PHRM 48500 Spring 2021 Intercultural and global health issues

Intercultural and Global Health Issues Spring 2021

World Earth Planet https://cdn.pixabay.com/photo/2016/04/01/22/32/world-1301744_960_720.png

Created by the students in PHRM 48500 Compiled by Cynthia P Koh-Knox Sharp, PharmD, RPh Purdue University College of Pharmacy

Table of contents Topic (Authors)

Page

Body image ...................................................................................................................................5 Social media and its impact on body image (Gabby Campbell) .......................................6 Mental health and body image (Chloe You) .....................................................................7 Body image and eating disorders (Evelyn Choe) .............................................................8 Cancer .........................................................................................................................................10 Preventative health strategies (Katarina Mai) .................................................................11 Affordability and accessibility to cancer treatment (Brooke Hollandsworth) ................12 Racial cancer disparities (John Petrovich) ......................................................................13 Health literacy .............................................................................................................................14 Misinformation (Lin Zhao) .............................................................................................15 Nutrition (Christie Kang) ................................................................................................16 Education (Taylor Osborn) .............................................................................................17 Healthcare disparities ..................................................................................................................18 Lack of resources in healthcare (Yuxian Xing) ..............................................................19 Lack of understanding and communication (Shengzhou Qiu) .......................................20 Lack of education in healthcare (Kyle Dickey) ..............................................................21 Healthcare equities ......................................................................................................................22 Racism (Anya Lu) ...........................................................................................................23 Cost and social class (Alana Mulloy) .............................................................................24 Access to healthcare (Miranda Liu) ................................................................................25 Human trafficking .......................................................................................................................26 Sex trafficking (Bryan Yan)............................................................................................27 Organ trafficking (Cheryl Chang) ...................................................................................28 Labor trafficking (Natalie Coldiron) ...............................................................................29

Table of contents Topic (Authors)

Page

Immunizations.............................................................................................................................30 Prices and effects of prices (Maxwell A. Frye) ..............................................................31 Vaccine perceptions (Ronald Mahan) .............................................................................32 COVID (Zamir Latif) ......................................................................................................33 Infectious disease ........................................................................................................................34 Immunization disparities (Yudong Sun) .........................................................................35 COVID and other infectious diseases (Seohyun Park) ...................................................36 Epidemics vs. pandemics (Joseph Kirchgassner) ...........................................................37 Mental health ..............................................................................................................................38 Stigma in China (Hanyu Liu) ..........................................................................................39 Criminal justice (Shuyun Yang) .....................................................................................40 Eating disorders at Purdue (Chrystal He) .......................................................................41 Animal mental health (Xuxi Li) ......................................................................................42 Mental health ..............................................................................................................................43 Mental health in the workplace (Brittany Galloway) .....................................................44 Cyber bullying (Saja Abbas) ...........................................................................................46 Barriers to mental healthcare treatment and access (Cindy Lam) ..................................47 Mental health in pediatrics ..........................................................................................................48 Anxiety in pediatrics (Maggie Van Kleek) .....................................................................49 Depression in pediatrics (Lindsey McDaniel) ................................................................50 ADHD What is it? (Emily Schultheis)............................................................................51 Nutrition ......................................................................................................................................53 Food insecurity/access to nutrition (Lexi Zavitsky) .......................................................54 Nutrition related to chronic disease (Brice Wuthrich) ....................................................55 Micronutrient deficiencies (Meg Tharp) .........................................................................56

Table of contents Topic (Authors)

Page

Social media ................................................................................................................................58 Impact on mental health (Nicole Redden) ......................................................................59 Impact on health literacy and health care access (Frank Zahariadis) .............................60 Impact on human trafficking (Tianqi Zhao) ...................................................................61 Social media ................................................................................................................................64 Social media’s effect on misinforming the public (Om Permsukkunakorn) ..................65 Poor sleep (Yuanrui [Gray] Zhao) ..................................................................................66 Consequences with body image (Leeann Cecil) .............................................................67

BODY IMAGE BY: CHLOE YOU, BSPS STUDENT GABBY CAMPBELL, BSPS STUDENT EVELYN CHOE, BSPS STUDENT

Understanding the Issue

SPRING 2021

Body image is how one pictures oneself in one’s mind. It encompasses what a person believes to be true about his or her appearance, how one feels about their body, including the height, shape, and weight. Many people these days internalize messages starting at a young age that can lead to either a positive or negative body image. Having a healthy body image is an important factor of mental wellbeing and eating disorder prevention. Also, body image dissatisfaction is a very prevalent issue worldwide which has only become more prevalent due to multiple factors such as social media and the changing understanding of what the ‘ideal’ body is.

SOCIAL MEDIA AND ITS IMPACT ON BODY IMAGE GABBY CAMPBELL

IMPLICATIONS UNDERSTANDING THE ISSUE GLOBAL Body image, or more specifically unrealistic beauty standards that influence one's body Since its creation, social media has allowed image, is a global issue because of the fact that social media is present on a global us to become increasingly more connected

scale. Social media allows us to connect with people from all around the world and as a

with what is happening all over the world,

result of that people are exposed to more beauty standards and information that can

but it has also enabled us as a society to put have an impact on their body image. a greater focus on our body image. The more we become exposed to bodies that vary from our, the more things we can become insecure about. Unlike other modes of media social media has a very interactive interface which means that not only are we watching it, we are actively giving these topics and images a platform to which they can be consumed.

FIXING THE PROBLEM Finding solutions for this issue is uniquely hard because of the method of the information. One of the biggest concerns is that by attempting to regulate some of the posts that could have unverified

WHO DOES IT AFFECT?

information regarding the body, it

This topic affects almost everyone in one

would be considered a type of

form or another. In fact, a study

censoring. That being said, some

conducted in 2020 found that 87% of

websites have tried to take matters

women and 65% of men compare their

into their own hands, but the results

bodies to images they consume on social

have been less than promising.

and traditional media. In that comparison,

For example, the Instagram policy

a stunning 50% of women and 37% of men

explicitly says that, “any account found encouraging or urging users to embrace anorexia,

compare their bodies unfavorably.

bulimia, or other eating disorders....will result in a disabled account without warning” and

(Fardouly and Vartanian). This study just

if you look up certain hashtags associated with eating disorders you can see that the

goes to show how universal of a topic this

content under them is being monitored to ensure it meets community guidelines. That

is and how these extremely curated

being said, there are lots of ways to find these types of posts, especially if people label

versions of our lives that we post on social

the posts as being about health, wellness, or fitness.

media can have very real and significant impacts on both ourselves and others. It is also worth noting that the spread and normalization of social media has resulted in younger and younger populations having access to unrealistic body expectations, diet culture, and other forms of information that can result in them developing a negative feeling about themselves.

Blackford, Meghan (2020, Nov. 30). Factors that Shape Body Image for Men and Women[Infographic]. FHE Health. https://fherehab.com/news/bodypositive/

MY OPINION Personally, I believe that social media has had significantly more harm on people's perceptions of their bodies. As someone who has largely grown up with social media, it can be hard not to compare yourself to the people that you constantly see on Instagram, Twitter, Pinterest, or even TikTok. I think the most alarming part of social media as it relates to body image is the amount of misinformation that can be spread and the normalization of very unhealthy behaviors. That being said, I also think social media has and can be used to normalize things regarding our body that are considered taboo and to spread awareness to all the different forms that bodies can take and how everybody is different

MENTAL HEALTH AND BODY IMAGE CHLOE YOU

THE ISSUE

GLOBAL IMPLICATIONS

As humans, we are all learning to live with the

There are many different sides to body image issues however the tools that are utilized

fascinations and limitations of our bodies as

to compute body image in research are often focused on body weight and/or shape

they change through life, and no piece of

which can be restricted when trying to interpret body image and ethnicity as people

technology that we will ever buy will match

from different cultural and ethnic backgrounds have different body ideals. According to

the intricacy, elegance and regenerative powers of our bodies. Yet, for multitudes of people all over the world, our bodies are sources of humiliation and distress. Having body image issues and concerns is a relatively

research, differences between people with different ethnic backgrounds in levels of body dissatisfaction are minute which means that ethnicity may have less of an influence on body image than other determinants like weight, gender or age. However, in general, Black British males and females are more satisfied with their bodies than Caucasians,

typical experience for all and is not a mental

and Asian Americans (adults and adolescents) tend to have lower body satisfaction than

health issue in itself. Nonetheless, it can be a

White Americans. It also has been found that the primary factor that leads to mental

risk factor for mental health problems.

health issues from body image dissatisfaction is media where many women and men are

Research has found that higher body

vulnerable to discriminations as well as comparison amongst influencers. This was found

dissatisfaction is associated with a lower

to be associated with mental health issues such as depression and anxiety. Not only that,

quality of life and psychological distress,

in the United States, body image immigrant communities may be vulnerable to stress

higher risk of depression or depressive

from adapting to a new culture. There are not enough research done about body image

symptoms and higher risk of unhealthy eating behaviors. On the other hand, body satisfaction has been linked to a better overall sense

WHO DOES IT AFFECT? .

Everyone can be affected by body image issues that lead to mental health concerns, but there are those who have higher risks

dissatisfaction in developing countries such as Africa.

STATISTICS

Mental Health Foundation has found that 47% of 18-24 yo, 36% of all women, almost 20% of 55+ yo people stressed over their body image to the extent of being overwhelmed.

In a survey performed by Mental Health Foundation, over ⅓ of adults said they felt anxious or depressed because of their body image and ⅛ experienced suicidal thoughts and feelings because of concerns about their body image.

such as children, teenagers, people who have a history of mental illness, women, Asian Americans and LGBTQ community. In

DETAIL >

today’s society, teenagers and children have earlier and easy access to social media.

There have been public health campaigns to help encourage positive body image but more work needs to be done. As the body image dissatisfaction stats increases, there should be advertising and social media regulations, especially as more and more children engage in them earlier in their lifetime.

2019. https://www.mentalhealth.org.uk/publications/body-image-report. Accessed March 28, 2021.

