National Minority Health Month: Child Asthma

According to the CDC, 7 million children suffer from asthma nationwide. According to the New York City Department of Health and Mental Hygiene, children in New York City were almost twice as likely to be hospitalized for asthma as children in the United States as a whole. Even more alarming, in recent years, the Bronx has been the New York City borough with the highest overall rates of asthma hospitalizations, deaths and prevalence among children as well as adults. Clearly, disparities exist.

Asthma is a chronic lung disease that can cause the airways to become inflamed and narrow. This can result in coughing, wheezing and tightness of the chest which may make it difficult to breathe. Asthma attacks are often triggered by illness, strenuous activity and the environment; smoke, allergies, pets, mold, dust and pollution can be a trigger. Cockroaches can also trigger asthma attacks, as many children are allergic to the material associated with decaying roaches, and live roaches' excrement. Partners Healthcare, a team of doctors, nurses, respiratory therapists and other health care professionals, cites cockroaches as a bigger trigger than pet dander and dust. Though asthma cannot be cured, it can be treated with regular long-acting medications, and fast-acting medications in the event of an attack.

Children with asthma tend to have family members with asthma, implying that the condition is inherited. However, it is difficult to establish a link between inheritance and an entire race because race is a social construct that cannot be clearly defined by genetics. Asthma can be inherited by any child, regardless of their ethnic background, depending on the child's family history. However, asthma affects children from ethnic minority groups at disparate rates. For example, non-Hispanic black children have a higher prevalence of asthma and die at higher rates from asthma than non-Hispanic white children. Hispanic children have a higher prevalence of asthma compared to non-Hispanic white children.

Many ethnic minority children tend to live in areas in which smoke, mold, dust, pollution and roach infestation may be a problem. These triggers can greatly exacerbate asthma. Due to a lack of health insurance or a regular primary care physician, minority children suffering from asthma may be forced to use a hospital's emergency department for care. Also, due to lack of insurance and/or family instability, it may be difficult for children to regularly take required long-acting asthma medication, as prescribed. One study actually examined the degree to which instability within a family can negatively impact a child's health. Investigators found that family instability is related to poor child health, including asthma.

Additionally, cultural boundaries may contribute to disparities if they result in poor communication between the physician and patient or sub-par care. Poorly controlled asthma has also been linked to poorer performance in school (for example, more absenteeism), and may even help explain the academic achievement gap that exists among children from different ethnic groups. The aforementioned factors contribute to health disparities but are really symptoms of much greater social injustices. In order to rectify the problem, we must more closely examine our society.

National Minority Health Month: HPV and Cervical Cancer

At the American Association for Cancer Research (AACR) annual meeting on April 1, researchers said that the human papillomavirus (HPV) lasts longer in African-American women than in their white counterparts. This may shed light on some of the disparities that exist among women from different ethnic groups regarding HPV and cervical cancer.

HPV is a virus that is contracted through sexual contact. According to the Center for Disease Control and Prevention (CDC), there are over 40 types of HPV that can infect the genital area, throat and mouth. Condoms lower the risk of transmitting the virus, but areas not covered by condoms can still become infected. The CDC estimates that 20 million Americans are currently infected with HPV.

In addition to causing genital warts, another major health problem that results from HPV is cervical cancer and other genital cancers. Cancer and warts result from the body's inability to return the infected cells back to normal. In addition to the use of condoms, a vaccine (i.e. Gardasil) can lower your risk of developing warts and/or cancer. Gardasil protects against 4 types of HPV. Condoms should still be used because other types of HPV exist, and to protect against other sexually transmitted infections. Gardasil is recommended for girls and boys ages 9-26. Prevention means working to stop something before it occurs. Even if an individual has not yet had her first sexual contact, she should still be vaccinated.

In recognition of National Minority Health Month, it is important to outline the disparities associated with HPV and cervical cancer among women. While the incidence of cervical cancer among non-Hispanic white women was 8.5 in 100,000 women, the incidence was 13.8 and 11.4 for Hispanic and African-American women respectively. Despite the fact that Asians and Native Americans and Alaskins had a lower incidence of cervical cancer than their white counterparts, these minority groups were more likely to die from cervical cancer; Hispanics and African-Americans were more likely to die as well.These disparities may stem from several issues. Regardless of race, uninsured women are less likely to have regular PAP smears, and thus may not learn they have cervical cancer until it is advanced. However, it is also true that many uninsured women happen to come from low socioeconomic backgrounds and/or are from ethnic minority groups. Health and Human Services (HHS) said in a report that in 2005 many uninsured people were just above, at or well below the poverty line. The same HHS report said that Hispanics are disproportionately uninsured as they represent 14% of the general population but 30% of the uninsured population. As a group, Hispanics, African Americans, American Indians and Asians/Pacfiic Islanders constituted 52% of the uninsured population.

