Author: Guest Blogger

So We Need Another YouTube Video on How to Use Eye Drops?

Eye drops

Scott A. Davis is a doctoral student in the Division of Pharmaceutical Outcomes and Policy at the University of North Carolina Eshelman School of Pharmacy.

Given the estimated 1 billion videos currently on YouTube, one might think that every important medical topic must be covered many times over. Thus I wasn’t surprised that my dissertation idea of testing a new online video to improve patients’ eye drop technique was met with some skepticism. Existing YouTube videos feature famous names from the likes of Johns Hopkins, Mayo Clinic, and the UK National Health Service. Why, then, am I proposing another one?

Health literacy: To reach the people who most need educational videos, roughly a fifth-grade reading level is recommended. Thirty-five percent of Americans have a basic or below basic health literacy level, and these are likely the population that need video instruction the most. That means avoiding difficult medical terminology such as “systemic absorption”.

Evidence-based coverage of all steps: Several videos did not mention blocking the tear ducts, hand washing before instilling eye drops, or even avoiding contamination of the bottle by not touch the eye or face. These are crucial steps to avoid eye infections from agents that can grow on the bottle.

vCultural appropriateness: An important study in the glaucoma literature found that their video intervention was less effective in African Americans, who are more likely to become blind from glaucoma than Caucasians. By incorporating the feedback that African American patients have provided in our past studies, we believe we can create a video that actually has the ability to reduce racial disparities in eye drop technique and adherence.

By incorporating these important principles, as well as the most advanced health behavior theory available, I believe our new video will enhance eye drop instillation skills and make much greater impact on the unfortunate burden of glaucoma. What do you think?

AfterWords: Words can connect survivors after sexual assaults


Liz Chen is a second year doctoral student in the Department of Health Behavior at the UNC Gillings School of Public Health where she studies adolescent sexual health.

According to the Rape, Abuse & Incest National Network (RAINN), there are approximately 293,000 victims of sexual assault each year. Of these, approximately 68% of them are not reported to the police. Four out of five assaults are committed by someone known to the victim and 47% of rapists are a friend or an acquaintance.

While survivors face many real and perceived barriers to reporting sexual assaults to the police, they also face many real and perceived barriers to sharing survivorship stories to friends and family members. A new project, AfterWords, is here to change this leveraging the power of the Internet. AfterWords is a space where survivors can share their stories and build a community.

According to Faith, the founder of AfterWords, she created the site with two populations in mind: survivors and their allies. In addition to providing a way for survivors to connect with each other, she wanted to help allies (friends, family members, partners, etc.) better empathize. She wrote:

I would love AfterWords to become a resource for those who want to increase their understanding and empathy. They have such a powerful role to play in the dialogue, as well, but many might not feel comfortable and confident to take part just yet. With increased exposure to these intimate moments, I hope they feel a burning desire to lend their voices to the cause.

AfterWords is the first website of its kind to highlight the stories of sexual assault survivors and I hope that this kind of project raises awareness of how prevalent sexual assault is in our country among the general public while supporting survivors and allies.

GamerGate: a case study of internet harassment


Photo Caption: Zoe Quinn, the original victim of GamerGate, is now an outspoken advocate for victims of internet harassment.

This post was written by Marjorie Margolis. Marjorie is Doctoral student in Health Behavior at the Gillings School of Global Public Health

****TRIGGER WARNING This article or section, or pages it links to, contains information about sexual violence which may be triggering to survivors.****

On August 27, 2014, a feminist advocate for women in the tech industry received the following message via Twitter: “I’m going to go to your apartment at [redacted] and rape you.” This message was part of a larger controversy sweeping the gaming community. At the center of the controversy lay Zoe Quinn, a female game developer whose former boyfriend had explicitly blogged about his allegations of Ms. Quinn’s transgressions during their relationship. Over the next several months, Ms. Quinn and those who spoke in her defense were mercilessly bombarded with violent threats and insults. In a Washington Post article, Zoe Quinn describes how her accounts were hacked, her address and phone number posted online and death threats caused her to flee her house. This incident, dubbed “GamerGate” led to a heated debate about inclusion in the gaming community, internet safety, and freedom of speech.

