By: Lamar Greene

​For countless people in the United States, some of the fondest memories take place around the dinner table. Many Americans can reminisce about home cooked meals that they ate with their families as they grew up, and how those dynamics may have changed over time. Some families still engage in the act of eating meals together as one collective group while others may consume meals individually. There are also many families who choose to dine out in today’s fast pace society. For many people in this country, however, this narrative takes quite a different shape. The question “What’s for dinner?” has a completely different context for the 12.3% of food insecure households reported by the United States Department of Agriculture (USDA) in 2016. 

​According to the USDA, food insecurity is defined as a household being uncertain of having, or unable to acquire, enough food to meet the needs of its members due to insufficient money and resources for food. In 2016, of the U.S. households with children, 16.5% of households were reported as being food insecure. Eight percent of the children in these families were reported to be food insecure. When looking at differences in childhood food insecurity across racial groups, researchers observed that household food insecurity was twice as prevalent among children in Black or Hispanic households in comparison to White households. Furthermore, the proportion of households with children who had “very low food security,” as reported in 2015 was approximately three times as high in Black or Hispanic households compared to White households.  

​The fact that there are children living in food insecure households, that are predominantly Black or Hispanic, speaks to a major issue of social justice and distributive justice in this country that needs to be addressed. When children do not have access to food in a sustainable manner during childhood, it interrupts their development and has lasting negative effects well into adulthood. The effects of childhood food insecurity can be observed in children’s health outcomes, cognitive development, and behavior patterns.

One of the effects of childhood food insecurity or food insecurity experienced during infancy is reduced learning and productivity due to severe iron deficiency. Low iron levels early in life are associated with poor performance on language comprehension tests and an inability to follow directions in the first five years of life.[1] When children exhibit bad behavior in the classroom or at home it may be due to a lack of consistent, quality meals leading to iron deficiency. Studies among school-age children have found associations between household food insecurity and low scores on measures of health, behavioral functioning, and academic performance.[1] 

Young children raised in food insecure households, furthermore, are known to be at increased risks for hospitalizations, poor health, aggression, anxiety, depression, and attention deficit disorder (ADD).[2] It seems very intuitive to say that food insecurity in childhood would negatively affect the physical health of the children who grow up under these circumstances. The American Academy of Pediatrics has reported that the toxic stress of food insecurity in early life leads to chronic diseases such as cardiovascular diseases, cancers, asthma, and autoimmune diseases.[3]  

With concerns such as aggression, anxiety, and depression being related to this issue, it becomes evident that food insecurity negatively affects the emotional and psychological environments of children as well as their physical health. These emotional and psychological health outcomes can last even into adulthood. The Canadian National Longitudinal Survey of Children and Youth found that child hunger was a clear predictor of depression and suicidal ideation during late adolescence and young adulthood, even after adjusting for confounding factors. The argument here is that nutritional deprivation in early life is related to depression later in life.[4] There has been further evidence that suggests childhood food insecurity is linked to substance abuse disorders as well as mood disorders. Childhood food insecurity is a horrible public health crisis that affects so many people across the country. We need to do better, as Americans, in ensuring that every citizen has the basic necessities needed to survive. 
​
​References

1. Ke J., Ford-Jones E.L. Food insecurity and hunger: a review of the effects on children's health and behaviour. Paediatr Child Health. 2015;20(2):89–91.
2.  Yoo, J.  P., Slack, K. S., & Holl, J. L. (2009). Material hardship and the physical health of school-aged children in low-income households. American Journal of Public Health, 99(5), 829-836.  
3. Garner AS, Shonkoff JP, Siegel BS, et al. Early childhood adversity, toxic stress, and the role of the pediatrician: Translating developmental science into lifelong health. Pediatrics. 2012;129:e224–31.
4. McIntyre L, Williams JVA, Lavorato DH, Patten S. Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. J Affect Disord. 2013;150:123–9. 

​The global HIV epidemic remains a public health crisis; an estimated 36.7 million people infected and around 2 million new infections each year.[1] Meanwhile, scientists have yet to find a cure or a preventive vaccine for the virus. Why is it that when there is an outbreak like Ebola or Zika virus, within a few months there are already several promising vaccine candidates in clinical trials, but we have not accomplished this same progress with HIV?
 
