Pip, Pip, Cheerio!

I will be out of the country for a research meeting in Cambridge, United Kingdom until October 11th. I'm sure I'll have a lot to share about peer support and diabetes self-management when I return. If you'd like to learn more about this topic in the meantime, visit www.peersforprogress.org

It Got Me!

Just a heads up that even the most well-informed and prepared people succumb to illness, and I am one of them.
After months of touting how easy it is to prevent yourself from the flu (basic hand-washing and sanitary precautions, people!), I unfortunately found out that it is much easier to catch the flu.
I don't know how or when or where, but all I know is that it got me! And it got me good!
So be warned, but don't panic. You will not die from the "swine flu."
I called my primary care doctor to ask whether or not I ought to come in and they told me it's really up to the person. If you think you WILL die from the flu, please go see your doctor. If you're confident in your abilities to care for it on your own (i.e. drinking fluids, getting rest, taking Tylenol to control fever), then you're probably A-okay.
One tip my doctor's office gave me I found to be particularly helpful is keep track of your daily/hourly body temperature fluctuations with a thermometer. If you don't have a thermometer, go buy one from your local pharmacist. Persistent fever is a key indicator of whether or not you need to see a doctor.

More to come as I'm "on the mend"...

Sun Protection Satire

I just posted an article from the New Yorker, which is a hilarious must-read!

Sometimes as a public health professional, you have to take a step back and laugh at yourself. One characteristic that makes a good health educator: a good sense of humor. No amount of schooling will teach you that, people!

I invite you to refer to my "serious" post about sun protection from September 2nd.

Shouts & Murmurs: A Guide To Summer Sun Protection: newyorker.com

Shouts & Murmurs: A Guide To Summer Sun Protection: newyorker.com

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Elmo Says, "Swine Flu is BAD!"

I've been a fan of Sesame Street since the beginning. And by "the beginning," I mean my beginning, not Sesame Street's.

Thousands of children have learned the alphabet, counting, lessons on sharing, friendship, and diversity from colorful puppets. And now, Sesame Street characters are getting in on the Public Health action by helping the Department of Health and Human Services with a flu prevention and hygiene campaign directed at small children. And I must say, I am a fan.

Check out the CNN article!

Watch the new Elmo (and Gordon) flu videos! (I'm a sucker for Elmo's cuteness)

Back to School!

Can you hear the school bells ring? Well here in North Carolina, public schools are back in session. More inconveniently, college students have returned to the multitude of universities and colleges in this area. Since I work at one of these universities, I am already missing the days of quiet and empty hallways in my building.

For many college freshmen, they not only face the challenge of college-level calculus, lecture halls, and dealing with a roommate, but also face the feared “FRESHMAN FIFTEEN.” I’m pretty sure I was a victim of the freshman 15 (I never weighed myself freshman year so I don’t really know), though by the end of college I came out under par.

So why is gaining weight so common among college students?

· Dining Halls: Buffet-style eating is never good for anyone

· Liquid Calories: Between sugared sodas, energy drinks, and frou-frou coffee drinks to stay awake to study and increased alcohol consumption – all of these pack a lot of caloric punch

· Inconsistent and Inadequate Sleep: late nights on weekends, early morning bio, sleeping until noon – many college students make the mistake of sleeping whenever and wherever they can (I used to take naps in the big chairs in the student center), usually not amounting to 5-8 hours every night.

· Late Night Binge Eating: Pizza. The forever friend of late night study groups.

· Food Kept in the Dorm Room: Easy Mac. Need I say more?

· Swapping Fitness for Physics: Quiz time! What’s more important to a college student – studying, sleeping, eating, socializing, or working out? Sorry “working out,” you’ve been voted off the island.

Needless to say it’s a combination of factors that leads to weight-gain, the primary culprit being poor eating behaviors. But awareness and preparation can aid college students in the battle with the scale. Here’s how:

· Most Dining Halls now post calorie information for each dish. So go ahead and count your calories.

· Use a plate format. Okay so this method may have been designed for people with diabetes, but it also helps the average person eat a balance diet. Check it out!

