Invisibility and Lesbian Health

One size does not fit all. Even when we evaluate trends within a given group, we need to deduce what are the individual traits of the person in front of us and what are the population trends that we need to be aware of when assessing support structures, risk and treatment options.


Littlest Pride J.Foster 2008

 Lesbian women, similarly do not fit any one socioeconomic class, ethnicity or educational status. They are young and old; majority and minority; affluent and poor. Although media images of Lesbians may portray stereotypic images of androgenous women (and some are), others are not. So, you can't just 'tell by looking at her.' Rather you need to create a safe clinical space to enable her to tell you about herself and who is important to her and her life.
Lesbian's health risks can differ from heterosexual women.
Would you ever ask a heterosexual woman when she 'came out' as heterosexual?
Sexual minorities have barriers to health. These include: discrimination, presumed heterosexism, lack of inclusivity in environment/language/forms. 

ENVIRONMENT
FORMS When a Lesbian woman sits in a waiting room, surrounded by images of happy (heterosexual) couples, the visual impact is not inclusive. When her first visit form gives her the option of "Single"; "Married"; "Divorced" "Widowed."What are her choices? She can leave it blank (and be treated as single, even if this is not accurate.) She can check off married as she has been in a monogamous relationship for 20 years. More likely than not, if she opts for the latter, the health care provider in their perusal of the form will say: "So what does your husband do?" So now - she comes out and risks a distancing response by the clinician or she is forced to create a story that colludes with presumed heterosexuality. Creating a condition that forces lack of authenticate communication is not the best start to a clinical relationship.

MORE THAN YOU So you may be saying that you are hip to inclusive language (who helps you? who all lives at home with you? Who do I need to include in your care and what connection are they to you?) But it is more than you. You may terrific, warm, sensitive and inclusive - but they have to get to you. So part of being a responsible clinician is being responsible for oversight of your environment. Snickers or disrespectful treatment of patients by staff have to be addressed and potentially in-service/staff trainings on quality care delivery need to include LGBT issues.
MISPERCEPTION OF RISKS BY PATIENTS AND CLINICIANS
PATIENT CENTERED Lesbian women may not be accurate in assessing their health risks. For example, despite statistics that most lesbian women (2/3-3/4) have had sexual intercourse with men (and therefore have similar risks to heterosexual women.) Many Lesbians feel that they have minimal risk for STIs and for screening studies. Thus, they don't come into care for regular preventive visits.

INVISIBILITY Clinicians might 'miss' risks if they don't know that the woman is a Lesbian. Unclear many other minorities with whom the visual at least generates a question, Lesbian women look like heterosexual women. Additionally, they may feel that it is none of our business (their sexuality) and not include it in their health information. Assessing a support structure is essential when dealing with health issues (who will take to the test? who else should be in the room to hear this in order to reinforce/ decode/support you?)  Thus understanding the context of a patient's world and who they are and identify as is important if our goal is excellent care for all.
SPECIFIC HEALTH CONDITIONS AT HIGHER RISK Health specific conditions of note include cancer, cardiovascular disease (as a result of suboptimal weight and smoking), delay in health screening, Breast cancer (both from higher risk factors and fewer screenings), depression, anxiety, smoking, heart disease, uterine cancer, obesity (and therefore obesity related cardiovascular disease), alcohol abuse  They may be at higher risk of unabated estrogen related cancers if they are nulliparous (uterine, breast, etc.)
SEXUAL HEALTH PRINCIPLES Remember that there are three important domains to consider when understanding sexual health: orientation, identity and behavior. Orientation: to whom do I gravitate to/ sexual attracted to; Identity: who do I say I identify as; Behavior: what exactly do I do and with whom. We've discussed how these three elements are not concordant (a patient - can have an orientation but not identify as such;can have an identity but not have concordant behavior; can have a behavior but not feel that this relates to identity) There is an arcane term of sexual preference which many people in the non-health arena inaccurately use interchangebly or substitute for orientation. Orientation of sexuality for all people (and creatures) has an neural basis, so it is the preferred medical description. Preference implies that behavior is rather capricious (e.g. I'd like strawberry ice cream, no, vanilla.) We are all socialized in a heterosexual environment. I have yet to meet a person who wants to have discrimination or barriers.

