding, co-sleeping, modes of dress, discipline, and all of the other advice well-meaning folks share when they see my baby bump - but those are for another post altogether.)

Even though my weight is on track for my stage of pregnancy, and I have been told as much by my doctor, in just one single week, I had three different people - yes, three - look at my baby bump and ask me whether I was sure I was not having twins. (Aka, "You look enormous!") Each time, I laughed it off and reassured the person that I am not having twins, to the best of my and my doctor's knowledge. Other times, I have had people tell me I am not eating enough at an event and that I shouldn't be depriving myself. I usually just chuckle and let them know that I have eaten a meal beforehand.

But inside, I keep wondering why so many people (mostly women) think these comments are ok, especially when they are in direct response to the size of my abdomen.

Here is what I really wish others around me knew. Being pregnant is physically and psychologically hard! And if you've been through it before, you should know that better than anyone! I hope that personal experience can lead to extra sensitivity instead of extra license to critique.

Comments about a pregnant woman's size in almost any form can cut especially deep; not only do they single out a woman's appearance, but they also carry the added weight of critiquing a mom's ability to adequately care for her unborn child. If I can't even manage to feed myself correctly for the sake of my baby's health now, imagine the parenting disaster when the child comes out!

Anything along the lines of, "Wow, you're huge!" no matter how cleverly disguised or cutely worded, does not feel good. I am capable of tracking my own weight and making decisions about when I am hungry and what is best to eat. Even if I were visibly struggling with putting on more weight than is ideal, that would be a matter between my doctor and me. And then there are some women who struggle with not being able to put on enough weight during pregnancy and can feel belittled or saddened by kind-sounding comments about how they "don't even look pregnant."

A pregnant body is no less personal than any other body. Every woman carries pregnancy differently, and each person who experiences pregnancy has to come to grips with a new physical reality that is different than any she has experienced before.

I am sure I have made insensitive comments to pregnant women in the past and not even realized the implications. I may even still be doing it from time to time! Going through it myself, however, I can really see the importance of being positive - and when in doubt, silent.

Despite the experiences described above, it's not all bad.

For me, the second trimester involved increased energy and much more positivity about the life stage my husband and I are entering. And I can confidently say that my close friends and family have been amazingly supportive. My mom and sister helped me shop for maternity clothes and kept telling me how great I looked. My husband reminds me every day that he loves me, appreciates what I am doing for our child already, and thinks I am beautiful and sexy. And many friends, both young and old, have said things like, "You look great!" or, "You have that pregnancy glow!" that make me feel uplifted and encouraged. They have listened well and even laughed with me in response to my so not carrying twins! To these amazing folks, I say, keep doing what you're doing. I am so thankful for you!

19 week ultrasound - It's a boy!
Baby feet.

Wednesday, April 1, 2015

The Wrong Way to Grieve on "The Bachelor"

There is no one single right way that people grieve a deep loss, neither in the midst of the sting of a fresh hurt nor in the subsequent days, months, and years.

On this season of ABC's reality show, "The Bachelor," there were two widows, one of whom became very controversial due to personality clashes with other women and due to famous lines, such as, "I am immeasurably blessed," and, "I love my story. My story is tragic, but my story is amazing," and, "My story is beautiful."

Of course, the interviews where these phrases came out were juxtaposed by editors with scenes of her sharing her story with the bachelor himself, portraying her statements and motives as manipulative.

Image source:
On more than one occasion, individuals articulated confusion, anger, and offense over her expressions and ways of dealing with her loss, some even questioning whether she had ever lost a husband at all. She just didn't act like someone who had lost a spouse.

Watching these interactions and comments made me feel truly sad and to me reflected a profound misunderstanding of grief and loss, regardless of what other conflicts existed in the house. I decided to write this blog post, not because everyone should care about what happens on "The Bachelor" (I'm embarrassed to admit I watched this season), but because this very public strife offers a chance for all of us to consider what it really means to walk with others through challenging times.

Having lost a few loved ones myself and having grieved over other situations not involving death - and perhaps more importantly, having had many friends who have suffered much more intense losses - one thing I have learned is that there is no one way that people grieve. There is no one right way to experience loss and no one right demeanor to express to the world, in the moment or years later.

