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Why the Use of Scare Tactics to Promote Sexual Health For Youth May Backfire

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Many adults do not like to think about youth engaging in sexual activity, but the reality is that the majority of young people have had sex before they graduate from high school. Exploring one’s sexuality is a normal part of adolescent development, but risks also accompany sexual behavior. Although people in American society have strong and divergent feelings about adolescents and sex, most will agree that research can and should guide efforts to help young people to stay safe and healthy as they navigate their journeys into adulthood.

Sexually transmitted infections (also called sexually transmitted diseases) are one of the most commonly diagnosed medical conditions in the United States. More than 110 million people in the United States live with such an infection. After years of decline, sexually transmitted infections are now on the rise, with young persons aged 15 to 24 disproportionately affected.

The good news is that many of these infections are curable, and all are treatable. However, if left undiagnosed, they can lead to serious conditions including infertility and cancer. In addition to their health toll, sexually transmitted infections also carry a financial burden, with $16 billion spent annually on treatment. Given such high costs, it is important for researchers to examine efforts to prevent sexually transmitted infections to ensure that they are implemented as effectively as possible. One approach questioned by research is the use of graphic pictures meant to scare young people about the suffering and disfiguration having a sexually transmitted infection might entail.

Sexually Transmitted Infections and Youth Education

The majority of young people in the United States receive school-based sexuality education, including information about sexually transmitted infections. Older adolescents may also get such instruction in collegiate settings, such as classroom-based health courses or at forums held in residence halls or fraternities. Often, instructors display graphic PowerPoint slides, initially developed for use in medical training, portraying real but atypical sexually transmitted infections that have led to visually disturbing symptoms such as severe genital warts.

Many sexuality educators have strong feelings about integrating such images into their programs. Educators who use graphic pictures feel that young people should be aware of potential consequences of unprotected sex, or of sex in general. They also want young people to be prepared to recognize sexually transmitted infection symptoms. But on the other hand, educators who do not use graphic images find them misguided, in that most sexually transmitted infections have no visible symptoms at all. What is more, these reluctant educators worry that graphic images may lead young people to think that sexually transmitted infections are rare, when instead they occur frequently in less visible forms.

Public health educators are expected to use evidence-based practices, but surprisingly, the impact of sexually transmitted infection graphic images on young people’s sexual health has been unknown until recently. While understanding the impact of these pictures may seem inconsequential, most people would never feel comfortable taking a medication if its efficacy had not been tested. The same standard should be used for public health interventions.

Pros and Cons of Instilling Fear about Health Issues

Scare tactics, also called fear appeals, are intended to make people think about the worst-case scenario that can follow from a problematic health behavior. The intention is to cause mental distress in order to prompt healthy behaviors that will minimize the health threat. Fear appeals are not new in public health; they have a longstanding place in health communication campaigns – such as the infamous, decades-old “this is your brain on drugs” public service announcements.

Research reveals mixed effects from fear-inducing strategies. A well-known large-scale study found that fear appeals can be useful at changing attitudes and behaviors when people feel susceptible to the health problem and confident in their ability to take action to prevent it. Yet for people who don’t meet these two conditions, fear appeals can backfire – indeed, such tactics can induce even more risk-taking behavior. Although this research is compelling, little attention has been paid to the ethical implications and potential unintended consequences of fear appeals.

A key issue is that many fear appeals portray possible but rare and unlikely maladies in ways that may mislead. People with sexually transmitted infections are more likely than not to exhibit no symptoms at all. Because educators are supposed to impart factual information, fear appeals pointing to atypical symptoms could be seen as deceptive. Fear appeals also put the full responsibility for decision-making on individuals without recognizing or working to change root causes, the underlying reasons why many people take health risks. This can be stigmatizing to already marginalized groups in society.

In 2016, I conducted an experiment with young people enrolled in a large public Midwestern university. Participants watched one of two randomly assigned web-based sexual health programs, one with graphic sexually transmitted infection images and the other without such images but otherwise identical. I then compared the two groups of participants to assess their knowledge, beliefs, and behavioral intentions related to sexually transmitted infections. Overall outcomes were the same, but when I asked participants to provide feedback, more than a quarter of those that saw the graphic images expressed disgust and dismay. These results suggest that presenting such images may prompt stigma – without having any health benefit.