MY OPINION

I definitely agree with all of the resources that I’ve collected. I think the media has the

most impact, especially in today’s society where almost everyone and anyone has access to them. Mental health issues from these body image dissatisfaction is not something that we can ignore because like I mentioned everyone can be exposed to them and are at risk. It can lead to serious mental disorders such as BDD, depression, anxiety and social anxiety which can in turn lead to suicidal thinking and ideations

BODY IMAGE AND EATING DISORDERS WHO DOES IT AFFECT ?

While there is no single cause of eating disorders, research indicates that negative body image is the best-known contributor to the development of

UNDERSTANDING THE ISSUE

EVELYN CHOE

Body image is how one pictures oneself in one’s mind. It encompasses what a person believes to be true about his or her appearance, how one feels about their body, including the height, shape, and weight. Many people these days internalize messages starting at a young age that can lead to either a positive or negative body image. Having a healthy body image is an important factor of eating disorder prevention. Although there is not only one factor that causes

anorexia nervosa and bulimia

eating disorders, body image definitely has a contribution. Research indicates

nervosa.

negative body image is the best-known contributor to eating disorders.

WHY IS IT A GLOBAL ISSUE?

There are two types of most prevalent eating disorders that are known to affect at least 9% of the population worldwide: anorexia and bulimia. Anorexia

Eating disorders affect people of

is an eating disorder characterized by an abnormally low body weight, an

every age, race, size, gender identity, sexual orientation and background. About 10,200 deaths each year are the direct result of an eating disorder - that’s one

intense fear of gaining weight and a distorted perception of weight. On the other hand, people with bulimia may secretly binge -- eating large amounts of food with a loss of control over the eating -- and then purge, trying to get rid of the extra calories in an unhealthy way. Both types can significantly impact one’s physical and mental health and needs to be appropriately treated.

death every 52 minutes. The economic cost of eating disorders is $64.7 billion every year.

SOLUTIONS BEING MADE

DETAIL >

The National Eating Disorder Association provides helplines through chat, call, and text for support, resources, and treatment options for people who are struggling with eating disorders. .

MY OPINION

My Southern Health (2018, Feb 26). Shattering myths about eating disorders [Infographic].

Vanderbilt Health. https://www.mysouthernhealth.com/infographic-what-parents-need-toknow-about-eating-disorders/

Eating disorder is a major health issue around the world, and it is affecting not only the adults, but also many young adults and even children. It is necessary to educate teens that having a healthy body image is an important health factor.

REFRENCES SOCIAL MEDIA

Aparicio-Martinez P, Perea-Moreno AJ, Martinez-Jimenez MP, Redel-Macías MD, Pagliari C, Vaquero-Abellan M. Social Media, Thin-Ideal, Body Dissatisfaction and Disordered Eating Attitudes: An Exploratory Analysis. Int J Environ Res Public Health. 2019;16(21):4177. Published 2019 Oct 29. doi:10.3390/ijerph16214177.

Cohen R, Newton-John T, Slater A. The case for body positivity on social media: Perspectives on current advances and future directions. Journal of Health Psychology. March 2020. doi:10.1177/1359105320912450 Blair Brurnette C., Kwitowski M., Mazzeo S. “I don’t need people to tell me I’m pretty on social media:” A qualitative study of social media and body image in early adolescent girls. Body Image.

2017; 23, 114-125. Dec 2017. https://doi.org/10.1016/j.bodyim.2017.09.001 Fardouly, J., & Vartanian, L. R. (2016). Social media and body image concerns: Current research and future directions. Current Opinion in Psychology, 9, 1–5. https://doi.org/10.1016/j.copsyc.2015.09.005

MENTAL HEALTH Grabe S, Hyde JS. Ethnicity and body dissatisfaction among women in the United States: a metaanalysis. Psychol Bull. 2006 Jul;132(4):622-40. doi: 10.1037/0033-2909.132.4.622. PMID: 16822170.

Body image report - Executive Summary. Mental Health Foundation. https://www.mentalhealth.org.uk/publications/body-image-report/exec-summary. Published August 6, 2020. Accessed February 22, 2021.

EATING DISORDERS McLean SA, Paxton SJ. Body Image in the Context of Eating Disorders. Psychiatr Clin North Am. 2019;42(1):145-156. doi:10.1016/j.psc.2018.10.006 Esposito R, Cieri F, di Giannantonio M, Tartaro A. The role of body image and self-perception in anorexia nervosa: the neuroimaging perspective. J Neuropsychol. 2018;12(1):41-52. doi:10.1111/jnp.12106 Staff Wby CP. 8 Ways to Prevent Eating Disorders (Plus 5 Recommendations for Parents). Casa Palmera. https://casapalmera.com/blog/8-ways-to-prevent-eating-disorders/. Published October 31, 2019. Accessed March 29, 2021.

Health Literacy

Spring 2021

Lin Zhao (PharmD Student) Taylor Osborn (BSPS) Christie Kang (BSPS)

Nations, U., 2021. Health Literacy and Sustainable Development | United Nations. [online] United Nations. Available at: <https://www.un.org/en/chronicle/article/health-literacy- and-sustainable-development> [Accessed 14 April 2021].

Overview The CDC definition of health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Those with poor health literacy often have difficulty understanding medication instructions which leads to poorer management of their own conditions, especially when these conditions are chronic. They also have trouble finding access to resources such as preventative care and are more likely to be misdiagnosed. These patients are more likely to have a greater use of emergency care and have lower rates of vaccination as well. In the United States alone, low health literacy costs the government between $106-239 billion per year. Here, we discuss how varying degrees of ability to assess health information can affect a person’s health.

Top Image: Health Literacy. Medline University. https://www.medlineuniversity.com/medline/viewdocument/healthliteracy?CommunityKey=d15198e2-e041-4be7-be2b1cc2c8291f86&tab=librarydocuments. Accessed March 19, 2021.

Bottom Image: Digital transformation boosts businesses. AsiaPacific Infrastructure. https://www.infrastructurenews.co.nz/digital- transformation-boosts-businesses/. Published October 23, 2017. Accessed March 19, 2021.

Misinformation by Lin Zhao One aspect with health literacy is the ability to recognize misinformation given vast prevalence and trends in how they contribute to decision-making when it pertains to individual health. In other words, people with high health literacy can generally distinguish between misinformation and credible knowledge. As access to the internet is usually available to the general public, it is just as easy to come upon misinformation as credible material. Thus, in route to improving health literacy, it is important to recognize what is considered as health misinformation and where the problem is most prevalent.

For starters, it is important to recognize topics of misinformation and their prevalence when it comes to healthcare, especially on social media platforms, before coming up with solutions to regulate or address them in route to improving health literacy. One such study by Suarez-Lledo V et al. looked into this prevalence by first nailing down topics of misinformation most concerned with in scientific databases and then extrapolating the search with these topics to social media platforms like Twitter. The highest trending healthcare topics with regards to misinformation were found to focus on drugs, smoking products, and major public health issues like vaccines and diseases. Knowing this can help guide future support in the development of evidence-based digital policies or action plans that can focus on health misinformation - especially given that anybody from any part of the world can access social media resources.1 Regarding the current pandemic, one infodemiology study found that 70% of the first 110 web sites encountered when searching up “Wuhan Coronavirus” resulted in low health accuracy scores. That is, the web sites providing health information on the novel coronavirus didn’t fall in line with the benchmarks used to assess for information accuracy such as Health on the Net Foundation Code of Conduct (HONcode), the Journal of the American Medical Association (JAMA), and the DISCERN instrument using Google ranking. And this is any web site - including ones outside of the US!2 As with solutions on the problem, assessing information with a healthcare professional has been one of the best ways in tackling misinformation. Given that credible sources such as medical databases tend to be riddled with jargon, health professionals play a big role in mediating this information on an understandable level for the common individual.

Opinion Tackling health misinformation is a lot of work seeing that, with the rise of the pandemic, much of it has been politicized or used to control public opinions across the globe. That is not to say there isn’t hope and solutions, but I think clinical or healthcare outreach to areas of low literacy should be one of the first steps in this endeavor as well as healthcare professionals already in the field continuously exercising professionalism, and reliability without judgement no matter the questions asked by anyone seeking confirmation on accuracy. ~ L. Zhao Sources 1. Cuan-Baltazar JY, Muñoz-Perez MJ, Robledo-Vega C, Pérez-Zepeda MF, Soto-Vega E. Misinformation of COVID-19 on the Internet: Infodemiology Study. JMIR Public Health Surveill 2020;6(2):e18444. doi:10.2196/18444 2. Suarez-Lledo V, Alvarez-Galvez J. Prevalence of Health Misinformation on Social Media: Systematic Review. J Med Internet Res 2021;23:e17187. doi:10.2196/17187 Image: Health Literacy In The Age of Social media and Misinformation: A Conversation with Dr. Eileen Fry-Bowers.

GroupSolver. https://www.groupsolver.com/2021/02/02/health-literacy-in- the-age-of-social-media-andmisinformation-a-conversation-with-dr-eileen-fry-bowers/. Accessed March 19, 2021.

Nutrition by Christie Kang: Health literacy has grown a lot compared to the past, but nutrition is one of the overlooked sectors. Nutrition literacy is very important for understanding how foods affect our health and making healthful decisions with the information we process. However, nutrition literacy disparity exists due to accessibility of healthcare by country. Lower class people tend to have a much harder time understanding nutrition and make healthful decisions because they do not have access to health professionals that can help them guide through nutrition.

Compared to Asia, where most countries have universal healthcare, the United States’ obesity rate has increased to 42% in 2020 while Japan and South Korea has only increased to 16% on average. This is most likely due to the disparity in accessibility of healthcare between Asian countries and the United States since people who have health experts to guide them through nutrition are more likely to make better nutritional decisions. Due to the rise in healthcare costs in America, obesity rates are also rising, especially among lower class, because they are less educated on nutrition so therefore they are much more likely to make bad nutritional decisions. As of now, the government has been pushing to promote healthy foods and increase access to healthy foods in communities. Recently, states have passed a program called SNAP-ed which provides people with nutrition education and obesity prevention measures for individuals and families whose income falls below the federal poverty line. After the passage of this program, individuals on average, have increased their fruit consumption by ⅓ cup, vegetable consumption by ¼ cup, and were less likely to reach for drinks with calories and instead opt for water.

