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JUUL: The Current Teenage Nicotine Fix

9/26/2018

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By: Ovidio Vasquez
​According to a survey from the Centers for Disease Control and Prevention, the percentage of smokers over 18 for January-September 2017 was 14.1%—the lowest it’s ever been.
 
In recent decades, smoking cigarettes has become less popular than alternatives like electronic cigarettes, which have increased their presence in the tobacco products market. Composed of a mouthpiece, e-liquid tank, microprocessor, heating element, and battery, e-cigarettes first arrived to the United States in 2007. Brushed off by many as a gimmick or fad, they began to gain a big following through the “modding” scene where owners could modify their e-cigarettes anywhere from adding lithium-ion batteries to different shaped enclosures. Following this rise, there are now even annual competitions where participants blow out the best vape cloud—which is produced when e-cigarettes converts the liquid nicotine into vapor.
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An example of someone vaping. http://vaping360.com/
​Now, more than a decade since its introduction to the United States, vaping is ubiquitous. Users cite a range of reasons for vaping including recreational use, believing that vaping is healthier than smoking, and to help quit smoking. A “satisfying alternative to cigarettes” is where e-cigarette company JUUL bases its product. Marketed as a tool for current smokers to help reduce or end their consumption of cigarettes, the company has seen a steep rise in notoriety since its inception in 2015. As recently as August of this year, JUUL has seen a market share of more than 70% in the electronic cigarette sector with the closest competitor more than 60 percentage points behind.[1] While JUUL seems to be profiting very well from public consumption of their product, a problem has arisen: teenagers have started JUULing at very high rates.
 
Possibly an unforeseen consequence from marketing a product that so closely resembles a USB drive is that students can easily stash it away while in school. JUUL has also become very attractive to the younger generation because its prominence on social media platforms such as Instagram and Twitter. They offer flavor pods ranging from mango to crème brûlée and cool cucumber.  High schools and universities have taken notice of the trend and are beginning to wonder about the future trajectory of e-cigarettes like JUUL. The company has fallen under the scrutiny of health organizations, including the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). These organiations have started to wonder about the health concerns of such products, especially with the increasing usage among teens.
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JUUL starter kits at a gas station with other tobacco products. Photo credit: Ovidio Vasquez
Earlier this month the FDA announced that they issued 1,300 warning letters and civil money penalty complaints to retailers who illegally sold JUUL and other e-cigarette products to minors. These warnings came as a result of a blitz program to target these retailers because, as the FDA’s commissioner Scott Gottlieb, stated: “youth use of electronic cigarettes has reached an epidemic proportion”. In response to this epidemic, Gottlieb made it clear that the FDA plans to take an active approach through their Youth Tobacco Prevention Plan. One big step that implicates JUUL specifically is the request from the FDA for documentation from JUUL Labs (among other e-cigarette companies) to investigate “reportedly high rates of youth use and the particular youth appeal of their products”.
 
With the health effects of vaping still not fully understood, the rise of e-cigarette companies that appeal to the youth, like JUUL, could have unwarranted consequences on a new generation. Gottlieb also declared, “we cannot allow a whole new generation to become addicted to nicotine.” This seems to be the driving factor for the FDA’s direct response to e-cigarette use among minors.
 
Just last week the FDA revealed that it will be launching an anti-vaping ad campaign that will focus on teens. The ads will be delivered to teens through YouTube ads, social media ads, and even in school bathrooms and will highlight the negative effects of the toxins in e-cigarettes. Although there is still a need for more research on the effects of e-cigarettes, it is clear that the health implications of JUULing for teenagers is high priority to the FDA and we can expect continued dialogue on this topic.
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Anti-vaping advertisement. Courtesy of U.S. Food and Drug Administration
References:
 
1: Ramamurthi, D., Chau, C., & Jackler, R. K. (2018). JUUL and other stealth vaporisers: Hiding the habit from parents and teachers. Tobacco Control. doi:10.1136/tobaccocontrol-2018-054455
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Transportation Inequities: How Built Environments Impact Health

