Seen about town, ads pushing calorie dense items and calorie disclosures, etc

It was really challenging to come up with a title for this blog post, which is a good sign that I am trying to say too much in one post. Nonetheless, I am stubborn and have been holding on to these photos and these thoughts for at least a month.

First, calorie disclosures are coming, they will be the law of the land, but probably not fully so until 2016. In other words, the congress persons representing businesses will get the law delayed, but they will not get it appealed (I understand from my sources).

Second, it is becoming clear that 'a calorie is a calorie' is not quite true - even for weight. You may recall a post from me some years ago that implied that as far as weight was concerned 1800 calories of twinkie are the same as 1800 calories of vegetables. I went on to say, and this part remains true, that a person will be a lot healthier and feel much better if they refrain from eating 1800 calories of twinkie. I think we've all known that the body handles macronutrients differently, i.e., refined carbs are metabolized differently than fats or fibers - but more recently science has established that the number of calories might be the same in say a twinkie and a piece of salmon, but once our body digests and metabolizes these foods, the calorie end point is not the same.

Some people have suggested that calorie monitoring may be less necessary, and to that point I strongly disagree.  Many people who have lost weight and kept if off do eat better and maintain high levels of exercise but they also remain vigilant to consuming a sensible range of calories.

I am not abandoning calorie monitoring. However, I am not involved in research on metabolism - nor am I a nutritionist-  so I will stick to watching what happens when calorie disclosure laws go into effect. For example, I anticipate changes in availability of lower calorie options and changes in purchasing behavior. I am not going to keep trying to describe the science on the relationship between calories and weight gain. Instead, I assure you that we cannot eat with reckless abandon and many of our away from home meal purchases are ridiculously high in those wrong kind of calories.

Now my pictures and why I chose to take and share these in particular.

This ad was presented to me while I was listening to Pandora Radio - not so targeted considering I am a calorie controlled vegetarian!

I was 'exposed' to this ad on the Philly transit bus;  a bargain for two high calorie items. PLUS I am a NYG fan :)

You may have heard that grocery stores do not want to put calorie labels on their prepared food; that is unfair to restaurants and leaves customers lacking important information for food choices. 

Manufacturers update their labels from time to time, they may reformulate a product which changes the calorie amount, they may change the serving size which would change the calorie amount or they may fear scrutiny and revisit the accuracy of their label. These side by side boxes are both Jacobsens Blueberry Snack Toasts, but the calories INCREASED from 40 each to 45 each. Everything else appears to be the same. When I find older version with less calories listed, I buy them, but I am just fooling myself!

This is my favorite!  This restaurant is in Philadelphia where a calorie disclosure law has been in place for several years. The menus also have to display sodium/salt content. This is one positive outcome of calorie disclosures! 

Using Fear to Change Behavior; Fear Appeals in Context

   My first love, before public health law, was health communications. A health communication in its simplest form is a PSA - think - Slip, Slap, Slop; Buckle Up Saves Lives; 1% or Less is Best.  Health communications become trickier to pull off when the goal is to change a complicated behavior, such as eating less fried food, getting more physical activity or quitting smoking.  To move people towards change in these areas some health advocates will use fear appeals embedded in a health communication.  I love a well-done fear appeal!  By well-done I mean that the fear message is constructed using a theory/model that has been tested and found effective, for example the Extended Parallel Process Model (see e.g., (Witte, 1992; Witte & Allen, 2000). 

   The most important components of the Extended Parallel Process Model are the constructs that, when taken into consideration, move the target audience towards danger control (e.g., quitting smoking to prevent lung disease (the feared outcome)) instead of fear control (e.g., smoking more).  There are four constructs that, though not unique to the EPPM, are especially important because without careful attention to these four constructs, a fear appraisal can backfire.

   The important constructs are relevancy of the threat, severity of the threat, efficacy of the response, and self-efficacy in regards to the response (action to be taken by the population). Relevancy and severity work together.  Staying with the smoking example, the message that smoking causes lung disease is relevant if the person hearing the message is a smoker and believes that lung disease is a serious condition - one that will affect them negatively. The person has to believe that the condition could happen to them and that it is worse than the discomfort of quitting the old behavior or adopting a new one, here the behavior to adopt is quitting smoking. 