· If you must drink soda, opt for diet sodas. Most coffee shops now offer sugar free and low-fat versions of their frou-frou drinks, too.

· I realize college students are going to drink regardless of anti-drinking campaigns, but try to stick to 0-4 drinks per day. Not only does this keep away from what is considered “binge drinking”, but you’ll limit your calories from alcohol too.

· Set a bedtime for yourself (especially on school nights) and strive for 8 hours of sleep per day. Easier said than done, I know.

· If you’re participating in a late night study group or pulling an all-nighter, chew sugar-free gum. Studies have shown this actually can help! If you do get the munchies, buy the single serving or 100 calorie bags of chips or cookies.

· Keep healthy snacks in your dorm room like baby carrot sticks, whole grain granola bars, nuts, and dried fruit.

· Most gyms at universities and colleges are free or low-cost to students, so take advantage of it!

· Not fond of weights or machines? Check out the fitness class schedule or join an intramural sports team.

· Walk or bike instead of taking the bus.

· Get credit for physical fitness by taking a class. Many universities offer classes for credit like running, tennis, and even ballroom dancing.

No Problem, Mon!

I just got back from a vacation to Jamaica – go ahead, be jealous.

While there, I learned that Jamaica was recently rated the 3^rd happiest nation in the world by the New Economics Foundation. I wondered about the source of the Jamaican happiness and what benefit happiness has for their country. Of course, being an American and a Health Educator I think in terms of economics and health status. But are those things really related to happiness?

Side Note: You may be asking yourself why I care about happiness as a health educator. The simple answer: mental health is part of public health!

The famous rapper, Notorious B.I.G. once penned a song called “Mo Money Mo Problems” (More money, more problems). And in fact, the same “happiness report” from New Economics Foundation found that the richer, more developed countries (e.g. USA and UK) tended to have lower scores on the Happy Planet Index. So perhaps there’s a negative relationship between money and happiness such that as money increases, happiness decreases?

Or perhaps this report is completely bogus since happiness is culturally defined? How do you control for cultures in which optimism and happy-go-luckiness are cultural norms?

On the health side of things, how do you treat diseases in a country where the motto is “No Problem!”? Is ignorance truly bliss?

On the flip side, the American health care system has created a culture of practicality and bleak outlooks, leading us to think about only about death and not about life.

Perhaps we should adapt an attitude of a “Jamerican,” somewhere between carefree and stark practicality. Perhaps if we take care of our mental health first, everything else will fall into place.

HIV: The Elephant in the Room

Human Immunodeficiency Virus, aka HIV, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV/AIDS lives up to its namesake – causing a deficiency (aka lack or absence) of the immune system. This means the body is unable to fight off infections, from strep throat to cancer.

As of 2007, there were 33 million people living with HIV/AIDS in the world. In the United States along, it’s estimated that there are 1.2 million adults and children living with HIV/AIDS (World Health Organization, 2008 http://www.who.int). About 80% of people living with HIV/AIDS in the US contracted the virus through high-risk sexual contact (e.g. unprotected sex), around 13% through injection drug use (e.g. needle/paraphernalia sharing), and the remainder through a combination of both or other means (CDC, 2006 http://www.cdc.gov).

I wanted to comment on two recent HIV-related news stories, one I posted last week. The United States House of Representatives voted to lift the ban on using taxpayer dollars to fund needle exchange programs. Needle exchange programs work to prevent the spread of HIV by allowing IV drug users to exchange used needles for clean ones. However, there are many opponents to such programs because they believe that by allowing drug users to exchange their needles that we are encouraging them to continue using drugs. I wonder if these are the same people who believe we shouldn’t hand out condoms in schools because it will promote pre-marital sex. My argument is we (and by “we” I mean people who support comprehensive HIV/AIDS prevention) are not promoting copious drug use, we’re promoting SAFE drug use. Similarly, we’re not telling teenagers “Here’s a condom, now go have lots of sex,” we’re teaching them to have SAFE sex. HIV/AIDS is a global problem that requires multi-point and multi-method intervention. Why not “nip it in the bud” at the points of transmission in addition to antiretroviral therapy (medicinal treatment for HIV/AIDS) after diagnosis. Additionally, thousands upon thousands of people around the world are living with HIV but don’t know they have it. Antiretroviral therapy is only good if a person is diagnosed. We need to take measures to prevent transmission of HIV, particularly HIV that is unknown.