Opinion I personally feel that the lack of access to healthcare in lower income class due to high costs of insurance is the reason why they are so behind on health education therefore they are much less likely to make healthy decisions which is the cause for the rise of obesity in that group. ~ C. Kang Sources Bellido MSC. Health Literacy and Implications in Nutrition Care. American Society for Nutrition. https://nutrition.org/health-literacy-implications-nutrition-care/. Published November 20, 2017. Accessed March 29, 2021.

Allen R. Nutrition Literacy in America. Military Families Learning Network. https://militaryfamilieslearningnetwork.org/2020/09/21/nutrition-literacy-in-america/. Published September 30, 2020.

Accessed March 29, 2021.

News, M., 2021. Study shows nutrition education for low-income people in Southeast states resulted in healthier diets and better budgeting. [online] Hoptown Chronicle. Available at: <https://hoptownchronicle.org/studyshows-nutrition-education-for-low-income-people-in- southeast-states-resulted-in-healthier-diets-and-betterbudgeting/> [Accessed 19 April 2021].

Education by Taylor Osborn: Health literacy and education levels have a very close correlation. Across the globe, as education levels rise, so do health literacy rates. Those with higher education rates have better self- reported health status, mental health, and physical health. One of the biggest issues faced by healthcare workers today is vaccination hesitancy. It was found that for HPV, an optional vaccine in the United States, those with a college education were more likely to be aware of and receive the vaccine. They also were found to have a better understanding of the knowledge behind the vaccine and how vaccines work to eliminate disease in society.

Another study was done on Asian immigrants in California that found that high intelligence alone was not necessarily linked to high health literacy. They found that another aspect of education, language, played an important role in health outcomes. The study was done on five subgroups of Asian American immigrants, each with high levels of education. However, it was found that the groups that spoke English proficiently, the language spoken by most physicians in their area, had the highest levels of health literacy. This can be seen in Figure 1 below. Patients within this population with high levels of health literacy were more likely to seek out preventative services and comply with treatment regulations.

Figure 1.Health literacy among Asian immigrants Lee HY, Rhee TG, Kim NK, Ahluwalia JS. Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from a Population-Based Survey in California. J Gen Intern Med. 2015;30(8):1118- 1124. doi:10.1007/s11606015-3217-6.

In order to help combat these issues in America, the Affordable Care Act passed in 2010 included training for physicians on how to better approach caring for those with language barriers or low educational levels. It also introduced legislation that requires insurance companies to describe their coverage in a way that is readable for those with low literacy levels. Another important step in combating low health literacy rates occurred in the formation of EDUCAIDS. EDUCAIDS is a program meant to lower AIDS/HIV rates through education of the disease and has been implemented in areas such as Viet Nam, Angola, Moldova, and Mexico. It teaches the public about ways to practice safe sex in order to avoid these diseases and aims to weave this information into their classrooms at school.

Opinion I believe that the world should make education a top priority. It will lead to better health outcomes in vaccine administration, preventative care, and better adherence to medications. It should especially be focused on areas where literacy rates are low and healthcare is lacking. ~ T. Osborn Sources Lee HY, Rhee TG, Kim NK, Ahluwalia JS. Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from a Population-Based Survey in California. J Gen Intern Med. 2015;30(8):1118-1124. doi:10.1007/s11606-015-3217-6 Lorini C, Santomauro F, Donzellini M, et al. Health literacy and vaccination: A systematic review. Hum Vaccin Immunother.

2018;14(2):478-488. doi:10.1080/21645515.2017.1392423 Nations, U., 2021. Health Literacy and Sustainable Development | United Nations. [online] United Nations. Available at: <https://www.un.org/en/chronicle/article/health-literacy- and-sustainable-development> [Accessed 14 April 2021

HEALTHCARE DISPARITIES SPRING 2021

Yuxian Xing (BSPS)

Kyle Dickey (BSPS) Shengzhou Qiu (BSPS)

Background Health disparities, defined by the CDC as “preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups in all age groups.” In addition, in our project we’re also looking at the disparity within the healthcare system.

The unequal information and power among doctors, nurses, pharmacists, patients, and many other groups in the healthcare system.

LACK OF RESOURCES IN HEALTHCARE: YUXIAN XING(BSPS)

Who is affected ?

Low-income and/or homeless individuals. In general, lowincome individuals are more likely to have chronic illnesses, and the impact of those illnesses can be more severe.

Certain geographical communities are the victims of lack of healthcare resources. The reason for this disparity is that rural populations experience geographic isolation, who have a lower socioeconomic status and limited job opportunities

What are healthcare resources?

also tend to be older.

Healthcare resources include all the

A lack of resources in healthcare has serious consequences

materials, personnel, facilities, funds, and

for the quality of patient care and the professional work

anything else that can be used for providing

environment for nurses, therapists, and other healthcare

health care services. Without doubt,

providers.

healthcare is always a limited resource compared to the number of people around

What efforts/solutions have been made?

the world because everyone needs

Health insurance coverage helps patients gain entry into the

healthcare.

healthcare system. Lack of adequate coverage makes it difficult for people to get the health care they need and, when they do

Intercultural/Global Issue

get care, burdens them with large medical bills.

WHO and the World Bank found 800 million people spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or other family member.

Professional/Personal Opinion Inadequate health insurance coverage is one of the largest barriers to healthcare access and the unequal distribution of coverage contributes to disparities in health. Improving the condition of healthcare requires new technologies and methods.

Data shown above is total national health

New technologies which measure and monitor people’s health

expenditures from 1970 to 2019, also

conditions can help with allocating healthcare resources. Thus,

indirectly indicates that demands of

the health care system can provide health care quickly after a

healthcare resources keep growing

need is recognized.

through time.

References: 1. Hellen R, John O. Allocation of Healthcare Resources: Principles for Decision-making. Pediatrics in Review Jul 2017; Vol. 38, Issue 7.

2. How has U.S. spending on healthcare changed over time? Health System Tracker.org. Published December 23, 2020. Accessed March 29, 2021.

3. Healthypeople.gov. Accessed March 29, 2021.

4. Laura Joszt MA. 5 Vulnerable Populations in Healthcare. Ajmc.com. Accessed March 29, 2021

LACK OF UNDERSTANDING AND COMMUNICATION

Who does it effect?

Usually in medical disputes doctors and patients’ family are affected and are in unequal positions. In many cases, doctors are facing violence and even death threats. For example, on January 20, 2020, three medical staff were stabbed and one patient was injured at Beijing Chao-yang Hospital by a patient named

Shengzhou Qiu (BSPS student)

Zhenguo Cui. Fortunately, no victim was killed. Cui was not satisfied with the effect of his eye treatment and decided

A Global Issue

to attack the medical team in retaliation.

Cui was sentenced death penalty with a

In China, 66% of the medical doctors

two year reprieve.

who work in clinical settings claim that they have experienced medical disputes and over 30% of the cases include a

My opinion

certain level of violence, according to the “White paper of Chinese medical doctor profession 2018”. In 2015, approximately

Efforts in medical system reform and

115,000 cases of medical disputes were

doctor’s professional training are required

recorded. In the US, approximately

to help improve this situation. More

17,000 malpractice cases are filed each

medical staff are needed to reduce the

year. All of that is caused by lack of

stress doctors are facing and doctors

understanding and communication.

need to be trained to communicate with patients and their family effectively to

Understanding the Issue

avoid medical disputes. Also people are promoting the education of patients about how to process the information

Many factors including communication problems, organizational structure, role

In Shanghai, a primary doctor only

given by doctors online. This can also be

disputes, lack of resources,

spends 8 minute on a patient on

helpful for the patients to have more

misunderstandings, lack of professional

average. The lack of time spent to

access to knowledge about medical

commitment, can cause the conflict

communicate with patients and

procedures and prevent them from

between patient and doctor.

help them understand the

misunderstanding.

treatment they’re having is the main In particular, the population density in

reason for these medical disputes.

China’s big city is extremely high. The population density of Beijing is 1,312 people per square kilometer and for Shanghai’s most populated district Hongkou it’s 33,816 people per square kilometer.

References:

Wu, Y., Jiang, F., Ma, J., Tang, Y., Wang, M. and Liu, Y., 2021. Experience of Medical Disputes, Medical Disturbances, Verbal and Physical Violence, and Burnout Among Physicians in China. Frontiers in Psychology, 11.

He, A. J., &amp; Qian, J. (2016). Explaining medical disputes in Chinese public HOSPITALS: The doctor–patient relationship and its implications for health policy reforms. Health Economics, Policy and Law, 11(4), 359-378. doi:10.1017/s1744133116000128 2018(White paper of Chinese medical doctor profession 2018) 6 . https://health.huanqiu.com/article/9CaKrnK6irf. Accessed February 15, 2021. https://www.jhsph.edu/covid-19/articles/how-health-disparities-are-shaping-the-impact-of-covid-19.html

中国医师执业状况⽩⽪书 纠纷

：超 成医⽣发⽣过医疗

LACK OF EDUCATION IN HEALTHCARE KYLE DICKEY (BSPS)

Resolution Attempts Healthcare education in practice is the information

healthcare professionals provide to patients on the disease that is affecting them, regardless of it being acute or chronic and if it is curable or only can be managed. Examples of healthcare education include a doctor counseling a patient with asthma that they should avoiding being around smokers as the cigarette smoke could trigger an asthma attack or a physician's assistant providing exercise and weight management information for an obese patient. As crucial as this information may be to a patient, they may be unaware or

Education's Importance in Healthcare

misinformed on their condition and actively do things that do

Education is a highly influential factor in the quality of

American study, healthcare professionals were not regularly

healthcare people receive globally. A lack of education

educating patients on how to manage their chronic

in healthcare can be primarily interpreted as a

conditions. In the 6 types of health education needed for a

patient’s lack of knowledge on a condition that affects

variety of conditions ranging from asthma to depression to

them, either due to a failure on behalf of healthcare

diabetes, not a single education category achieved higher

professionals to educate them or through the patient’s

than a 50% education rate across all healthcare professionals

lower education restraining them from having access

including nurses, physician’s assistants and even doctors.2

not better or even worsen their condition. Noted in a 5-year

to the information. According to the Organization for Economic Co-operation and Development (OECD), which includes 37 member countries across Europe, Asia, North and South America, and Australia, people with lower levels of education are expected to live on average 6 years less than those with a college degree or equivalent education.1

Resolution Attempts Attempts to manage this issue include the American Medical Association, CDC, and other American health organizations offering free or low-cost training to improve healthcare workers’ interpersonal skills to allow them to better communicate the information they need totell the patients effectively.4 Attempts like this should be supported globally and even requirements for patients post-diagnosis of a chronic condition with followup annual counseling free of charge would allow for vital health information to be accessible to all who need it.

