Tuesday, July 27, 2010

Obesity as a Risk Factor for Early Sexual Debut in Young Adolescent Girls?

The topic of obesity in relation to adolescent girls and sexual activity first arose during a patient encounter of an obese 13-year-old girl, who was asking for birth control pills.  The family physician I was following, mentioned that recently, in the past few years, she has noticed that her overweight and obese adolescent female patients are having sex much more than her normal weight patients.  She prompted me to read an interesting article on the topic on Medscape Medical News, which is summarized below:
“In a recent study presented at the 58th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists by Villers, et al, showed that overweight and obese adolescent girls are more likely to engage in risky sexual behavior than their normal-weight peers.  The researchers evaluated data from the CDC’s Youth and Behavior Survey from 2003-2007 of 21,773 girls in grades 9-12.  The BMI was calculated using self-reported height and weight.  The study analyzed 6 different risky sexual behaviors such as whether or not the teens had sexual intercourse age at first sexual intercourse, number of sexual partners, condom use, and alcohol/drug use during their last sexual intercourse.  The results revealed that obese and overweight girls were more likely to have an earlier age of sexual debut, more sex partners, and were less likely to use condoms than their normal weight counterparts.”
During the women health discussion of the topic at DUCOM, it was noted that the study did not account for history of abuse, socioeconomic factors, and other factors such as self-esteem and depression.  Another interesting point is that obese and overweight girls reach puberty earlier than their normal weight counterparts.  More research needs to be done on why overweight and obese adolescent girls are more likely to engage in sexually risky behaviors than those are normal weight.  Childhood and adolescent obesity is a risk factor for many things from health related ailments to psychosocial limitations, and this recent survey adds to the list of the harmful effects of obesity.

-- Mimi Mak MS IV, adapted from Obesity a Factor in High-Risk Sexual Behavior in Adolescent GirlsMedscape Medical News , 2010-05-28

Thursday, July 15, 2010

Healthy nutrition - need to ask about access

When you ask about nutrition - you need to ask about access to food.

During your third year as a medical student,  caring for people in the Philadelphia area, you quickly realize that obesity, hypertension and diabetes are the norm. Diet has a big impact on these health problems.

As clinicians we instruct our patients to eat a healthy diet and maintain a healthy weight. When we advise patients in this way we assume that they have access to healthy food. The fact is that many Philadelphians do not have access to fresh healthy food.

In fact the recently proposed Food Desert Oasis Act of 2009 named Philadelphia as one of 20 “Food Deserts” in the US. This means that many of the people who we care for do not have access to fresh food, they many not live within a walkable mile of a grocery store, and may not have transportation to grocery stores in other neighborhoods. This problem disproportionally affects lower income and minority neighborhoods.

So ask!
Before you advise someone to eat more fruits and vegetables ask,
  1. Where do you get your food?
  2. Do they sell fresh food where you shop?
  3. Is it quality and affordable fresh food?
  4. Do you have affordable transportation to a grocery store?
Want to learn more about fresh food access in your neighborhood? Check out the USDA interactive food atlas.

Blog submission Alethia Donahue MS4 WH Pathway class of 2011
Photo credits: Homegrown tomatoes Alethia Donahue 2009; Saharan Beetle Juice A. Núñez 2009

Friday, July 2, 2010

Women's Health Ambulatory Experience

Many moons ago when we developed the Ambulatory rotation, we wanted to give seniors an opportunity: for 1:1 face time with mentors and role models; to learn practical issues on sex/gender health disparities and women’s health; to reflect on an (self-defined) interesting topic and become expert on it and; to see how health and illness fit together in the context of where patients live – in their communities. Toward that end the clinical piece, community piece and scholarly pieces were birthed.

Primary and specialty clinical care affords a basis for skills development and reinforcing issues about health promotion and disease prevention. The community piece is rarely (if ever seen) in training – it is the taken-for-granted-wallpaper, yet the context of care, the strengths that arise from families and communities are essential for optimal heath outcomes. Lastly, there is the scholarly piece. We wanted an opportunity for students to work on an issue that they care about or create something that they could be proud of (that was needed and useful!) Originally, it was a paper – a time to reflect on an issue or topic and demonstrate your thoughtfulness and analysis – not a book report or regurgitated list of facts. In time, students asked for an opportunity to ‘make’ something – a bulletin board; a presentation with a powerpoint; a brochure; a training experience on a topic – and now a women’s health education blog opportunity.

During your senior year, we value you as role models for years 1-3 and hope that (beyond Ambulatory requirements) that you will come to events and seminar series when you are in town.

Here’s some tips on getting the most out of your experiences

1. Think about what the clinician can teach you that you ‘need to know’; that would be useful

2. Generate objectives to see if it makes sense (to you and them)

3. Do a midpoint check in with Dr. Kahng or me

4. Think now about your paper or project (you can do it in advance!)

5. Consider what is culturally appropriate behavior in community outreach – what does it mean? What does it look like?

6. Decide what you want more information about (and ask about resources) so that you can get questions answered.

This experience is supposed to be organic - you need to let us know as we go, so we can continue to improve it.

Women's Health Pathway versus Women's Health Scholars and the Seminar Series

Happy Summer - such that it is, being in medical training! Let me clarify two different experiences house here at the Women's Health Education Program - the Pathway and the Scholars experience. The Pathway is open to rising third years/seniors and is an opportunity to spend focused time with us; do student-driven projects and become expert at sex and gender health issues within their specialties (and get aid/advice/support while getting wonderful residencies.) Pathway alumni include more than 70 women and men physicians - in fields such as Internal Medicine; Family Medicine; Ob/Gyn; Peds; Med/Peds; Neurology; Surgery (including Ortho and Urology); Radiology; Anesthesia; and Psychiatry. Our only requirement is the Ambulatory rotation (more on that later) We have eight awesome pathway students and anticipate a terrific year! Our first group meeting is July 20th. After we finish, let me know if you'd like to hang out - my house or elsewhere. I'm not posting any Pathwayer pictures (yet) since all  we have are you entering mug shots - so we'll get better ones on the 20th!

The Women's Health Scholars is an opportunity for all students. The eligibility to become a Scholars is 1)attendance at the majority of the Seminar Series (WHSS) sessions in year 1 and 2; 2) a community involvement activity and 3) a vetted scholarly project that must be completed (optimally in the third year) but no later than early fourth year - so that your Scholars designation can appear in the graduation program. Detailed requirements are here.

The Seminar series commences Sept 14th - but this year, we have a preview of 'Cool Stuff We Did At WHEP' from our summer and research students. Stay tuned for the date!