   The response/action is whatever the health communication encourages the person to do in order not to “get” the disease or condition they should be ‘afraid’ of getting.  Some examples include, wearing sunscreen, exercising every day, quitting smoking, using condoms.  The efficacy of response refers to whether or not a person believes: sunscreen stops aging or sunburn, quitting smoking reduces lung disease risks, exercise prolongs life or condoms prevent sexually transmitted infections.  I think you can probably guess what self-efficacy in regards to the response is and why it is vital.   If a person does not believe that they have the ability to do the action, AND they have been sufficiently frightened of the outcome if they do not, they could engage in what Witte refers to as fear control - and in the case of lung disease and smoking, that could mean smoking more. (I am scared that I will get a lung disease and die, but I do not think I can quit smoking; this is very stressful, in order to handle my stress, I need to smoke.)

   Though it is not explicit in the model, there is an association among the constructs of relevancy, severity and efficacy and the source of the message itself.  When there is time and money, health educators/advocates create the best fear appeals from formative work with the target audience.  The formative work involves asking people to rate certain sources for their veracity and impact.  A question might be - Where do you go for information about health?  * friend, *partner, *doctor, *coworker etc.

   I have a personal anecdote to offer as an example of the source concept in action.  I live in near the coast in SW Florida  and I visit the beaches as often as I can.  When I first arrived here in 2007, my running friends and I would end our runs near the water. My friends said that the cold water would reduce the inflammation caused by our long runs and help us to remain injury free.  I believed my running friends because they were a reliable source.  Who would know more about keeping the body in running condition than people who run marathons every month?!  But these same friends, and plenty of other people, told me that I should shuffle my feet in the water to avoid getting stung by a sting ray.  Really?  To me that was just asking for trouble, if the sting rays were even there.  (i.e., I did not believe in the threat itself (though I did think a sting ray was VERY scary) and I didn’t think shuffling my feet made any sense.) So…. 7 years later (yesterday)…I was walking the shore at Lido Beach and at each life guard stand there was a sign (see image below) that said “Watch out for Sting Rays, Shuffle your feet!”  That did it - to me, the source was to be trusted and now I believe 1) there are sting rays in these waters and 2) shuffling is the recommended response.  But - and here is where it falls apart.  I am very fearful of the sting rays but not very confident in the response or my ability to do the response correctly.  I am, for the most part, going to engage in fear control.  I will stay out of the water.  This response keeps me from fully enjoying my day at the beach, but it doesn’t increase my risk of the outcome (getting stung), like smoking more would increase the risk of lung disease.  My reaction to the sting ray sign may not be that uncommon.  If I were to create a health communication for sting ray awareness I would build in a component that explains what shuffling the feet accomplishes and show images (via TV) of someone successfully carrying this action out.

Witte, K. (1992). Putting the fear back into fear appeals: The extended parallel process model. Communications Monographs, 59(4), 329-349. doi: 10.1080/03637759209376276

Witte, K., & Allen, M. (2000). A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns. Health Education & Behavior, 27(5), 591-615. doi: 10.1177/109019810002700506

Vaccines

The Institute of Medicine released a report which details their study on vaccines and possible side effects.  From their website comes this statement - verbatim:

Using epidemiologic and mechanistic evidence, the committee developed 158 causality conclusions and assigned each relationship between a vaccine and an adverse health problem to one of four categories of causation:

• Evidence convincingly supports a causal relationship
• Evidence favors acceptance of a causal relationship
• Evidence favors rejection of a causal relationship
• Evidence is inadequate to accept or reject a  causal relationship

 The IOM also created a chart which I find very helpful.  You  can view it by clicking this link.  It does take a while for this link to open so be patient with it.

To learn even more about the committee research and vaccine safety please go to the website and access the full report, which you can do here.

October IS

Domestic or Intimate Partner Violence Awareness Month

I know this because I have spent most of today looking into the matter of IPV for a class discussion that I am going to lead a week from today. The course I am taking is not about any particular health problem - it is about involving communities in identifying and solving problems - or Community Based Participatory Research (CBPR). The readings for the week in question regard deconstructing a problem and finding hidden transcripts and capacity. Yes capacity. Researchers often come in seeing only what is wrong. Identifying what is right is empowering. CBPR always includes acknowledging disparities with regard to race, gender and socioeconomic status when they exist.