Many cases of cervical cancer are related to HPV. Many minority groups are not well-educated about how HPV is contracted, spread and treated. This may relate to the level of access to general education and health care. Even among minority women that are educated and have access to regular health care, cultural attitudes toward Western medicine and the health care system may contribute to these disparities. These same factors can also influence whether or not a woman chooses to be vaccinated for HPV. Lower vaccination rates can lead to an increased risk for contracting HPV, and the development of cervical cancer.

The study presented at the AACR annual meeting found a biological factor that may also contribute to disparities related to HPV. The investigators found that African-American women hold on to HPV longer in the body than their white counterparts; this may be a reflection of their genes and immune systems. Kim Creek, vice-chair and professor of pharmaceutical and biomedical sciences at South Carolina College of Pharmacy said, " [the] body recognizes it [HPV] as a viral infection and usually clears the virus within one or two years...It is those women who have difficulty clearing it that are at higher risk of cervical disease and cervical cancer." This recent finding may help explain the higher prevalence of cervical cancer among African-Americans. It would be interesting to study whether other minority groups disparately affected by HPV and cervical cancer, also hold on to the HPV virus longer than their white counterparts.

In summary, access to health insurance, education, health care, cultural attitudes and genetics are all factors that contribute to health disparities related to HPV and cervical cancer. It is clear that this is a complex problem. Cultural competency within the health care system, and initiatives that target high-risk populations will help us make great strides toward the elimination of health disparities.

Three Weeks In, and the Horns are Blaring

This post was written in June 2010, during my time volunteering with VE Global in Santiago, Chile.

Alexa Mieses
New York, USA

The roar of plastic horns and shouting filled the air as I awoke to the sound of hundreds of ecstatic Chilean soccer fans. Chile had triumphed in their first Mundial (World Cup) match. Upon embarking on my journey to volunteer at Colegio Anakena, I saw hundreds of people painted red, white and blue. I could not help but begin to feel a bit excited, and given that I cannot explain what a red card penalty is, it was clear I had given in to World Cup madness. Mundial fever is infectious here in Chile, which has already begun to feel like home. I cannot believe it has only been three weeks since I arrived.

This trip marks the first time that I have traveled alone for an extended period of time. Though I generally adjust well to new situations, I did not know what to expect. What I’ve discovered thus far is that Chile is a warm and friendly country, and VE Global only made my transition easier. Orientation took place last week and each day served to teach the new volunteers about VE Global’s mission and work. VE orientation was more than just cheesy icebreakers; orientation consisted of seminars lead by local professionals to inform the new volunteers about the Chilean social system and children’s rights, and to better prepare us for what we will endure during our time in our institutions and in Santiago. VE also conducted a seminar on typical Chilean cuisine and even hosted a seminar on Chilean slang, or Chilenismos—que bakan!

In addition to teaching the new volunteers about VE Global and Chile, orientation also served to foster relationships among both the new volunteers and the antiguos. Antiguos are volunteers that have been with VE for at least three months and they are the driving force behind VE culture. They are the warmth in the office and the energy we take with us to our institutions. Antiguos not only offer their knowledge but their kindness and a listening ear. In just one short week I have not only learned a lot from the antiguos but also consider them my friends. VE attracts a certain type of personality which translates into a warm and welcoming work/volunteer community. I am excited to see what the rest of my time with VE will bring!

Abstinence-only Sex Education and the ACA

I learn something new every day. There has been a lot of news recently about the Patient Protection and Affordable Care Act (ACA) as the nation celebrated its two-year anniversary (or not, in the case of opposition). Also, today the Supreme Court concluded its review of the health care bill. I support many aspects of the ACA. Although many aspects of the ACAwill be enacted at different times, the Act: does not allow health insurance companies to deny someone coverage because of pre-existing health conditions; allows children to be covered under their parent's health insurance until they are 26; requires health insurance companies to cover, free of charge, preventable health services such as vaccines, mammograms and screening for conditions like obesity and Type II diabetes. Also, this March it became mandatory that federal health programs collect racial, ethnic and language data which will perhaps help us better understand health disparities. However, thanks to a CNN article I learned that the Act also renewed $50 million per year for five years, for abstinence-only sexual education.