9/25/2018

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By: Lamar Greene

Imagine walking a mile or so home from the bus stop with your hands full of groceries. Imagine walking a mile or so to the bus stop when you are ill so that you can go to the doctor. This is the reality for so many Americans. Inequities in transportation contribute poor health outcomes reported for low-income people, particularly those of color. Specifically traffic-related air pollution and minimized autonomy to safely practice active forms of transportation (e.g. walking, bicycling). The structural and built environments that low-income people of color occupy have been heavily influenced by histories of racism in infrastructure and neighborhood development in United States, and continues to influence people's health today.
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A historical factor contributing to modern day inequities in transportation includes the expansion of suburban living, which took place in the 1950s. Suburban living was an exclusionary phenomenon that served as an extension of Jim Crow ideology—there were restrictive covenants that barred most Black, Asian, and Hispanic families from living in suburban neighborhoods at all. It was commonly believed that the presence of people of color in subdivisions would lower the value of the properties and banks refused to loan money to people living in the inner city, which were primarily occupied by people of color. Suburban living promoted the use of automobiles for transportation because the sprawled out living meant that more people needed cars to get around. This expansion to suburbs led to the vast expansion of America’s highway system.     
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The highway boom resulting from the rise of suburbia in the mid-twentieth century, which consisted of the building of the American interstate highway system, was completely destructive for the thriving Black neighborhoods of that time as well as other communities of color. Not only was housing destroyed for prospering Black communities, but churches and businesses were lost as well. Losing pivotal local institutions altered the sense of community that Black populations experienced, which has implications that are still felt today.    
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Seeing that highway infrastructure has historically been built through black and brown neighborhoods, it is not surprising to see that communities of color are still likely to live near highways. Hispanic people are 38% more likely and Black people are 30% more likely than White people to live within 300 meters of major highways, where rates of respiratory and cardiovascular diseases are increased.[1] The EPA estimates that the heavy concentration of minuscule air particles from highway traffic causes up to 100,000 annual deaths in the U.S., which serves as one mechanism for the number of chronic illnesses that people of color disproportionately experience. These preventable conditions have taken their toll on the healthcare system, specifically in safety net medical centers which are more likely to treat patients of color who are low income. The health costs associated with poor air quality from the U.S. transportation system is roughly $50 to $80 billion dollars, with the presence of communities near major highways and roadways driving the costs.[2] 
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Low-income people of color are also more likely to live in communities that do not support active transportation. Only 49% of low-income neighborhoods have sidewalks and only 5% have requirements for bicycle lanes, which limits the health benefits that low-income persons of color could gain from walking and biking.[2] Not having the physical infrastructure necessary to navigate one’s neighborhood safely leads to an increase in road injuries as well. Black people and Hispanic people are twice as likely to be killed while walking compared to white people. Likewise, black people are 30% and Hispanic people are 23% more likely to be killed while bicycling than white people.[2] Living in a physically underdeveloped neighborhood without a car also makes it harder to access public transportation, which makes accessing grocery stores and medical care increasingly difficult. People must walk to bus stops that are often just outside of their neighborhoods, which can be a journey in an of itself.

Black and brown people are stigmatized for our disproportionate rates of chronic and infectious diseases. The social and physical environments forced upon black and brown people, however, often constrain our agency and influences our health behaviors. Living in a highly polluted environment or in a neighborhood without sidewalks has health consequences that goes beyond individual control. There is a lot of work to be done to improve the infrastructure of low-income neighborhoods of color in ways that can enhance rather than disrupt our communities.      
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References
  1. Boehmer, T. K., Foster, S. L., Henry, J. R., Woghiren-Akinnifesi, E. L., Yip, F. Y., National Center for Environmental Health, CDC, & Agency for Toxic Substances and Disease Registry. (2013, November 22). Residential Proximity to Major Highways — United States, 2010. In CDC Home. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6203a8.htm
  2. Zimmerman, S., Lieberman, M., Kramer, K., & Sadler, B. (2015). At the Intersection of Active Transportation and Equity (Rep.). Oakland, CA: Safe Routes to School National Partnership. doi: https://www.apha.org//media/files/pdf/topics/environment/srts_activetranspequity_report_2015.ashx?la=en&hash=4B088BB4405E6FA97B6E552CEEED8D7B6958A265  
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Weekly Health Digest

9/24/2018

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A summary of important health news from the past week.

