Talking About Health; Why Health Communication Matters

What happens when mothers talk to daughters about HPV vaccines?

January 6, 2011

This will not be the first time I have focused on HPV… In fact, about a year ago, I posted on this topic. Today, I want to mention that Janice Krieger and some of her colleagues at Ohio State published an article in Human Communication Research about the importance of mothers talking to daughters about HPV [http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2958.2010.01395.x/abstract]. Another article published in the Spring of 2010 has similar conclusions [http://pediatrics.aappublications.org/cgi/content/abstract/125/5/982].

Mothers’ confidence about talking to their daughters about HPV — believing that they had knowledge and could answer their daughter’s questions — had an important effect on the likelihood of talking. Also, mothers’ belief that the HPV vaccine is an effective response in preventing cervical cancer motivated them to have these conversations. Both findings emphasize the need to communicate about HPV and the HPV vaccine to form knowledge. The findings, as the authors note, also bring to light a need to observe these actual conversations and their effects. For example, mothers may talk about HPV as being a common and easily transmissible virus. Or, mothers might say that HPV causes cervical cancer. The latter might lead daughters to assume that brothers and male friends are not at risk for HPV. That would be an inaccurate conclusion.

puzzlepic3 I have a granddaughter who is seven years old. She happens to live in Texas. This is one of the states that considered making the HPV vaccine mandatory in order to be in public school [http://politifact.com/texas/statements/2010/feb/06/rick-perry/perry-says-hpv-vaccine-he-mandated-would-have-been/]. It didn’t happen … for various reasons. For one, the vaccine is really a series of three shots — not one. The cost for the three shots is about three hundred dollars [http://cancer.about.com/od/hp1/f/hpvvaccinecost.htm]. Time and money… and debate about sexuality.. and religion… then there is the belief that government should not mandate anything… How do we communicate strategically to build mothers’ confidence to talk about those things? And what do we say to boys as well?

http://www.nytimes.com/2010/10/29/us/29vaccine.html

What if… I only had a short time to live?

January 5, 2011

I added a blog link today. It goes to my sister’s blog. She started it as she faced disturbing mammogram results this past fall. Disturbing? Well, what do we say in communicating about test results that lead to more tests and raise lots of questions about the meaning of what they find?

Isn’t this yet another reason why it is so hard to talk about our health? It raises the truth before us that life as we know it is a timebound condition. And so, rather than talk about it, we avoid talking about it.

In the midst of health care reform, conversations about the cost of end-of-life care and failure to make end-of-life decisions about when to terminate care emerged. And they reflected that all too often, we don’t have these conversations. All too often, the pat phrase is, ‘do all you can…’ And that is one way to avoid thinking about ‘what if… I only had a short time to live…’

Why is it hard to talk about our health?

January 4, 2011

A new year. After trekking from PA to Texas, I feel … excited about the year ahead. Yes, I sat in the airport with John on our journey to and from for many hours more than we expected to linger. Yet, through all of the waiting, it was remarkable to see all the families and all the strangers just working together to get along. Not that there weren’t frustrations. We saw one father, mother, and teenage daughter who just missed a connecting flight… as in, the plane was still sitting just outside the big plate glass window but had already closed the door.

girlpups1 I noticed something during the waiting in the airport. Whether I wanted to eavesdrop or not, the crowded conditions and the accessbility of cell phones presented me with endless conversations among family members. Mostly they were keeping each other posted on flight delays and revised plans. But in so many cases, there was talk about how someone in the family was feeling now or whether someone in the family was well enough to be present for the holiday or if there was any news about a loved one’s recovery. In one case, a distressed young woman was talking to someone close to her about a mother’s drug and alcohol recovery. We got up and moved out of the mass of people in this case to avoid hearing so much of what was clearly painful to her. She moved as far as she could from the throngs. But there was just only so much space.

It’s personal. That is why it is so hard to talk about our health… and yet, that is why we must…. In this new year, we will take a closer look at some of the ways we can cope with talking about our health when it is… personal.

If you are driving or traveling during the holidays, do you know you are at risk to form blood clots?

December 20, 2010

119_1944a3 Tens of thousands of us develop blood clots each year. Sometimes, they start as a pain in your thigh. Often, the cause is too little movement for too long a period of time. Hence, the need to take breaks and walk around if you are traveling in a car. Get up and move about on the plane or train or bus. Stretch your toes forward from your ankles when you are sitting and then pull your toes back. Repeat half a dozen times.

Stay hydrated. Drink water and not alcohol. For more advice about traveling and blood clots, visit http://www.mdtravelhealth.com/illness/deep_vein_thrombosis.html.

AND, talk to your family about this. Ask, “has anyone had a blood clot?” Your family history may predict greater than average risk. All of us need to avoid cramped spaces and long periods of not moving around. Some of us may have a family history that suggests we should be tested for genetic contributors to clotting. You won’t know if you don’t…ask.

Have you gotten your flu shot?