Personal Opinion Personally, I believe that the lack of education in healthcare needs to be addressed as it leaves disadvantaged people based on their education at a greater disadvantage. Those lacking health education do not receive the assistance they Figure 1: Adapted from Health Impact of Education: a review, Institute of Public Health in Ireland.

need from healthcare professionals to be aware of and make conscious decisions to better their health.

References 1. OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health_glance_eur-2018-en 2. Ritsema TS, Bingenheimer JB, Scholting P, Cawley JF. Preventing Chronic Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/pcd/issues/2014/13_0175.htm Accessed March 29, 2021.

H EAL T H CA RE EQUITIES AL ANA MU LL OY (B SP S) AN YA L U ( BS PS) MI R ANDA LI U (BS PS) SPRING 2021 Healthcare equities are equal experiences for healthcare access, treatments, and outcomes. However, there are inequities that directly impact the health of individuals and populations due to differences in race, social class, and location. The health statuses of different populations can vary and as a result, impact the ability for these populations to lead healthy lives.

RACISM

Racial equities can be impacted by the behavior of individuals but is upheld by institutional policies and negative stereotypes

IN THE UNITED STATES WHO IS AFFECTED?

People of color (POC) have higher rates of morbidity and mortality 1 Lack of quality healthcare due to poor neighborhoods, high unemployment rates, and lower incomes Solutions & Efforts More affirmative action programs Increase research and funding

ANYA LU

LACK OF DIVERSITY IN CLINICAL TRIALS

Black people make up less than 4% of all patients enrolled in trials for treatment of lung cancer

GLOBALLY (AUSTRALIA) WHO IS AFFECTED? Aboriginal and Torres Strait Islander populations (⅓ less likely to receive quality 2 medical care) Naomi WIlliams 27 F, pregnant Wiradjuri woman went to hospital with stomach pain Given 2 paracetamol tablets + ice block 2 hours later died of septicemia Solutions/Efforts Examine institutionalized racism and for whom it has benefited and harmed Impossible to fix issue with the denial of indigenous sovereignty and lack of rights

→

https://ascopubs.org/doi/full/10.1200/EDBK_100021

Barriers to Diversity in Trials Minorities are more likely to be uninsured and wary of the cost and consequences of participating in trials 3 Solutions/Efforts Partnerships between academic centers and satellite sites in poor communities to increase representation Educate those in underserved communities in what participating in a drug trial entails

REFERENCES

https://www.stdominics.nsw.edu.au/wp-content/uploads/2020/05/close-the-gap-flags-web.jpg

PROFESSIONAL/PERSONAL OPINION

Health care provider implicit bias is a pertinent issue with POC receiving proper health care, but the larger issue is systemic problems that affect every aspect of POC's lives (access to healthcare and systemic racism). The issues discussed here are large scale and will take much effort and time to reduce these healthcare disparities (local, statewide, and at the national level).

1. Williams DR, Rucker TD. Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2000;21(4):75-90.

2. Mayes C. White Medicine, White Ethics: On the Historical Formation of Racism in Australian Healthcare. Journal of Australian Studies. 2020;44(3):287-302. doi:10.1080/14443058.2020.1796754 3. Nazha B, Mishra M, Pentz R, Owonikoko TK. Enrollment of Racial Minorities in Clinical Trials: Old Problem Assumes New Urgency in the Age of Immunotherapy.

American Society of Clinical Oncology Educational Book. 2019;(39):3-10. doi:10.1200/edbk_100021

COST AND SOCIAL CLASS Refers to differences in availability of healthcare because of family/individuals’ social class and financial situation can affect their access to health care, can also be influenced by government activities.

ALANA MULLOY

IN THE UNITED STATES FOOD ACCESSIBILITY

Disproportional access to healthy foods between neighborhoods 1 Low income: more fast food restaurants and convenience stores High income: more grocery and health food stores Mainly affects low income families Improvement Efforts: Fast food restaurants encouraged to improve menu Introduce grocery stores to underserved areas

INSURANCE

Large burden placed on households even when provided through insurance (see figure below) 2 High cost of healthcare prevents many from receiving medical care and filling prescriptions Especially affects low income families and patients with serious medical conditions 2 Improvement Efforts: Lowering the cost of generic drugs pushes lowered cost of drugs overall Lowering the cost of import taxes and fees

https://www.who.int/publications/i/item/9789240017788.

GLOBALLY

Health care spending has been increasing globally Low income countries have been hit harder and out of pocket spending has increased 3 (Fig. 1.13) Essential medicines deemed unaffordable to those who need them4 There is a low availability and 4 high unaffordability

REFERENCES

https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/

PROFESSIONAL/PERSONAL OPINION

Most people can agree that the cost of healthcare can be seen as costly and unaffordable. While there are many factors contributing to this, efforts must be made to make health care more affordable and more accessible to all people, regardless of their financial situation. This is no easy feat, but each step in the right direction has a significant impact.

1. Hilmers A, Hilmers DC, Dave J. Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health.

2012;102(9):1644-1654. doi:10.2105/AJPH.2012.300865 2. Ashley Kirzinger. Data Note: Americans' Challenges with Health Care Costs. KFF. https://www.kff.org/health-costs/issuebrief/data-note-americans-challengeshealth-care-costs/. Published February 6, 2020. Accessed March 28, 2021.

3. World Health Organization. Global spending on health: Weathering the storm. https://www.who.int/publications/i/item/97 89240017788. Published 2020. Accessed March 28, 2021.

4. Sado, E., Sufa, A. Availability and affordability of essential medicines for children in the Western part of Ethiopia: implication for access. BMC Pediatr 16, 40 (2016). https://doi.org/10.1186/s12887-0160572-3

ACCESS TO HEALTHCARE Refers to the ability for patients to gain entry into the healthcare system, accessibility to the facilities and services needed, and the ability to find trusted providers who meet the needs of these patients-includes access and availability of necessary medical equipment, energy stability, the availability of water and sanitation facilities, and the existence or lack of stable policies and procedures.

Miranda Liu IN THE UNITED STATES According to the United States Centers for Disease Control and Prevention (CDC), rural Americans are at a higher risk for poor health outcomes.

About 50% higher risk of mortality from CV disease, cancers, respiratory diseases, and unintentional injuries than urban areas.1 Causes Longer travel times/distances to specialty and emergency services Residents to have to take hours off work for appointments and follow-ups, leading to delay or avoidance of care and more compliance and adherence issues Solutions/Efforts American Hospital Association (AHA) Task Force on Ensuring Access in Vulnerable Communities created in 2015 2 Academic tracks for medical students interested in a rural and underserved community focus 3 Expansion of broadband Internet, Telehealth use, and remote patient monitoring

Canva. Photos. Accessed March 26, 2021. https://www.canva.com/photos/.

GLOBALLY Access to healthcare on the global front differs from country to country depending on its economic and political situation, the resources and facilities available, and the cultural differences leading to differing priorities of their leaders and people.

Yemeni Civil War since March 2015 Unrest has caused the loss of several healthcare facilities, chronic supply shortages, and inadequate upkeep of healthcare policies and procedures. 4 First confirmed case of COVID-19 in Hadhramaut, Yemen, caused panic as there were no existing procedures to prevent the event of further viral spread.

Political and military conflict took priority over viral containment.

Sub-Saharan Africa About 28% of health facilities have access to reliable electricity.4 Ability for healthcare providers to treat patients dependent on fully functional and reliable electricity to keep clinics and medical equipment running and to store medications Lack of reliable energy to the community, leading to the inability to adequately cook and store foods as refrigeration would be an issue.

PROFESSIONAL/ PERSONAL OPINION

What we as Americans see as an issue that needs to be addressed in one country may either not be seen as such to the leaders and people of that particular location, or they may have other areas of concern that must take priority. Efforts and solutions to accessibility are never a one-size-fitsall due to political and cultural differences between regions and require tailoring to fit the unmet needs of each area and demographic population. In addition some solutions may be viable in one area, but not another.

RESOURCES

1. Centers for Disease Control and Prevention. About Rural Health.

Accessed February 22, 2021. https://www.cdc.gov/ruralhealth/ about.html.

2. Bhatt J, Bathija P. Ensuring Access to Quality Health Care in Vulnerable Communities. Acad Med 2018;93(9):271-1275. doi: 10.1097/ACM.00000000000022 54.

3. Jaret, P. Association of American Medical Colleges. Attracting the next generation of physicians to rural medicine. Accessed March 1, 2021. https://www.aamc.org/newsinsights/attracting-nextgeneration-physicians-ruralmedicine.

4. McCarthy, J. Global Citizen.

Access to Health Care Around the World Is Not Equal. COVID-19 Proved That. Accessed March 1, 2021. https://www.globalcitizen.org/en /content/unequal-health-careaccess-covid19/.

S P R I NG 2 0 21

Human Trafficking N ATA L I E C O L D I RO N ( B S P S ) B RYA N Y A N ( B S P S ) C H E RY L C H A N G ( B S P S ) Understanding the Issue Human trafficking is a multidimensional human rights violation that centers on the act of exploitation. It involves the use of force, fraud, or coercion to obtain some type of labor or commercial sex act. It can happen to anyone no matter their age, race, gender, or nationality. Traffickers might use violence, manipulation, or false promises to lure victims into trafficking. There are different types of human trafficking included in this monograph including sex trafficking, organ trafficking, and labor trafficking.