Globally, losing the fight against cancer and other chronic diseases
By: Susan Scutti

New analysis shows that more than half of the countries making up the United Nations will fail to reduce premature deaths from cancer, cardiovascular disease, chronic respiratory disease, and diabetes by 2030. These were commitments that all countries in the UN agreed to under the latest version of the Sustainable Development Goals (SDGs) that were introduced in 2015. The SDGs are thought of as a blueprint for achieving global well-being with aims ranging from "no poverty" to "quality education."  

This fall, all New York students will be learning about mental health
By: Sarah DiGiulio

Due to a July 1st bill, New York state students will have mental health included in their health curriculum. This is the first state in the country to mandate mental health content in general health courses and is in response to both rising rates of mental health concerns and the stigma associated with mental illness. Students will be taught about mental health and illness as well as relevant skills and resources they can apply to their lives. 

Disaster response needed to bring homeless people inside, says King County health board
By: Asia Fields

In Washington State, the King County Board of Health has voted to officially declare homelessness a public health disaster. Last year, 169 people experiencing homelessness died in the County, a record high, and about half of those deaths occurred outdoors. In addition to exposure to the elements, these populations are also more vulnerable to outbreaks of infectious diseases like HIV and hepatitis A. ​

Accountable Care Organization model already generating net savings
By: William Bleser, David Muhlestein, Robert Saunders, Mark McClellan

The Department of Health and Human Services has analyzed savings rates within the Accountable Care Organization model of care, in comparison to a managed care systems. Their analysis has shown that the model is yielding greater savings rates in the past five years than the managed care model has in decades. 

Alzheimer's cases to nearly triple by 2060, CDC says
By: Maggie Fox

​Last week the Centers for Disease Control and Prevention announced that the number of people with Alzheimer’s is expected to triple over the next 40 years—from 5 million cases to nearly 14 million cases. Part of this increase will be due to population growth and longer lifespans. While the body of research around Alzheimer’s has grown in recent years, there is still no treatment or cure for the disease. Experts say that while Alzheimer’s is difficult to prevent, lowering blood pressure has been shown to significantly lower risk, and exercise has been shown to delay symptoms. 
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CDC MMWR Podcast: "Living with Pain"

9/21/2018

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Today we bring you the Morbidity and Mortality Weekly Report (MMWR) podcast from the Centers for Disease Control and Prevention (CDC). This week's topic is chronic pain and covers what it is like to live with chronic pain and how to seek help for pain management. Follow the links below for a short overview or a more in-depth discussion.

A Minute of Health (1:00)
A Cup of Health (4:02)
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The Hidden Dangers of Florence's Floods

9/20/2018

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​By: Deanna Altomara

​Hurricane Florence has created havoc in North Carolina, wreaking damage on homes, flooding whole towns, dismantling beaches and businesses, and killing at least thirty people. Yet as the floodwaters begin to recede, they are revealing the watermarks of a phenomenon that is potentially more dangerous than the storm itself--environmental contamination.
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Image retrieved from https://www.doi.gov/emergency/hurricane-florence-information
North Carolina is one of the largest producers of pork, turkey, and chicken in the country. Each year, the hog farms alone produce 10 billion gallons of manure.  This manure is often stored in outdated lagoons that are at high risks of flooding during major storms. In 2016, Hurricane Matthew flooded 14 lagoons, causing manure to overflow into the floodwaters that flooded streets and basements. Yet Florence has gone even further, flooding at least 22 lagoons and drowning 3.4 million poultry birds. 

As feces, excrement, and runoff mix into the floods, risk of exposure to potentially harmful substances increases. In the past, these substances have been known to cause large-scale fish death and algal blooms that smother ecosystems. For example, high levels of fecal bacteria and other contaminants and microbes were found in the aftermath of flooding caused by Hurricane Floyd in 1999.[1]The problem is worsened by the fact that many of North Carolina’s rivers are used as sources of drinking water, and a significant amount of its piping dates back to the era of World War II or before. These weathered pipes are susceptible to cracking and subsequent contamination.  Many regions in North Carolina have mandated that people must boil their water.

