Ad Campaigns to Combat Obesity Spark Controversy

by Kate Isenberg, Mentor Connection Program Coordinator

"What do you want to do? Do you want to have people lose their legs or do you want to show them what happens so that they won’t lose their legs?" This was what New York City Mayor Michael Bloomberg had to say in response to outcries over the City Department of Health’s (DOH) new ads that graphically connect obesity with negative health outcomes including limb amputation (a procedure sometimes required in severe cases of diabetes). It is just one in a series of ads that DOH has recently released with facts about why people should avoid sugary drinks and cut down their portion sizes, and many have criticized these ads as being too negative or even counterproductive. Yet the DOH is not the only organization coming under fire over its controversial ads to fight obesity. In a part of what may be a growing national trend, a campaign from a hospital in Georgia has also created a stir with its commercials intended to raise parents' awareness of childhood obesity issues. These ads bluntly depict overweight children asking into the camera, "Why am I fat?" or stating they have, "something called hypertension."
Both the DOH and the Atlanta children's hospital, Pediatric Healthcare of Atlanta, have separately defended their ads, saying the shock factor was very much intentional. As Linda Matzigkeit, vice president of Pediatric Healthcare of Atlanta, stated in an interview, "It has to be harsh. If it's not, nobody's going to listen." Perhaps Matzigkeit’s approach is so extreme because we live in a country where an estimated one of every three adults is considered obese and the average citizen is 23 pounds overweight.
If the national obesity problem truly is so pervasive, then what is the problem with grabbing people’s attention through these types of ad campaigns? Health experts have used the term “fear appeals” to describe “persuasive messages that emphasize the harmful physical or social consequences of failing to comply with message recommendations.”[1] According to Diana Johnson, a Health Educator at Bronx Heath REACH, an organization aimed at eliminating disparities in health outcomes in the southwest Bronx, one largely accepted theory is that fear appeals only work when there are equally strong efficacy messages that accompany them. In other words, if fear or threats are used in a campaign, there must be an equally powerful “solution” to go along with the message, otherwise people feel overwhelmed and shut down. For many New Yorkers, however, the image of someone with a diabetes-induced amputation accompanied by advice to order smaller drink sizes does not hit the mark. In fact, New York Faith and Justice (http://nyfaithjustice.org/), a Bronx Health REACH Legacy project grantee working to advocate for the Farm Bill to be changed to include nutrition education at SNAP (food stamp) recertification sites, is unlikely to use the image of the amputee in its program materials because it, “may be too graphic and turn away some of the members from participating in the workshop.”[2]
The reactions to the Georgia campaign directed at obesity in children have been, in many ways, even more polarizing than to the amputee ads in New York. In response to the Georgia campaign, Dr. Miriam Labbok, director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill told ABC News, “Blaming the victim rarely helps. These children know they are fat and are ostracized already.”
In many ways, however, Dr. Labbok’s comments about victim blaming apply to both ad campaigns. When we focus on the individual people who are obese, but who live in areas with little to no outdoor spaces to exercise, we are overlooking the fact that local governments allowed for these types of infrastructures to take hold in the first place. When we chastise the parent who buys a hamburger and fries, a whole meal for two or three dollars, we are ignoring the fact that these foods are being sold at below-market prices thanks to antiquated federal subsidies given to industrial farms. At what point do we need to stop spending countless dollars on getting individuals to change their “poor lifestyle habits,” and start looking at the systemic policies that have allowed for this epidemic to grab hold of our nation?

[1] Hale, Jerold L., and James P. Dillard. "Fear Appeals in Health Promotion Campaigns: Too Much, Too Little, or Just Right?" Designing Health Messages: Approaches from Communication Theory and Public Health Practice. Ed. Edward Maibach and Roxanne Parrott. Sage, 1995. 65-80.
[2] Howard-Norman, Regina. "NYC DOHMH: Cut Your Portions. Cut Your Risk." Message to Kelly Moltzen. 10 Jan. 2012. E-mail.