December 6, 2010

A couple of weeks before setting out on the Thanksgiving trip to hike in the New River Gorge area and dine with family at a bistro in Asheville, North Carolina, John and I got our flu shots. This year, the shot combines the swine flu shot with the ‘regular’ flu shot so that you will not be offered two…but instead get two for the price of one. I hadn’t paid much attention to this fact until arriving for the appointment to get the shot.

I have adopted the view that getting a flu shot is something I should do, even though I find that end up with a bruised arm that I can’t sleep on for a couple of days. I do it because I teach a lot of college students who come and go from their hometowns across the northeast and beyond, and they work in area establishments with many customers. So, protecting me and protecting them…the public good angle of public health discussed in the book.

How does informed content about the flu vaccine work for you when you get the flu shot? For me, it went like this. Here is a form for your to read whenever you have time and want to. Are you allergic to eggs?

Vaccine information sheets are not quite the same as informed consent documents for surgery. We don’t have to sign a vaccine information sheet. Why? I suppose because so often, shots are being given to lots of people in a small span of time.

Perhaps because shots are given by so many different types of health care staff and a wide range of questions might be asked, making it hard to provide training for responses. And, shots are supposed to benefit the public in general. So, identifying the possible risk of receiving a shot–such as being allergic to eggs and the flu vaccine–becomes a shorthand method of informed consent.

Recently, there has been some effort to encourage those with egg allergies to talk with their doctors about the flu vaccine. An article on Science Daily discusses the issues [http://www.sciencedaily.com/releases/2010/10/101018121440.htm]. Take a look…

Why does Grandma’s green bean casserole get a failing grade from Dr. Oz?

November 23, 2010

It’s that time of year again. The time when family and friends gather to eat together… with all kinds of traditions coming to the table. And when I can count on at least one person calling me ‘the food police’ either directly to my face or in a more subtle way, “Watch out, the food police have arrived.” Subtle, yes? 118_1818

I find that talking about food, nutrition, and healthy eating is one of the most difficult topics to discuss with family and friends. Especially during the holidays. I loved it when Dr. Oz provided an example of ‘A’ through ‘F’ graded categories of green beans on his show this week. The best grade went to fresh green beans which earned an ‘A’. Next came frozen green beans, earning a ‘B’. Then there were canned green beans, netting a ‘C’ grade. The ‘D’ grade was for processed green beans. We’ve all seen the three bean salad in a can, for example. Looking at the label, one quickly sees how many things got added to that can besides green beans and water. And then there was the ‘F’ grade assigned to processed green beans cooked into nearly unrecognizable casseroles with other highly processed ingredients, such as canned mushroom soup with enough salt content to last a week, and processed onions that do NOT look like onions even after floating in the casserole bowl with enough moisture to plump anything that has any chance of coming back to life if only enough water is added.

So, no, food police I am not. I just like fresh green beans, fresh cranberries, a fresh green salad, freshly baked bread, and freshly baked pies… even a fresh turkey when it is an option. I still may overeat, but I won’t feel like a chemical factory has been preserved inside my stomach when I am done. Cheers to giving thanks and enjoying the holiday with friends and family…

Why does Vicks vaporub say for ‘external use only’ on the warning label?

November 22, 2010

I took my plastic bag and whipped through my medicine cabinet, laundry room, and kitchen over the counter medication shelf. We were discussing warning labels in my undergraduate health communication class, and I use products from my home to have students identify the parts of the warning as we discuss the content and what the research says about the likely effects.

Several products say, ‘for external use only.’ One says to avoid use on the lips. The latter is a product called ‘bite-aid’ and it comes in a chapstick kind of container. I told the story about sitting in the airport and reaching into my purse for my chapterstick, feeling the ‘bite-aid’, and applying it to my lips. It didn’t take long to feel like my lips were swelling. I told my class about how I asked my husband if my lips were swelling. I told him how odd they were feeling after putting on my chapstick, which I held out to show him. Still not realizing that I was not holding out my chapstick. He took one look and said, ‘That’s not your chapstick.’ With surprise, I looked down, read the label, visited the bathroom and scrubbed my lips–which soon returned to feeling normal.

“That,” I told my class, “is an example of a potential harm related to a product that could be solved with different packaging.” As I noted, “I didn’t intentionally put it on my lips, so even though the label says, ‘do not use on lips’, that content didn’t really help in my situation.”

One of the student’s then told about how the Vicks vaporub said, ‘for external use only.’ “My grandmother always made us eat a tablespoon of it when we were sick,” she said. I hardly knew what to say to that. “Why?” I asked. “Because it is for your chest cold and that is how to get it in your chest.” I was quiet as I thought about that. “It works,” she said.

Another product a student had was benadryl gel. The label also said, ‘for external use only’. The student observed, “That’s probably because you usually take benadryl as a pill… and this liquid looks like you could put it in a spoon like cough syrup. So I bet some people have done that.”

Warning labels have content that may help us avoid harm…if we read them. …and they make sense.