H T TP S : // W W W . J A P A NT I M E S . C O . JP / C O M M U N I T Y /2 0 1 9 /0 7 /2 8/ I S S U E S / B O N N I E - J I N M O N - D E D I C A T E D - L I F E - F I G H T I N G - H UM A N - T R A F F IC K I N G - W AN T - W O R K - B I G G E R /

ttps://www.soroptimistinternational.org/campaigns/modernsla

Sex Trafficking Bryan Yan Understanding the Issue Sex trafficking occurs when someone uses force, fraud, or coercion to cause a commercial sex act with an adult or causes a child to commit a commercial sex act. Traffickers lure their victims by promising them things like protection, a home, love, adventure, and opportunity. They often use violence, fear, threats, and intimidation to make their victims compliant. Traffickers find their victims through social network, home neighborhoods, clubs or bars, the internet, and school. Traffickers often utilize the internet in order to obtain their victims.

They do this through social media, dating sites, and other various methods.

Who Does it Affect?

Anyone can be a victim of sex trafficking. Some are more likely to be victims than others, like women and children. Victims can include all races, ethnicities, sexual orientations, gender identities, citizens, and non-citizens.

However, indigenous populations and those individuals who live in poverty are one of the more vulnerable populations.

Global Implications Globally, there are an estimated 4.5 million victims of sex trafficking. Yearly, about 600,000 to 800,000 people, who are mainly women and children, are trafficked across national borders which does not include the millions of people trafficked within the United States every year.

Traffickers primarily obtain their foreign victims from Mexico, the Philippines, Thailand, Honduras, Guatemala, India, and El Salvador.

Professional Opinion In my professional opinion, it is important to be educated about this topic in order to help those trapped in sex trafficking and to identify potential victims. Doing things like raising awareness to appeal to help victims and taking action to report immediately to become an advocate for real or close-to-be victims could also help those who are trapped in sex trafficking. Also, teaching men at a young age to respect women is important.

https://www.forthepeople.com/sex-trafficking-lawyers/

Efforts and Solutions The people who are freed from this lifestyle should be treated as victims of crime and not criminals. This would help men and women speak out against their attackers and in turn lead to an increase in prosecutions of traffickers.

Sex trafficking can also be prevented through awareness and knowing the signs of sex trafficking. States and communities can implement and evaluate efforts that encourage healthy behaviors in relationships, foster safe homes and neighborhoods, identify and address vulnerabilities during health care visits, reduce demand for commercial sex, and end business profits from trafficking related transactions.

References 1. Chang G. Sex Trafficking.

In: Encyclopedia of Migration. Springer Netherlands; 2016:1-4.

2. Sex Trafficking. Cdc.gov. Published January 28, 2021. Accessed April 19, 2021. https://www.cdc.gov/ violenceprevention/sexualviolence/ trafficking.html 3. Shared Hope International. 2021.

What is Sex Trafficking? - Shared Hope International. [online] Available at: <https://sharedhope.org/theproblem/what-is-sex-trafficking/> [Accessed 15 February 2021].

4. State.gov. Accessed April 19, 2021. https://2001-2009.state.gov/ documents/organization/33216.pdf

https://www.insidehalton.com/news-story/10019321--it-s-not-going-away-human-trafficking-in-halton-increasing-with-hot-spots-in-oakville-and-burlington/

Organ Trafficking Cheryl Chang Professional Opinion In my professional opinion, the government could create an incentive to encourage people to donate their healthy organs.

Also, the government could introduce an anonymous reporting policy to report patients who have received organs from unknown sources, and then the police could trace those sources. Keeping people informed is very important in preventing and keeping individuals out of organ trafficking.

Understanding the Issue The high demand of organ transplants and the long waitlists drive a lot of people to take part in organ trafficking and transplant tourism. Organ trafficking is the practice of stealing or buying organs through exploitation to be sold on a black market for profit. Transplant tourism is the act of traveling to a foreign country for the purpose of buying, selling, or receiving organs.

Traffickers tell their victims they will receive a large sum of money and will often convince a person that the organ is not needed.

Global Implications

References 1. Gonzalez J, Garijo I, Sanchez A. Organ trafficking and migration: A bibliometric analysis of an untold story. Int J Environ Res Public Health. 2020;17(9):3204.

2. Jafar TH. Organ trafficking: global solutions for a global problem. Am J Kidney Dis. 2009;54(6):1145-1157 3. Meshelemiah, J. and Lynch, R., 2021. Chapter 9: Organ Trafficking. [online] Ohiostate.pressbooks.pub.

Available at: <https://ohiostate.pressbooks.pub/ humantrafficking/chapter/chapter9-organtrafficking/#:~:text=Organ%20trafficking% 20is%20the%20practice,%2C%202 011%3B%20United%20Nations%2C %202018> [Accessed 15 February 2021].

https://ohiostate.pressbooks.pub/humantrafficking/chapter/chapter-9-

https://www.invivomagazine.com/en/focus/dossier/article/412/the-fight-against-

Who Does it Affect?

Organ trafficking leads to not only organ harvesting from donors but from unwilling innocent people, such as homeless, indebted, and refugee people. Victims of organ trafficking are mostly the poor, vulnerable populations.

It is estimated that 10% of the organ transplants done globally are completed using black market organs.

Organ trafficking is a global business where organs are bought from the poor and sold to the rich.

China is one of the countries that is extremely well-known for organ trafficking after executing prisoners to illegally harvest their organs against their will.

The internet is a useful tool traffickers use to lure their victims, especially victims that are across borders.

Efforts and Solutions In order to solve the problem, the government should: develop better systems of deceased organ donation, encourage altruistic living kidney donation, prevent needs for transplantation by treating diseases that lead to organ failure such as diabetes and hepatitis, and implementing laws that prohibit organ trading and trafficking. Also, the victims who come forward need to be treated as victims, not as criminals. This would help bring more traffickers to justice.

http://notenoughgood.com/2017/07/apydcon-2017-child-trafficking/

Labor Trafficking Natalie Coldiron

Understanding the Issue

Global Implications

Labor trafficking is a form of modernday slavery in which individuals perform labor or services through the use of force, fraud, or coercion. There are several forms which include bonded labor, forced labor, and child labor.

Bonded labor occurs when the victims’ labor is demanded as a means of repayment for a loan or service, forced labor occurs when victims are forced to work against their own will due to the threat of violence or punishment, and lastly child labor is a form of work that is likely to be hazardous to the health of a child and can interfere with their education. Victims are trafficked for many reasons, including domestic servitude, agricultural and plantation work, commercial fishing, textiles, factory labor, construction, mining, and forced sex work.

Globally, there are ~24.9 million people trapped in forced labor. There are many negative health consequences associated with labor trafficking that are damaging to people everywhere across the globe which has caused a public health problem on a global scale. Low-income and middle-income countries are more vulnerable to abusive working conditions.

Who Does it Affect?

https://www.cbsnews.com/news/trafficking-forced-labor-

Professional Opinion In my professional opinion, it is extremely important to be able to recognize the signs and patterns of someone trapped in labor trafficking. Also, making people aware of labor trafficking and what they can do if they come across a trafficker or a victim could help save many people trapped in this undesired life.

Labor Trafficking

Labor Trafficking

Victims of labor trafficking are not a homogenous group of people. They are young children, teenagers, men and women. Migrant workers and indigenous people are particularly vulnerable to labor trafficking. Some victims enter the country legally on worker visas or some enter illegally. Women and children make up most of the victims in labor arenas because of their lack of power, social marginalization, and their overall status compared to men.

Efforts and Solutions It is important to be able to recognize the signs and patterns of someone trapped in labor trafficking. Some common patterns include isolation to prevent them from getting help or threatening their victims with blackmail. There are many programs available to victims who have been identified in order to get their life back to normal. The U.S. Department of Health and Human Services (HHS) allows trafficking victims who are non-U.S. citizens to receive federally funded benefits and services to the same extent as a refugee.

If you suspect someone is a victim of labor trafficking, call the National Human Trafficking Resource Center at 1-888-3737888.

References

1. Administration for Children and Families. 2021. OFFICE ON TRAFFICKING IN PERSONS. [online] Available at: <https://www.acf.hhs.gov/archive/otip/f act-sheet/fact-sheet-labor-traffickingenglish> [Accessed 15 February 2021].

2. FACT SHEET: LABOR TRAFFICKING (English). Hhs.gov. Accessed April 20, 2021. https://www.acf.hhs.gov/archive/ otip/fact-sheet/fact-sheet-labor-trafficking -english 3. National Human Trafficking Hotline.

2021. Labor Trafficking. [online] Available at: <https://humantraffickinghotline.org/typ e-trafficking/labor-trafficking> [Accessed 15 February 2021].

4. Zimmerman C, Kiss L. Human trafficking and exploitation: A global health concern. PLoS Med. 2017;14(11):e1002437. Published 2017 Nov 22. doi:10.1371/journal.pmed.1002437

IMMUNIZATIONS Since the discovery of vaccines by Edward Jenner in 1796, we now have more than 30 vaccines against 26 of the main viral and bacterial infectious diseases, greatly minimizing further disease progression and transmission, therefore reducing disease incidence, severity, and mortality after exposure to these agents.

When it comes to public health, each culture has a different history regarding medicine and immunology, and as a result, every culture holds a different set of perceptions and ideals surrounding vaccinations, resulting in varying strategies on how infectious diseases should be handled. This monograph looks at immunizations and vaccinations across different cultures and globally to explore the production and cost value regarding vaccinations, how vaccine accuracy and trust have changed over time, and what is next to come with the COVID-19 pandemic.

By: Maxwell Frye (BSPS) Zamir Latif (PharmD) Ronald Mahan (PharmD)

Maxwell A. Frye

Prices and Effects of Prices

Implications on COVID-19 Effects of high costs can be seen for the current COVID-19 pandemic as well Prices of vaccines are not consistent across the globe. Prices depend on buyers, hurting some poorer countries.

Immunization, measles. Data. https://data.worldbank.org/indicator/SH.IMM.MEAS. Accessed April 19, 2021.

With high cost of production comes high prices.

Increasing and varying prices of vaccines for common Example: In 2018, Madagascar experienced a measles but deadly infectious diseases can cause many at-risk outbreak due to low vaccination rates caused by to people to not be vaccinated, causing health issues unaffordable prices for the people, among many other factors. 112,000 cases of measles were reported. around the globe.