QUICK SAFE SEX TIPS: HPV is a STI (as well as Chlamydia) that is found among women who have sex with women. So first, we need to advise women to wash up (as is true actually with everyone!). Hand washing is important in safe sex. Cleaning sex toys or using condoms and/or dental dams is also important. Lastly, getting regular health maintanence visits to be promote wellness is important. There are a number of resources for Lesbians to identify high quality respectful clinicians. Some cities have Rainbow Health Pages; resources can also be found on the Internet. There are national groups that promote Lesbian Health like our friends at UCSF Lesbian Health & Research Center

Updating our discussion on health issues for women who are lesbians, here's some additional resources.
JAMA September article mentioned - across the U.S. in med schools the coverage is low and variable in nature.

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Institute of Medicine 2011 Report available here

and the previous Lesbian Health IOM Report available here 

Is Body Image Protected in Lesbian Relationships?  Romantic Relationships and Body Image - Lesbian women are not 'protected' by body image issues by being in a relationship and are influenced by their self-perception; their perception of their partner and their partner's actual opinion of their body (image) (Markey, Markey, & Birch, 2004; Markey & Markey, 2006) and Markey, P. M. & Markey, C. N. (2011). The complementarity of behavioral styles among lesbian couples. Manuscript under review


Other web resources:
Gay and Lesbian Medical Association: http://www.glma.org/

Gay Mens Health Crisis (GMHC): http://www.gmhc.org/
CDC Gay and Bisexual Mens Health: http://www.cdc.gov/msmhealth/http://www.cdc.gov/msmhealth/


Lesbian Health and Research Center (UCSF): http://www.lesbianhealthinfo.org/http://www.lesbianhealthinfo.org/


LGBT Aging Project http://www.lgbtagingproject.org/


Lesbian and Bisexual Women’s Health Fact sheets (DHHS): http://www.womenshealth.gov/


American Public Health Association LGBT Initiatives (APHA): http://www.apha.org/about/Public+Health+Links/LinksGayandLesbianHealth.htm


Gay and Lesbian Advocates and Defenders  http://www.glad.org/
  New England Legal Advocates (lists laws and topics by state)


Makadon H. Improving health care for the lesbian and gay communities. New England Journal of Medicine 2006, Vol. 354 (No. 9), pp. 895-7.
 Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health 2010. Vol. 31. pp 457-77.


Coren JS, Coren CM, Pagliaro N, Weiss LB. Assessing your office for care of lesbian, gay, bisexual, and transgender patients. Health Care Manager 2011. Vol 30 (No. 1), pp 66-70.


Dowshen N, Garafalo R. Optimizing primary care for LGBTQ youth. Contemporary Pediatrics, October 2009, pp. 58-65.


Kann L, Olsen EO, McManus T et al. Sexual Identity, Sex of Sexual Contact, Health-Risk Behaviors Among Students Grades 9-12 – Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. MMWR, June 10, 2011, Vol 60, No. 7.


Katz K. Health Hazards of “Don’t Ask, Don’t Tell”. New England Journal of Medicine 2010. Vol 363 (No. 12), pp 2380-1.

WHERE TO BEGIN? Figuring Out What You Don't Even Know That You Don't Know?

It is pretty easy to feel comfortable with what we know. It is equally comfortable (especially in an insatiably curious person) to be comfortable asking lots of questions about a topic that we are aware we don't know enough or have enough knowledge (aka a 'Wiki dip' to answer a question).

But how do we get an inroad to asking a question when we haven't yet thought about it? When we don't even know that we need to know about it?  It is a huge challenge. The only approach I have come up with thus far, is to intentionally expose yourself to diverse experiences - stream a video on a topic or area you know little about; read a book (or even a blog!) on a topic that you stumble upon; go visit an art exhibit on a style that doesn't grab you; visit countries and work on gaining a different perspective.

So here'a health literacy example, I came upon while delivery a community engagement workshop that highlights 'knowing.' In our Philadelphia Ujima Network, we have the honor of training lay health ambassadors. These women and men are the informal opinion leaders and experts on health in their community based groups(faith based, social service, educational, etc.) Our training sessions happen on Saturday mornings and we have highly interactive sessions to learn things like "Know Your Numbers and Your Health." In one of these sessions, we were discussing heart health risks and hypertension. As I spoke to the group, I became aware that 1) they knew many people with hypertension; 2) they had heard 'a lot' about it; 3) they were aware that it was a very prevalent condition (HTN). But here is where they didn't know what they didn't know.