In other HIV news, researchers have identified a new strain of HIV that is derived from gorillas. Check out the article here. What are the implications of this? HIV is ever-changing. Microbiologically, we need to be aware of the different variants that may emerge in the next few years. Anthropologically, the face of HIV/AIDS has changed and will continue to change. It is not longer a virus that affects vagrants, druggies, prostitutes, and homosexual men. It affects EVERYONE.

House lifts ban on federal funding for needle exchange programs - The Boston Globe

House lifts ban on federal funding for needle exchange programs - The Boston Globe

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Social Media: A Health Educator's Friend or Foe?

I am truly overwhelmed by the social media frenzy and the advances in new technology. More so, there’s the whole subset of “vocabulary” that needs to be learned to effectively stay in the loop. Sometimes I want to throw my hands in the air and give up on trying to stay in touch with it all, but then I realize by being culturally relevant, I become a better health educator.

Now the question is: are social media like Facebook, Twitter, blogging, and texting my friends or foes? I think if social media can be harnessed and used appropriately it can be a very effective health education tool. However, like your mother always told you “Everything in moderation.” I think if overused or used improperly, we could have a global disaster on our hands. Okay, maybe that’s an exaggeration. But the results wouldn’t be good.

Example 1: The CDC on Twitter

The Centers for Disease Control and Prevention have multiple sub-centers/departments on Twitter, tweeting updates to their followers. This is a pretty effective way of keeping the general public (at least those on Twitter) updated to any breaking public health news like a new publication or report or “Hooray! It’s International Eat-Your-Veggies Day!” But probably the section that may have the most purpose with Twitter is the Disaster Preparedness section of the CDC. Twitter is potentially a good channel for communicating information (albeit, brief) on preparing yourself for, well, disaster. One situation where this may have back-fired, however, is with the swine flu. Tweeters panic and make assumptions since there’s no way to get the whole story due to the 140 character limits. Plus, there’s no room for a post-script “Don’t Panic.”

Example 2: Online Forums

Gobs and gobs of research have shown that social support in its various forms is an effective way of managing chronic disease. If you Google Scholar or do a PubMed search of “Social Support and Disease" you’re bound to be overwhelmed with the search results. Online support groups, such as those for type 2 diabetes or breast cancer, have had great impact on mental and physical well-being of their participants. You might even know someone who participates in one and can attest to how much they love their online support system. Some benefits of online support groups are:

1. Common interest. Not feeling alone in your suffering is a good thing.

2. Anonymity. Participants don’t feel judged by people who already know them and have preset opinions.

Some health issue support groups, however, aren’t destined for greatness. Studies have found that support groups of teenagers suffering from anorexia or bulimia are counterproductive because the teens share their “methods” for staying thin. I give an “A” for effort, though.

Example 3: Texting Health Messages

I hate texting. I’m so glad I’m not a middle or high school teacher because I’d probably hate it more. I think we’ll have an emerging pandemic of “texter’s thumb” on our hands (no pun intended) in the next few years. And I think it teaches teenagers bad grammar and inappropriate use of the acronym. However, realizing we live among the “text generation,” I think it can be an important avenue for health messages. I’m currently working on a project that works with multiple sites doing diabetes self-management studies. One of our studies is using text messaging as a means of reminding participants of upcoming doctor appointments, medication reminders, healthy eating tips, and the list goes on and on. I’m very interested to see the results of this study. Several studies have already been done (mostly international) that have found text messaging (or SMS) to have a positive impact on certain behavior changes. However, several studies have also been deemed “inconclusive,” so more research needs to be done in this area.

Okay, so I haven’t covered all forms of social media. I tried to be objective, but let’s face it, I’m a fan of you, social media. Let’s be friends.

Fireworks, Food, and the Fourth of July!

