A Perfect Fit: Teen Pregnancy Prevention and Public Health

Today's guest blog is from Sarah Kershner. Sarah received her Bachelor of Science degree in Health Science from Clemson University, Master of Public Health degree from the University of South Carolina, and is currently pursuing her Doctorate of Philosophy degree in Health Promotion, Education and Behavior from the University of South Carolina, Arnold School of Public Health. Sarah is a Certified Health Education Specialist and has worked with high risk youth since starting the graduate program at the University of South Carolina.

Usually when I tell people that I work in the field of public health, they naturally assume that I focus on physical fitness, diet and nutrition (these are obviously not the people that know of my love for Little Debbie Swiss Rolls).  However, people normally do not assume that my focus is in teen pregnancy prevention.  Why is it that people do not connect the dots between public health and unintended teen pregnancy?  Teen pregnancy is associated with multiple social issues impacting the public health of a community, family and individual.  Teen pregnancy is linked to foster care, early birth weight, premature birth, receiving welfare, and lowered educational achievement, just to name a few.  Here are the facts:[1]

• Young teen mothers (17 and younger) are 2.2 times more likely to have a child placed in foster care than mothers who delay childbearing until age 20 or 21.
• Teen mothers ages 18-19 are about one-third more likely to have a child placed in foster care than mothers who had their first child at age 20 or 21. 
•  Infants of teen mothers are at increased risk of being born prematurely.
•  Almost half of all teen mothers began receiving welfare within five years of the birth of their first child.
•  Parenthood is the leading cause of school dropout among teen girls. 
•  Children of teen mothers are 50 percent more likely to repeat a grade, less likely to complete high school and have lower performance on standardized tests. 
•  Less than half of mothers age 17 and younger ever graduate from high school.

Additionally, teen pregnancy impacts the physical, emotional, psychological and financial health of the teen mother, teen father, involved families and community.  April is Public Health month, followed by Teen Pregnancy Prevention month in May.  So this spring as you are watching young people enjoy some of the pivotal “firsts” in their lifetime such as going to prom or walking across the stage to accept their diploma, consider that in 2010 there were 6,847 teens (15-19 years old) who gave birth in South Carolina, putting them at an increased risk for drop out and the other negative societal issues as listed above.[2]

So why should we consider teen pregnancy as a critical part of addressing public health?  Because the impact on the community, family and individual IS public health.

ACTIVE LIVING & HEALTHY EATING

Today's guest blog is by Elena Ong, Communication Chair for APHA Asian Pacific Islander Caucus for Public Health

WHAT’S THE EPIDEMIC?   OVERWEIGHT & OBESITY

Nearly two-thirds of adults[i] and nearly one in three children are overweight or obese.[ii]   Being overweight or obese increases risk for heart disease, type 2 diabetes, high blood pressure, stroke, breathing problems, arthritis, gallbladder disease, sleep apnea, osteoarthritis and some cancers.[iii]

WHAT’S THE POPULATION?  ASIAN AMERICANS AND NATIVE HAWAIIANS AND OTHER PACIFIC ISLANDERS (AANHOPIs).[iv] 

Nearly half (45 percent) of AANHOPIs are not at a healthy weight, and 68.4 percent of Pacific Islanders are overweight or obese.[v]  

Obesity rates for the second generation of Asian adolescents is twice as high than first generation obesity rates[vi].

From a clinical point of view, AANHOPIs tend to have more inner abdominal fat than other races, which increases their risk for chronic disease[vii].   Mildly obese AANHOPIs are at greater risk for heart disease and diabetes.  For example, AANHOPIs have a 60 percent  higher rate of type 2 Diabetes than whites of the same BMI[viii].  

From a behavioral point of view, less than half of adult AANHOPIs meet recommended physical activity levels - only 17.8 percent of Asian adults met the 2008 Federal Physical Activity Guidelines[ix]. 

WHAT’S THE SOLUTION?  ACTIVE LIVING & HEALTHY LIFESTYLES

Empower AANHOPIs to improve their health by improving social, cultural, environmental, structural, economic and political factors that contribute to overweight and obesity-related diseases.

1.      Educate, analyze and empower “healthy weight” management in a culturally and linguistically sensitive way.  Disaggregate the NHOPI data from AANHOPI data to get a true picture of risk.

2.      Adopt API-specific BMI definitions for overweight and obesity. The WHO consultation suggests that 22 kg/m2 – 25 kg/m2 may be a better cut-off point for Asian populations.[x]

3.      Promote community wellness and active living:  public transportation, safe parks and sidewalks for exercise, physical fitness programs at schools/community centers, access to healthy food at vending machines/trucks/grocery stores/restaurants/cafeterias.