Because of health outreach successes of others, almost every knew that high blood pressure was associated with the reading of 140/90. But here was the gap. What hadn't been conveyed effectively was that this number represented the 'admissions ticket' to a diagnosis of hypertension,  instead of the audiences' interpretation on this number. Most of the group believed that controlled blood pressure MEANT a bp of 140/90 (or 'near that, 150/100'!). When I clarified that the target BP control range (at least) was 120-134/70-84, many were shocked. "How can you have that blood pressure if you have High Blood Pressure?" one asked.  "By taking medications," I responded. It was new news to the group - something they didn't know (that they needed to know), that good control of BP had readings that were the same as someone who didn't have High Blood Pressure. We didn't even get to the lower numbers needed if you also had Diabetes.

It made me wonder, from a literacy perspective - do we confuse people by accepting the common phrase of High Blood Pressure instead of Hypertension? (e.g. If you have High Pressure (this condition), how can it be low  or normal?)

Every opportunity to teach, we open ourselves up to the gift of learning.

Stimulating questions of the unknown, reminds me of the saying that when you learn a little about a topic, it is not too dissimilar to lighting a match in a huge auditorium - you become aware how little you know and how much more you need to know.

Gaining experiences that engage us in the uncovering of what we don't know and haven't yet thought of asking about, increases the number of matches we hold!

RESOURCES:
Health Literacy •Ask Me Three click here
•Teach Back Technique in Removing barriers to safer care. Health literacy and patient safety. Help patients understand. Manual for clinicians. Weiss, B. AMA Foundation
•Institute of Medicine (2010) Safe Use Initiative and Health Literacy: A Workshop. National Academy Press. Washington, DC.

READ MORE: A very interesting blog to read more on Knowing and Not Knowing:  
Atherton J S (2011) Doceo; Knowing and not knowing [On-line: UK] retrieved 23 February 2012 from http://www.doceo.co.uk/tools/knowing.htm #ixzz1nFFYq2B6  Under Creative Commons License: Attribution Non-Commercial No Derivatives

ASSESSING RISK AND STILL PROMOTING HOPE FOR THE FUTURE

In Medicine, we are taught to assess risk. To identify factors that make a condition more or less likely. It is akin to a detective novel. Uncovering and eliciting information to put together a high, medium or low risk for conditions. It enables us to generate our differential diagnosis - the list of most to lesser likely items associated with a symptom.

Risk assessment is not an emotional charged process for the assessor.

Pulling out the Framingham risk factors for heart disease and assessing becomes a memorized habit. Switch seats and it becomes an entirely different experience.

Patients often say that they'd rather not visit their clinicians office because we will 'find something' (wrong) with them.

In fact, in lifestyle and disease prevention, in history and laboratory screening - we do just that. But it is important for the assessment to not stop there. We have a role in assessing what is right as much as what is not. The twice weekly exercise (in contrast to none) needs to be identified and lauded, for example. Dr Bloom's Trauma model talks about SELF - safety, emotions, loss and future. Without future, there is no healing from trauma. As we 'do our jobs' and identify health risks, patients can feel traumatized. So we need to intentionally include optimism in the process.

During a Ujima Lay Health Ambassador training session, the participants brought this point home to me. We talked about risks associated with heart disease. As I went through the components (DM, HTN, premature heart disease, elevated lipid levels, smoking, etc.), the vibe from the group back to me was of being sad or overwhelmed. This made me mentally pause and reconsider how I was presenting the information. I paused in the laundry listing of 'bad stuff' to then start to highlight the impact of intervening in each factor. Inside of the runaway railroad train of bad stuff down to Heart Attack land, I covered one area at time and then talked about how, for example, quitting smoking, can decrease your risk.

Every time you have the privilege to teach, you can also have the opportunity to learn - another way of thinking, a question not yet considered, the impact of your information.  The group enabled me to truly appreciate how the automatic nature and the speed of risk assessment can adversely affect hope for the future. And if hope for the future is annihilated, the likelihood of intentional action for behavior change is too.
 