What does Barbra Streisand’s new book have to do with communicating about women’s health?

breastexam02 November 18, 2010

Barbra Streisand and Robert Redford appeared on Oprah’s show this week…the first time they appeared together. And Barbra talked about her new book, My passion for design. She told us all about how some of the proceeds will be used for women’s heart health. She is supporting Cedars-Sinai Women’s Heart Center. You can read more about the center at http://www.discoveringforlife.org/whc.

Barbra asked Oprah if she realized that more women die from heart disease than cancer, and Oprah said, “yes…” with a smile and a comment about how it has been discussed on her show before. Barbra said it was news to her and that the idea that there is so little research that has been done with women about this issue was something she wants to change.

I was thus reminded of the past several posts in which this issue has been discussed and that we need to do a better job of communicating about the status of health science. More women need to understand that too few of us participate in medical research. Barbra Streisand is helping to increase awareness by talking about this reality.

But taking it one step further, even when research has been funded and could include women, women may not participate because families and jobs make it seem nearly impossible to do so. We need our families and our employers to support our participation. We need to ask them to support our participation. If not us, who will do it?

I have participated in clinical trials a couple of times as I describe in my book, ‘Talking about health’. I was asked to participate in research relating to the use of surgery for endometriosis. I felt that I could not say ‘no’ when I am always promoting participation to others and when I am always asking people to participate in my own research. But I had some questions and some concerns. I wanted to know how my privacy would be protected when researchers were looking at my case and seeing the laser treatment being used for my endometriosis. breastexam011

I asked questions about my concerns. I learned that the recorded images would be of the internal activities, so my body as I know it was not going to appear on anyone’s screen. That was reassuring to me. I had several other questions as well, and asking them made me more comfortable with the idea of participating. In fact, now when I have a diagnosis that is a chronic condition, I ask if there are any reseach studies going on that I might be able to participate in. I hope you might consider talking to your doctors about medical research and how you might be involved as well…

What does health policy have to do with communicating about health?

joy-in-boat-hoc-2009 November 16, 2010

Product recalls. Nutrition labels. Informed consent documents. Patient package inserts. Lots of people spend a lot of time designing these messages. Yet, research shows that far too often, no one reads them. Of course, one reason we don’t read them is because the print is so small, we need a magnifying glass to see what it says. Other times, we take for granted that the product wouldn’t be available if it was going to be harmful. Still other times, we need to add up the content of product labels to know how much we are really getting. Too much of an ingredient, such as aspirin, can cause serious health problems and may occur because aspirin is included in creams being used for joint pain or products being used to treat cold symptoms or any number of other combinations of things being used that individually do not pose a risk but combined can even be deadly.

parrottch5fig2 Warning labels provide another way that policmakers are trying to assure that we have information to protect our health. Warning labels are designed to get our attention with a signal work about a hazard: caution, danger, or often–warning. The label also includes a statement about what makes the product risky. For example, if it contains alcohol, then it may be flammable. If it contains an herb, it may interact with prescribed medication or the drug to be used for your medical procedure. The label may also include a way to avoid the harm, such as talking with your doctor about using the product. And it may include content about outcomes that could occur, although these may be worded abstractly, such as–“adverse reaction”–meaning what exactly?

In the end, it is still up to us. Policies give us the chance to gain some information. They can’t make us read the labels and use them to make decisions…

“Women’s” Reproductive Health–What’s Wrong with This Expression?

156_09041

November 2, 2010

Yesterday, I asked my undergraduates in a health communiction class that question. And I got…nothing in response. “Really?” Almost a whole semester of conversation about how we communicate about health, beginning with a discussion about “science” as a starting place for what we “know” and talk about when it comes to health, and — nothing?

Celeste Condit and I talked about this issue in our book, “Evaluating Women’s Health Messages,” and I continue the discusssion in the chapter devoted to, “What’s politics got to do with it?” in my book, “Talking about Health.” The bottom line: Groups of activists have been working to expand attention and information about health care for women since the birth of the contemporary women’s movement. This contributed to the formation of the Office of Research on Women’s Health.

A Women’s Health Caucus formed in Congress and a woman-oriented political task force led by Representatives Patricia Shroeder and Olympia Snowe, and Senator Barbara Mikulski published a report on women’s issues. Five criteria were use to categorize a health conditon or disease as a woman’s issue for funding purposes: unique to women or some subgroup of women; more prevalent in women or some subgroup of women; more serious in women or some subgroup of women; one for which risk factors are different for women or some subgroup of women; and/or one for which interventions are different for women.

These criteria emphasize women’s reproductive health, the most apparent area where women differ from men. Reproductive health issues are important to women. However, these are not the only health focus that demand attention with regard to women’s health. And the flurry of research about women’s reproductive health also breeds a paradox for men: men have babies, too. A focus on women’s reproductive health ignores the interaction of effects owing to the father’s behavior. It may in fact perpetuate knowledge gaps and a sense of confusion about what is missing in the expression…”women’s reproductive health…”