Production and Costs

Curent Efforts

Organizations such as the Expanded Program of Vaccines can cost up to $5 billion to produce Immunization (EPI), Global Vaccine Action Plan (GVAP), and COVAX, have all been formed to provide Time of production ranges from 1 year to 10 immunization for at-risk people. However, many of the years WHO recommended doses of vaccines can cost goals set by these organizations were not met by the $652 out of pocket, 68x higher than 15 years ago end of the decade (2020). Given the current situation of the COVID-19 pandemic. There is likely to be a Prices need to be dramatically lowered, 84% on greater effort and more attention brought to the issue average, for developing countries so some may of immunizations. afford to be vaccinated.

Increasing prices, among other factors leads to people poorer nations not being vaccinated It is a tough situation. While it is not the responsibility

Primarily developing countries and poorer families.

However, given the connectedness of the world diseases can reach far across the world

United States Brazil Uganda

Cost of Oxford- AstraZeneca Vaccine (USD) $4.00 $5.00 $8.50

% of population with at least one dose. United States 39%, Brazil - 11%, Uganda - 0.5% Ritchie Rand data: H. Coronavirus (COVID-19) Vaccinations - Statistics and Research.

Our World in Data. https://ourworldindata.org/covid-vaccinations. Accessed April 19, 2021.

Maxwell A. Frye References Mikulic M. COVID-19 vaccine doses ordered by manufacturer. Statista. https://www.statista.com/statistics/1195971/number-of-covid-19vaccine-doses-by-manufacturer/. Published April 14, 2021. Accessed April 19, 2021.

Vaccine Development: How Long Does It Take to Make a Vaccine? of more developed countries to help vaccinate poorer Science ABC. https://www.scienceabc.com/humans/how-long-does-itones, help should be given. Infectious diseases affect take-to-develop-a-new-vaccine.html. Published April 14, 2021.

Accessed April 19, 2021 Beaubien J. Price Check: Nations Pay Wildly Different Prices For the entire world, directly or indirectly, and greatly Vaccines. NPR. affect individual human lives. The current programs are https://www.npr.org/sections/goatsandsoda/2021/02/19/969529969 a great start but more work needs to be done to ensure /price-check-nations-pay-wildly-different-prices-for-vaccines.

Published February 19, 2021. Accessed April 19, 2021 no more lives are taken from very preventable diseases. Dyer O. Covid-19: Countries are learning what others paid for vaccines.

BMJ. 2021. doi:10.1136/bmj.n281

My Opinion

Who's at risk?

Country

Vaccine Perceptions

Ronald Mahan

Herd Immunity: resistance to the spread of an infectious disease within a populaiton that is based on pre-exxisting immunity of a high proportion of individuals as a result of previous infection or vaccination

Vaccine Accuracy

• New vaccine types created (mRNA) • Adapting previous models for measuring vaccine effectiveness to improve reliability and data accuracy • Computerized programs help predict future virus mutations and strains • Increasing understanding of infectious diseases, including viral spread and concept of herd immunity

Vaccine Distrust

Tuskegee Experiments: ethically unjustified experiments to observe natural progression of untreated syphilis in African American male population, with researchers lying to participants about them receiving available syphilis treatment when they actually were not.

Perpetuated a culture of mistrust amongst African Americans and the medical community Anti-Vax Movement: Resistance group against the use and clinical effectiveness of vaccines due to personal beliefs which may include safety concerns, human right infringement, or religious contradictions. It is estimated nearly a billion dollars is generated through anti-vax content through social media (CCDH 2020), with detrimental effects to county health departments due to preventable outbreaks, costing up to millions of dollars per outbreak (HealthDay 2021) Misinformation: False or inaccurate information surrounding vaccines or their implementation. Many misinformation propositions against vaccine use are intended to discredit vaccine’s place in medicine

Caudal H, Briend-Godet V, Caroff N, Moret L, Navas D, Huon JF. Vaccine distrust: Investigation of the views and attitudes of parents in regard to vaccination of their children. Ann Pharm Fr. 2020;78(4):294-302. doi:10.1016/j.pharma.2020.03.003 Jamison AM, Quinn SC, Freimuth VS. "You don't trust a government vaccine": Narratives of institutional trust and influenza vaccination among African American and white adults. Soc Sci Med. 2019;221:87-94. doi:10.1016/j.socscimed.2018.12.020

Vaccine Mentality

Since the discovery of immunization in 1796, the prevalence, morbidity, incidence, and mortality of infectious and communicable diseases have decreased significantly in Western cultures because of vaccination programs starting with infants and children, carried throughout adult life (Ventola 2016). Vaccinations are effective due to immunization against a specific infectious agent from a pathogen and herd immunity, thus improving overall public health, quality of life, and longevity in economically developed countries, despite resistance from small

percentages of the population to avoid vaccinations throughout their community. Because diseases do not pick and choose who their infect or how fast they mutate, a lack of immunized citizens puts the whole community at risk for an infectious disease outbreak. Most hesitant countries against vaccines include Japan, Lithuania, and Albania (Boyd 2020) with proposed rationale being hesitancy towards outside information and religious leader’s outspokenness against foreign substance injection. Efforts have been made to combat these fears with community outreach programs to show support and importance for childhood and adulthood immunizations and increased transparency with clinical trials including how they are conducted, the statistics and models used to calculate effectiveness, and the immediate and longerterm adverse effects. In my opinion, the discovery and implementation of vaccines programs are the most significant human advancement of this century, and in order to minimize fears and misconceptions against their use, education regarding their importance should be stressed in early schooling.

Larson HJ, Clarke RM, Jarrett C, et al. Measuring trust in vaccination: A systematic review. Hum Vaccin Immunother. 2018;14(7):1599-1609. doi:10.1080/21645515.2018.1459252

COVID

Zamir Latif

Vaccine

that many vaccinations per person as, currently, there is productivity have been severely impaired by the COVID only two doses max per vaccine series.

19 virus. The severity of this virus, while undermined and This mismanaged vaccine supplies will leave many citizens in the less developed nations without the ability masked by some, has caused an incredible change in to overcome the virus. There is a great risk in leaving how we are able to interact with the world around us; these less-wealthy nations without an adequate vaccine social gatherings are small and infrequent, classes and supply as the virus would be more likely to mutate and work places have become virtual and socially distanced, become more infectious or dangerous in these and commercial office spaces are eerily quiet and environments (WHO 2020). In order to ensure that the lacking the energy they once had. While everyone is vaccine is supplied to less wealthy nations, the World interested in returning to pre-COVID life, there are Health Organization has created a task force called multitude of issues that need to be addressed in order to COVAX in whose sole purpose is to ensure that less ensure that we’re getting the most evident from our new wealthy countries have access to vaccine doses.

While COVAX continues in their efforts to vaccinate the vaccines. less fortunate across the globe, there are still other https://www.rockpa.org/responding-to-covid-19-suggestionsand-recommendations-for-donors-as-of-march-2020/ logistical issues that will need to be addressed like, for example, securing a cold chain that will keep the vaccines at the appropriate storing temperature. These vaccines require specific storage conditions to preserve and guarantee its effectiveness. Many developing nations still lack the necessary infrastructure to support the transportation of these vaccines and will require additional funding and technologies.

Over the past year, the world’s citizens, economies, and

One of the larger issues that are associated with this pandemic is that there’s a large income inequality among the world’s nations; wealthier nations, due to their higher gross domestic product, have a greater ability to finance the purchase of vaccines. For example, according to some sources, the nation of Canada has already ordered nine vaccines per citizen (Nature News 2020). While it is within a nations best interests to provide for a citizenry, there is no reason for

https://www.statnews.com/2020/02/11/disease-caused-by-thenovel-coronavirus-has-name-covid-19/

Distribution

As of right now it appears that COVAX is on track with its current goals, but it will require further funding and cooperation with other nations. In the past, much of the funding that was acquired was due to moral arguments; but with the recent upturn of the world economy, many of these arguments know make financial sense as the virus is more likely to mutate and cause more damage to the global economy in these less wealthy countries.

Inside the mammoth undertaking of global vaccine distribution. (n.d.). Retrieved April 19, 2021, from https://www.who.int/news-room/featurestories/detail/inside-the-mammoth-undertaking-of-global-vaccine-distribution

References Mullard A. How COVID vaccines are being divvied up around the world. Nature News. https://www.nature.com/articles/d41586-020-03370-6.

Published November 30, 2020. Accessed February 11, 2021.

Inside the mammoth undertaking of global vaccine distribution. (n.d.). Retrieved April 19, 2021, from https://www.who.int/news-room/featurestories/detail/inside-the-mammoth-undertaking-of-

Infectious Disease Joseph Kirchgassner, Sun Yudong, Seohyun Park Bachelor of Science in Pharmaceutical Sciences (BSPS), Purdue University PHRM 48500 Spring 2021

Abstract Infectious diseases are diseases caused by organisms like bacteria, viruses, or parasites.

Communicable diseases are types of infectious diseases that can be problematic all over the world and cause numerous deaths. As SARS-CoV-2 continues for more than a year, interest in global health effects is also increasing. In this report, the relationship between immunizations and COVID-19 and impact of infectious diseases on our society and lives are covered. Also, we will discuss the difference between epidemics and pandemics.

Immunization Disparities

Yudong Sun Class of 2021 Vaccines were firstly performed in 1796. Currently, immunization plays important roles in each country’s health system to combat infectious diseases, due to its abilities to stimulate immune memory and provide immunity. However, contrary to its unlimited potential, quantities of vaccines are limited. Taking current COVID-19 Vaccines for example, many countries’ health systems were impacted greatly and challenged their abilities to develop or acquire COVID-19 vaccines and allocation during COVID-19 pandemic.

Different actions in developing Covid-19 vaccines United States

Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), when the Secretary of HHS declares that an emergency use authorization is appropriate, FDA may grant unapproved medical products or unapproved uses of approved medical products Emergency Use Authorization. However, this process still requires rigorous review of safety and efficacy data.

Currently, there are three vaccines authorized for emergence use: ● Pfizer-BioNTech COVID-19 Vaccine ● Moderna COVID-19 Vaccine ● Janssen COVID-19 Vaccine All authorized vaccines have acceptable rates of adverse events.