Some assert that the central issue of GamerGate is an allegation that Ms. Quinn attempted to further her career through intimate relationships and that attempts to publicize these allegations were suppressed. Within social media discussions of GamerGate, arguments about ethics in journalism and whether and when to curtail free speech are interspersed with blatant insults branding Ms. Quinn as sexually promiscuous, manipulative, and lying. Some claim that while they do not condone threats toward Ms. Quinn, they feel that the more pressing issue is the ethics of how games are created and marketed.

This case illustrates a severe example of a disturbing trend on the Internet toward acceptance of violence. In youth, cyberbullying has been associated with increases in depression and suicidal ideation. As people increasingly rely on the internet to create and maintain social connections, understanding how to prevent and address violence that occurs in this channel is an imperative public health concern.

Further complicating the situation is the fact that many people gain valuable support and acceptance from online communities. An underlying thread in GamerGate discussions is the sense of companionship found in the gaming community. Given the strong ties within the gaming community, I find the dismissal of violence in favor of “more pressing issues” to be incredibly disappointing. By shifting the conversation away from the violence occurring in their community, they allow it to perpetuate. Compromising the safety of one member of a community threatens not only that person but the entire group. By turning a blind eye to threats and viscous insults, members of the gaming community not only fail to protect Zoe Quinn but fail to protect themselves.

Additional links:

Interactive map of vaccine exemptions in the United States


GUEST BLOGGER: Sophia Bernazzani

You may not think about vaccines when they are booking domestic travel within the United States, but it’s worth considering, because each state has a different set of exemptions to vaccines to be aware of. Nursing@Simmons created an interactive map of vaccination exemptions by state to illustrate how these differences in policies can impact public health.

Although they differ throughout the United States, vaccination exemptions can include those related to medical, religious and philosophical reasons.

  1. Medical exemption: An MD or doctor of osteopathy (DO) is usually required to write a medical exemption, but in some states, other health care workers are able to certify that one is needed.
  2. Religious exemption: This exemption is based on First Amendment rights for religious freedom, but can be withdrawn if the state can provide a compelling reason for doing so.
  3. Philosophical, conscientious or personal exemption: This is a blanket exemption, and must include all vaccines. In some states, collaboration with a health care professional is required—as well as the completion of a vaccine education program.

Only three states restrict exemptions to medical reasons alone: West Virginia, Mississippi and most recently, California.

Why do vaccination exemptions matter?

The differences among state-by-state vaccination requirements potentially increase risk to both individual and public health. The CDC states that there is evidence that increased incidence of vaccine-preventable diseases (VPDs) may be connected to higher rates of nonmedical exemptions. Furthermore, philosophical and personal exemptions often happen in specific pockets of the country, which puts people in those areas at greater risk of contracting VPDs, like pertussis and measles. These VPDs can represent a tremendous health risk for anyone who is not vaccinated, particularly infants, young children, and frail, older adults.

VPDs have been declared eradicated in the United States, but there are occasionally small outbreaks of certain diseases, such as what happened with the measles in Disneyland in 2014. Vaccine awareness when planning domestic travel is just one more reason to gain greater understanding of state-based exemptions and how they may impact both your health and that of your family members.

Maternal Death [Infographic]

maternal infographic

GUEST BLOGGER: Sophia Bernazzani

One of the United Nations Millennium Development Goals, established in 2000, calls for an improvement in maternal health, which is measured by the the number of maternal deaths. Maternal death is typically attributed to a lack of accessible and affordable prenatal care and unattended births in areas where medical birthing professionals are few and far between. However, improving the maternal death rate in countries with advanced health systems is still challenging, especially in the United States. For example, the United States spends more on hospitalization for pregnancy and childbirth than any other country, but the rate at which women are dying due to pregnancy or birth-related complications continues to rise. Nursing@Georgetown created an infographic to illustrate what causes maternal death and how it can be prevented, both in the United States and globally. Tragically, by the time you’ve finished reading it, another woman will have lost her life due to complications from pregnancy or childbirth.