Certainly, there are some ways of dealing with grief that may be personally destructive (and I would hope close friends would intervene if I went down one of those paths some day), but beyond directly harmful coping techniques, there is a very wide range of healthy ways people experience, express, and move through loss.

Just because someone does not look sad the way you expect them to does not mean they are not grieving. Just because someone does not use the words you would choose in such a time does not make their grief less real. Just because someone reconciles a loss to a greater significance in a different way than you would does not mean they have not experienced the grief profoundly.

I wish the best for all of the individuals who participated on this season of "The Bachelor." Each of us will experience losses in our lives in one way or another, and I hope that when those times come, we can be surrounded by loved ones who will understand that we are grappling in our own ways and will support us on our paths to healing, whatever forms those may take. And I hope that we too will be the kinds of friends who learn to walk alongside others who are grieving in ways that bring hope and peace.

Tuesday, March 31, 2015

First Trimester Experiences of the Mind-Body Connection

Matthew and I are expecting our first child in September 2015!

I am at the start of my second trimester (now 15 weeks along). Most surprising so far, never has the mind-body connection been more real to me than during my first trimester of pregnancy.

9-week Ultrasound
The first trimester was rough. I was tired almost all of the time (constant napping) and got sick to my stomach almost daily, sometimes multiple times in a day. Whereas television makes morning sickness look cute (like on the Mindy Project this season – just throw up in a drawer, smile it off, brush your teeth, and then enjoy intimate time with your partner right after), it was anything but cute in my experience.

My expectation was an hour of nausea a day or some fleeting moments, with most of the day being normal; my reality was more like a couple hours of feeling good on most days while just praying not to throw up in class or on mass transit the rest of the time. Doing all of the activities of normal life while feeling extremely ill all day and with very few people around you having any clue that you are suffering in front of them is pretty lonely and hard. My most memorable lesson from those months was that throwing up a raw apple – even a full hour after eating it – is so painful and chokes you so much that it can burst blood vessels in your eye lids and cheek bones. (And I learned that particular lesson twice.) I know it sounds pretty graphic, but it was my everyday experience until I recently started feeling good more of the time than I feel bad.

Although people kept telling me that it would soon pass, having never had a stomach flu or food poisoning for two months straight before, “soon” didn’t sound very soon to me. It was hard to see past the moment.

But the challenge was not just in the physical. The first trimester is a hormonally tumultuous time, which can make it emotionally challenging for many women already. However, I found that when I was physically ill, my ability to control my thoughts and emotions and to lean towards optimism was much more limited than on the days when I was feeling physically stronger.

Having a child was a planned event for us, so I was not prepared for all of the mixed emotions that would come along with it. Although we have both always known we wanted children and feel we are as prepared now as we are likely to be, I think we also both feel satisfied with our lives and marriage as they are without a child right now. I never felt like something was missing. Rather, the decision was more about wanting to open myself up to what God might want to do with and in me – the ways He might want to grow and change me – through the special relationship of parent and child and through the unique challenges that parenting brings.

Many people I know with children have expressed that it is the hardest thing they have done, but that they now feel less selfish, have realized they are capable of more than they ever thought, and have a bigger view of God and the world due to the experience. On my best days, these were the things that encouraged me and gave me hope.