The state is also home to coal ash ponds, many owned by Duke Energy. The ponds store the chemical residue leftover from the coal-burning process, which contains high levels of arsenic, lead, mercury, and selenium. These are highly toxic chemicals which could cause significant environmental and health concerns if leached into public water. Unfortunately, that is exactly what happened. Despite decades of warnings about the dangers posed by its ash ponds, Duke has been slow on its commitment to close all ponds by 2029. After a drainpipe collapsed in 2014, spilling 39,000 tons of ash into the Dan River, the company pled guilty to several violations of the Clean Water Act. Prior to the storm, Duke took measures to prevent its ponds from overflowing, such as partially covering the ponds. Yet these measures did not prevent a major slope collapse at an ash pond near Wilmington. Although Duke has allegedly been trying to clear this site of ash since 2013, the pond still spilled enough ash to fill 180 dump trucks. The ash has likely found its way into Sutton Lake, which is a recreational site, and possibly the Cape Fear River. There have been incidents at other sites as well, yet the company does not think that the flooded ponds will be a danger to public health or the environment.

Florence was also projected to put over 41 Superfund sites at risk. Florence was also projected to put over 41 Superfund sites at risk. Superfund sites are some of the most hazardous and polluted places in the country and are often contaminated with toxic chemicals. Two located along Cape Fear are Horton Iron and Metal and Carolina Transformer Co. Together, these sites cover 12 acres of land. Other Superfund sites include centuries-old shipyards thick with years of illegal dumping.  And even non-Superfund sites could cause an environmental hazard—paper mills and pesticide manufacturers often house large amounts of toxic chemicals. If any of these places are flooded, the consequences could be disastrous.

In an era of climate change, storms like Florence are expected to increase in intensity and frequency. This puts everyone at risk. America’s dependence on meat has not only contributed to methane output and climate change, but has also produced endless amounts of waste products [2]. Toxic waste from coal plants and Superfund sites could contaminate large swaths of area during flooding events. It is estimated that 327 Superfund sites are now at risk because of the dangers of climate change, endangering the 2 million Americans who live within one mile of these sites. And in many cases, these dangerous sites are already located near or within low-income communities who lack access to advanced healthcare.

There is no doubt: the climate is changing. And Americans are going to have to change with it.
 
Resources:
1. Casteel, M. J., Sobsey, M. D., & Mueller, J. P. (2006). Fecal Contamination of Agricultural Soils Before and After Hurricane-Associated Flooding in North Carolina. Journal of Environmental Science and Health, Part A, 41(2), 173-184. doi:10.1080/10934520500351884
2. Laestadius, L. I., Neff, R. A., Barry, C. L., & Frattaroli, S. (2013). Meat consumption and climate change: The role of non-governmental organizations. Climatic Change, 120(1-2), 25-38. doi:10.1007/s10584-013-0807-3
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Biobanks facilitate research, pose ethical questions

9/19/2018

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By: Sarah Cardwell-Smith

​Imagine a bank that accepts not money, but human saliva.
 
This is a biobank— a type of biorepository or ‘library’ that collects and stores human biological samples and their associated data for use in current or future research. Biobanks can collect samples of blood, urine, skin cells, organ tissue, saliva, or any other specimen taken from the body.[1]
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A researcher in the laboratory. Photo by Michal Jarmoluk via Pixabay.
There are dozens of types of biobanks, but researchers commonly classify them as either population-based or disease-oriented. Population-based biobanks store both biomaterials (genotypic data) and their associated characteristics (phenotypic data) such as demographic, lifestyle, medical, and environmental data. Population-based biobanks are “prospective” in that they focus on the study of the development of common, complex diseases over time. Disease-oriented biobanks, on the other hand, aim to discover and validate genetic and non-genetic risk factors of diseases. Disease-oriented biobanks can be either tissue or rare disease repositories, which collect valuable samples from a small number of individuals with low-prevalence diseases.[2]

Biobanks are emerging and growing amidst the era of personalized medicine, or precision medicine, in which there is an increased focus on research and clinical settings on treatment strategies based on a patients’ unique genetic profiles—as opposed to the traditional “one size fits all” approach in which all patients with the same diagnosis receive the same treatment.[3]

Since the late 1990s, biobanks have become an increasingly important resource in medical research, particularly in genomics and personalized medicine.[4] (In 2009, Time magazine included biobanks on their list of “10 Ideas Changing the World Right Now.” ) Biobanks collect samples and associated data from several dozens to several thousands of donors, and make the information available to researchers throughout the country and across the globe. 
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Biobank samples in a freezer. Photo by ILRI via Flickr.
​Bio-banks are allowing researchers to identify new biomarkers for complex diseases, by conducting genome-wide association studies (GWAS) using large collections of samples. The wide reach of data collection and the relative ease of accessing its information also give bio-banking the potential to hasten drug discovery and development. Today, bio-banking is an increasingly common feature of clinical research trials.[4]
 