So my take home with this is that despite time constraints to quickly deduce and figure out risks, it is even more important in imparting hope for positive change when relaying this information to a patient. From risks to findings it important to put the data in a context that promotes understanding and change. For example - What lab value is abnormal? What does it / can it mean? What can I do about it?

Perhaps risk and hope are a yin/yang type of thing - highlight the change I need and support me to be optimistically ready to take action (and coach me to make the hard changes.) Either way, we need to have one script inside our heads and a different language of delivery to patients if we hope to have them a) come back and see us again :> and,  b) take action to promote healthier lives.

An Open and Fruitful Discussion

Hi All,
First off, kudos to Iris, Shayne and Yeshika for coordinating a terrific session last night. Also kudos to our panelists - Matt, Emily, Mo, Mike, Sarah, Drs Foster and Harris. Lastly, kudos to all the students who contributed to a terrific turn out for our discussion!
So, here's what I heard around which we had consensus:
  *We can gather together having different points of view and have a robust discussion about making a difference with our patients.
  *Docs should be skilled to deliver effective health and sex education to their patients (and parents.)
  *In ways small and large, there is a great interest in helping promote safety of children so that they have as many options available to them.
  *Lives of our patients may be very different than our own, so imposing our attitudes and expectations may not be a 'best fit.'
   *Patient autonomy and respect are important.
   *We can be respectful of difference in opinions but facts and opinions are two very different things and excellent clinicians based actions on evidence.
   *Free condoms never hurt!
   *Women's reproductive choices play an important part of their lives and are never a trivial matter.
Regrettably, we weren't able to 'solve' the healthcare delivery and finance problem in the time provided. We did have an engaging discussion about divergent opinions and varied viewpoints.

So from a least to most about getting involved or learning more - here's some after-care sites to check out:

THE NUMBERS: Numbers and trends of abortion
*Abortion is one of the most frequently performed procedures in the U.S. Abortion rates have steadily declined since the procedure was legalized in 1974; however, the rate of decline has been slowing down since 2000.

*Of the 49% of unplanned pregnancies (2001), 24% ended in abortion (this number excludes miscarriages)
*This 24% consisted of 16% of currently married, 16% formerly married and 67% never-married women.
*61% of abortions were obtained by women who have one or more child
*The majority of women who obtained an abortion (54%) were using some type of contraceptive method (that failed due to inconsistent or incorrect use) 13-14% (pill vs condom) uses reported correct use and method failure.


References Finer LB, Henshaw SK. Estimates of U.S. Abortion Incidence, 2001–2003. Guttmacher Institute. August 3, 2006. Available at http://www.guttmacher.org/pubs/2006/08/03/ab_incidence.pdf. Accessed September 09, 2006.; Jones RK, Darroch JE, Henshaw SK. Patterns in the socioeconomic characteristics of women obtaining abortions in 2000–2001. Perspectives in Sexual and Reproductive Health. September/October 2002; 34(5):226–235. ; Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.; Jones RK, Darroch JE and Henshaw SK, Contraceptive use among U.S. women having abortions in 2000–2001, Perspectives on Sexual and Reproductive Health, 2002, 34(6):294–303.
*ABOUT 1/3 - An estimated 35% of women will have at least 1 abortion by the time they are 45 years old.
Reference  Boonstra HD, Gold RB, Richards CL, Finer LB. Abortion in Women’s Lives. New York, NY: Guttmacher Institute; 2006.

OVERALL DOWN TRENDING RATES

References 
Finer LB and Zolna MR, Unintended pregnancy in the United States: incidence and disparities, 2006, Contraception, 2011, doi: 10.1016/j.contraception.2011.07.013.

Jones RK and Kooistra, K., Abortion incidence and access to services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41-50.
*Abortion rates are trending downward - The CDC reported a 2% drop in rates (see here)
A number of factors contribute to the overall decline in abortion rates in the US:   1. More and better contraceptive options; 2. Increased and improved contraceptive use, particularly of long-term contraceptives;     3. Decreased access because of fewer providers and/or anti-choice harassment and stigmatization         (This study did not delineate differences in age, income levels or other factors)
References  Finer LB, Henshaw SK. Abortion incidence and services in the United States in 2000. Perspectives on Sexual and Reproductive Health. January/February 2003; 35(1):6–15.