The Fourth of July is right around the corner and there are a lot of things that can go wrong when you’re camping, picnicking, or family reunioning. Not to rain on anyone’s Fourth of July parade, but there are some things everyone should be wary of in the midst of the festivities. I’ve seen a lot of crazy Independence Day celebrations and seen a lot of things go wrong. Here are some mistakes people make on the Fourth of July:

1. Drinking too much. Many adults raise a glass in celebration of our nation’s independence, and unfortunately, many adults will binge drink. Binge drinking means drinking more than 5 alcoholic beverages in one sitting for men and more than 4 alcoholic beverages in one sitting for women. According to the CDC, excessive alcohol use is the 3^rd leading lifestyle-related cause of death.

Like drinking and driving, drinking and fireworks DO NOT MIX. If you’re drinking feel free to go to a professional fireworks show, but don’t try to set them off yourself. Please.

2. Carelessly using fireworks. 60% of injuries related to fireworks occur on or around the 4^th of July (Green & Joholske, 2006). In the months of June and July, firecrackers, sparklers, and rockets account for most injuries seen in emergency departments, and sparklers are associated with half of the injuries seen in children under 5 (Green & Joholske, 2006). And the best way to prevent firework-related injuries? Leave them to the professionals!

3. Eating contaminated or spoiled food. Be wary of food that’s been sitting out in the sun too long, especially if it’s a mayonnaise-based salad, dairy product, or meat product. Even if a food has been washed and cooked thoroughly, bacteria flourish at room (and warmer) temperature. If you can, try to keep leftovers cool or throw them away.

Also, even if you love your burgers rare, ground beef is a common culprit for food-related illness. Make sure the internal temperature of your hamburgers is a balmy 160 degrees Fahrenheit to keep yourself safe from bacteria.

Obviously these aren’t the only things that can go wrong on the 4^th. I urge you to be safe and wary as you “eat, drink, and be merry!”

THIS is Public Health

When I lived abroad, people always asked what is my profession. I would always reply, "I work in public health." Which is a phrase that unfortunately doesn't translate well into other languages. "Public Health" either is equated to medicine or sanitation...neither of which I do.

Even in America, people aren't quite sure what Public Health is or what it means to be a public health worker. In America, people usually think I'm a health inspector or do stuff related to AIDS. Wrong again. I don't do those things either! For those of you with lingering questions, check out this video!

http://www.thisispublichealth.org/

"I'm healthy! I went to college!"

Back in May, a report was released by the Robert Woods Johnson Foundation that ranked states according to the gap between college graduates and non-college graduates who rate themselves in “less than very good” health. Meaning, the states ranked the highest had the smallest gap in self-reported health status between those with college degrees and those without. Top-ranked states were Delaware, Hawaii, and Maryland. Lowest-ranked states were California, West Virginia, and Kentucky.

Click Here to download the report.

This report is chocked full of other data about self-reported health status among American adults, but I want to focus on the relationship found between education and health status. What they found was that as education levels rise, health improves.

As someone who’s been in the health field for years, I can look at these finding and say “Well, duh!” But is it all that intuitive? Let’s deconstruct it:

College Education > More Knowledge > Awareness of Health Risks > Healthy Behaviors > Reporting Good Health

OR

College Education > Higher Income > Ability to Regularly Access Health Care Services (by health insurance or out-of-pocket expenses) > Reporting Good Health

OR

Both?

I think the gap between college-educated and non-college-educated folks is somewhat a combination of the two models proposed above, but I think the main factor is probably linked to income. We know that people with higher education levels get paid more (check census data: http://www.census.gov/hhes/www/macro/032008/perinc/new03_000.htm)

I would venture to say that most Americans have access to basic health knowledge. Most children learn basic health behaviors all through primary school, from teeth-brushing to healthy eating. And there are so many public service announcements and news reports related to health nowadays (providing you have a television), so the basic knowledge is there. However, people who make more money are more able to access healthier foods (fresh veggies cost more!), physical activity (e.g. gym membership), and regular health care.