European Union

The European medicine agency apply conditional marketing authorization for medicines with less safety and efficacy data than normal, where the benefit of immediate availability of the medicine outweighs the risk inherent in the fact that additional data are still required. Also, this act allows the vaccine developers to submit additional data after the marketing authorization.

Currently, there are four vaccines granted EMA: ● Comirnaty ● Moderna COVID-19 Vaccine ● Vaxzevria ● Janssen COVID-19 Vaccine All authorized vaccines have acceptable rates of adverse events.

Immunization rollout of COVID-19 vaccines United States

Phase 1A: Healthcare personnel residents of long-term care facilities.

and

Phase 1B: Frontline essential workers and People aged 75 years and older.

Phase 1C: People aged 65—74 years; People aged 16—64 years with underlying medical conditions; Other essential workers

Germany

Most African Countries Instead of developing vaccines, most african countries have joined COVAX Facility. This is an international health program intended to improve access to new or currently using COVID-19 vaccines for many lower-income countries. Those vaccines come from donations by higher-income countries or personnel.

Currently, COVAX has shipped 32 million COVID-19 vaccines to 60 participants.

European Union

1. Those over 80 years old.

2. Care workers who work in elderly people's homes or regularly look after the elderly or the mentally ill.

3. Health care workers with a high risk of exposure to COVID-19, especially those working in intensive care units, emergency rooms, and first responders.

4. Health care workers who primarily treat patients with a higher risk of dying from COVID-19.

France

1. Residents of Ehpads 2. Highest risk groups – phase 2 will concern all over 75s, and anyone in the 65-74 age group who has a chronic illness that makes them vulnerable to COVID, such as heart and lung conditions.

3. Vulnerable people and health workers 4. High-risk employment 5. All other adults

However, in most African countries like Nigeria, there is lack of the government guidance on vaccine rollout. No clear COVID-19 vaccine rollout plan is available. Though there are rollout plan provided by COVAX and WHO, it is all the same and is not suitable for every lower-income countries.

Solution and Effort: Currently, WHO has started accelerated the approval process for Vaccines entering COVAX program and begins sending inverstigators to different low-income countries to collect information and design rollout plan based on local conditions. In my opinion, the immunization disparities are not limited to COVID-19 vaccines. This disparity also applies to MMR vaccines, DTaP, etc. Those areas also need constant effort from WHO and cooperation from other international organizations.

References:

1. France prepares 5-stage plan for Covid-19 vaccination campaign. The Local France. Published December 1, 2020. Accessed March 28, 2021. https://www.thelocal.fr/20201130/france-prepares-5-stage-plan-for-covid-19-vaccination-campaign/ 2. Welle (www.dw.com) D. COVID: German regulations on who gets vaccine first | DW | 18.12.2020. DW.COM. Accessed March 28, 2021. https://www.dw.com/en/covidgerman-regulations-on-who-gets-vaccine-first/a-55987647 3. Research C for BE and. Emergency Use Authorization for Vaccines Explained. FDA. Published online December 14, 2020. Accessed March 27, 2021. https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained

Seohyun Park COVID and other Infectious Diseases COVID-19 is an ongoing pandemic disease which has been prevalent over a year. The number of cases worldwide has exceeded 127 million and the number of deaths is approaching 3 million people. This is not the only time such infectious diseases have been a global issue. For example, SARS, MERS, and Swine flu are infectious diseases which had global impact. I would like to discuss how these diseases have humanity focusing on mortality rates and infection counts. In addition, the impact of COVID-19 on our lives would be addressed.

Mortality Rates and Infectious Counts Mortality rate is determined by units of deaths per 1,000 individuals per year.

(Charts retrieved from MRP News. 2020.)

Impacts of COVID-19 • People who are feeling the symptoms of depression increased by about 17 % in the 6 months from August 2020 to January 2021. (source: United States CDC) • Due to the social distancing by pandemic, the rates of anxiety and depression has increased worldwide.

• COVID-19 has not only affected personal lives but also greatly affected socioeconomic conditions.

• Limitations to travel caused unemployment, and the entire travel market had significant downfall last year.

• Increase in sales of disinfectants, vitamins, and coffee.

Solutions and Efforts • Vaccines were rapidly developed and distributed around the world.

• There are voices of concern about the stability of the vaccine.

Personal opinions on safety concerns on COVID-19 vaccine • I think COVID- 19 vaccine is safe even though it developed quicker than other vaccines in the past because vaccines must go through several safety and stability tests before they get used.

• Also, side effects and results of the vaccine are continuously monitored so that it can be confirmed to use in general.

Reference 1. CDC: Depression, anxiety continue rise in U.S. due to COVID-19 pandemic. Gephardtdaily.com. Published March 27, 2021. Accessed March 29, 2021. https://gephardtdaily.com/national-international/cdc-depression-anxiety-continue-rise-in-u-s-due-tocovid-19-pandemic/ 2. McCarthy N. COVID-19’s impact on tourism: Which countries are the most vulnerable? [infographic]. Forbes Magazine. Published online May 5, 2020.

Accessed March 29, 2021. https://www.forbes.com/sites/niallmccarthy/2020/05/05/covid-19simpact-on-tourism-which-countries-are-the-most-vulnerableinfographic/ 3. Montgomery DH. COVID-19: How it compares with other diseases in 5 charts. MPR News. Accessed March 29, 2021. https://www.mprnews.org/story/2020/03/11/covid19-how-it-compares-with-other-diseases-in-5-charts

Epidemics vs. Pandemics Why does it matter?

Terms to Know

The spread of infectious disease starts where the disease is endemic. Then through outbreaks, it turns into an epidemic, which can turn into a pandemic if not controlled.

All of this is a way to describe how a disease is spreading. It is not an indication of the severity or death rate. Countries, or states, with different views present the risk of spreading diseases more than necessary and can lead to confusion and poor health outcomes for individuals in affected areas.

Endemic: a disease present in a specific area Outbreak: greater presence of disease than expected Epidemic: disease that affects many people in an area/region Pandemic: disease over multiple countries/continents World Health Organization (WHO): This is an international organization that provides guidance and resources to countries to improve public health.

How Organizations Differentiate Epidemic and Pandemics United States

World Health Organization

The Center for Disease Control didn’t list any specific metrics for an epidemic or pandemic. They refer to a pandemic as an epidemic that is present in multiple countries or continents. They note that epidemics occur due to novelty, mutation, or a new mode of transmission of a disease. The CDC does affirm that epidemics and pandemics are solely a way to describe how a disease spreads.

The WHO also doesn’t have definite metrics that make an epidemic turn in to a pandemic. They take a broad approach like the CDC, but they do outline the 6 phases seen above.

There is also a post-peak/pandemic phase in which the disease infection rate is dwindling. I find it interesting that technically only three countries have to be infected and transmitting the disease for it to be considered a pandemic.

Canada Health Canada had similar definitions to the CDC and WHO, but they went into much more detail about pandemics. They primarily listed characteristics about recent flu pandemics and how they generally are more deadly and last for 1-2 years.

These claims are much different from everything else I’ve read, as the CDC and WHO do not touch on the severity or length of disease transmission in their epidemic and pandemic definitions.

WHO Pandemic Phases: Phase 1: No Disease → Phase 2: Disease in Animals → Phase 3: Isolated Animal-Human transmission → Phase 4: Human-Human transmission, with outbreak potential → Phase 5: Outbreaks in 2 countries in a WHO Region → Phase 6: Same as Phase 5 and one additional country in a different WHO region

Personal Opinion: Cultures have ingrained ways of viewing disease and how they should be treated, mitigated, and managed. I think in the end, travelers and citizens need to take responsibility for their own health. Understanding the local customs of the places you live or are visiting can provide the most applicable information for personal decisions. One government agency might think a disease is a concern, while others may not give it thought. It comes down to the individual to evaluate their risks and understand how they can stop the spread of infectious diseases. ~ J. Kirchgassner

WHO Regions https://en.wikipedia.org/wiki/File:World_Health_Organisation_regio nal_offices.svg

References: Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector. Canada.ca. https://www.canada.ca/en/public-health/services/flu-influenza/canadian-pandemicinfluenza-preparedness-planning-guidance-health-sector/table-of-contents.html#a2a2. Published August 2018. Accessed March 28, 2021 Principles of Epidemiology in Public Health Practice. Lesson 1: Introduction to Epidemiology. Section 11 Epidemic Disease Occurrence. cdc.gov. https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html#:~:text=Pandemic%20refers%20to%20an%20epidemic,source%20to%20the%20susceptible%20hosts. May 18,2012.

Accessed March 28,2021.

The Who Pandemic Phases. Pandemic Influenza Preparedness and Response: A WHO Guidance Document. Geneva World Health Organization;2009. https://www.ncbi.nlm.nih.gov/books/NBK143061/ Accessed March 28, 2021

MENTAL HEALTH

BSPS students Crystal He, Hanyu Liu, Shuyun Yang, Xuxi Li Spring 2021

According to World Health Report 2001, one in four people in the world are suffering from mental problems and two-thirds of mental disorder patients don't ask for help. Not only human beings are affected by mental disorder, study shows animals can also suffer neurological disorders. Therefore, in this monograph, we present 4 main topics to further discuss the issue.

STIGMA IN CHINA Background

Personal Opinion(HL) There are approximately 0.24 billion people having mental health problems in China according to the latest statistic report from the Office of mental health Supports. This means there are about 16% population are affected by mental problem and there will be three times more people being affected as family members. Only 14% of patients are having mental supports and help from specific hospitals. Most of the patients are still in blind with their own mental health. Although the symtem is not that obivous compared with physical injury, the suicide rate is extremly high which is about 86.6%. Mental issues should be considered in social insurance.

Solutions

Improvement on psychology education especially at primary education state.

Increasing socail activities in topics like mental supports and mental disorders.

Social media that can help convey knowledge of different types of mental issues and increase the acceptance of patients having mental health problems.

In many developing countries, especially in China, psychological problems have not received enough attention. Although reports of mental problems have gradually increased in society in recent years, ingrained beliefs have not changed with media reports. We infer that the formation of this phenomenon may be caused by the various influences of family, education and negative media reports. In China, the knowledge of psychology was not popularized and taught in primary and secondary schools, which resulted in more than 90% of people in high school, even over the age of 25, to misunderstand this subject of psychology. The misunderstanding of psychology leads to a series of stereotypes and fixed thinking patterns, and it also increases the number of deaths caused by mental diseases each year.