*AGE RANGE FOR HIGHEST RATES: 56.9% of abortions occurred in women ages 20-29 (29.4 abortions per 1,000 women aged 20--24 years and 21.4 abortions per 1,000 women aged 25--29 years).

TEEN DATA
Eighteen percent of U.S. women obtaining abortions are teenagers; those aged 15–17 obtain 6% of all abortions, teens aged 18–19 obtain 11%, and teens younger than age 15 obtain 0.4%
In contrast to the overall unintended pregnancy rate of 49%, teens unintended pregnancy rate is 82% with 40% of these ending in abortion.
Reference   Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010; Finer LB, Henshaw SK. Disparities in Rates of Unintended Pregnancy In the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health. 2006; 38(2):90–96.

PARENTAL NOTIFICATION AND IMPACT - Fear is a health hazard for teens

Parental notification laws have a negative impact on adolescents’ access to reproductive health care.


According to the American Medical Association and the Society for Adolescent Medicine, the primary reason that adolescents often do not get the health care they need is that they fear disclosure of confidential information to their parents or guardians.

A regional survey of suburban adolescents found that less than 20% would seek care related to birth control or STDs if parental notice was mandated.

Another study found that 59% of sexually active adolescent girls would stop, delay, or discontinue using specific sexual health care services if parental notification were legislated.
References   Lieberman D, Feierman J. Legal issues in the reproductive health care of adolescents. J Am Med Womens Assoc. Summer 1999; 54(3):109–114.; Marks A, Malizio J, Hoch J, Brody R, Fisher M. Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population. J Pediatr. March 1983; 102(3):456–460.; Reddy DM, Raymond F, Swain C. Effect of mandatory parental notification on adolescent girls’ use of sexual health services. JAMA. August 14, 2000; 288(6):710–714


HEALTH CARE DELIVERY RE-INTEGRATION - A FOCUS OF CHANGES TO SUPPORT OPTIONS? "Most of the difficulties in providing and obtaining access to abortion services would disappear if abortion were integrated with other health care for women" 
Reference  Henshaw SK. Factors hindering access to abortion services. Family Planning Perspectives. March/April 1995; 27(2):54–59, 87.

This is a procedure that is part of comprehensive women’s health care - Perhaps the health care delivey change is putting it back into comprehensive care practice?

SAFETY ISSUES AND ABORTION - a complete listing of information is available from the Guttmacher Institute located here  Highlights include: highly safe procedure; no evidence of association between abortions and risk for any types of cancer; no hazard for mental health.

SOCIOCULTURAL DETERMINANTS OF HEALTH AND INEQUITIES
Poverty compounds sexual health educational understanding, resources and choices - abortion rates decrease across all racial/ethnic groups as income levels increase. (So maybe better educational systems and better jobs are one solution!)
Although women who are White have the lowest abortion rates, they also have the lowest pregnancy rates.
Reference  Jones RK, Darroch JE, Henshaw SK. Patterns in the socioeconomic characteristics of women obtaining abortions in 2000–2001. Perspectives in Sexual and Reproductive Health. September/October 2002; 34(5):226–235

CAUSES: So if we consider that we want to address root causes (the why) rather than the symptoms (the abortion) - what is in the literature about the causes and what can we do to address them?
TOP THREE
1- (74%) Not ready for parenthood and make changes involved (including employment and educational opportunities put at risk) and overall increase in responsibility
2- (73%) Can't afford a child - lack of economic support for a child (or another child)
3- (48%) Don't want to be a single parent or relationship problems (not in one, not want to marry or continue with parnter or he won't/can't marry or support her)
Additional reasons:
Does not want anyone to know she has had sex or is pregnant

Too young or immature to be a parent or carry the pregnancy to term
Does not want any more children; may feel overwhelmed and overworked
Partner, man involved in the pregnancy, or parents want her to have an abortion
The fetus has health problems or genetic abnormalities

Victim of interpersonal violence/sexual coercion, including rape or incest
Pregnancy may pose risk to the woman’s health

References Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives. Perspectives on Sexual and Reproductive Health. Sep 2005; 37(3).; Planned Parenthood. Choosing Abortion. New York, NY: 2006. Available at http://www.plannedparenthood.org/birth-control-pregnancy/abortion/choosing-abortion.htm. Accessed November 14, 2006.