While biorepositories in some form have existed for over a century, only within the past decade have biobanks grown large and comprehensive enough to facilitate larger-scale research.[1] In the past ten years, small collections of samples have become large repositories as governments and industries have begun to invest heavily in biobanks.[2] In 2016, the National Institutes of Health (NIH) launched the Precision Medicine Initiative (PMI) which included a $130 million grant to develop All of Us,  a large prospective biobank of biological samples and personal health and lifestyle information from participants from all walks of life. Today, the All of Us project has collected samples from over 1 million Americans.[2]

As the field of bio-banking grows, however, so do concerns about legality, privacy, and ethics. Who owns the data derived from donor samples? How can donors give informed consent if their samples may be accessed for unknown uses years in the future? Is it ethical to collect samples from vulnerable populations if they may not benefit directly from the research to which they are contributing? How can donors give informed consent if their samples may be accessed for unknown uses years in the future? Is participant data adequately protected under confidentiality? How should researchers deal with incidental findings (i.e., the discovery of a previously unidentified medical condition during investigation for another condition)?  These are just a handful of the questions and issues surrounding biobanks that remain unsolved.
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An ad for the NIH's All of Us research program. Photo via Flickr.
Some have proposed the solution of having donors give a broad ‘blanket consent’ that allows their samples to be used in future research for a variety of purposes. Many legal experts, however, worry that a move toward ‘blanket consent’ will not be able to capture the diversity and complexity of issues that arise with bio-banking.[4] For instance, what if your sample is used for research you ethically do not agree with? Is there a mechanism through which one can withdraw consent, which is a requirement for most research protocols?
 
While scholars agree on the importance of establishing guidelines around consent, ownership, and privacy, there is still no consensus on many key issues.[5] And, as a 2017 analysis warned, “there is little reason to think that a consensus will coalesce in the future.” Further, while guidelines are certainly important to consider, some researchers worry that too-strict policies surrounding bio-banking will inhibit research.[6]
 
Despite ongoing conversations about privacy and data ownership, biobanks are here to stay. As biobanks continue to grow and expand in the US and around the world, new understandings of complex diseases, and drug therapies for a host of conditions, may soon be within spitting distance. 

References:
[1] Siwek, M. (2015). An Overview of Biorepositories—Past, Present, and Future. Military Medicine Vol. 180, October Supplement.
[2] Paroti, B. (2015). Biobanks: A Definition. Ethics, Law and Governance of Biobanking, 8(277).
[3]Kinkorova, J. (2016). Biobanks in the era of personalized medicine: objectives, challenges, and innovation. Springer EPNA Journal, 7(4).
[4] Caulfield, T. (2007). Biobanks and Blanket Consent: The Proper Place of the Public Good and Public Perception Rationales. King's Law Journal, 18(2), 209-226.
[5] Caulfield, T., Murdoch, B. (2017). Genes, cells, and biobanks: Yes, there’s still a consent problem. PLOS Biology, 15(7).
[6] Hofman, P., Bréchot, C., Zatloukal, K., Dagher, G., Clément, B. (2014). Public–private relationships in biobanking: a still underestimated key component of open innovation. Virchows Archiv, 464(1), p. 3-9. 
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Weekly Health Digest

9/17/2018

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A summary of important health news from the last week. 

​New Medicare Advantage Tool To Control Drug Prices Could Narrow Choices
By Susan Jaffe

New restrictions under the Medicare Advantage plans could require patients to try low-priced drugs before high-priced ones. Medicare Advantage plans, which are run under private companies approved by traditional Medicare, cover approximately 20 million people across the country. Critics are concerned that patients will not be treated with their doctors’ drug-of-choice, while proponents argue that this move will pressure drug manufacturers to lower costs. Patients and doctors will be able to request exceptions from this policy. ​

E-cigarette use is an 'epidemic,' FDA chief says
By: Maggie Fox

The FDA has determined the use of e-cigarettes among teenagers to be at epidemic proportions, which has led the federal agency to consider taking e-cigarette products off the market. The FDA has also been taking action to limit the astronomical number of sales of e-cigarettes to minors, occurring via online and retail markets. This is the largest single enforcement action in the history of the federal agency.

