Friday, September 2, 2016

Is the story of the sexual transmission of Zika virus clear to the public?

I am concerned with how the story of the Zika virus is being told to the public. Most articles - including those which claim they contain "Everything you need to know about the Zika virus," start with some variation on, "Zika is a virus transmitted by the bite of an infected mosquito," and then don't get into the sexual transmission until the bottom of the article (if at all). 

Example 1 (The Star Online - sexual transmission mentioned only towards the middle/bottom)
Example 2 (NYT - the article is about the mosquito, but there is still no other mention of sexual transmission, even in passing to clarify the risks for readers). 
Example 3 (Washington Post, all about Cuba's efforts to control the mosquito, no mention of sex).
Example 4 (Fox News, all about the mosquito, not even a passing mention of sexual transmission).
Example 5 (CNN - no mention of sexual transmission in this article about Singapore).
Example 6 (CNN - 5 things you need to know about Zika, and nothing having to do with sex unless you scroll down to find the next list of related articles). 
...... and so on. 

All of this is not to say that controlling the mosquito population is not important: it is, and vitally so. However, the message about sexual transmission does not seem to be coming across clearly in the major news articles, and I worry that people in monogamous relationships will think they're not at risk, because of their monogamy. 

Do women understand that they can get the disease from their one partner if he or she was bitten by an infected mosquito? Is a person's understanding of the virus' transmission associated with other behaviors that would increase or decrease a person's risk of contracting Zika?

Here is one (older) article which just focuses on sexual transmission. We need more of this. However, Dr. Gupta doesn't go into the details. He mentions that the virus can be sexually transmitted, but doesn't discuss how those in monogamous relationships still need to be cautious, since someone who got the disease from a mosquito bite can pass it on sexually. 

When the news started to come out about the sexually transmitted Zika cases, there was a flurry of news articles. But that seems to have died down. 





Friday, August 19, 2016

A petite ode to the last week of summer

Last night, I used a proper blanket for sleeping, instead of just a sheet.
Oh, summer, where have you gone. Wasn't commencement just last week?
Goodbye to greasy sunscreen, sweating profusely, and sticky kiddos.
Goodbye to not wanting to use the oven, and to bats in the house (I hope).
Not goodbye to summer food yet, as Eddie's Footlong Hotdogs is open in the mall now.

Looking back on the reading and writing and presenting done (and a wedding) is satisfying.
Even though, I didn't get done as much as I had planned. Does that ever happen to you?
I got to play lots of Magic: The Gathering, though, so I can't complain about a thing.
Are low expectations the key to summer satisfaction?
Probably, but I can't bring myself to lower mine. Maybe in a few years.

Summer research work is relatively solitary, and I want new energy on campus.
And really, I've always loved fall. The first days and weeks of class are magical.
Thanks, summer - but I'm done with you now. I can't think by myself any longer.
I want to wear a sweater, for goodness sake. I want more structure in my day.
Is 'being done with summer' heresy, coming from a professor?

I don't care. 
I know you all love fall too, admit it. 
Hurry up, students! Get your butts into my classroom.



Monday, August 15, 2016

Creating coherence of the educational experience

Last week, I had the opportunity to participate in a multi-campus workshop on curricular coherence at Denison University. I learned a lot about good advising, and about what other colleges are doing. One idea that I think is excellent is advising circles. I would love to implement something like this at Allegheny, especially if I could stay with the same group(s) of students over the course of their four years here. In an advising circle, students have scheduled, structured opportunities to get together in a small group, regularly, with a faculty member.

Getting to know faculty members is one of the most valuable things students can do in college. There are a few challenges with advising circles - including basic logistical ones (i.e., scheduling!). Also, I'm only familiar with my field and can't adequately advise a student on graduate opportunities or career options in neuroscience or communication arts. However, if advising circles could be combined with a 'major advisor,' we could potentially have our cake and eat it too.

I'd imagine the potential topics for discussion are wide open - especially in the first semester - and that conversations would go with the flow as needed. From my own experience, I've very much enjoyed being a mentee in a mentoring group. One-on-one mentoring shouldn't be discounted, but there are also benefits to being in a small group. For one thing, like we always tell students, someone might ask a question that you've been wanting to ask, or that you didn't even realize you needed answered.