There are several reasons why HIV is an elusive target for a vaccine, a few of which are described here. Nonetheless, scientists are working tirelessly to uncover and test new strategies that could one day lead to a successful vaccine against HIV.

​The first major challenge to creating an effective vaccine to prevent HIV is the virus’s incredibly high rate of mutation. The genome of HIV is made of RNA, instead of DNA, which is overall less stable, and more likely to change than viruses with DNA genetic material. The virus also has a unique lifecycle, as it converts this RNA genome into DNA using an enzyme called reverse transcriptase (RT). The RT is highly error-prone which results in rapid mutation, essentially making HIV a moving target for the immune system, and any response that might have been generated by a vaccine.
 
The error-prone replication over many, many years has led to broader evolution of the virus into at least 9 distinct genetic subtypes.[2] These vary regionally throughout the world, and can sometimes recombine into mixtures of two or more subtypes. This means that even if a vaccine was effective in one part of the world, it might not be as effective against other subtypes in other regions.
 
Safety is always top priority when designing a potential vaccine. Some vaccines are made using a live, weakened version of the pathogen, while others use parts of a dead pathogen to train the immune system to recognize key characteristics. Given HIV’s notorious reputation for mutating and rapidly evolving, a live vaccine is not the safest option since a weakened HIV virus could possibly evolve into a more harmful one, which is not the case for many other viruses. Therefore, much attention is focused on identifying key parts of the virus that are rarely mutated, or ‘conserved’, and using these as possible vaccine targets.

​Lastly, a major challenge in developing an HIV vaccine is determining the purpose of this particular vaccine. Scientists are not entirely sure what they want the vaccine to do. The purpose of a vaccine is to teach the immune system how to fight off a specific pathogen without requiring the individual to ever be infected. People who are naturally infected by HIV never become immune, and can even become infected by a second strain of HIV in an event called “superinfection”. Due to these complications, no one actually knows what it means to have an effective immune response against HIV. Scientists have a lot of ideas about whether it is better to generate protective antibodies to block the virus, train specialized T cells to kill infected cells, or some combination of the two. Without this basic knowledge of how exactly we want the immune system to respond, however, it is difficult to design a vaccine to teach the immune system what to do.  
 
While there are many challenges to developing a vaccine for HIV, not all hope is lost. There are 4 HIV vaccine candidates currently in clinical trials[3], with several different strategies for protection, and some based on earlier vaccine trials that showed promising results.[4] In addition to vaccines to prevent initial infection, scientists are exploring therapeutic vaccines which could be used to cure infected individuals, or reduce the amount of virus circulating in their body to levels that would limit transmission and extend the healthy years of life. Already available is a medication that can be taken by HIV-negative individuals to prevent becoming infected, called Pre-Exposure Prophylaxis (PrEP).[5] While PrEP doesn’t have the effect of training your immune system to fight off the virus the way a vaccine might, it is an effective way for high-risk individuals to protect themselves in addition to other prevention strategies such as correct, consistent condom usage. 

References
[1] GLOBAL HIV AND AIDS STATISTICS 2016,
<https://www.avert.org/global-hiv-and-aids-statistics> (2017).

[2] HIV STRAINS AND TYPES,
<https://www.avert.org/professionals/hiv-science/types-strains> (2018).

[3] Clinical Trials Search, Vaccine Research, HIV Preventive Vaccines,
<https://aidsinfo.nih.gov/clinical-trials/search/ar/1/category/91/Vaccine%20Research/92/HIV%20Preventive%20Vaccines/29816/1> (2018).

[4] RV144 Trial,
​<https://www.hivresearch.org/rv144-trial> (2018).
​
[5] PrEP,
<https://www.cdc.gov/hiv/basics/prep.html> (2018).

Throughout this series examining the relationship between marijuana and health, I have explored the harms and benefits of legalizing both medical and recreational marijuana. In my previous article, I explored the health effects of legalizing recreational marijuana. I discussed how marijuana was the most popular street drug in America and how research shows that mortality risk associated with marijuana is much lower than that of alcohol. In considering the health effects of legalizing marijuana on a community level, I had the opportunity to interview Dr. Jon E. Zibbell, a professor of medical anthropology and human health at Emory University. Professor Zibbell has more than 20 years of experience conducting behavioral and community-based epidemiological research on the public health implications of illicit drug use, such as drug overdoses and infectious diseases caused by injection drug use, including HIV and viral hepatitis. In addition to research, Dr. Zibbell works with states and community organizations to develop evidence-based approaches to combat morbidity and mortality incidence associated with the opioid epidemic. Dr. Zibbell has previously worked at the Centers for Disease Control and Prevention (CDC) in the Division of Viral Hepatitis and the Injury Center and is currently an adjunct professor at Emory University. Below is a transcript of our interview. 