But when I was leaning over a toilet feeling sick, or laying on the couch moaning, or sitting on mass transit just trying to make it to the other end, it was difficult to feel any connection to those encouragements. In those moments of sickness, the fear and negativity easily took over.
None of our close friends nearby have kids yet – they will not understand or will write us off as being unavailable now. The culture of parenthood here in the Bay Area is very different than what I saw growing up, and people seem to disappear into another world. What if I don’t want to be disappeared? Do I even have a choice living here?
Or what if it’s me that becomes a bad friend? Of course I will have less time, but I lead a busy life now and still try to make margin for important people. What if I lose all of my margin and the ability to be available to those in need?
Our families don’t live nearby. We will have no practical and familial support. This is going to be very lonely. And then there's the added downside that the going rate for babysitters these days is astronomical. How will we ever do anything just the two of us again?
My new career in public health is just getting started, as I will graduate with my MPH in May. Will anyone hire me while pregnant? Do I even want to work during the last few months of pregnancy? What if I take a break until the baby is a few months old and then employers don’t understand when I go to apply for jobs again?
My body is changing. Even the purposes of my body parts will change. I like the way they all function now and don't like the idea of having to share so much of me with a little dependent person. Not to mention the skin stretching and the organ smushing and all of the other fun things to come. 
There are so many ways for a kid to be messed up in and by this world. So many addictions and harmful choices and selfish motives and hurtful words and prejudices and fears and broken relationships in the men and women around me, including in my own life at times. How will we ever raise a child to be a man or woman of compassion and integrity? 
I never had an overly warm and fuzzy view of having a baby in the first place. But I still want a family and at least expected the prevailing feeling to be happiness when our plans came to fruition. What is wrong with me that I feel so negative so much right now? I should be feeling something different than I am right now. There are people all over the world longing for what I have right now. I should be thankful that it happened so quickly and that God is blessing us with a child. Can all of these confused feelings really morph into a good and loving parent?
And perhaps the darkest place for me and the most prevailing thought of all: a baby will change our marriage relationship forever and change my life – but I truly like my life and my marriage right now. What if everything just goes south? Will it be worth it? What if after that six-month “hard period” that everyone talks about, we don’t rebound out of it into a healthy rhythm again? What if these are the last months of this great thing we now have, to be replaced by something mediocre?
I wish I could say these thoughts were fleeting, but they weren’t. They came and went in varying intervals, sometimes sticking around just for a few minutes and other times for a few days. And the sicker my body felt, the harder it was to cheer up or listen to other voices. The body is so deeply connected to the mind and spirit, so intertwined, that I could not separate the experiences of the two. Many tears were cried during the first trimester, both over the pain in my body and the confusion in my heart and mind.

Today, going into my second trimester, I feel like I am in a better place than I was for most of the last couple months.

Sharing honestly with close friends has made a big difference. An extremely supportive, understanding, flexible, and sacrificial husband has made a big difference. Spending time in prayer and scripture has made a big difference. And in a very real way, not throwing up every day (just some days) for the last couple weeks is making a big difference, too.

Today, I have been optimistic about our growing family. I have thought about the ways I want to savor and enjoy this time, instead of wishing away the days and weeks. Today, I remember that billions of people have entered into parenthood before me, that God promises never to forsake me, and that He will lead me through challenges in whatever way He knows is best for me. That gives me reason for hope and peace in this time of change.

Friday, March 20, 2015

Big Soda and the Open Truth Now Campaign

Full disclosure: I drink soda every now and then, and I really like it! Sometimes I even sip on soda to calm an upset stomach. But knowing it is unhealthy, I try to limit my intake.

Recently, on my morning Bart commute, I have been seeing signs like this one, which reads, "Big Soda says open happiness. What's happy about diabetes?"

Image Source:

The Open Truth Now campaign, led by Youth Speaks Inc. and UC San Francisco's Center for Vulnerable Populations at San Francisco General Hospital, is riding on the heels of Berkeley's historic passage of a one-cent-per-ounce soda tax to keep the anti-soda train going.

The soda tax passed in Berkeley with a wide margin, despite millions spent by the beverage industry to prevent it, while a similar two-cent-per-ounce tax measure lost in San Francisco (with 55% of voters in favor, not enough for the 2/3 margin the measure required). While public health supporters of the measures pointed to evidence that even a small tax changes behavior (more than education typically does), many opponents felt the tax was an example of ineffective overreach by an overly controlling "nanny state."

The Open Truth campaign is now tackling the issue from a direction that many opponents to the law advocated - reaching not for our wallets but for our brains, by educating the public about critical media consumption and the health consequences of sugar intake.

Image source:

According to Dr. Dean Schillinger, "Americans' sugar consumption has tripled over the past 50 years. And sugary drinks are now the No. 1 source of calories in the American diet — and a major contributor to Type 2 diabetes. Just one 12-ounce soda has about nine teaspoons of sugar — more than the recommended daily maximum for adults and more than three times the daily maximum for kids. Just one to two sugary drinks a day increases risk for Type 2 diabetes by 26 percent."