Abstinence-only sex education was something I heard about long ago. Then I really began to pay attention to the issue while I was a Public Policy Fellow at Gay Men's Health Crsis in 2009. Abstinence-only sex education places a great emphasis on waiting to have sex until after marriage. Such education often minimizes the biological aspects of sex, and often speaks very little about the use of condoms and birth control, if at all. Such education has been linked to increased rates of teen pregnancy and contraction of sexually transmitted infections. One 2011 study at the University of Georgia examined the correlation between abstinence-only sex education and teen pregnancies, births and abortions.

For every state, the investigators examined education laws and other policies regarding sex and/or HIV/AIDS education. Actual education laws were retrieved from the Education Commission on the States, while other related policies were retrieved from the Sexuality Information and Education Council of the US (SIECUS). All but two states (Wyoming and North Dakota) had education laws and/or policies on record. Each state's laws and policies were assigned a number from 0-3 indicating the level of importance each state placed on abstinence from sex; level 0 laws indicated no specific mention of abstinence, while level 3 indicated that abstinence from sex until marriage was the fundamental teaching standard. The policy level for each state was correlated with data on teen pregnancy, and birth and abortion rates. The investigators also accounted for population factors like socioeconomic status, education level, ethnicity and access to Medicare waivers for family planning.

The results? States that were described as Level 3 (abstinence was their fundamental teaching standard) had the highest rates of teen pregnancy and births among teen moms. The investigators also found that richer states tended to have a higher proportion of white teens in their teen populations, and emphasized abstinence less. These richer states also tended to have lower teen pregnancy and birth rates than poorer states. These results support the notion that abstinence-only sex education is ineffective.

Politics often involves compromise between the concerned parties. In June 2009, when I was a Public Policy Fellow, the major source of funding for abstinence-only education expired. A new bill was signed in December 2009 that provided $114 million to more comprehensive and evidence-based sex education (hooray)! Therefore, I was surprised to learn that the ACA provided funding for abstinence-only education which yields questionable outcomes. But like I said-- compromise.

The debate about whether or not abstinence-only sex education works is important; however, it is the unwanted outcomes with which we should be very concerned. The University of Georgia study found that teenage pregnancy was strongly correlated with ethnicity and socioeconomic background. Public health campaigns that target high-risk populations to educate them about teen-pregnancy and provide better access to preventative services will be invaluable moving forward.

March is Women's History Month

In celebration of Women's History Month, I would like to highlight the nation's first female and first Hispanic Surgeon General: Dr. Antonia Novello. The following information was taken from the U.S. Government Surgeon General website:

Antonia Novello was born in Puerto Rico on August 23, 1944. She received her B.S. degree from the University of Puerto Rico at Rio Piedras in 1965 and her M.D. degree from the University of Puerto Rico School of Medicine at San Juan in 1970. She then completed her internship and residency in nephrology at the University of Michigan Medical Center in Ann Arbor. Novello remained at Michigan in 1973-1974 on a fellowship in the Department of Internal Medicine, and spent the following year on a fellowship in the Department of Pediatrics at Georgetown University. From 1976 to 1978, she was in private practice in pediatrics in Springfield, Virginia.

In 1978, Novello joined the Public Health Service Commissioned Corps,. Her first assignment was that of project officer at the National Institute of Arthritis, Metabolism and Digestive Diseases of the National Institutes of Health (NIH). She held various positions at NIH, rising to the job of Deputy Director of the National Institute of Child Health and Human Development (NICHD) in 1986. She also served as Coordinator for AIDS Research for NICHD from September, 1987. In this role, she developed a particular interest in pediatric AIDS.

During her years at NIH, Novello earned an M.P.H. degree from the John Hopkins School of Hygiene and Public Health in 1982. From 1976, she also held a clinical appointment in pediatrics at Georgetown University Hospital. Novello also made major contributions to the drafting and enactment of the Organ Transplantation Procurement Act of 1984 while assigned to the Senate Committee on Labor and Human Resources.