What do you consider to be some of the potential risks or harms on the individual and community level for legalizing recreational marijuana (i.e. public safety, transportation, mental health concerns)?

The proponents of recreational marijuana have consistently said that regulations should somewhat resemble alcohol, with a minimum age, strict motor vehicle limitations, etc. Concerns with respect to alcohol do translate to recreational marijuana, such as consumption by younger populations. If cannabis is to be regulated like alcohol, then what is the cannabis level that is appropriate for driving? We also need to consider that marijuana is stronger than it was 25 years ago and this has implications for new initiates to cannabis use. Another aspect of this is work concerns occupational health. Does the NFL, for example, tell players in Seattle or Oakland that they cannot use marijuana despite them residing in states that have legalized the drug? There are many issues between the federal government and states, and between states and private business, that need to be deliberated and discussed so people are not negatively affected as state policies continue to unfold. 

Some opponents argue that America does not have a grip on drunk driving, do you think that we have the necessary tools to address drivers who are under the influence of marijuana?
​
When looking at the differences between alcohol and marijuana, we know that alcohol is more harmful in terms of social and medical costs and physical harms to the body. When thinking about driving regulations for cannabis, we should frame our laws around the findings from evidence-based research. Continuing to have social problems with alcohol should not preclude use from making recreational marijuana safe with minimal social harm.

Would you say that the benefits outweigh the cons for legalizing recreational marijuana or vice versa?

​I think the science is clear on the harms associated with cannabis use. Outside the potential negative effects of cannabis on youth, there are relatively few harms related to adult cannabis use. The social harms from cannabis are relatively small, but the harms caused by the criminal justice system via the criminalization of cannabis is pervasive. 

Some proponents for the legalization of recreational marijuana argue that state governments who have struggling budgets should legalize the drug for economic purposes. What is your perspective on this?

We should never support legalization merely for an economic opportunity. The central argument is that the scientific evidence shows that marijuana is not harmful to civil society, especially in comparison to alcohol and tobacco. The first concern should be that legalizing recreational marijuana won’t cause additional harm to civil society, then we should consider economic and tax benefits. 

Can you speak more to the argument that marijuana is a gateway drug for harder drugs such as crack, cocaine, and heroin?

​The gateway argument is an unscientific argument. The logic of the gateway argument is that drugs like marijuana eventually lead to the abuse of other, more dangerous drugs like cocaine and heroin. The central problem with the gateway argument is that its logic is backwards. The gateway argument often functions by asking people already using hard drugs like cocaine and heroin users what drugs they started with. Most, if not all, people who use heroin, for example, will reporting initiating their drug use with alcohol and marijuana. Thus, if you ask the question this way, you would say that cannabis leads to heroin since everyone who uses heroin started out with marijuana; ergo, pot is a gateway to heroin. But to really demonstrate that one drug is a gateway to another, you need to start at the beginning of the line and assess people who have used cannabis as adolescence to examine the number that went on to use heroin.

In other words, you need to interview people who used cannabis when they were young to see how many transitioned to harder more dangerous substance. This is where the gateway argument breaks down for cannabis. Evidence shows that the number of people who smoked cannabis in their youth and then transitioned to heroin is so nominally low (~0.01 of 1.0%) that it is laughable when employed to justify the gateway argument. What I am trying to say is that the vast majority of people, say 99%, who smoked pot in grade school did not transition to harder drugs. Therefore, cannabis is no more a gateway to heroin than the rush that derives from hitting a home run in Babe Ruth baseball.

Note: The responses in this article are paraphrased responses of answers that Dr. Zibbell gave in the interview.

A summary of important health news from the last week.

A new research study published in JAMA Pediatrics found that children with autism are less likely to be fully vaccinated than children without autism. As a result, these children may be at higher risk for contracting diseases that can be prevented by vaccines. These results likely indicate that more needs to be done to educate the public about vaccines.