What Now?

Because sexuality education is an important tool to help prevent sexually transmitted infections among young people, it is vital for programs to be crafted with great care. Given the mixed evidence, the use of graphic sexually transmitted infection images should be reevaluated. Parents, policymakers, and community members should learn more about what kind of sexuality education is being taught in local schools, and if scare tactics are used, assess whether they may be more harmful than helpful.

Alyssa Lederer is an Assistant Professor of Public Health at Tulane University. She is a behavioral scientist and health education specialist. Lederer’s interests focus on the design and evaluation of programs that aim to enhance the health of adolescents and emerging adults, particularly in school and collegiate settings. Much of her research has been on young people’s sexual health, physical activity, and nutrition, especially the intersection of health education and behavior change. Lederer also works to identify the most effective ways to prepare the future public health workforce. Lederer is a leader in the American College Health Association, including serving as the immediate past Chair of the Health Promotion Section.

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Health

Self Help Tips and Advice For Social Workers

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There is no denying the positive impact social workers have on hundreds of families and individuals throughout their career. They will tell you about the rewarding experiences they have helping others in need. Unfortunately, for every success, there is at least one case in which they could not help. Social workers see the best and the worst of society every day, and even the strongest among us can crack under the pressure. That is why self-care is so important. Being mindfully aware of your needs as well as the needs of those around you can keep you healthy and able to be there when you’re needed.

What is Self Care and How Can You Do It Every day?

Self-care is a practice that becomes a lifestyle. Understand and commit to the idea that it is not something you do once, it is something you do every day. The key is to be mindful and aware.

It is important to be mindful of where you are and what you are doing as you go about your day. Whether you are in a meeting or at the grocery store, notice how you are feeling in the moment. This can range from listening to your body and noticing your state of health to recognizing an emotional situation in your life.

Become aware of your breathing. When we are feeling stressed, emotional, or run down, we forget how to breathe. Our breath can become fast and shallow which deprives our bodies of the oxygen it needs. Pay attention to your breathing and focus on slowing it down. Allow the air to fill your abdomen, not just your lungs. You will find that mindful breathing exercises calms your thoughts, allows for greater clarity, and lessens your anxiety.

Now That You Are Aware, How Do You Improve?

It’s one thing to be mindful and aware of how you are feeling, but doing something about it is another matter. Improving your physical and emotional state requires some life changes as well.

Many social workers have the stress relieving habit of smoking or grabbing an unhealthy snack from the vending machine. It makes us feel like we’re taking a moment for ourselves. Instead of grabbing a cigarette or a bag of chips, try an e-cigarette starter kit or grab a granola bar. This gives you a moment away while making healthier choices through controlling the nicotine and sugar you intake. The idea is not to deprive yourself but to make small changes that will make you feel better over time.

Changing the way you approach daily tasks is another life change that will give you some added peace of mind. For decades we have been taught to multitask but all we’ve learned is how to start tasks but not finish them in a timely manner. By focusing on one task at a time you’ll allow yourself to finish a job before moving onto something else. This creates a sense of accomplishment and boosts your confidence at the job you are doing.

Maintaining Your New Found Awareness

Creating a support system is important when attempting to care for yourself. By relying on your friends and family you are willingly accepting love and nurturing that you simply cannot give to yourself. When meditating on an issue in your life doesn’t result in answers, one of the best things we can do is turn to our support system for help. It’s not necessary to face every challenge alone and often times, they can see from a perspective that you cannot. You may also find that the more willing you are to receive care from others, the easier it becomes for you to provide care for the people you’re working to help.

Self-care is difficult for those who spend their lives taking care of others. By allowing yourself the care you need you will find that it not only feeds your soul but it will improve your ability to care for the people around you.

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SNAP Benefits Aren’t Enough to Afford a Healthy Diet

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A new study from North Carolina State University and the Union of Concerned Scientists finds that the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, only covers 43-60 percent of what it costs to consume a diet consistent with federal dietary guidelines for what constitutes a healthy diet. The study highlights the challenges lower-income households face in trying to eat a healthy diet.