Antonia Novello was appointed Surgeon General by President Bush, beginning her tenure on March 9, 1990. She was the first woman and the first Hispanic to hold the position.

During her tenure as Surgeon General, Novello focused her attention on the health of women, children and minorities, as well as on underage drinking, smoking, and AIDS. She played an important role in launching the Healthy Children Ready to Learn Initiative. She was actively involved in working with other organizations to promote immunization of children and childhood injury prevention efforts. She spoke out often and forcefully about illegal underage drinking, and called upon the Health and Human Services Inspector General to issue a series of eight reports on the subject. Novello also similarly worked to discourage illegal tobacco use by young people, and repeatedly criticized the tobacco industry for appealing to the youth market through the use of cartoon characters such as "Joe Camel." A workshop that she convened led to the emergence of a National Hispanic/Latino Health Initiative.

Novello remained in the post of Surgeon General through June 30, 1993. She then served as the United Nations Children’s Fund (UNICEF) Special Representative for Health and Nutrition from 1993 to 1996. In 1996, she became Visiting Professor of Health Policy and Management at the Johns Hopkins School of Hygiene and Public Health. Dr. Novello became Commissioner of Health for the State of New York in 1999.

Click this link for more information about the current female Surgeon General, Dr. Regina Benjamin.

Match Day!

Students search for their Match envelopes
Photo taken from: whsc.emory.edu

Today the National Resident Matching Program (NRMP) released their results. On “Match Day”, thousands of medical students across the country open envelopes at the exact same time and learn their fate—at least that of the next 3-5 years! According to an NRMP report, close to 47,000 students participated in the Match in 2011.

In medical school students spend four years studying the basic science material and rotating through clerkships in various medical specialties. Each clerkship serves to train the student, but also to allow the student to develop an idea of which medical specialty she will pursue. Will it be Pediatrics? Pathology? Perhaps Preventative Medicine?

Within the four years of medical school, students are required to pass Steps 1 and 2 of the United States Medical Licensing Examination (USMLE) in order to receive their degree. After graduation, novice physicians complete more extensive and hands-on clinical training program called “residency” that will transform them into full-fledged, autonomous doctors.

The difference between the NRMP and other application processes is that the applicant can only be matched to one residency program. This is a stark contrast to the college and even medical school application processes, in which an applicant can be accepted to multiple schools. The Match is like any other application process—on steroids!

Once decided on a medical specialty, medical students sometimes apply to fifteen programs or more! They travel all over the country to interview with program directors and medical faculty. They meet current residents in each program and explore the geographic area. Finally, medical students rank each program according to their preferences. However, residency programs also rank the applicants. Programs evaluate the applicant's academic record, USMLE scores, letters of recommendation, personal statement, professionalism and many other aspects of the student's application. Both parties submit their rank lists to the NRMP system which uses a mathematical algorithm to generate the best match possible. In an ideal scenario, a program’s very highly ranked candidate will also rank that particular program very high. Voilà! A match made in heaven!

However, creating a rank list is challenging for both applicants and programs. One of the most troubling points for applicants is coping with a lack of control over the process. Students are matched to one program and one program only. Beyond creating their rank list, students do not have control over where they will end up. The student may have preferred to match with a program in California but match to a program in Massachusetts. This can have a profound impact on the student's professional and personal life and loved ones.

A book entitled, “Match Day,” by Brian Eule, addresses this issue exceptionally well. Eule endured Match Day with his medical student-girlfriend. The non-fiction book tells the story of three medical students (including Eules girlfriend) and the way in which the Match impacted their lives; the book also brings in facts about the history and development of the match process. This book is useful for medical students and their loved ones, and anyone interested in learning more about Match Day.

After a 6-month hiatus, Match Day prompted me to write a post. I recently had my own “Match Year” as I learned which medical schools had accepted, rejected or waitlisted me for admission to their programs. This year has been one of celebration as I was accepted to several of my top-choice medical schools. However, I cannot help but think this is the quiet before the storm! In just four months, I will officially begin my transformation into a physician. In just four months, I will be studying for biochemistry and dissecting a cadaver. While this process began many years ago when I first decided to pursue medicine, August 2012 will mark the month in which school officially starts, and I am already thinking about Match Day 2016!

Health disparities found for Baltimore Latinos

Health disparities found for Baltimore Latinos