Lots of other cool ideas came out of this workshop. For me, a theme running underfoot the whole time was, "students are completely overbooked." We should help students emphasize quality over quantity of experiences in college - and also practice what we preach in our own faculty lives. Easier said than done, but we should try!

Another key theme is that we need to provide space for students to reflect meaningfully on their experiences in college, so that they are prepared to tell their stories when trying to launch into careers after college. If they themselves can't articulate why their liberal education was important for their development as a person and professional, no one can.

Friday, August 5, 2016

Things I'm currently worried about with respect to the Zika outbreak

Becky Dawson and I just finished surveying 2000 women of childbearing age living in the southern U.S.A. about their knowledge, attitudes, perceptions, and behavioral changes surrounding the Zika virus outbreak. We will start formally analyzing the data soon, and are looking forward to learning any clues about what women and families are doing in response to the outbreak.

As of August 3rd, the CDC was reporting 6 locally acquired Zika cases in U.S. states, and 5,525 locally acquired Zika cases in U.S. territories. This recent article from NPR examines the implications that the Zika outbreak has had for the practice of obstetrics in Florida. One OB-GYN says that Zika could be a "reproductive game changer." Like many others, I'm worried about a lot of things with respect to this unprecedented outbreak.

I'm worried that individuals in monogamous relationships will not be as vigilant as necessary at preventing Zika infection, because usually when you think of an STD, you think of being at risk only if you have multiple partners. This is why STDs are (wrongfully) stigmatized. But Zika isn't just an STD, it's also transmitted by mosquitoes. It also seems to be able to live in testes for months after the initial infection. If your significant other travels for work, you could be at risk, regardless of whether you're monogamous or not.

This page contains the most up-to-date advice from the CDC related to traveling in Zika affected areas. I'm worried that women who wouldn't want to spray themselves with DEET are the same women who wrongfully believe that Zika worries are overblown, or even a conspiracy. They incorrectly think that Zika or microcephaly is caused by a pesticide, or by genetically engineered mosquitoes (it's not)! I'm also worried that these behaviors correlate with not wanting to follow medical advice.

For example, some women and families have started to rely on methods that don't actually work to prevent mosquito bites, or may not decide to delay pregnancy in response to the outbreak. I'm worried that anti-science, anti-medicine, anti-vaccine culture - such as that which inhibited gains in controlling or eliminating vaccine preventable diseases like measles and pertussis - may also hamper the response to the Zika outbreak. The results of a failure to prevent a Zika outbreak are permanent, tragic, and costly (financially, socially, emotionally).

Lastly (for now), I'm worried that after the outbreak is over in the U.S. and elsewhere, we will forget that we have work to do at the policy level to prevent scary outbreaks from happening in the future. For preventing Zika outbreaks, a major policy area to focus on would be mitigation of climate change. The connections between climate change and various emerging infectious diseases is something that is discussed often, but doesn't seem to enter into high-up discussions of climate change policy.

Monday, March 28, 2016

How are American women of childbearing age responding to the Zika virus outbreak?

In the coming years, large-scale nationally representative health survey data from Latin America will be collected by various organization and agencies, and some of the data will be available for analysis by health researchers around the world. I expect that this information will tell us lots of interesting things about the risk of Zika virus and the effects on birth outcomes. Cross-sectional health surveys are useful, and we should do them. However, we're limited in how we might be able to interpret the results.

For example, one finding that we - as health researchers - would expect to come out of those large-scale health surveys is that poorer women in Zika-endemic areas are at an increased risk of contracting Zika virus. When these data are collected and released, it will be difficult to interpret the causal mechanisms behind those findings, without deeper information. Do we see these patterns because poorer women couldn't afford bug spray? Do we see these patterns because poor women are more likely to live in areas which are ideal for the Aedes Aegypti mosquitoes? Do we see these patterns because poorer women are more likely to work outside during the day, where mosquitoes can be biting? Do we see these patterns because the word about Zika risk didn't get to these women in time, before they conceived their babies?

The answers to these questions will inform how policies are designed in the future. Understanding the actual mechanisms behind the data is key for making effective policies. Poverty is associated with ill-health, but how this occurs is a much deeper (and location-specific) question. We need data - including and especially qualitative data - on how women are planning and thinking through their fertility and family planning decisions, right now. Family planning decisions are long-term. If we don't know what was going on in women's minds before these large-scale health surveys are conducted, we'll have a hard time interpreting health survey data satisfactorily.