The ads seen around San Francisco focus on youth and aim to expose the marketing practices that companies have used to target youth of color in particular. The posters allude to the serious increase in diabetes prevalence in recent years, pointing out that the happiness promised by advertisements has actually led to a scourge of illness in many communities.

In many ways, the message of these ads reminds me of the most effective anti-tobacco ads of several years ago, which I wrote about in an earlier post:

You can follow the Open Truth Now campaign on Facebook here:

What do you think? Is education, taxation, or both the best way to limit unhealthy consumption of sugar-sweetened beverages? Will the Open Truth Now campaign make a difference?

Sunday, February 8, 2015

What Is Public Health Anyway?

Now that I am in my last semester of my MPH program, I am often asked what I plan to do when I graduate. For the immediate future, the answer is, "I don't know yet! I need to start applying to soon as I get my capstone project done!"

But along with this question is often an undercurrent of confusion - and sometimes an openly voiced question - of what exactly public health is? I mean, I'm not training to be a doctor or a nurse. What do public health practitioners actually do?

The answer's complicated.

Public health can mean nearly anything. If something has any tie to health, you can bet there are public health professionals working on it. Many public health professionals are also doctors and nurses. But many others, like me, are not.

In general, I explain public health this way. Traditional medical professionals are generally concerned with treating an individual once you get sick or engaging in proximal prevention at the individual level (when you walk through their doors, they can tell you to eat better foods or take a pill to keep your blood pressure down to prevent further issues). Public health, on the other hand, is typically concerned with preventing disease in the population at large (or in a group of folks) by affecting health further "upstream," ideally long before any symptoms related to disease emerge.

For example, whereas a doctor may refer you for a mammogram to catch breast cancer early, public health would investigate what is it that puts some groups of people at greater risk for breast cancer in the first place? And what is it that affects breast cancer outcomes beyond the biology of the disease?

For example, if a large group of individuals do not have insurance and therefore cannot access doctors, how does that change the outcomes for that group and others in similar situations? Further upstream still, if they do not have insurance, why? What circumstances are contributing to lower rates of insurance in certain communities compared to others? Also, are there any experiences in the population at large that can be changed to lower rates of breast cancer itself? For example, if eating certain foods might decrease risk, why is it that some groups eat those foods and others do not? What are the cultural norms around food? What is the availability and quality of produce in a neighborhood? What is the availability of disposable income and time for that group to invest in healthy eating? Or what types of chemicals are found in one location that are not found in another which might increase risk of cancer? How are these exposures unequally distributed across neighborhood, socioeconomic, racial, and other lines? Or what is it that leads to greater stress and thus greater risk for disease in one community compared to another?

And then public health might ask, now that we have answered these questions and know there are differences in experience for different groups, which lead to differences in disease outcomes (what we call "disparities"), what can we do to improve the average experiences and exposures of the populations who are not achieving optimal health?

The answers to that question can range from vaccination campaigns that broadly affect rates of infectious disease, to economic development initiatives that aim to improve overall conditions in a neighborhood, to policy changes that limit toxin-producing industries from concentrating in low income neighborhoods, to organizing communities to campaign for changes that matter to them. Public health interventions can be Medicaid expansion or quality improvement of the patient experience or violence prevention efforts or reducing stigma and increasing health care access for a particular group of people. Public health can mean creating school gardens to increase vegetable consumption or teaching sexual education to students to lower rates of STIs and unwanted pregnancies. Public health can involve educating the public about the benefits of breastfeeding or campaigning for a new farmer's market to increase access to fresh produce or removing lead from buildings frequented by children. It can mean encouraging exercise programs in schools or limiting advertisements of unhealthful products or requiring restaurant employees to wash their hands after using the restroom or campaigning for equitable housing rules. Public health can mean increasing employment opportunities or teaching stress management classes or passing stricter laws about elder care abuse or requiring safety precautions in factories or creating emergency preparedness plans.

And, get the idea.

Public health can be almost anything that aims to prevent injury or disease and to decrease health disparities between groups. Public health also often involves research in how to do all of these things well and how effective our efforts really are at preventing disease anyway.

Ultimately, decreasing health disparities is what I want to do when I graduate! Exactly what that will entail is TBD, but I'll be sure to keep you posted!