A new study, published on Monday, found that 76% of food products shown in sports sponsorship advertisements are unhealthy, and 52.4% of beverages shown in these ads are sweetened with sugar. The study used data from Nielsen ratings to determine the top 10 sports organizations watched by children ages 2 to 17. Sport sponsorship ads could have a negative impact on children's diet and food choices. Both sports organizations and food companies should take responsibility in order to promote healthy foods and beverages to children. 

Donald Trump's appointee to head the CDC is facing significant criticism due to a 20 year old controversy he has with research misconduct during the height of the HIV/AIDS epidemic. This comes at a time when the preceding head of the CDC had to step down after being exposed for trading with the big tobacco industry while leading anti-smoking campaigns. Claims against the current appointee include that he was either sloppy with data or that he fabricated it when conducting the clinical trials for an HIV vaccine. 

Apps designed to sell and deliver prescription birth control are meeting needs in rural areas and women in low socio-economic situations. Women are able to easily fill out forms and get advice and a prescription for birth control without having to see a doctor. Not only do these apps help access but also seem to be improving privacy for women needing birth control. 

This week's podcast of the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) focuses risk factors and preventative strategies for kidney disease. Follow the links below for a brief overview or a more in depth discussion.

A Minute of Health (1:00)
A Cup of Health (4:05)

A summary of important health news from the past week.

Judge Dan Aaron Polster of the Northern District of Ohio wants to quickly settle more than 400 lawsuits against drug makers and distributors in wake of the national opioid crisis. Many lawyers are skeptical that he can pull off this difficult feat. The lawsuits are being brought against the makers of prescription pain killers, companies that distribute them, and pharmacy chains that sell them.  

The latest issue of Public Policy & Aging Report focuses on the importance of social connectivity and social engagement for aging populations. A lack of social connectivity is associated with risk factors such as obesity, inactivity, and smoking as well as early mortality. The issues includes innovative approaches to address isolation in aging, such as providing free transportation and technology based services to remind people of events of interest.

Despite continued interest in psychiatry among emerging physicians, there is a shortage of psychiatrists in America. This shortage is partly explained by a growing population of people 65 and older, who have high mental health concerns. Further, there is a cap of federally funded psychiatric residence program, which are required for physical training.  

The most recent Morbidity and Mortality Weekly Report (MMWR) podcast from the Centers for Disease Control and Prevention (CDC) focuses on causes and prevention of hypertension, or high blood pressure. Follow the links below for a short overview or a more in depth discussion.

A Minute of Health (1:00)
A Cup of Health (4:58)

Last week, the Center for the Study of Human Health and the Candler School of Theology hosted a talk from Dr. Marie Marquardt and I had the honor of interviewing her about her research, community work, and new book centered around immigration reform in the United States. Dr. Marquardt is a Scholar in Residence at Emory University’s Candler School of Theology. She is an advocate for social justice of Latin American immigrants in the South for two decades and serves as a chair of El Refugio, which is a non-profit organization in Georgia that serves detained immigrants and their families. Her new book, Flight Season (Wednesday Books, 2018), is Dr. Marquardt’s third young adult novel, which focuses on the intersection of two broken systems in the United States: the immigration system and the healthcare system. It is now available for purchase. 

​Below are exerpts from my interview with Dr. Marquardt.   

​That’s a great question. That sort of depends on the day of the week. I think that in the time that we are living in now I really let my work to promote immigration reform come to the front burner. It’s such an important time now, and there’s so much happening. We all need to be paying attention and doing what we can, so I really try to focus a lot on that work. I’m so thrilled that my fiction writing can tie in with that work and help me do what I want to do in expanding the voice for change and the need for change. 
​

For about twenty years now I have been working with immigrants from Latin America, and that work began as academic work. I am a sociologist of religion by training, and I came to Emory for my PhD back in 1997. I was planning to do research with immigrants from Latin America. Atlanta, at the time, was what we called a “new destination” because there wasn’t a long history of migration, the demographics of the communities were changing very fast, and there was a lot of tension around that change. As I dove in as a sociologist to understand what was happening, I also dove in and started building some amazing friendships and relationships with people who were themselves undocumented and had no way of adjusting their status to become permanent residents or citizens. 