“The federal government has defined what constitutes a healthy diet, and we wanted to know how financially feasible it was for low-income households, who qualify for SNAP benefits, to follow these guidelines,” says Lindsey Haynes-Maslow, co-author of a paper on the study and an assistant professor of agricultural and human sciences at NC State.

This can be a tricky question to answer, as federal dietary guidelines vary based on age and gender. SNAP benefits also vary, based on household income and the number of adults and children living in the household. For the purposes of this study, the researchers used average monthly SNAP benefits for 2015.

To address their research question, the researchers looked at the cost to follow federal dietary guidelines based on the U.S. Department of Agriculture’s monthly retail price data from 2015 for fruits, vegetables, grains, protein, and dairy. They calculated costs under a variety of scenarios. For example, what would it cost to comply with dietary guidelines if one only ate produce that was fresh, not frozen? What if one only consumed fruits and vegetables that were frozen? What if a household followed a vegetarian diet? The researchers also included labor costs associated with shopping and preparing meals, based on 2010 estimates produced by other economics researchers.

“We found significant variability in the costs associated with following federal dietary guidelines,” Haynes-Maslow says. “For example, it was most expensive to consume only fresh produce, and it was least expensive to consume a vegetarian diet.”

To place this in context, consider a four-person household that has one adult male, one adult female, one child aged 8-11 and one child aged 12-17 – all of whom qualify for SNAP benefits. They would need to spend $626.95 per month in addition to their SNAP benefits if they ate only fresh produce as part of their diet. That same household would need to spend $487.39, in addition, to SNAP benefits if they ate a vegetarian diet.

“Many low-income households simply don’t have an additional $500 or $600 to spend on food in their monthly budget,” Haynes-Maslow says.

The researchers did find that SNAP is sufficient to meet the healthy dietary needs of two groups: children under the age of 8 and women over the age of 51. However, SNAP was insufficient to meet the needs of older children, younger women, or men of any age.

“Even though SNAP is not designed to cover all of the cost of food – it’s meant to be a supplemental food program – this study makes it clear that there would be many low-income households that would not be able to cover the gap needed to eat a diet consistent with federal dietary guidelines,” Haynes Maslow says. “Even without including labor costs, a household of four would need to spend approximately $200-$300 in addition to their SNAP benefits to follow the dietary guidelines.”

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12 Years After Fleeing Katrina, Family Displaced by Harvey Seeks New Life in Dallas

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Ashley Aples, left, speaks with his 8-year-old son Zion at an evacuee shelter at Kay Baily Hutchison Convention Center. Mr. Aples fled to Dallas with his family as flood waters from Hurricane Harvey rose around their apartment in Houston.

Flooded homes. People stranded on roofs. Rescue boats patrolling neighborhoods.

Ashley Aples saw the chaos and panic engulf Houston in just a few days, and he knew from experience it was time to flee. He did so 12 years ago when Hurricane Katrina ravaged his hometown of New Orleans and forced him to rebuild his life in Texas.

Now he and his family are rebuilding their lives again – this time in Dallas, with no plans to return to an area facing years of painful recovery from Hurricane Harvey’s historic wrath.

“We’ve seen it before; we know what this means,” Mr. Aples said from the Dallas Mega-Shelter at the Kay Bailey Hutchison Convention Center, where UT Southwestern faculty are coordinating and providing medical care to Harvey evacuees.

By Friday, the medical unit there had treated nearly 200 people like the Aples family, while still awaiting a potential influx of evacuees struggling to escape the floods.

The 35-year-old forklift operator sat on a green cot next to his wife and 8-year-old son, who along with other relatives packed into two cars as floodwaters began to rise around their apartment. They headed north, not sure what they would find.

“My family got what they needed,” Mr. Aples said with a smile, looking across the multitude of volunteer groups spread across the sprawling shelter.

“Some of the worst times bring out the best in us and show us who we really are,” Mr. Aples said of the physicians and volunteers helping at the shelter. “We have individuals here of different faiths and races, all helping their fellow man.”