Men's Health at the Helen B. Atkinson Health Center

by Kate Isenberg, Mentor Connection Program Coordinator

Less than two months ago, when Steve Hemraj was appointed director of the Helen B. Atkinson Health Center, his vision was clear: to improve the quality, accessibility, and awareness of men’s healthcare in Harlem. Men in medically underserved areas such as Harlem too often address their health issues only by going to the emergency room or waiting until it is too late. Hemraj and his staff would like to change all of that. The center, located on 115th and Lenox Avenue, happens to be uniquely positioned in a medically underserved area, and already works with patients who do not have medical insurance or are living below the poverty line. In the upcoming months, Hemraj will be putting an extra emphasis on expanding and improving services directed towards men’s health and the men’s health clinic, which is held at the center two Saturdays a month.

Recognizing that good health underlies an individual’s ability to thrive in all areas of life, Hemraj and his staff have hit the ground running by focusing on some of the most pressing issues for men in Harlem including sexual health, family planning, and mental health. In order to make the clinic expansion a success, however, Hemraj wants to create a space where men feel comfortable. His team will begin by surveying men in the community to see what would draw them to a health clinic—this means addressing even the smaller details such as what to play on the television in the waiting room. The center will aim to provide a confidential, comfortable, and culturally competent space for men to go to in order to address their health concerns.

Ultimately, Hemraj wants the clinic to be a place where men can easily access education and treatment for sexually transmitted diseases, where they can pick up emergency contraception for their sexual partner who may be too busy, where they can learn about what it means for sexual reproductive health or simply get a vasectomy, or where they can find a counselor to help them get through mental and emotional barriers. In short, it will be a one-stop shop to address the most pressing health needs of Harlem’s men.

The men’s health clinic is held on the first and fourth Saturday of each month, and any male over the age of thirteen is welcome to come in for medical assistance, medication or information for themselves or their sexual partners. Please call 212-360-2561 to find out more or make an appointment. You can also email Steve Hemraj, Center Director at Shemraj@chnnyc.org

Mount Sinai School of Medicine Awarded More Than $2 Million to Continue the Northeast Regional Alliance Health Careers Opportunity Program

By Cher Smith, Pharm D. Candidate

When an opportunity comes knocking, we have to answer the door. But what happens when opportunity is knocking to collect some spare change? Well, fortunately, for a group of students, this opportunity came with a price tag that was paid in full. The Northeast Regional Alliance (NERA) Health Careers Opportunity Program was able to renew its funding to give disadvantaged students a chance to pursue their career path in the medical field. This is especially great news for Manhattan Staten Island Area Health Education Center (MSI AHEC), who partners with NERA. This will allow MSI AHEC to continue the support of students in healthcare oriented programs. These programs will eventually expand diversity in the healthcare profession. Read the full details on this exciting moment:http://www.mssm.edu/about-us/news-and-events/mount-sinai-school-of-medicine-awarded-more-than-2-million-to-continue-the-northeast-regional-alliance-health-careers-opportunity-program

The Depression Factor and Smoking

By Tina Bruno, OMS II and Virginia Valerio, Mentor Connection Program Coordinator

At some point in our life we are asked, “Do you smoke cigarettes?” Tobacco use, or the possibility of it, has become embedded in our society to the extent that physicians must ask this vital question when assessing patient lifestyle and illness risk-factors. Cigarette smoking is harmful, but why is it such a hard habit to break? A possible explanation to understanding how to help people quit or prevent smoking may be found in the correlation between depression and smoking.

According to the US Centers for Disease Control and Prevention (CDC), almost half (43%) of the people over the age of 20 who suffer with depression are also smokers. Key findings from the CDC report include:

• Adults aged 20 and over with depression are more likely to be cigarette smokers than those without depression
• Women with depression have smoking rates similar to men with depression, while women without depression smoke less than men
• The percentage of adults who are smokers increases as depression severity increase
• Among adult smokers, those with depression smoke more heavily than those without depression and
• Adults with depression are less likely to quit smoking than those without depression.