One thing that concerned me about the release of this report is that the chairman of the commission that put out this report said that in order to improve our nation’s health we need to improve education quality and education attainment. I’m all for improving the nation’s schools and giving every child the opportunity to go to college if they want, BUT…

-Do we really know that education actually precedes health status? I mean, which came first, the chicken or the egg? Maybe kids who already value health and consider themselves to be healthy, physically and mentally, go to college. Many college-bound kids are able to stay on their parents’ health insurance during their college years and maybe they see health insurance and regular health care as important. Who knows?

-Maybe before correcting the educational system in the US we need to fix the health care system. We ought to consider striving toward getting every person, regardless of age, equal access to health care. We’ve missed the boat on folks who will not go back for an education, so why not seek to meet their current needs? In the coming years, people over 80 will become the fastest growing age group in America and people over 50 will represent 35% of the population. Let’s meet the ever-increasing need for access to health care.

-Keeping in mind, access to health care and education alone will not fix the problem. Both issues need to be tackled to move toward improving the health status of the American people.

Weight Loss for Real

So I’m getting married in a few weeks, and I was recently browsing a bridal discussion board. One woman said she wanted to lose 45 pounds for her wedding. While the time frame of 8 months was perfectly reasonable and healthy – most experts consider 1-2 pounds per week to be healthy weight loss – this goal concerned me.

For one, did your fiancé propose to you as you are? Don’t your friends and family love you as you are?

Presumably, there was no ultimatum for this girl from other people, and she wants to lose the weight for herself.

BUT…

She said she wanted to lose the weight for the wedding. And to me, this means “I want to look skinny in pictures,” or “I want to look amazing on my wedding day (because I think I look slightly less than amazing currently).” Don’t get me wrong, I want to look amazing on my wedding day too.

HOWEVER…

As a health educator, I get concerned when people want to lose weight for a particular event, e.g. wedding, reunion, etc. While those are good jump-start motivators and provide a specific and measurable timeline for a weight loss goal, losing weight for an event does not necessarily translate into life change and enduring weight loss.

I probably sound like an echo from the Biggest Loser when I say weight loss is about life change. For a bride who has 45 pounds to lose to be at a healthy weight for their body type, this is not about dropping pounds to fit into your dress, this has to be about changing habits and mindsets.

I understand full well the battle with weight – I’ve lived it. Just over 5 years ago, I weighed over 200 pounds and had a Body Mass Index (BMI = weight-height ratio) of 34 (30 and above is considered obese). I came to a point where I felt very unhealthy and decided to become more disciplined about my diet and exercise. In my first 6 months, I lost 25 pounds and felt awesome. For about 2 years, my weight plateaued and I was perfectly content. My diet and exercise routine were just that – routine. Then I decided to set a fitness goal for myself: to run a marathon. As a result of training for the marathon, I lost 30 pounds. I had changed very little about my diet, increased the intensity and duration of my daily exercise, and totally changed my mindset.

All of my weight loss has been very gradual and has come as a result of mindset not focused on weight loss, but focused on other goals: feeling healthy and fit. And this is what I would recommend to anyone.

You can say you want to lose X number of pounds by a certain date, but you’ll need smaller, specific goals and plans to reach your overall weight loss goal. So consider setting diet and fitness goals like these:

Run (and finish) the Annual Spring Fun Run 5K on April 23.

Play and walk 18 holes of golf with my son at the Father-Son Golf Tournament on June 11.

Starting Monday, cut back to 1 can of soda per day.

Eat a piece of raw fruit or vegetable with every meal for 1 week.

Notice these are SMART goals. SMART stands for:

Specific

Measurable

Attainable

Realistic

Timely

Obviously, diet and fitness goals won’t look the same for everyone. You’ll want to set goals based on your lifestyle.

Another key tip: It really helps when you have a partner in crime! Find someone (friend, co-worker, family member, spouse, or partner) who will work towards those specific diet and/or fitness goals with you. Social support is key to maintaining motivation and regular, mutual encouragement. And there’s a lot of research showing the effectiveness of peer support in long-lasting health behavior changes.

Note: I’m not a physician or a dietician, so I can’t make specific recommendations. I speak from personal experience. What worked for me, will not necessarily work for everyone.

Summer Tan-Tastic!

