The Future of Food

Food security is an environmental health issue I have become interested in. It is defined as the availability and accessibility of nutritious foods. There are nearly one billion people deprived of both available and accessible foods. Food shortage is a fallacy; the causes are unequal distribution of resources and socio-political environment of the affected society. To make matters worse, the "fresh" foods that are available are composed of synthetic materials, harmful chemicals, genetically modified organisms (GMOs) and additives. I would like to discuss GMOs, specifically.

Background 

Biotechnology is used to alter the genetic composition of an organism. The gene is modified through the process of transformation, insertion of a piece of DNA or synthetic combination of smaller DNA pieces. The purpose of creating GMOs is to increase crop production for the increasing population and to maintain food security.

 Do you remember my statement about the hungry people in this world? How are they benefiting from this? 

Other purported advantages are decreased use or herbicide and pesticides, decreased cost of production and more variety of food. This sounds promising, but is this a safe solution?

Biosafety
Literature indicates significant biosafety issues with use of GMOs. Some researchers stated that GMOs should have never been introduced. Pesticides are still used with GMOs, so people are exposed to those in addition to new toxins and chemicals. The organisms have a significant impact on human and environmental health. Studies have shown that GMOs are responsible for allergic reactions, cancer, degenerative disease, antibiotic threats, birth defects, shorter life-spans, and death. They are also poisonous to livestock. Environmentally, GMOs have caused an inundation of superweeds and superpests. There is also concern for toxins in the soil which affects non-GMO crops and destroys forest life. The following YouTube video discusses GMOs and its harmful effects.

After taking an environmental health course and doing my own research, I have become more conscious of what I choose to eat. There are many resources available for consumers to take initiative and become advocates for nutrition labeling of GMO foods and beverages. Recently, I signed a petition that would help stop the Coca Cola company from funding anti-GMO labeling campaigns. We deserve to know everything about what we put into our bodies. If a company cannot do this, it is likely that there are GMOs in their product(s). 

Here is a list of websites that can help you shop for non-GMO foods and beverages:
Non-GMO Project 
Non-GMO Shopping Guide
Tips from Food Should Taste Good

Reference

Khan, S.J., Muafia, S., Nasreen, Z., & Salariya, A.M. (2012). Genetically modified organisms (gmos): food security or threat to food safety. Pakistan Journal of Science, 64(2), 7-12. 

Promoting Sustainable Communities

I will dedicate these next two posts to health promotion of our environment. This is an area of public health that has gained attention in recent years. 

We were asked to watch an online video about Healthy Community Designs. Dr. Frumkin, former Director of the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry discussed the connection between the communities we live in and our health. Better community design can improve physical activity, lower greenhouse gas emissions and increase social connectedness. Here are some take-away points from the video :

During the healthy community designs discussion, Dr. Frumkin refers to urban planners, architects, members of zoning boards and citizens as health professionals, too. It is the duty of both technical and political professionals and public health professionals to advocate for walkable communities. His message presents a few implications (in my opinion) for public health educators and promoters. First, the physical environment impacts both chronic and infectious diseases, access to goods and services, social connectedness, risk of injury and air quality. As public health professionals, we have the epidemiological data showing the connection between disease and social and environmental determinants. Now, the goal is to collaborate with local government officials and others who want safer, cleaner and healthier communities.

Another striking statement Dr. Frumkin made was regarding aging in place. We must give special consideration to the aging population. By the year 2030, people sixty-five and older will account for approximately nineteen percent of the United States’ population (Department of Health and Human Services, Administration on Aging). Not all elderly will be able to age in place but if they elect to, there should be options for them to dwell in familiar communities that are conducive to their needs.

A third implication is policy development; an example would be pedestrian and bicyclist infrastructure, as well as safety. Better policies and regulations would prevent injury and deaths, while increasing the ability and willingness to commute by foot or bicycle. The video message indicates that there are several aspects of healthy community building that warrant policy and administration intervention. We have the information and know what needs to be done. The difficult part is to collaborate with the other professions and to actually “build” these communities.