4.      Promote workplace wellness and healthy lifestyles: standing/walking meetings; exercise breaks; access to healthy foods at vending machines/cafeterias/farmer’s markets/kiosks.

5.      Promote personal wellness and healthy lifestyles:  eat well, exercise and limit videogame/computer over-use, relax, reduce stress, etc.

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[i] Flegal KM, Caroll MD, et al.  Prevalence and trends in obesity among US adults, 1999-2009. JAMA. 2010 Jan 20; 303(3):235-41.

[ii] Ogden CL, MD Caroll, et al. Prevalence of high body mass index in US children and adolescents, 2007-8. JAMA. 2010 Jan 20;303(3):242-9.

[iii] US DHHS Office of Minority Health.  Health Status of Asian American and Pacific Islander Women.  May 12, 2009, http://www.omhrc.gov/templates/content.aspx?ID=3721.

[iv] US Census, 2000-2010.

[v] US National Center for Health Statistics, Vital and Health Statistics, Series 10, Number 235, Summary Health Statistics for US Adults: NHIS, 2006.

[vi] Popkin. J Nutr 1998; Haas, AJPH, 2003

[vii] Lear, Am J. Clin Nutr 2007, Davis, Ethnicity & Disease, 2004 and Craig, Acta Diabetol, 2003.

[viii] Razak http://www.ncbi.nlm.nih.gov/pubmed/14726171

[ix] Op cit.

[x] Sue Hughes.  Asian populations may need different definitions of obesity.  Heartwire, January 9, 2004

Sexual Reproductive Health for Older Adults

Today's National Public Health Week guest blog is by Lené Levy-Storms, PhD, MPH, Section Chair of Aging & Public Health Section.

Are you having sex after 50? Chances are: yes. In a New England Journal of Medicine study by Dr. Stacey Tessler Lindau et al. (2007), 50-75 percent of adults ages 57-85 reported being sexually active in the past year [1].

With Viagra readily available and women’s reproductive years behind them, why not? Well, there are barriers, such as illness, but also risks for communicable diseases, such as being sexually active. One sexually transmitted disease in particular, Human Immunodeficiency Virus is not only communicable for anyone who is sexually active but also now not necessarily a death sentence, if one receives ongoing drug therapy. Without a cure, though, HIV and Acquired Immune Deficiency Syndrome are on the rise among adults over 50. In 2005, persons aged 50 and older accounted for

• 15 percent of new HIV/AIDS diagnoses [2]*
• 24 percent of persons living with HIV/AIDS (increased from 17% in 2001) [2]*

So HIV/AIDS is yet another chronic condition that we face with age. Older adults need to be aware of their risks for HIV/AIDS and other communicable STDs, if they continue to be sexually active in the golden years, as well as how to prevent them. According to the CDC, such persons who are age 50 and older may have some of the same prevention challenges as younger adults including:

•  Lack of practicing safe sex [1].  
•  Engaging in risky accompanying behaviors such as drug use.
•  Low knowledge and/or awareness of risk [3, 4]
• Discrimination that may deter access to care and/or slow down treatment [5]. 
• Health care providers who underestimate the risk for HIV/AIDS [1]. 
• Physicians missing a diagnosis due to other age-associated diseases
• Stigma associated with positive HIV/AIDS status. 

Get educated about and screened for HIV/AIDS, regardless of age if you are sexually active, and enjoy safe sex after 50!

References
1. Lindau ST, Schumm MA, Laumann EO, et al. A study of sexuality and health among older adults in the United States. N Eng J Med 2007;357:762–774.
2. CDC. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, CDC; 2007:1–54. 
3. Lindau ST et al. Older women’s attitudes, behavior, and communication about sex and HIV: a community-based study. J Womens Health 2006;6:747–53.
4. Henderson SJ et al. Older women and HIV: how much do they know and where are they getting their information? J Am Geriatr Soc 2004;52:1549–53.
5. Zingmond DS et al. Circumstances at HIV diagnosis and progression of disease in older HIV-infected Americans.Am J Public Health 2001;91:1117–20.