My class activity is going to be deconstructing a music video. The song came out in July of this year and had a pretty big impact on me. Since I did my research today, the impact is even more intense. The song is Love the Way You Lie. It was written by the white rapper Eminem. I was familiar with him, his history and his work prior to that video and prior to today. I do NOT dislike the man or his music. In this song, the chorus is sung by pop star Rihanna. She is younger than Eminem, from Barbados, and in my opinion, very beautiful with an angelic voice. Eminem has experienced violence in his childhood and in his previous marriage. Rihanna was the victim of a very public incident of violence between she and her equally famous boyfriend. The couple who are in the video are also celebrities.

Both stars deny any connection between this song and real life events. The lyrics are available on line as is the video. I downloaded both today for my class, but I have heard the song many times and seen glimpses of the video. Today I bought the video and watched it with complete attention. It upset me greatly.


It is really difficult to have a clear picture of domestic violence in this country. Our numbers are subject to disclosure - whether or not someone wishes to disclose. We have what is reported to police or gleaned from ER records. The CDC does a telephone survey as well. It is expected that the numbers are higher than our statistics show. I have been all over the WEB today - tracking down legitimate sources and trying to find current numbers. DV/IPV is not my area of expertise. I did find from the CDC, the National Institute of Justice and the Bureau of Justice Statistics - the following: 4.3 per 1000 females and .8 per 1000 men are victims of partner violence each year. Females are the victims of 70% of fatal assaults. It is reported that the incidence is down significantly from its peak- likely due to attention and programing. However, there is again room for error. The current expectation is 1.3 million females and 835,000 men are victims each year. With regard to race, there is a big difference between whites and American Indian/Alaskan Natives and some difference between whites and blacks.

I was curious about age differences due to the song. More violence occurs in the 16-24 age group in general, but more deaths occur in the 35-49 age group. There are 20 cases per 1000 white women and 29 per 1000 black in the 20-24 age group. Rihanna is 22 years old.

The reason this got my attention at all is because the song has broken all kinds of chart records. It has been number one for most of the 15 weeks that it has been out. It has been number one on pop lists, rap lists and lists in many other countries. It is the top digital download and the top ring tone. It broke a You Tube video record.

WHY?! It is going to be very important for us to know WHY these young persons identify with this song so very much. For my class activity, I am going to have us as I said, deconstruct this video - and we are going to have to look at what the "community" is seeing as positive here. That is a scary but necessary challenge.

Here is the official website link to view the video - add yourself to the over 150 million views! Note to new rap listeners - the video and song start after a commercial that sounds like a song... :) The lyrics are available on this webpage - they are explicit - meaning - hard language that may offend you - of course, DV should offend you, but expression is important and telling - so let us not censor it. (make sure your pop up blockers are on when you visit the lyrics site :))

Swimming with the Pathogens

Let us take a break from food and exercise, obesity, over medication and sun damage... let's go to the BEACH. I love the ocean. It is calming and peaceful. The ocean is vast, at times still and others turbulent. I go there alone. I go with family. I revigorate with friends.
I am even overcoming my fear of swimming with the fishies(sic)... because the water is often warm and good for my running muscles.

But according to the National Resource Defense Council.. I should be worried about a lot more than the fish. Indeed, we are swimming with much smaller vectors. Microorganisms that carry disease or pathogens, have been a growing problem in our oceans and bays for years with no improvement in the last four years. The disease causing bacteria are mostly accumulated from storm water run off and from sewer system leaks or overflows. In other words, we are getting sick from human and animal waste.. not marine waste.. but waste from our pets and livestock.

Measures to curtail the storm water run off can be put in place with policy and monetary support. Some bills in congress now would enable states and localities to do so.

Other causes of ocean related illness are chemicals, from spills, dumping, and run off as well as harmful algal blooms or HAB. It is not true for example, that red tide is harmless.

The illnesses associated with beach pollution include, but are not limited to, respiratory infections, rashes, hepatitis, dysentery (bloody, mucus filled diarrhea - aren't you glad I said dysentery), stomach flu, and neurological disorders... which include problems with the central, peripheral and or vascular nervous systems. The illnesses can be especially harmful if not fatal to the elderly, children and those with impaired immune systems.

It is best to avoid swimming in the ocean for 24 hours after a significant rainfall.


If you have the opportunity, let your legislators know that you support policy that would address beach pollution.



resource used: http://www.nrdc.org/media/2009/090729.asp