Image from Washington State Department of Transportation

Social Cognitive Theory: a Health Promotion Perspective

Throughout my Theories of Health Behavior course, we have learned about several individual and sociocultural theories and what it takes to apply them to public health programs. I chose to create a narrated powerpoint about Albert Bandura’s Social Cognitive Theory (SCT). I believe SCT best describes the self-efficacy construct compared to theories I have studied. You will hear about the history, how SCT evolved, constructs and its limitations. In addition to discussing each construct, I operationalized them. There are tips and steps for health educators to consider for program planning and creating interventions. I intend for the content to serve as a guideline. No single theory is perfect for every public health problem. However, even with one of the most comprehensive theories, SCT, it is still difficult to apply every construct to a health program.

Know Your Power Campaign

According to Potter (2010), there are 20% of undergraduate females who have been sexually assaulted while attending college. The Prevention Innovations team at the University of New Hampshire developed the Know Your Power   social marketing campaign to reduce intimate partner abuse and sexual assault. This team is also known for their Bringing in the Bystander training program, an "in-person training program that teaches bystanders how to intervene safely before, during, or after an incident of sexual and relationship violence or stalking". Yet, the Know Your Power Bystander campaign uses marketing materials and social media to promote the importance of bystanders intervening in cases of intimate partner abuse. 

Image from Know You Power

                                                                                                                           Image from Know You Power

The website discusses intimate partner violence and how bystanders can safely intervene. The intervention slogan is ABCs: Assess for safety. Be with others. Care for the victim. 

                                                                                                                                                                                                                                              Image from Know You Power

In the resources section, there is local contact information for both on and off-campus authorities. There were 8 primary images used in the campaign to demonstrate bystander intervention for incidences of stalking, sexual and relationship violence (Potter, 2012). Employing a social marketing campaign on college campuses is exceptionally beneficial because much of what college students do involves a higher level of social engagement and interaction. Often, these interactions require a variety of social negotiation skills (Potter, 2012). 

Know Your Power used a modified version of the Transtheoretical Model (TTM) to evaluate the effectiveness of the campaign. Results indicated that exposure to such campaigns increases the students' awareness of the bystander role, as well as their willingness to intervene. Those who participated in the campaign were more likely to report taking action to reduce intimate partner violence and sexual assault (Potter, 2012). 

References

http://cola.unh.edu/thecollegeletter/2013-02/prevention-innovations
http://know-your-power.org/index.html

Potter, S. J. (2012). Using a multimedia social marketing  campaign to increase  active bystanders on the college campus. Journal of American College Health, 60(4), 282-295.

A closer look at Social Marketing

I will be honest--I was unaware that social marketing could be applied to public health issues. One of our assignment consisted of reviewing a CDC module on social marketing. Here is what I discovered...

Social marketing encompasses key elements of influencing health behavior. Although commercial strategies are applied, changing health behavior is voluntary and marketing techniques are not used to force or coerce target populations. Social marketing principles also recognize the importance of individual welfare and how it affects the community at large. This debunks the assumptions of social marketing as advertising or awareness campaigning to reach everyone. This is a methodical process that seeks to target certain sub-populations through formative research and segmentation.Throughout our coursework in this program, instructors have emphatically expressed that thorough research of the target population is what makes an intervention or program successful. I believe social marketing principles, which is not a theory or a conventional health planning model, best embodies this mission. The quote from Wendy Carlin, a program coordinator, confirmed my sentiment. It is not a matter of raising awareness in the target population, but to understand what needs to happen to create change. 

I am amazed by the versatility in applying social marketing concepts; the CDC states that concepts can be used for environmental and policy changes, considering who the actual target audience is. Social marketing also considers  current behavior, as seen in TTM, and what motivate that current behaviors, as opposed to immediately attempting to change that behavior. It appears to be a more realistic approach to health issues in a target population. Competition is noted as “behaviors and related benefits that the target audience is accustomed to or may prefer to the behavior you are promoting”. Following social marketing planning process, researchers would know why someone would prefer a behavior with negative health outcomes over the health-promoting behavior.

As in the individual, social and environmental health behavior theories, self-efficacy is also emphasized in the exchange concept of social marketing. Starting with small, feasible goals will allow for the target audience to move towards the ideal behavior.The objective of the exchange is to increase benefits, while minimizing costs, which are also constructs of HBM. Social marketing borrows from SCT, referring to expectations and expectancies for the marketing mix. The CDC also reiterated that the planning process for social marketing is cyclical, which allows planners to evaluate from the beginning to the implementation of the program intervention. After completing the CDC social marketing module, I have discovered the usability of social marketing for health-promoting behaviors. I would have never inferred how relatable it is to the health behavior theories we have discussed.