The Aples family was among the first of a few thousand evacuees expected to seek refuge at the shelter this week after torrential rains from Harvey left much of the Texas Gulf Coast submerged, destroying thousands of homes and killing more than three dozen people.

Inside the medical unit

UT Southwestern faculty, fellows, residents, and students from UT Southwestern Medical School who are spearheading the medical response at the shelter include a wide range of specialties from Emergency Medicine, Pediatrics, and Psychiatry. Caregivers are checking on blood-pressure levels, helping control potential issues such as diabetes, and ensuring evacuees are able to acquire the medications they may have left behind.

Dr. Raymond Fowler, who is directing the medical response at the convention center, said the team has plenty of experience dealing with such situations. He has overseen several similar medical responses to major disasters, including Hurricane Katrina, though he notes this operation is twice as large.

“We’ve gotten pretty good at this,” said Dr. Fowler, Division Chief for Emergency Medical Services at UT Southwestern, who holds the James M. Atkins, M.D. Professorship in Emergency Medical Services. “As soon as we can get them here, we’re ready for our friends in the South.”

The shelter has about 5,000 beds available if needed, and the initial evacuees seeking shelter in Dallas provided an opportunity to test the processes and ready the medical unit, said Dr. Raymond Swienton, Professor of Emergency Medicine, Chief of the Emergency and Disaster Global Health Program at UT Southwestern, and long-standing senior adviser to the state of Texas.

“We are now gaining access to large numbers of people who have been stranded for days in this unprecedented disaster impacting our entire Texas coastal area,” Dr. Swienton said. “We stand ready to provide shelter and medical care to our fellow Texans who arrive in Dallas.”

The medical wing has been bustling this week with volunteers and emergency response crews unpacking food and going over final plans. A pediatrics section decorated with walls of colorful birds and clouds was stocked with formula, diapers, and a box of stuffed animals. One mother sat on a cot in a corner, bouncing a laughing toddler on her knee.

UT Southwestern Pediatrics faculty physicians are staffing and providing support to the pediatric clinic daily to help treat the evacuated children.

“We will provide services as long as they are needed,” said Dr. Maeve Sheehan, Associate Professor of Pediatrics who is overseeing the shelter’s pediatric care with Dr. Halim Hennes, Professor of Pediatrics and Chief of Pediatric Emergency Medicine. “We will also be providing telehealth services throughout the night in conjunction with Children’s Health.”

UT Southwestern pediatric neonatologists aided with the evacuation of neonatal patients as the flooding began, and UT Southwestern pediatric nephrologists are providing dialysis to several displaced children.

Next steps

Outside the medical wing, Mr. Aples sat with his wife and son, listing his next steps: getting a job, finding a home, enrolling his son in school.

“Kids don’t have the same coping mechanisms as adults,” he said, noting one reason why he won’t bring his son back to Houston for anything beyond gathering belongings from their apartment.

“Every time we went back to New Orleans, we saw places from our childhood destroyed. Your mind is fighting itself, looking at the devastation. You have to fight your way out of that box, because that box will put you in a depression.”

Mr. Aples said he has explained the situation to his son but is trying to keep the mood lighthearted.

Mental health experts at UT Southwestern’s Peter O’Donnell Jr. Brain Institute say that’s generally a good approach to take with children dealing with such traumatic events.

In addition, they recommend showing a calm demeanor around the children. Parents should offer but not force them to talk about the incident. They should also filter some of the news updates children may receive from television or social media.

“This can be overwhelming and scary for kids,” said Dr. James Norcross, Professor of Psychiatry. “But the good news is that kids are remarkably resilient. If you can reassure them, keep them in a routine as much as possible, they will be able to overcome and manage this.”

Mr. Aples is keeping his family’s thoughts positive. He is hoping to get a job as soon as he can and perhaps have the family out of the center in the next few days.

Until then, he wants to spread his message of hope to anyone who needs it.

“I want everyone to really, really just love on their families and be optimistic about the change,” he said, glancing over his shoulder at his son. “We’re going to figure out what we have to do, and the whole family will come together.”

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