I find it terribly unfortunate that being tan is so glamorous. You may think I’m saying this because I’m of Northern European ancestry and couldn’t get a tan if my life depended on it. Hardly. I can tan with the best of ‘em. I’m saying this because it’s nearly summertime and Americans have terribly unhealthy skin care behaviors when it comes to the sun. I work on a college campus and have a pool in my neighborhood and I have seen so many people of Northern European ancestry out trying to get a tan. News Flash: If you’ve never gotten a tan in your life, why would this year be any different?

But I’m not just going to target the pale, pasty types – though fair skinned, light-eyed people are at greater risk for severe sun burns and skin cancer – no, EVERYONE needs to think about taking care of their skin for the long run.

As a 20 something, being tan may make you the envy of all your friends, and as a 30 something getting a tan can make you appear 5 pounds lighter. But what can extended and unprotected sun exposure do for you in your 40’s, 50’s, and beyond? Sun exposure (and tanning beds!) commonly leads to wrinkles, leathery skin, sun/age spots, increased risk for cataracts (eyes), and increased risk for skin cancer. Last I checked, none of these are glamorous.

According to the CDC, you are at an increased risk for skin cancer if you have:

• A lighter natural skin color.
• Family history of skin cancer.
• A personal history of skin cancer.
• Exposure to the sun through work and play.
• A history of sunburns early in life.
• Skin that burns, freckles, reddens easily, or becomes painful in the sun.
• Blue or green eyes.
• Blond or red hair.
• Certain types and a large number of moles.

Though most of these are not true for me, I did have serious sunburns as a teenager, which is one of the greatest predictors of skin cancer later in life. Now I Take precautions when I know I’ll be exposed to the sun for any length of time. Some things I do include:

· Seeking shade, whether it’s under a tree or the shadow of a building

· Wearing a hat when I’m doing work outside or going for a run

· Wearing sunglasses especially when I’m near water

· Slathering on sunscreen that’s a higher SPF than I probably need

Even though I’m not fair-skinned, I wear SPF 30 sun block or higher anytime I’m outside. I know everyone has their favorite sunscreens or sun blocks based on smell or functionality (e.g. oil-free, spray-on, waterproof), but to see how your sunscreen or sun block stacks up against the competition, check out reviews at http://www.consumersearch.com/sunscreen.

I hope I didn’t spoil the summer for the sun gods and goddesses out there…

Don't Fix What Ain't Broke

One of the major political and public health issues facing our country today is Children’s Health Insurance. There has been a big push to cover all children in the US. It would be huge if we could figure out how to provide adequate and equal access to health services for all American children.

In recent years, there’s been some forward progress. But I learned recently that some states, such as North Carolina, are looking to take a big step backward by cutting school-based dental programs for children.

According to the CDC (www.cdc.gov) and ADA (www.ada.org), findings from several scientific studies show that school-based sealant programs work. These programs reach children at high risk for tooth decay, especially those who don’t have access to private dental care. Why would a state see an effective program as expendable?

Here’s why states should NOT cut school-based dental services:

1. According to the CDC, tooth decay (dental disease) is the most common health problem for school-aged children.

2. According to the state oral health survey in North Carolina, 1 in 4 children entering kindergarten show obvious signs of tooth decay. In many states, the percentage of 3rd graders with untreated tooth decay is upwards of 44%!

3. Recent studies conducted by researchers at Harvard and the University of Puerto Rico found a link between periodontal disease and obesity. These findings also have implications for links between oral health and heart disease and type 2 diabetes. Therefore, we ought to think of school-based dental services as preventive health services that extend beyond the teeth.

I’m not an economist, I’m a health educator. Do I understand that states have budget shortfalls? Yes. Do I understand why a state would cut a program that is effective and is good for the health of its future workforce? No. In my opinion, the economic returns of keeping a program of this nature far outweigh the costs…

Healthiest Nation in One Generation

I think this little video is very clever - check it out!



To find out more, visit http://www.generationpublichealth.org/

Travel Woes

I’ve finally returned from a long week of travel. After 8 flights and 6 airports, I’m thankful to be back to my stomping grounds.