In my next post, I will discuss Know Your Power, a great example of a social marketing campaign.

Minimizing Stress using Theory-based Action Plans

We often hear the aphorism, "What doesn't kill you makes you stronger"! This holds true for just about anything except stress. Stress is a risk factor for chronic disease. Long-term stress can lead to poor health outcomes and affects us physically, psychologically and emotionally; long-term stress can kill you.

Image from Mental Health America

Stress is avoidable in most expected events. Although there is no panacea for stress, there are ways to prepare yourself for this bully. 

The tables are behavior action plans I created based on the Health Belief Model (HBM), Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) and the Transtheoretical Model (TTM). I discussed HBM in previous posts. For basic information, visit sources from the Boston University's School of Public Health:  TRA/TPB and TTM. 

Goal: An individual will engage in various self-guided mindfulness meditations 30 minutes daily to reduce stress and anxiety. 

Health Belief Model (HBM)

Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB)

Ready to take a break from reading these activities? UCLA's Mindful Awareness Research Center offers a variety of free guided meditations. Please take advantage of these resources and the many free podcasts and youtube videos available.




Transtheoretical Model (TTM)

You can also peruse literature on stress and disease. During my studies, I found an article that discussed the effects of mindfulness in stress reduction. The participants engaged in an eight week mindfulness course. Participants increased mindfulness activity within two weeks of the program; their perception of stress improved significantly halfway through the study. 

Reference

Baer, R. A., Carmody, J., & Hunsinger, M. (2012). Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 68(7), 755-765. doi:10.1002/jclp.21865

Application of the Health Belief Model to Maternal Care in Pakistan

Image from Women Deliver

Studying HBM coincided with a semester long project in my International Health course. My group and I investigated Sindh, Pakistan. This province has one of the highest maternal mortality ratios (MMR) in the world. Thus, our goal is to create a program that will reduce the high MMR. We applied HBM as a foundation for our intervention program and understanding of --a maternal mobile care unit.  The following is an excerpt from our program intervention section of our program project paper.

The women in the rural Sindh province may or may not seek and receive maternal, prenatal, antenatal and postnatal care based on six components: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy (Edberg, 2007, p. 37). The existing role of Lady Health Workers (LHWs) includes dissemination of information and educating Pakistani women about the importance of receiving quality care throughout pregnancy; thus, increasing women’s awareness that they maternal death is attributed to a lack of maternal and prenatal care (Bhutta, et al, 2013). A program that provides participants with this information about pregnancy risks achieves greater participant perception of susceptibility and severity regarding maternal complications. 

            A mobile maternity care unit is likely to increase access to adequate care in Sindh’s rural communities. This also fulfills one of the LHW tasks: acting as liaisons between the federal health and public health systems, but more directly and methodically (Bhutta, et al, 2013). Ultimately, establishing mobile care units can improve access and diminish the perceived barriers of access and cost. Husbands and in-laws have a major, influential role in the care or lack of care rendered to wives. Consequently, the program will also educate relatives, especially husbands and in-laws, as well as the rest of the community about how efficacious maternal and antenatal care is, leading to the reduction of maternal mortality rates.

Image from Pakistan's Population Welfare Department

            Cues to action, or external events will motivate the women and their families in Sindh to be more proactive and willing to receive care. Such events would include required, regularly scheduled appointments with LHWs mobile maternal unit throughout pregnancy and presentation of female community members’ demises due to maternal complications. The LHWs can set small, achievable goals for the program participants to increase self-efficacy, or the belief in their ability and willingness to receive maternal care (Edberg, 2007, p. 37). Women can be given supplies a resources to continue and manage their care at home (i.e. folate supplements, prenatal vitamins, fluid intake, adequate rest). 

J. Abston, E. Bracken, & M. Smith (2013). Reducing MMR in Sindh, Pakistan by use of a mobile care unit. University of North Florida, Jacksonville, FL.

REFERENCES

Bhutta, Z., Hafeez, A., Rizvi, A., Ali, N., Khan, A., Ahmad, F., & Jafarey, S. (2013).

Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. The Lancet, 381(9884), 2207-2218. doi:10.1016/S0140-6736(12)61999-0.