Some of the most gratifying and heartbreaking parts of those friendships that I’ve built is that I’ve had the chance to watch young adults who were brought here as children (often referred to as the dreamers, now DACAmented students) grow up and be with them through the process of overcoming a lot of incredible barriers. I struggle to see that many of them are still facing barriers that are insurmountable. However, I feel fortunate and blessed actually to have some amazing friendships and relationships with people that not everyone in the United States gets a chance to know well, love, and understand. I wanted to be able to share that love and affection in different ways. 
​

I think of human health as this question of thriving. Although I am not a person who studies healthcare or the medical field, I have always been concerned as an ethicist for what are the ways we can build a society that create the capacity for people to thrive. I’m also really interested in community building, and I believe we are all better in our health when we are embedded in our community. So, I’ve been trying hard to support efforts to build community and relationships. For Flight Season, I became interested in the converging of two very broken systems: one is healthcare and the other is immigration. When those two intersect, it’s just a rough place to be. It’s costly both for taxpayers and for the health and well-being of our communities. It is a problem that needs to be addressed directly.  

This has been a rough week, so I’ll try not to get too emotional. Right now, the obstacles are enormous. It’s hard to believe that when survey after survey shows that the American public wants to see a pathway to American citizenship that the federal government just cannot get it done. Depending on which survey you look at, we see 86%, 87%, and 90% percent of Americans want to see this happen. It’s heartbreaking and angering. One of the things that I am really trying to do to support both DACAmented and unDACAmented young adults is trying to help all of us understand the ways in which our lives are intertwined. 

This isn’t a problem of them. It is a problem of us and our future. When I talk about the 24,000 DACA recipients here in Georgia and the possibility that they are facing that as of March 5th they can begin to go out of status with the capacity to be deported potentially, that’s a problem that is going to affect all of us in so many ways. It is going to affect us here on Emory’s campus and throughout the city and the state. I’m just trying to show that we are all trying to thrive together. 

I’ve been around Candler for many years, starting as a T.A. when I was in graduate school. My favorite course that I teach is this “Church on the Border” course. What we do is we go to the U.S.-Mexico border for a week before the semester begins in the January term. It’s not a service trip. It’s really a trip for us to understand what is happening on the border, what issues exist on both the U.S. and Mexico side, and what social movements and organizations are developing to address those issues. 

This year, I just did it with a group of students in January. Our goal with that trip is to see and experience and to analyze what we experienced. We bring these experiences with us when we can come back to Georgia to see how this is affecting our communities here and how we can address these issues. We talk about bringing the church to the border and then bringing the border to the church. 

I have written academic nonfiction about immigration and immigration policy. My research and the things that I have written have been around undocumented immigration and what work are religious organizations and social movements doing to address the problems that undocumented immigrants face. When speaking about my research and immigration, I found that I could present people with data and facts in this myth busting type of context. 

What I realized is that people aren’t going to seek solutions until they are compelled by their hearts and they have entered a relationship with someone who is deeply affected by this. I decided to try fiction to see if fiction is a better place for us to step aside from the politics and media and just dwell for a while in the story and in empathy. Good fiction builds empathy, and I think we have a profound shortage of empathy in our society these days. I am in fiction for empathy building and because I love writing. 

​Note: Please note that the responses written in this article are paraphrased responses of some of answers that Dr. Marquardt gave in the interview.

A summary of important health news from the past week.

​Uber is launching Uber Health, which will help clinics, hospitals, and rehab centers more easily assign rides for their patients. This specific business line of Uber will not require that the rider have the Uber app or a smartphone. Uber Health can be used through landlines and takes into account the specific nature of the healthcare industry and HIPPA compliance.  

Even before announcing plans to address rising health care costs for its employees last month, Amazon has been quietly disrupting power in the broader health care sector. Last summer the company launched Basic Care, a line of private-label over-the-counter medicines, many of which are significantly cheaper than those sold at pharmacies such as CVS and Walgreens. Amazon is also building a business selling medical supplies to doctors and hospitals. 

Since the beginning of the year, Nigeria has been grappling with an outbreak of Lassa fever, a disease which can lead to epidemic levels and for which there is no vaccine. Lassa is viral haemorrhagic fever and can affect many organs and damage blood vessels. Normally, there is a 1% fatality rate but in this epidemic it may be as large as 20%.