So look at that list - what do you think needs to be in place to address the root causes?
If you go to an area school that has no books and are unable, even at graduation to read, what type of job can you obtain?
You may be saying that as a future physician - reading or public education isn't on your 'to-do list' - but maybe your voice can mobilize action and change.
What do you need to be doing to educate boys and men about what it means to be a man in our society?
How can you support economic empowerment so that individuals can garner a living wage and be able to support a family?
What messages do we need to be better at conveying about self-esteem? About protection of children from sexual assault? How can we provide meaningful information about real-world options to prevent the legacy of teen motherhood?
We need your ideas - your innovation - your time understanding the people who are disconnected from being as healthy as they can be. If we had the answers, in theory, we'd be done - we aren't. So....

So these all seem huge and daunting, I'm sure.
Here's some baby steps to take (from little to more :>)
1. BE INFORMED: Subscribe to, add to an RSS feed or regularly check out Kaiser Family Foundation Women's Health Policy located here ; CDC data here; Preventing Teen Pregnancy here  Read about What Can Be Done here

2. IDENTIFY USEFUL RESOURCES: Check out the CDC Adolescent Health site here; There is an amazing library of resources at CORE (Curricula Organizer for Reproductive Health Education) located here; A Philadelphia based awesome resource, Women's Law Project located here

3. FIND OUT WHAT YOUR FUTURE FIELD IS DOING IN THIS AREA - APA (Peds); SGIM (General Medicine); APGO (Ob/Gyn); AAFP/STFM (Family) all have information. Check it out and see how you can be involved.


4. FIND OUT OTHER ORGANIZATIONS like the Association of Reproductive Health Professional (click here) ; the Guttmacher Institute (click here); Our local family planning council has a wonderful list of resources here. Here's a site that's mission is to use the law to advance reproductive freedom as a human right (click here ); APHA and reproductive rights (policy statement here); Association of Clinicians for the Underserved (click here)

5. VOLUNTEER to get a better idea of the lives, circumstances and challenges (as well as strengths) of our patients (and future patients) Reflect on the causes noted above. Consider what interventions or changes you could create to make a difference.

6. MAKE TIME FOR LOBBYING TRAINING AND VISIT PEOPLE (Harrisburg, Washington, local offices, attend a town hall of someone running for election/re-election, your hometown...)




Together, we can come up with ideas and solutions that respect our patients and help them have more options in their lives while living healthier!

Skill Not Will - A CHANGE FOR THE BETTER

At the most recent Association of American Medical Colleges conferences, there was a presentation by Joseph Gerry from Vitalsmarts  who talked about research about behavior change.

BEHAVIORAL INFLUENCE IS FOUR TIMES THAT OF MEDS!
Mr Gerry cited an article by McGinnis (J.M. McGinnis, P. Williams-Russo, and J.R. Knickman, “The Case for More Active Policy Attention to Health Promotion,” Health Affairs 21, no. 2 (2002): 78–93.) that attributes 40% of deaths due to behavior. In contrast, medications, procedures, labs and tests only contribute 10-15%!

SOURCES OF BEHAVIORAL INFLUENCE  His theme for his presentation was about the six areas that need to be working to promote behavior change.

THE SIX SOURCES OF INFLUENCE

1. Personal Motivation – overcome your own reluctance and resistance
2. Personal Ability – learn how to master the necessary skills for success
3. Social Motivation – enlist help from leaders or other opinion leaders
4. Social Ability – leverage teamwork
5. Structural Motivation – reward your early successes 

6. Structural Ability – surround yourself with a supportive physical environment  

If you want to make change, you need to use four or more of these sources of influence to change bad habits. If you use all six, you can be 10 times more successful.
 
Per research from his organization, if a person has four areas working for them, they have four times the likelihood at making the change.
 
PRACTICING CHANGE - The average number of times you need to make the change (before it sticks) is 23!!
 