Edberg, M. (2007). Individual Health Behavior Theories. In Birtcher, K. (Ed.), Essentials of

            Health Behavior: Social and Behavioral Theory in Public Health (pp. 35-47). Sudbury,

            MA: Jones & Bartlett.

Health Belief Model Analysis

One of my assignments in this course was to complete a literature review on one of the individual health behavior theories. I selected the Health Belief Model (HBM), mostly because of my background and interest in social psychology. I will continue to discuss this theory and its application to both maternal health and stress prevention in the next two posts. Meanwhile, the following is background information and my analysis of HBM: 

Developed by leading social psychologists in the 1950s, the Health Belief Model (HBM) has been a popular model used in public health. This is a behavioral theory used to explain individuals’ perceptibility of a potential health problem (NCI, 2005). HBM is rooted in both cognitive and stimulus-response theories. Stimulus-response theorists posited that consequences of behaviors are learned and eventually, reduce physiological drives that initiate a behavior (Champion & Skinner, 2008, p. 46). Contrary to this notion, cognitive theorists believed that a certain behavior is a mere result of subjective value of an outcome and expectation that the behavior will achieve a particular outcome, also known as value-expectancy theory. According to  cognitive theory, reinforcements influence expectations about a situation, but do not directly influence behavior (Champion & Skinner, 2008, p. 46). In terms of health-related behavior, value-expectancy was defined as: value of avoiding diseases and getting well and the expectation that a specific health action may prevent or alleviate disease burden (Champion & Skinner, 2008, p.46). Today, these concepts are known as perceived susceptibility and perceived severity, respectively, two of the six HBM constructs.

HBM is an investigative model used to explain why people are either encouraged or discouraged from engaging in health-sustaining behaviors (NCI, 2005). The six constructs are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. Cues to action and self-efficacy are the most recent constructs. Self-efficacy was added in 1988 and is based on Social Learning Theory (Edberg, 2007, p. 36). Perceived susceptibility is the “degree to which a person feels at risk for a health problem” (Edberg, 2007, p. 37). If a person believes he or she is at risk, then, he or she may perform certain behaviors to avert a negative health outcome. Second, perceived severity is the “degree to which a person believes the consequences of the health problem are severe” (Edberg, 2007, p. 37). The person is either aware or unaware of the severity of the disease or illness, which also influences action. The third construct, perceived benefits, are the positive outcomes the individual knows to be a result of the behavior (Edberg, 2007, p. 37). If someone believes that performing a certain behavior will benefit their health status, they are likely to perform that behavior, vice versa. Conversely, the fourth construct, perceived barriers, states that the individual knows negative outcomes will result from an action (Edberg, 2007, p. 37). Cues to action refers to the events that motivate the individual to act (Edberg, 2007, p. 37). Finally, the self-efficacy construct, used for many health behavior theories, is one’s belief in his or her ability to act (Edberg, 2007, p. 37). Self-efficacy involves a person’s skill and will to take an action.

Click here to view an illustration of the Health Belief Model.  

                                       

There are several things to consider when using the HBM for a health promotion program. The aforementioned constructs are abstract and should only be used as guides or influences on behavior. This error is known as the EZ program structure illusion (Edberg, 2007, p. 37). In order to avoid this, program planners must conduct extensive research on the target population and not to rely solely on the theory or model; effective programs are beyond theory and models alone. It takes real world information, resources and materials to understand the potential efficaciousness of a program based on any behavioral health theory or model. It is imperative to also note the shortcomings of the HBM, too. First, it does not address social and environmental factors that influence individuals’ behaviors. Secondly, it assumes that all people have equal access to and the opportunity to have the necessary resources and information to make rational decisions (Edberg, 2007, p. 38). As Edberg stated, it is the obligation of health program planners to select and apply the most appropriate theories and models.

REFERENCES

Champion, V.L. & Skinner, C.S. (2008). The Health Belief Model. In Glanz, K (Ed.4), Health Behavior and Health Education (pp. 45-65). San Francisco: Jossey-Bass.

Edberg, M. (2007). Individual Health Behavior Theories. In Birtcher, K. (Ed.), Essentials of

            Health Behavior: Social and Behavioral Theory in Public Health (pp. 35-47). Sudbury,

            MA: Jones & Bartlett.