The Truth About Indoor Tanning [Infographic]

GUEST BLOGGER: Fiona Erickson

indoor tanning.pngDespite the known health risks of UV overexposure, a surprising number of people still seek out tanning beds once summer fades away. In a 2010 survey, 5.6% of adults reported using indoor tanning services during the previous year.
Changing minds about indoor tanning starts with the facts. The most basic fact of all: Whether from the sun or an artificial source, UV rays are the cause of most skin cancers as well as long-term skin damage. Below are more facts:

Indoor tanning increases the likelihood of melanoma in young adults.
Use of a tanning bed is associated with a 20% higher risk of developing melanoma skin cancer (1). Indoor tanning before the age of 35 increases this risk by 87%.

Men are also at risk—even more so than women.
One study found that 39% of males under age 40 reported using indoor tanning during their lifetime (2). Men have the highest risk for skin cancer due to many factors, such as more time spent outdoors and failure to get routine screenings.

Having a “base” tan does not prevent sunburn.
A recent study confirmed that tanning via an artificial UV source does not prevent sunburn. In fact, indoor tanning was linked with a slight increase in risk (3).

It’s critical that we continue to spread awareness of indoor tanning dangers—through advocacy, policy making, and face-to-face dialogue. Health care practitioners in particular have the opportunity to play a key role in helping young adults lower their risk of cancer and maximize their chances of a healthy future.

For some eye-opening tanning statistics, check out our infographic.


1 Boniol et al. “Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis.” BMJ, 345:e4757 (2012): 1–12. Print.
2 Blashill et al. “Indoor Tanning Use Among Adolescent Males: The Role of Perceived Weight and Bullying.” Annals of Behavioral Medicine, 46 (2013): 232–236. Print.
3 Dennis, Leslie K. et al. “Does artificial UV use prior to spring break protect students from sunburns during spring break?” Photodermatology, Photoimmunology & Photomedicine, (2013): 29, 140–148. Print.

Public Health vs. Public Hysteria

Guest Blogger: Sophia Bernazzani

The recent Ebola outbreak claimed thousands of lives and brought West Africa to its knees. While the fight to stamp out the disease continues, many in the public health community are blaming the media for inciting public hysteria about its possible spread in the United States. Misinformation about the disease heightened anxiety among news media consumers, but failed to improve understanding.

For many AmA burial site was opened on 23 December 2014 in the Disco Hill district to ensure that Ebola victims from Monrovia and the surrounding counties could be buried in a safe and dignified way. The cemetery is a much needed addition to the region since many Liberians were not seeking treatment or informing about the death of loved ones out of fear, their bodies would be cremated - a practice to which many Liberians are opposed out of cultural reasons. Global Communities, in partnership with the USAID Office of U.S. Foreign Disaster Assistance and the Government of Liberia secured the land for the site which is located less than an hour from Monrovia. The site includes Muslim and Christian sections, a temporary morgue, structures for administrative functions, sufficient parking space and an isolated disinfection area. Eventually the 25-acre site will have the capacity to accommodate 13,000 individual graves. While Global Communities is managing the site and continuing construction during the initial phase, management will be fully transitioned to the Government of Liberia when the construction is completed and the virus is under control, There are now 5 burial teams and disinfection teams working at the burial ground. They manage all aspects of dead body management and are trained in the same World Health Organization (WHO) methodology and standards as other burial teams around the country. Disco Hill, Liberia, on 26 January 2015 Photo: UNMEER/Martine Perretericans eager to become more informed about the disease, accurate and responsible reporting took a back seat to sensationalist headlines, menacing graphics and the dissemination of erroneous information. As a result, hysteria, anxiety and panic ensued, leaving many to conclude that an Ebola epidemic throughout the country was imminent. Headlines like “Ebola: The ISIS of Biological Agents” on CNN, or “Broader U.S. Ebola Outbreak ‘Inevitable’?” on Fox News were commonplace. But cable news outlets were not the only culprits. Even respected news magazine Bloomberg Businessweek chose to illustrate their September 14, 2014, cover with “Ebola is Coming,” written ominously in dripping blood.

The stories behind the headlines are now beginning to reveal themselves, and within these stories are not only glimpses of heroism, but also lessons that need to be learned for nearly every sector touched by this public health emergency.

MPH@GW, the online Master of Public Health from the Milken Institute School of Public Health at the George Washington University, is featuring stories that provide a glimpse into the narrative that sensationalist headlines did not capture but, in many ways, tell the real story. Learn more about them here.