​Doctors gave no reason for a third of opioid prescriptions, study finds
​
By: Maggie Fox

A team of researchers from Harvard Medical School and the RAND Corporation reported last Monday that from 2006 to 2015, physicians provided no explanation for 29% of the opioid prescriptions they wrote. This research echoes concerns voiced by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) that inappropriate prescribing patterns among physicians in recent years have worsened the opioid crisis. In 2016 alone, 42,000 people dies from opioid-related deaths.

Home health care: It’s a grim world with victims on both sides
By: Scott LaPierre

Motivated by personal experience with home health workers, reporter Linda Matchan started looking into home health workers. She found both neglect and abuse at the hands of home health workers, but also stories of people traveling from around the world to improve their lives and the lives of their families. This short documentary tells the stories on both sides. 
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The Doula Movement: A Growing Response to America’s Maternal Mortality Crisis

9/10/2018

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By: Lamar Greene

Maternal mortality, death that occurs during pregnancy or shortly after, is used by the World Health Organization as an indicator of how healthy one country is compared to others. A common misconception is that maternal mortality is a public health issue reserved for developing nations. The United States, however, has the worst maternal mortality rate of any nation—despite spending more money on hospital-based maternity care than any other country in the world. Ranking 47th globally for maternal mortality, the United States also fares worse than many developing countries in protecting women from death during childbirth.
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When looking at the factor of race, we see that black women are three to four times more likely to die as a result of childbirth than white women. According to the Centers for Disease Control and Prevention, this is one of the widest racial disparities present in women’s health, which is driving the international disparity for the United States. Furthermore, racial disparities in maternal mortality persist across income and educational levels for black women, revealing that traditional social protectants are not effective for black women in the maternal mortality crisis. In New York City, college educated black women are twice as likely to die from childbirth than white women who never finished high school. One study demonstrated this ideology as well by demonstrating that race/ethnicity was the strongest predictor for maternal death or near miss, with Black women suffering disproportionately from maternal death across income lines. [1]

The Serena Williams’ story, among others, help us to put a face to this reproductive injustice. Williams’ narrative paints a picture of how medical providers are not listening to women of color during the deliveries of their babies.
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Picture of a pregnant black woman
Many black women have turned to doulas to assist during their birthing process so that they can receive culturally competent care that is tailored to them. A doula is defined as a person who is trained to provide advice, emotional support, and physical comfort to mothers before, during, and shortly after childbirth. A doula is not to be confused with a midwife, who is a medical provider who helps to deliver the baby. Doulas and midwives, however, can and often do work together to support women during pregnancy. For many black women it is the difference between life and death.
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Darline Turner, physician assistant and certified doula in Austin, Texas, took matters into her own hands when responding to the pressing human rights concern of disproportionately high rates of maternal mortality affecting black women. She was startled by the nonchalance and lack of urgency surrounding the issue. So she started Healing Hands Community Doula Project, an organization that provides pregnancy care and support to black women of all economic backgrounds. When discussing her vision for Healing Hands Community Doula Project, Turner said, “Any black woman who so desires will be able to have the support, resources, information, education to have a healthy full-term infant and to live to see that infant grow up to be an adult.” 
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Picture of two hands lifting a heart
There has been a surge of community health solutions like Healing Hands Community Doula Project that have increased culturally competent care for black women, which has been proven by research to be more effective than the medical system’s traditional approach. One such study focused on the impact of doulas on healthy birth outcomes and reveals that expectant mothers matched with a doula had significantly better birth outcomes compared to women who were not assisted by a doula. Doula-assisted mothers were four times less likely to have a low birth weight baby and two times less likely to experience a birth complication involving themselves or their baby. [2] These results show that there is hope that the maternal mortality crisis can be resolved. Doulas actively listen to mothers throughout their birthing process and provide them with emotional support so that the pregnancy process is tailored specifically to the needs of each individual mother.