Many studies have been conducted that support these findings and demonstrate a link between depression and smoking; yet, the correlation between smoking and depression is not completely understood. As Malcolm Gladwell states in his book The Tipping Point, “not only do some smokers find it hard to quit because they are addicted to nicotine, but also because without nicotine they run the risk of a debilitating psychiatric illness.”

The recent outdoor smoking ban in New York promises hope for smoking cessation. The ban on smoking at beaches, parks, and pedestrian areas leaves few areas for a person to smoke. A recent article from CNN reports that according to New York City Mayor Michael Bloomberg, the 2003 ban on indoor smoking led to 35,000 fewer smokers and extended the life expectancy of New Yorkers by an average of 19 years.

This ban, also, can have positive effects on an individual who is suffering from depression and is also a smoker. Just as banning smoking in public places leads to reductions in many diseases, it also leads to a reduction in individuals who are suffering from depression. A recent study found that the risk of depression was higher for individuals living where smoking was allowed anywhere as opposed to those living where there was a smoking ban.

Understanding what makes tobacco use appealing or addicting may improve tobacco cessation interventions. Some chronic smokers are aware of the negative effects of smoking, but are unable to quit because they are addicted. For smokers who are suffering from depression, these studies suggest that treating them for their depression could help break their habit.

Health Challenges Facing New York City Mexican Populations

By Virginia Valerio, Mentor Connection Program Coordinator

Mexicans are one of the fastest growing Hispanic groups in New York City, as indicated by a 6.7% yearly rate of population increase from the Latino Population of NYC 2007 report. Mexicans are also the highest to report fair or poor health, lack of health insurance, and the usual source of care as the emergency room. Despite the right of all humans to basic health care, Mexicans in New York City face numerous challenges to high quality health.

Statistics show that New York City Mexicans are almost five times less likely to have health insurance than all New Yorkers, and almost three times less likely than other Hispanics. What are contributors to having no health insurance? Many Mexicans are undocumented, have recently arrived from Mexico, or are employed in low-wage jobs that are less likely to provide any health insurance. Having no health insurance means that many Mexicans will face expensive health fees when trying to see a physician for preventative care (e.g. annual physical). It is easy to understand why Mexicans cite usual source of care as emergency room since they have no health insurance and are probably not going to see a doctor until the need presents itself in an emergency.

Another factor that contributes to poor quality health is high household density. High household density is the number of occupants per room or square foot, and is associated with lower health outcomes. The cost of living in New York City is extremely high so many immigrants are forced to live in crowded conditions to help contribute to rent. “High household density increases exposure to communicable diseases, psychological distress in adults, and poor long-term health in children.” Many undocumented Mexican immigrants, especially who do not speak English and are food insecure, live in high density conditions. Good judgment determines that it is in the best interest of our communities to control the spread of infectious and communicable diseases by allowing access to basic primary care for the undocumented.

Medical and Health Research Association of New York City, Inc published a study that addressed health concerns for Mexicans in New York City. They stated that “this study of a specific population subgroup, Mexicans in New York City, was undertaken as an important step in serving our target populations by gaining a better understanding of their health needs.” In the article, they described sources of stress faced by Mexican communities in New York City which included “ overcrowded, and unaffordable housing, frequent moves, job instability, long working hours, low pay, depression, loneliness and isolation flowing from separation from family and other support networks, fear of being discovered and deported (if undocumented), and language barriers.” These high risk factors may contribute to illness and/or poor health among New York Mexicans.

Mexicans are one of the largest growing Hispanic group in New York City, but are facing many barriers to quality health. Lack of health insurance is a serious concern because people tend not to seek costly preventative care as indicated by emergency room visits. The alarming statistics demonstrate that much work remains to be done to ensure that Mexicans in New York City have adequate health access and health care.