SKILL NOT WILL - Another area highlighted was that we overdepend on motivation ("If only I wanted that enough!") and under-rely on learning skills to promote change. He refers to this as the 'will power trap.' My this over-reliance we merely abuse ourselves (at our failures) rather than learn from our mistakes. The barrier to change is our blindness to this fact - not our motivation.  See the blindness video here or click below:

 
HOLD TWO VIEWPOINTS In the presentation, Gerry encouraged the audience to become "the subject AND the scientist." By identifying how I am excellent at avoiding exercise, for example, I have a long list of what doesn't work - what skills to not-exercise that I have. By writing them down, I can generate the skills I need in order to make a change.
Check out the Changeanything.com website with a custom change plan here.
 
SO WHAT DO YOU WANT TO CHANGE? Per Gerry - we aren't unmotivated, we are blind and outnumbered. So we have to first see what we are (and aren't doing) and identify the skills we need.
 
WHAT EXPERT SKILLS DO YOU HAVE IN NOT-CHANGING? (aka "I'm aware that ultimatums don't work for me'; "I'm excellent at procrastination) WHAT SKILLS DO YOU NEED?
 
DO YOU HAVE GOOD COACHES TO HELP WITH THE CHANGE? (OR DO I HAVE ACCOMPLICES INSTEAD OF HELPFUL FRIENDS?)
 
HOW DO I DRAFT A CHANGE STATEMENT (or personal motivation statement) AND FRAME IT IN A MODEL OF SOMETHING DESIRABLE?
 
I think that part of the success we've had within the Philadelphia Ujima Collaborative is that we include a number of the change factors.
 
To read more - Check out tutorial videos at change anything.com website 
 

From little time to more - Listing of opportunities for you

INVOLVED!!!!

Come spend time with us at WHEP.

1. Get information about a topic you are learning about or exploring. Just stop in - check with Winnie (wjones@drexelmed.edu) or Mikelle (mnickens@drexelmed.edu) and they can identify who can help you.

2. Access high caliber sex/gender health education materials. Again, stop in (228, 239) and ask!


3. Spend a session with us at the seminar series - topics are posted on the blog and emails are sent out to the classes. Just RSVP and show up. You can learn about an interesting topic, meet a future mentor, learn about access to clinical shadowing or research.


4. Drop by WHEP and let us know you are interested in community health education outreach. Set up a time to meet with Candace Robertson-James (croberts@drexelmed.edu) and join us as we go out to our partners.
 
5. Sign up for the Seminar Series elective - join us for the whole series and give us feedback on what you'd like to see in the next series.

6. Sign up to be a Scholar. Set up a time with Drs Kahng (kkahng@drexelmed.edu) or Núñez (anunez@drexelmed.edu)  to discuss your area of interest and set up a plan of attack to getting it done!

7. Get involved in work study or independent research. We are newly funded with our Philadelphia Ujima and in need of students (English and Spanish speakers) who are interested in children and adults to work with us in the Ujima collaborative. Just stop by and let us know!

8. Join us for the year in your senior year as a Pathway student. Selection time is February of your junior year.

HIV Virus May Hide in Brain

FRIDAY, Aug. 27 (HealthDay News) -- The brain can be a convenient hiding place for HIV, the virus that causes AIDS.
That's the finding of Swedish researchers who analyzed samples from about 70 HIV-infected patients who'd been taking anti-HIV drugs. The tests showed that about 10 percent of the patients -- a larger proportion than expected -- had traces of HIV in their spinal fluid but not in their blood.
Another study by the researchers found that 60 percent of 15 HIV-infected patients treated with medication for several years showed signs of inflammation in their spinal fluid, although the levels were lower than they were without treatment.
Anti-HIV drugs can prevent the virus from multiplying, but the virus also infects the brain and can cause damage if the infection isn't treated, according to lead researcher Dr. Arvid Eden, a doctor and researcher at the Institute of Biomedicine at the Sahlgrenska Academy at the University of Gothenburg.
"Antiviral treatment in the brain is complicated by a number of factors, partly because it is surrounded by a protective barrier that affects how well medicines get in," Eden said in a university news release. "This means that the brain can act as a reservoir where treatment of the virus may be less effective."
It is unclear whether small quantities of the virus in spinal fluid represent a risk for future complications, researchers said. Still, the findings indicate that "we need to take into account the effects in the brain when developing new drugs and treatment strategies for HIV infection," Eden added