Mental Health and Physical Health — Maintaining the Balance

Today’s National Public Health Week guest blog is by Kawika Liu, MD, PhD, JD, Chair Elect of the Asian Pacific Islander Caucus for Public Health 

 

For centuries, Asian and Pacific Islander cultures have, in different ways, made the connection that the mind and body are inseparable, a connection that Western science has only more recently recognized. In some Asian cultures, the mind-body unity is a condition to be strived for, while in traditional Hawaiian culture, maintaining pono (balance) is a key obligation for all beings.1  Maori can draw on the strengths of hinengaro (psychological), wairua (spiritual), tinana (physical) and whanau (family) health in order to remain healthy. 2

What does Western science tell us about the mind-body connection? Initially, people who have very serious mental illness live much shorter lives than people without such illness, from 13.5 to 32 years shorter.3 And not all of this difference in life span is explained by increased risk for suicide, as people with serious mental illness die earlier of heart disease, diabetes, and cancer than people without mental illness.4 Physical illnesses such as diabetes can also increase the risk for mental illness, such as depression.5 Social factors, such as discrimination and poverty, also can contribute to both mental and physical illness. 6,7

 
Thus, because it is important to maintain mental health in order to be physically healthy, and to be physically healthy in order to maintain mental health, what can you do?

•  Embrace the positive in life: recognize and celebrate your successes and the good people in your life.
•  Learn techniques for self-relaxation, and other stress management tools.
•  Know yourself, your physical, mental and emotional strengths and areas that need to be strengthened.
• Maintain your physical health, including getting enough rest, exercise, and eating well.
•  Nurture positive relationships, particularly with family and community.
• Take time to refresh yourself in creative, fun or relaxing activities.
•  Participate in activities that help you maintain your sense of who you are, in your culture and/or community.
• Learn to recognize the signs of depression and anxiety, and seek treatment.
• Limit your consumption of alcohol.

 

For more information contact: Mental Health America, www.nmha.org; Substance Abuse and Mental Health Administration, http://www.samhsa.gov/

REFERENCES
1. Yuasa Y. The body: towards an Eastern mind-body theory. Available at: http://books.google.com/ebooks?id=_DOku4pM5wYC&ganpub=k370973&ganclk=GOOG_1412634472
2. BPACNZ. Te whakataunga me te maimoatanga o nga mate o te hinengaro Maori: recognizing and managing mental health problems in Maori. Available at: http://www.bpac.org.nz/magazine/2010/june/mentalhealth.asp
3. National Association of State Mental Health Directors. Available at: http://www.nasmhpd.org/.
4. Platt EE, Munetz R, Ritter C. An examination of premature mortality among decedents with serious mental illness and those in the general population. Psychiatric Services. 2010 July 1;61(7). Available at: http://ps.psychiatryonline.org/article.aspx?articleID=101466
5. American Diabetes Association. Depression. Avaiable at: http://www.diabetes.org/living-with-diabetes/complications/mental-health/depression.html.
6. Lu N, Samuels ME, Wilson R. Socioeconomic differences in health: How much do health behaviors and health insurance coverage account for? J Health Care Poor Underserved. 2004;15:618-630.
7. Isaacs SL, Schroeder SA. Class—the ignored determinant of the nation’s health. N Engl J Med. 2004;351:1137-1142.
8. Canadian Mental Health Association. Ten tips for mental health. Available at:http://www.vcn.bc.ca/rmdcmha/tips.html.
9. Maryland Coalition on Mental Health and Aging. Maintaining mental health. Available at: http://www.mhamd.org/aging/mentalhealth/maintaining.htm.

An ounce of mental health prevention is worth a pound of cure

Frances M. Harding serves as director of the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention, and is recognized as one of the nation’s leading experts in the field of alcohol and drug policy. The center provides national leadership in the federal effort to prevent alcohol, tobacco and drug problems. As part of an executive leadership exchange within the agency, Harding recently served as director of SAMHSA’s Center for Mental Health Services, whichleads federal efforts to treat mental illnesses by promoting mental health and preventing the development or worsening of mental illness when possible.


Harding also serves as the lead for SAMHSA’s Strategic Initiative on the Prevention of Substance Abuse and Mental Illness, which will create prevention prepared communities where individuals, families, schools, faith-based organizations, workplaces and communities take action to promote emotional health and reduce the likelihood of mental illness, substance abuse, including tobacco, and suicide. As National Public Health Week comes to a close with a focus on mental health and emotional well-being, Frances Harding, director of SAMHSA, offers her insights into public health interventions to address mental health challenges.

Approximately 20 percent of children currently have, or will have at some point in their life, a mental health challenge. Approximately 10 percent of children will have a serious emotional disturbance that significantly impairs their ability to function at home, at school or in the community.