In traveling, I only saw a handful of people wearing masks covering their mouths and noses. I had been expecting more based on the swine flu media frenzy. Of course, it’s unclear whether these mask-donning folks were trying to avoid swine flu, allergy or respiratory disease sufferers, or immuno-compromised.

Perhaps all air travelers should wear masks since international hubs like Dulles pack a lot of people in small terminals and the recycled air on planes may make us all more susceptible to infection.

If I had a nickel for every time someone told me they got sick after air travel, I’d be a millionaire. But the looming question is “why?” Why does air travel make us sick? I’ve already mentioned recycled air and small terminals, but I think there are key mistakes travelers make that cause them to be more susceptible to illness.

• Not drinking enough water. The truth of the matter is when you fly on an air plane you become dehydrated. Staying hydrated may help you avoid upper respiratory and GI illness.

My suggestion: bring a water bottle with you on the plane. The flight attendants can only provide you with so much water on a flight, so bring your own. Yes, it means you may have to ask your neighbor to move so you can get to the lavatory, but trust me, it’s worth it.

• Not eating enough or healthful foods. Many travelers choose to not keep a regular meal schedule when traveling. Yes, airport food prices are expensive, but not getting the calories and nutrients you need for your body to properly function can be detrimental to your health.

My suggestion: bring snacks from home. Many travelers are under the impression that you are not allowed to bring outside food through security. Well, this is not a movie theater, and that rule never stopped you before. Granola bars, nuts, and dried fruit hold up really well and will also provide nutrition that will help keep you “regular”.

• Being stressed out. I get it. Air travel is a stressful thing. Between rushing to a connecting flight, delays, lost baggage, and squishing into a tight space between strangers, air travel can be a major trigger of elevated blood pressure and anxiety. Did you know that elevated stress levels are related to weakened immune functioning? It has to do with elevated hormone (Cortisol) levels and inflammation and little things called cytokines. It’s kind of complicated so I won’t explain in detail, but all you need to know is that stress can make you susceptible to disease.

My suggestion: deal with your stress! I know, easier said than done. Try some deep breathing in your seat. Close your eyes and focus on how your stomach expands and contracts with every breath. Take a walk in the terminal or find a space to do some stretches. Exercise is a great way to combat stress, not to mention it feels great to stretch your legs after sitting for several hours.

If you have any travel tips for avoiding illness, please comment!

May is Asthma Awareness Month!

Did you know that asthma is the most common chronic disease among children? Approximately 6.7 million children are currently living with asthma in the United States (CDC, 2009). Asthma disproportionately affects:

• African Americans
• People with lower income
• People living in urban areas

Unfortunately, children with asthma must live with this condition for their entire lives. If asthma is poorly controlled, it can lead to:

• Restricted activity
• More sick days (from school or work)
• Emergency room visits
• Decreased quality of life

However, if asthma is properly and effectively controlled, children with asthma can live healthy and active lives no different from children without asthma. Here are some tips for helping your child control his or her asthma and avoid hospital visits:

• Visit the doctor regularly
• Develop an asthma action plan with your primary care provider
• Make sure your child regularly takes any prescribed asthma controller medication
• Always carry a rescue inhaler wherever you and your child go
• Identify your child’s asthma triggers (e.g. dust mites, mold, pets, pollen, cigarette smoke, etc.)
• Help your child avoid contact with their asthma triggers

*Note: If your child experiences an asthma attack that cannot be alleviated by a rescue inhaler, take them to the emergency room immediately.

These tips may seem simple, but in practice, they carry some degree of difficulty and I’ll tell you why. Controlling a child’s asthma often relies on a behavior change with the parent or other members of the household. This can include reminding a child to take their medication, quitting smoking, regular cleaning, or getting rid of a pet. As with any behavior change, there are a number of internal and external factors that come into play, such as time, motivation, and social support.

I once worked on an asthma control pilot study targeting children with asthma and their caregivers who lived in rural mountain areas of North Carolina and were on Medicaid. Participants came in and developed an asthma action plan and a set of short-term goals related to reducing asthma triggers with their health care provider. Participants were supposed to return one and three months later for follow-up on their goals and other variables, such as use of rescue inhaler and emergency room visits. But participants never returned . When we found out why, it primarily came down to lack of finances, time, and knowledge.