National Cancer Institute. (2005). Theory at a glance: a guide for health promotion practice (2 ed.), p. 9-18.

Cardiovascular Disease in African Americans

The following video, HealthWatch MD, features a short interview with an African American cardiologist in Atlanta. He addresses the health disparity of cardiovascular disease (CVD) in African Americans. This ethnic group has disproportionately higher rates of CVD than Caucasians. He does not believe that this is due to discrimination, but lifestyle and genetics. The cardiologists emphasizes the importance of patient education and promoting health literacy as a means of prevention for the African American community.

Although the interview is generally informative, I disagree with his statement about discrimination not being a determinant; it is major determinant of health. Discriminating is not always an overt act during the provision of care. This could entail access as a barrier because of institutionalized racism and discrimination. Perhaps, the facilities in one community are not available or the transit does not permit an individual to get to a health facility. The problem is not merely rooted in biological predispositions or even behavior; it is also social.

Health Disparities

This Prezi is my adaptation of the Healthy People 2020 social determinants of health diagram. I used a “journey” template to convey that community and culture, education, environment, economic climate are, not only interdependent factors, but they are a part of a trajectory towards access to services affecting health outcomes, primarily, quality of life. This journey begins with the community and its culture,which involves family structure, social cohesion, equality and discrimination. 

The values and perceptions of this community and culture affect education. Educated people are most likely to perform healthier behaviors, are typically health literate and are proactive when making health-related decisions. Moreover, the community, culture and peoples’ ways of thinking shape the environment in which they dwell. All of those factors can either perpetuate a healthy environment or one rife with crime, violence, poverty and disease. 

The fourth determinant is economic climate, which is easily determined by environment, education, and certain elements of the community and culture. For example, a place where there is high crime and where people are not educated beyond ninth grade, is less likely to have high employment rates and a thriving economy. 

The journey ends with accessibility to transportation, healthy foods, healthcare and any good or service that improves quality of life. I do believe people are a product of their environment and culture, but it is ultimately that person’s decision to make the changes to better his or her quality of life.

Public Health and Health Psychology Theoretical Commonalities

One of the course's first assignments, Social and Behavioral, core entailed exploration of public health professional opportunities, assumptions about the field and the basics of health behavior theory. 

As a past health psychology student, it is a pleasure to know that I can apply some of those theories to health promotion and education. I would like to focus on the connection between health psychology and public health.

I found a questionnaire featuring CDC's Dr. Rodney Hammond. He discussed the relationship between psychology and public health. Hammond was director of the CDC's Division of Violence Prevention, a position that relied heavily on his psychology expertise. His work involved epidemiology, development of evidence-based prevention strategies and community capacity building.

Dr. Hammond's statement (above) is quite profound. Throughout this course, I will be studying, analyzing and at some point apply health behavior theories.

According to Simon and Bennett (2004), public health has both implicitly and explicitly applied social and behavioral psychology theories to program planning and prevention strategies. Health communication, environmental health, behavior in relation to health promotion participation and empowerment. Psychology theories provide structural approaches to prevention through emphasis on barriers, cues and benefits that encourage or discourage a health behavior. 

I am elated that the CDC oversees the National Institute for Occupational Safety and Health (NIOSH). This institute strives to promote the application of psychology, particularly through Occupational Health Psychology. The inception of this field occurred after psychologists urged that the psychology field needs a proactive role in public health practice to prevent stress, illness and injury, especially regarding occupation. This is one major example of how psychology is being used in a major sector of public health. Thanks to the accomplishments of those like Dr. Hammond, we see these theories effectively applied as prevention strategies and program agendas materialize.  


References:

Rodney Hammond's Interview

Murphy, s., & Bennett, p. (2004). Health psychology and public health: Theoretical possibilities (English). Journal Of Health Psychology, 9(1), 13-27.

http://www.cdc.gov/niosh/topics/ohp/

Introduction

Hello and welcome! My name is Jasmine and I am a second year MPH student. The purpose of this blog is to document my progress in a Theory of Health Behavior course I am completing. I hope to expand upon the course content and use this as a digital portfolio. I would also like readers to learn more about the field of Public Health, too.

Here is a video my classmates and I viewed during a Foundations of Public Health course (first year, first semester). This is a general introduction to our field of study. Public Health is, indeed, everything and everywhere. Take a look for yourself. What does Public Health mean to you?