Professor Becky Dawson and I want to understand whether and how women are changing their contraception, travel, pregnancy, or family planning behaviors in response to the Zika virus outbreak, which has been widely covered in the media. To this end, we are crowdfunding a research study to survey women of childbearing age who live in the U.S. states which border Mexico. This region is one where Zika could be actively transmitting in the summer months (Monaghan et al. 2016).

So...come support our project! We are part of a Zika Virus Challenge. If we get the greatest number of "backers," out of our group, we win an extra $10,000. We'd use the funds to support student researchers and increase the geographic scope of our survey. We're especially interested in Puerto Rico.



Tuesday, December 8, 2015

The NYT editorial about guns is right on point, except for one word...

A few days ago, in response to the latest mass shooting in San Bernadino, CA, the New York Times published an editorial on the front page of the paper for the first time since 1920. It was a great piece and they are right on point.

Except for....the term they used in the title: epidemic. Gun violence is not an epidemic situation in the U.S. It has not spiked all of a sudden. There has been a recent upswing, but before this recent upswing, there was a long history of gun violence and mass shootings in the U.S.A. In the future, this period of time may be referred to as an epidemic, but there's no way to know that for sure yet. Careful measurement will allow us to decide that later on.

Instead, we should consider gun violence as endemic in this country. Gun violence is a regular occurrence, normally found where we live, and relatively restricted to our area (the U.S.A). As in: no other country experiences this public health problem. And, this has been going on for a while now and it hasn't abated. And: it's apparently not severe enough yet for our policymakers to do anything about it.

Framing mass shootings and gun violence in the U.S. as endemic to our country rather than epidemic is a relatively small semantic distinction. However, it has important connotations for how we view mass shootings and gun violence as a public health emergency. It emphasizes that this has been going on for a while, and that it is unique to the U.S.A., and that it has become "normal" for us.

It also puts policymakers back on the hook. If guns were truly an epidemic, that could imply that they didn't have time to address the issue yet. In fact, that is decidedly incorrect. They could have done something long ago to solve this pervasive public health emergency, but they haven't.



Tuesday, October 13, 2015

This year's Nobel Prizes have coincided beautifully with our Introduction to Global Health syllabus...

This has been quite the coincidental year of Nobel prizes. The morning we started our unit on neglected tropical diseases, the Nobel in Medicine was announced. Two days before we start our unit on the socioeconomic determinants of health, the economic sciences prize was announced. 

First, William Campbell, Satoshi ┼îmura, and Youyou Tu won for their deeply important work in treatment of parasitic worm infections (Campbell and ┼îmura) and malaria (Tu). In our Intro to Global Health class, we got to talk about how, in most cases, treating these parasitic diseases is actually quite straightforward (thanks to the work of these researchers). The challenge remains with scaling-up access to treatment. Thankfully, treatment and prevention (generally) require quite similar interventions in the case of neglected tropical diseases (NTDs). There are still technical challenges, especially with growing resistance of Plasmodium (the parasite that causes malaria) to various drugs, and with the spread of some NTDs to places where they aren't (originally) endemic (Chagas disease and Dengue fever, for example). However....in most cases, these horrible diseases can be treated, thanks to these Nobel Laureates in Medicine, and others! This fact was frequently discussed as a reason to be optimistic by my students in their midterm essays. 

On Monday, the Nobel committee just recognized Angus Deaton for his work in increasing our understanding of consumption behavior using micro-level data (in contrast with aggregated data on economic indicators, like GDP). My students just read his PNAS paper "Health, height, and development" for our nutrition unit, as a counter-argument to what I'm always telling them, which is that increased income = better nutrition. As always, Professor Deaton - being the ultimate health empiricist (at least, from an economics standpoint) - makes us look closer at the data to see that the income-nutrition relationship is not as clear as it may seem! What an excellent recognition of empiricism, and of applied health economics. I think Professor Deaton would be optimistic too - just like many of my students - about the state of and trends in global health. 

I'm lucky that this year's Nobel's seem to coincide so nicely with our topics in the Global Health Studies program. It can lead to some interesting discussions in class, and I hope it helps convince students that this is a useful and productive area of study and practice!