UNC Student’s Global Experience

By Hillary Murphy, UNC-CH MPH:Health Behavior candidate 2016

Summer of 2015 I found myself unexpectedly working in sub-Saharan Africa on a pilot intervention involving breastfeeding practices among mothers with HIV.

File:Malawi in Africa.svgJust to help you, the reader, understand how out of my element this was, here is a little background on me. My public health experience up to this point involved local food movements, health disparities in rural North Carolina, and, for a few months, community engagement and education in permaculture practices in Java, Indonesia.  Despite my obvious lack of experience, I was lucky enough to be offered a practicum position, and less than a month later, I began working in Malawi, a small country in southern Africa.

Currently in Malawi, 13% of pregnant women are HIV positive. Without intervention, 5-20% of their children will become infected from HIV exposure though breastmilk, suggesting that prevention of mother-to-child transmission is of critical importance.

During my time in Malawi our goal was to tailor and pilot test an Infant and Young Child Feeding (IYFC) promotion intervention among HIV+ Malawian women in community-based village savings and loan associations (VSLAs). We tailored training materials and IYFC learning sessions on 1) breastfeeding, and 2) complementary feeding for use with Malawian trainers and VSLA volunteers, and pilot tested these materials to further refine them for use in Malawi.

Although this practicum certainly helped build my skills in program implementation and tailoring, and gave me a deep love for sub-Saharan Africa, it most importantly was a reminder to be open to unexpected experiences. There is no way to know what your true passions in life are unless you welcome opportunities that are out of your element.

Photo source: Wikimedia

Improving the cancer survivorship transition with survivor care plans

By Brynn Fowler, MPH

“Too many survivors are lost in transition once they finish treatment. They move from an orderly system of care to a ‘non-system’ in which there are few guidelines to see them through the next stage of their life or help them overcome the medical and psychosocial problems that may arise”.

-Institute of Medicine

Has this happened to you? Do you know anyone in this position?

The American Cancer Society estimates that more than 14.5 million children and adults with a history of cancer were alive in 2014 in the United States.  By 2024, this number is expected to increase to almost 19 million people—more than the combined population of New York City, Los Angeles, Houston and the state of Utah.

There have been many efforts to help survivors in this period of transition. One such effort is through the creation of survivor care plans. A survivor care plan is an individualized and coordinated plan that is created for the survivor and their healthcare team following active therapy.

A survivor care plan provides patients with a tool to guide their discussions with their primary care provider and explain needed follow up care. It is also a guide to help survivors identify important lifestyle modifications to help reduce the risks of having cancer again (e.g. weight management, smoking cessation, exercising regularly). Not only is this a good idea for helping patients, survivor care plans will soon be required for cancer centers to complete. The goal is that these plans can help to improve survivors’ health and quality of life.


UNC Fitness Breaks


Kaitlyn Brodar, UNC Grad. Student & UNC Fitness Breaks Leadership Member

UNC Facilities Services employs over 1,000 low-wage workers whose jobs all require physical demands, such as moving or lifting heavy supplies and equipment (University of North Carolina at Chapel Hill Facilities Services, 2014). These demands increase the risk of injury on the job (Krause et al, 2005), including back injuries and strains (Bureau of Labor Statistics U.S. Department of Labor, 2014).

UNC Fitness Breaks is a student/volunteer led worksite wellness program for UNC housekeeping and groundkeeping staff.  Our main goal is to help prevent injury by building muscle strength and cardiovascular endurance, but we also strive to encourage staff to adopt an overall more active lifestyle.  We do this by providing 10-15 minute fitness sessions that consist of moderate-intensity exercises and are conveniently held on campus at staff member clock-in locations—currently we are conducting over two dozen sessions throughout the week at 10 different locations.

This Friday, September 25, to coincide with International Housekeeping Week, we will be measuring BMI and blood pressure at the UNC housekeepers’ annual banquet.  We hope to have fun interacting with the staff, get staff excited about fitness breaks, and start a discussion about improving overall UNC worksite health. We have plans to apply for funding and recruit more volunteers so that we can consistently hold more sessions at more locations year around. If you are interested in volunteering please visit our Facebook page and leave us a message.