The Dental Workforce

By Virginia Valerio, Mentor Connection Program Coordinator

The need for primary care physicians in underserved areas gets a lot of attention, but what about the need for dentists in underserved areas? The Health Resources and Services Administration (HRSA) estimates that as of September 30, 2009, there are 4,230 Dental Health Professional Shortage Areas (HPSAs) with 49 million people living in them. This means that it would take 9,642 additional dental providers to meet the need of those living in HPSAs.

On April 2, 2011, the New York State Area Health Education Center (AHEC) system hosted its first Dental Recruitment Fair at the New York University College of Dentistry. The purpose of the Dental Recruitment Fair was to encourage third and fourth year students and dental residents to work in underserved areas.

The event started at 10:00AM and ended at 1:00PM, with many people in attendance and plenty of information distributed. I wanted to inquire more about the fair, so I contacted Patricia Alisme, the Director of Programs for the Brooklyn-Queens-Long Island AHEC.

How many people attended?

Ms. Alisme: 70 people attended, 45 students and residents, 8 dental employers including the United States Navy. We received great responses on the fair evaluation. One evaluator stated, ‘Well done! I didn’t realize dentists can work in community health centers in health profession shortage areas.’

What was your over all impression of the conference?

Ms. Alisme: The fair was fantastic, well-attended, great presenters and representation of employers.

Is the conference going to be an annual event?

Ms. Alisme: The fair is annual event that will be held through 2013.

Health Professional Shortage Areas have needs of primary medical care, dental or mental health providers, for reasons that include geographic, demographic and institutional barriers. A great way to work in underserved areas is to work in a community health center. As stated on the HRSA website, “health centers are community-based and patient-directed organizations that serve populations with limited access to health care.” Access to dental care is a challenge for the uninsured, poor and elderly people, and some minorities. While it is important to encourage primary care physicians to work in underserved populations, it is equally important to recruit dentists along with them.

Grant Increases Medical Training Slots

By Virginia Valerio, Mentor Connection Program Coordinator

It is no secret that New York State has an impending shortage of primary care physicians. In a recent blog posting, we noted that policy focus should be on opening more medical schools and creating job opportunities to address this projected shortage.

Someone must have been listening.

On February 17, The Institute for Family Health (IFH) announced that it will be one of the first federally-funded Teaching Health Centers in the country. IFH’s program seeks to address critical shortages of primary care physicians across NY by training 12 additional physicians in the next five years.

The Institute, a non- profit health center network, is one of only 11 organizations to receive a grant from the Human Resources and Services Administration (HRSA), and the only one in New York State. This grant will permit IFH’s Mid-Hudson Family Medicine Residency Program to expand from 18 to 30 residents, with the first four additional residents beginning in July 2011.

Dr. Neil Calman, President and CEO of the IFH, explained, “the Institute has a strong track record of training family medicine residents who continue to practice in high-need communities. By adding residency positions through the Teaching Health Centers program, we’ll attract more committed family physicians to the Mid-Hudson Valley, many of whom will choose to stay here once their training is complete.”

According to HRSA, The Affordable Care Act authorizes the establishment of teaching health center development grants to establish or expand primary care residency training programs in health centers, which are community-based ambulatory patient care centers such as Federally Qualified Health Centers and Rural Health Clinics. In a statement announcing the awards, the Human Health Services Secretary Kathleen Sebelius said, “The Teaching Health Center program is an integral part of our mission to strengthen the nation’s primary care workforce and ensure that all Americans have adequate access to care.”

The Teaching Health Center program is a great medical training initiative to address the much-needed production of primary care doctors. New York is responding to this shortage through IFH’s increase in slots, as well as Hofstra University’s newly established medical school that will welcome its first 40 students in the fall of 2011.