· Follow-up visits required a parent to take off work – they could not afford to take time to not work

· Follow-up visits required round-trip drive times of up to 2 hours due to the mountainous, rural landscape

· Parents did not see a reason to bring their child into the doctor for follow-up if the child was not experiencing any immediate asthma complications

But there’s hope! There is some recent research regarding caregiver behavior change. A study published in the Archives of Pediatric and Adolescent Medicine in March 2009 by Fisher, et al showed that asthma coaches were effective in reaching low-income parents of African American children (http://archpedi.ama-assn.org/cgi/content/abstract/163/3/225 ). Asthma coaches consisted of trained community members who provided information and social support by regular contact (monthly or bi-weekly) with parents over a two year time period. As a result, parents who had regular contact with asthma coaches experienced 50% less hospitalizations among their children compared to a control group.

There are two things I’d like you to ponder:

1. Our choices and health behaviors as parents can have a significant impact on the health status of our children.

2. Could social support be the key ingredient that’s been missing from the medical model?

Hmmm...

Outbreak!

When I was much younger, I saw a movie called, “Outbreak”. You know – the one with Renee Russo and Dustin Hoffman. Monkeys. Virus. Panic. That’s the one.

I LOVED this movie. This movie made me want to be on the front lines of infectious disease control. And, consequently, as an adult, I decided to bravely enter into the field of public health – though much less on the infectious disease side of public health. But my life-long fascination with microscopic organisms has hardly diminished.

Yes, the physiology and adaptability of microbes is something to ogle in amazement. But what really fascinates me is the human reaction to infectious diseases. And I don’t mean immuno-response. Think about it. When people hear any word ending in “demic” (e.g. epidemic, endemic, pandemic), they panic.

So now life is imitating art. Except instead of monkeys the culprits are pigs, and there’s no Renee Russo or Dustin Hoffman to save us. Yes, I’m talking about the Swine Flu. People are panicking worldwide. And why? Because that’s what people do – react before understanding the facts. So here are some facts about Swine Flu that might dispel any myths you may have heard:

1. The swine flu is not a “new” virus. In fact, the CDC estimates about 75% of swine farmers and exhibitors carry antibodies for the swine flu. This means, they were infected with the swine flu at some point in their life.

2. This is not the first swine flu outbreak. In 1976, there was an outbreak of the swine flu among soldiers at Fort Dix, New Jersey.

3. You cannot get the swine flu from eating pork. Swine flu spreads just like any other form of the flu or common cold. So go ahead and eat your BLTs!

4. Your doctor cannot diagnose you with swine flu on the spot. If your doctor suspects swine flu, a blood sample must be sent off to a CDC lab for confirmation.

5. Swine flu is treatable. There are 2 antiviral medications that can treat the current strain of swine flu.

*Source: www.cdc.gov

The CDC gives the following tips for avoiding contracting the swine flu:

· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the used tissue away immediately.

· Thoroughly and frequently wash your hands with soap and water

· Avoid touching your eyes, nose, and mouth

· Avoid close contact with sick people

· If you get sick, stay home from work or school to avoid contact with other people

These are not ground-breaking tips. They are the same tips given to avoid the common cold. It’s common sense, not rocket science.

In addition to the CDC’s tips, I’d like to offer my own:

1. Avoid over-washing your hands with antibacterial gels and soaps. Viruses can easily adapt and quickly become resistant to antibacterial products if these products are overused.

2. Thorough hand-washing includes making lots of friction and soap suds. I tell kindergartners to sing the alphabet song while they wash their hands so they know they’ve lathered them enough. A simple squirt-and-rinse will not do.

3. Do simple things to boost your immune system. Exercise regularly, eat lots of fruits and veggies, drink plenty of water, and get plenty of sleep.

4. Finally, DON’T PANIC. Learn the facts, and trust that there are professionals trained in infectious disease control doing their job to protect you and your family.

So don’t pack your bags and move to Antarctica. Do what you can to protect yourself and trust that others are doing what they can to protect you too.