A significant amount of research provides evidence that many of these disorders can be prevented. Implementing evidence-based interventions effectively assists in delaying or even preventing the onset of mental, emotional and behavioral disorders as well as avoiding the associated economic costs in the school, health care and judicial systems. Intervening in a child’s life with appropriate evidence-based services increases the likelihood of academic success, and can reduce the risk of delinquency and substance abuse. Early intervention also can increase the child’s capacity to develop social skills, resolve conflicts, and reduce the risk of depression and anxiety.



To read the full article, visit APHA's Public Health Newswire.

Importance of preconception care for improving maternal, child health

Today’s National Public Health Week guest blog is by Katie Baker, MPH, doctoral candidate and research coordinator at the Skin Cancer Prevention Lab at the College of Public Health of East Tennessee State University.

In the U.S., most people are familiar with prenatal care. These services, which became popular in the 1980s, are provided to pregnant women and are meant to increase the likelihood of a healthy delivery. Despite the fact that the majority of pregnant women in the U.S. receive some sort of prenatal care, we haven’t seen the dramatic improvement in birth outcomes that many experts anticipated. This is not to say that prenatal care is ineffective; we may simply be implementing services too late.

By the time most women realize they’re pregnant and present for their first prenatal care visit, they are 11 to 12 weeks pregnant. Interestingly, some of the most critical fetal developments occur between weeks four and 10 of gestation. By focusing on reducing health risks during pregnancy, we may be ignoring risks when their impact on fetal development may be the greatest: before pregnancy. Common sense tells us that by focusing only on risk reduction during pregnancy, we have failed to address existing risks before pregnancy, when they’re likely to have the greatest impact on fetal development.

While maintaining high standards of prenatal care, we should begin shifting our focus and our resources to improving preconception health for women, men and couples. As providers and public health practitioners, we should encourage women and their partners to:

• learn about reproduction, the menstrual cycle and fertility awareness;
• learn about and get screened for sexually transmitted infections;
• create a reproductive life plan that includes both short- and long-term personal goals; a timeline detailing the optimal time to have a child while working toward those personal goals; the couple’s desired number of children; appropriate birth-spacing; and the contraceptive method(s) the couple prefers; and
• schedule a preconception health care visit at least three months before trying to get pregnant.

We must also stress that women who intend on becoming pregnant make sure their immunizations are up-to-date; focus on a healthy diet and exercise plan; stop smoking and drinking alcohol; be screened for nutritional deficiencies, such as anemia; and begin taking a daily multivitamin at least three months before they become pregnant.

For more information, download facts on preconception care from the Centers for Disease Control and Prevention (PDF) or visit the CDC website. Additional information is online via the American College of Obstetricians and Gynecologists (PDF) and WomensHealth.gov.

Family Planning & Public Health

Today’s guest blog is by Clare Coleman, president & CEO of the National Family Planning & Reproductive Health Association. Coleman’s previous experience includes serving as president & CEO of Planned Parenthood Mid-Hudson Valley in New York State, and 12 years on Capitol Hill, ultimately serving as Chief of Staff for Representative Nita Lowey (D-NY).

Picture this: You’re a 22-year-old woman with a job you don’t love, a toddler you would die for, and no health insurance. You live paycheck to paycheck, and you always know, to the penny, how much cash you have until the end of the month. You’re rushing home on Route 9 to relieve your mom, who is helping you out with childcare, and the engine light on the car goes on. Your heart thuds in your chest and you feel a wave of panic. You know that you are just one emergency — one job change, one accident, one engine light — from everything falling apart. That’s the reality of the typical Title X patient.

Title X of the Public Health Service Act is the only dedicated source of federal funding for family planning services in the United States. It is a public health success story. The Title X network provides nearly 2 million pap tests, over 2 million breast exams, over 6 million STD tests, and over 1 million confidential HIV tests each year. Providing millions of low-income and uninsured women and men with these and other educational, medical and social services for sexual health and well-being, Title X family planning is a critical component of ensuring a healthier America, today and for the future.

Despite the proven successes of family planning, ideologically motivated activists are going after Title X and other safety-net programs — often the only source of health care for the most vulnerable in our society. Congress threatened Title X with elimination twice in 2011, and the program has been cut by nearly $24 million — a 7.4 percent loss of funding — in less than two fiscal years and in the midst of the worst recession since the Great Depression.

A healthier America does begin today: join the movement and stand with family planning providers to champion their public health contributions and to ensure that the vulnerable populations served by these providers continue to receive quality preventive health care.