The research and experiences documented about the doula movement signal that more solutions outside of the medical system may be effective in reducing racial disparities in maternal mortality. When speaking about the maternal mortality crisis, medical ethicist Harriet Washington looks to the past. She notes that “trying to understand a historical problem without knowing its history is like trying to treat a patient without eliciting their medical history–you’re doomed to failure.” Washington claims that the American medical system is still haunted by the history of slavery, which involved medical experimentation on enslaved African women to create the modern practice of gynecology and obstetrics. 
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Image portraying slavery in the United States
The doula movement and other community health initiatives provide an alternative to the institutional racism that all black women face when entering the medical system, regardless of their level of education or income status. The State of New York has expanded the use of doulas to reduce childbirth deaths. Americans can only hope that the federal government or other state governments will take similar action because women of color cannot continue to wait for this urgent issue of human rights and reproductive justice to be addressed. Their lives literally depend on it.

References
  1. Goffman, D., Madden, R. C., Harrison, E. A., Merkatz, I. R., & Chazotte, C. (2007). Predictors of maternal mortality and near-miss maternal morbidity. Journal of Perinatology, 27(10), 597-601. doi:10.1038/sj.jp.7211810
  2. Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of Doulas on Healthy Birth Outcomes. The Journal of Perinatal Education, 22(1), 49-58. doi:10.1891/1058-1243.22.1.49 
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Weekly Health Digest

9/5/2018

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A summary of important health news from the past week. 

​'Pandemic' of inactivity increases disease risk worldwide, WHO study says 
By: Susan Scutti

With physical activity levels continuing to trend downwards worldwide, a World Health Organization (WHO) study has shown that people are in need of lifestyle modifications. The researchers recorded people's activity levels at work and at home.  Their results showed a distinction between wealthier and lower-income countries: the former seeing a larger shift towards more sedentary occupations and modes of transportation. Even still, physical inactivity proves to be "pandemic" and researchers agree that there is no simple solution to this worldwide problem. In this fight against physical inactivity, they are suggesting that "small changes" in daily life can help combat the lack of activity.  

Raging wildfires send scientists scrambling to study health effects
By: Sara Reardon

As climate change hurtles forward, wildfires are predicted to burn more frequently, creating cataclysmic scenes of smoke and ash that have already decimated California this summer. But very little is known about the health consequences of wildfires−so scientists are making these natural disasters into natural experiments. They are collecting data from towns and a local primate research center that have been hit and are likely to be hit in the future, analyzing blood samples, respiratory function, and even donated placentas for clues as to how wildfires impact health. ​

Infectious Theory of Alzheimer's Disease Draws Fresh Interest
By: Bret Stetka

Researchers are showing a renewed interested in an infectious disease model for Alzheimer's Disease, which is a theory that was first suggested in the early 20th century. Some have noticed that the disease show similarities in pattern with infectious disease. Other researchers are interested in exploring the possibility of viruses, like herpes, which may combined with particular genetic combinations to contribute to the development of dementias and Alzheimer's Disease. 

With STDs on the rise, back-to-school will include condoms in one big Maryland county
​
By: Maggie Fox

The CDC recently released a report detailing the high incidence of STDs across the country, which many are considering a public health emergency. Montgomery County in Maryland has made efforts to address the high incidence of STDs in their county. The county will start stocking condoms at health centers it runs in four of their public high schools. Two Montgomery County officials are pushing to get condoms stocked in all high schools and middle schools as well. 

Drug May Slow Brain Atrophy in People with Progressive MS
By: HealthLine

​Researchers are making progress in evaluating an existing drug, Ibudilast, in its ability to treat patients with multiple sclerosis (MS). Ibudilast is approved in Japan to treat asthma and prevent stoke, but has not yet been approved in the United States. Researchers in a phase-II trial found that patients taking Ibudilast experienced a 48 percent lower progression of brain atrophy when compared to participants who took a placebo. Other research has pointed to Ibudilast’s anti-inflammatory properties, as well as its potential in treating amyotrophic lateral sclerosis (ALS) as well as substance abuse and addiction.

How the U.S. Elevates Corporate Interests Over Global Public Health and How the World Can Respond
By: ​Lawrence O. Gostin, Neil R. Sircar, and Eric A Friedman

​This Health Affairs article discusses the role of the United States in hindering advances in global health initiatives due to its own corporate interests. The article points to a recent example from May 2018, when the U.S. threatened to impose trade sanctions on Ecuador if they continued to support a resolution that encouraged women to breastfeed. This was in the interest of the U.S. infant formula industry. The article focuses on past presidential administrations, but mostly focuses on the behavior of the Trump administration. Finally, the article concludes with how other countries can respond to these actions and continue to protect global health initiatives. 
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