Who/What is affected

The patients that have mental problems, including people know about their issues and people who aren't aware of mental problems.

Also teenagers that need to be taught about psychology.

Reference: Yin H, Wardenaar KJ, Xu G, Tian H, Schoevers RA. Mental health stigma and mental health knowledge in Chinese population: a cross-sectional study. BMC Psychiatry. 2020;20(1):323. Published 2020 Jun 22. doi:10.1186/s12888-020-02705-x

Bram, B. “WeChat Apps Are Tackling China's Hidden Mental Health Crisis.” WIRED UK, WIRED UK, 12 Aug. 2019, www.wired.co.uk/article/china-mental-health-wechat-apps.

CURRENT Though China continues to develop its mental health services, it continues to have a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.

CRIMINAL JUSTICE Background

https://cdn.givingcompass.org/wpcontent/uploads/2019/12/19083952/We-Need-an-Attitude-Shift-forCriminal-Justice-Reform.jpg

Who or what is affected

According to a report from the Council of State Governments Justice Center, 16.9% percent of the adults in the local jails had serious mental illness, which is 3-6 times higher than the rate of that in the general population. Considering there are 13 million jail admissions, there might be more than two million people in the prison with serious mental illness. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.naco.org%2Fblog%2Fmental-health-andcriminal-justice-case-studiesreleased&psig=AOvVaw1tsqwo7ZsE2VMe5mBRAp3D&ust=1618942971183000&source=images&cd=vfe&ed =0CAIQjRxqFwoTCOiUrNr2ivACFQAAAAAdAAAAABAR

During incarceration, many prisoners with mental illness don’t receive treatment, which might cause the conditions to worsen. This could lead them to be a greater threat to themselves and to others when they leave jail or prison..

Solutions Awareness of the need for criminal justice Develop a system to help criminals with mental illness Educate the public with the importance of criminal justice and the seriousness of the mental illness

Reference: Justice.gov. Addressing Mental Illness in the Criminal Justice System. https://www.justice.gov/archives/opa/blog/addressing-mental-illness-criminal-justice-system Walsh, N. "Mental Health and Criminal Justice Case Studies Released". 8 Jul. 2015. https://www.naco.org/blog/mental-health-and-criminal-justice-case-studies-released

Personal Opinion (SY) "All men are created equal" -U.S. Declaration of Independence Being aware of criminal justice is a step to support the human right Realizing others' mental health is essential for everyone in the society

EATING DISORDERS AT PURDUE Background According to the American Psychiatric Association, an Eating Disorder (ED) is defined as an "illness in which the people experience severe disturbance in their eating behaviors and related thoughts and emotions". There are numerous ED that an individual can be diagnosed with. The three most common ones are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder (BED).

Anorexia Nervosa Underweight Limited food intake

Bulimia Nervosa Consume a large amount of food in a short period of time Purging/clearing Binge Eating Disorder behavior Consuming large

amounts of food

Who is affected?

Eating disorders are mental illnesses that have the highest mortality rate when compared to other mental health disorders. It affects 9% of the population over the world and affects approximately 30 million people in the US, among which the majority are college students at the ages of 18 - 21. Moreover, the chance of developing an eating disorder is continuing to increase among college students [1]. Therefore, universities need to provide students with resources to spread eating disorder awareness and help with early diagnosis and treatment.

100

Female Male 75

50

25

0

Previous or possible ED

No ED

What about Purdue?

The majority of the students (94%) who took the survey have heard of ED before, indicating that most of the students at Purdue have an awareness of eating disorders. Among all of the participants, 54 students (33%) have ED history or symptoms, among which 39 were female, representing 45% of the female participants, and 15 were male, representing 23% of the male participants.

Considering the overall student population at Purdue University, many students might be suffering from ED right now. Therefore, it is urgent to provide more resources for ED populations by Purdue University.

S OL UTIONS Purdue offers nutrition counseling services and the Counseling and Psychological Service (CAPS) program, but they are not dedicated for students with ED.

OPINIONS AND RECOMMENDATI ONS( YH) Create a comprehensive ED program through PUSH that offers partial hospitalization, intensive outpatient care, and general outpatient care.

Incorporate other medical practices such as psychiatry.

2013. eating disorders on the college campus. a national survey of programs and resources. [online] Available at: <https://www.nationaleatingdisorders.org/sites/default/files/CollegeSurvey/CollegiateSurveyProject.pdf>. Accessed 17 February 2021.

Healthline. 2021. Eating Disorders on College Campuses. [online] Available at: <https://www.healthline.com/health-news/eating-disorders-on-collegecampuses-are-on-the-rise> Accessed 17 February 2021.

ANIMAL MENTAL HEALTH Background A famous experiment conducted by Harry Harlow for maternal-separation on infant rhesus monkeys.

The researchers observed abnormal changes on infant rhesus monkeys' emotions and behaviors that were isolate with the surrogate mothers.

Besides the insightful notes on maternal and infant relationship, the experiment revealed that animal can suffer from mental health problems.

Who or what is affected Animals can also develop mental disorders when they encounter trauma or excess anxiety. For pets that experience wars or earthquakes, they may develop symptoms similar to PTSD. In addition, some animals in captivity may develop odd behavior such as OCD or even suicide. We should not only care about the health of humans, but also the physical and mental health of animals.

Solutions Species-specifics mental stimulation, social engagement, exercise, comfortable environment.

Apply positive reinforcement Develop resilience and flexibility by desensitize their fear and anxiety

Personal Opinion (XL) News showed a high demand in adopting dogs and cats during the pandemic.

Studies have been demonstrated that interact with pets will reduce stress and release endorphins which keep us relax. However, animal behaviorists or psychological scientists have observed abnormal behavior when their habitat changes or experiencing unfairly treats. Human beings are not the only creators stay in this planet. Therefore, we should take care of each other when animals are vulnerable.

References 1. McMillan FD. Mental Health and Well-being in Animals, 2nd Edition: How can we protect our pets from behavioral or mental health problems? Oxfordshire, UK.: CAB International; 2020. https://books.google.com/books/about/Mental_Health_and_Well_being_in_Animals.html? id=Lge9DwAAQBAJ. Accessed Feburary 16, 2021.

2. Harlow HF, Suomi SJ. Social recovery by isolation-reared monkeys. Proc Natl Acad Sci U S A. 1971;68(7):1534-1538. doi:10.1073/pnas.68.7.1534.

SPRING 2021

MENTAL HEALTH Saja Abbas, Professional Student Brittany N. Galloway, Professional Student Cindy Lam, Professional Student, BSPS Candidate

HTTPS://HBR.ORG/2018/10/AIS-POTENTIAL-TO-DIAGNOSE-AND-TREAT-MENTAL-ILLNESS

What is Mental Health?

Mental health is defined as an individual’s emotional, psychological and social well-being that affects how we

MAIN AREAS OF FOCUS

think, feel and act. Our mental health determines how we handle stress, relate to others and make choices.

-Mental Health in the workplace

According to the CDC, nearly 1 in 5 US adults aged 18 or older reported a mental health illness in 2016 and

-Cyberbullying

about 71% of adults reported at least one symptom of stress, such as a headache or the feeling of being overwhelmed or anxious.

Reference: What is Mental Health? Mental Health.gov.

Accessed March 27, 2021. http://www.mentalhealth.gov/basics/what-is-mentalhealth

-Treatment and access

SPRING 2021

Mental Health in the Workplace

By Brittany N. Galloway

Mental health impacts every aspect of an individual’s life. This is true for the workplace as well, despite the different types of workplaces that can vary across industries. One of the impacts of working so many hours is an increased amount of stress that an individual can experience. Working more hours can result in less time caring for home life, less time spent with loved ones and less time spent enjoying hobbies. According to the CDC, stress is the number one cause of health problems, both physically and mentally. Chronic stress often leads to individuals developing mental health issues, such as depression and/or anxiety.

In the workplace, poor mental health, caused by stress, can cause multiple issues such as negatively impacting job performance and productivity, communication with coworkers and one’s physical capability of functioning normally. The CDC states that mental illnesses, such as depression, can interfere with a person’s ability to complete tasks 20% of the time and reduces cognitive performance 35% of the time. But why is there such a prevalence of mental illness in the workplace? Partly because employees are afraid of discussing mental health issues with co-workers and bosses out of fear of losing jobs, damaging relationships or out of fear of future employers learning about illnesses and judging them. There still remains a stigma around discussing mental health in the workplace.

Reference: Why Employers Need to Talk About Mental Illness in the Workplace. NAMI Pierce County. Accessed March 27, 2021. https://namipierce.org/why-employers-need-to-talk-aboutmental-illness-in-the-workplace/

It is a Global Issue Mental health issues occurring in the workplace is a global issue because it is not unique to any one culture or country. The countries that work the most number of hours per week can provide some insight into where mental health issues in the workplace may by most prevalent.

According to the world population review, workers in Mexico work the most amount of hours in a week. Full time employees can work over 50 hours a week on average. Costa Rica is second with an average work week of about 48.5 hours a week. America came in at number 10 with an average of 41.5 work hours per week. America does not have any laws setting the maximum length of the work week.

In order to have a successful team meeting, keep the discussion focused and

always encourage participation.

Reference: World Population Review. Most Overworked Countries 2021. Accessed March 27th, 2021. https://worldpopulationreview.com/country-rankings/most-overworked-countries

SPRING 2021

American Heart Association Study: What to do?

In 2019, the American Heart Association conducted a research study that pinpointed 7 specific strategies to address workplace mental illness. The seven strategies included role modeling a mental-health-friendly workplace, the implementation of mental health plans, increasing the frequency of sharing information regarding mental health policies and resources, inviting employees to play a more active role in company mental health policy decisions and finally, encouraging companies to continuously report on the outcomes of these initiatives in order to ensure full transparency of outcomes. According to the American Heart Association, all seven of these strategies could build a healthier and more productive workforce if enforced by employers

HTTPS://MAGAZINE.UTORONTO.CA/R ESEARCH-IDEAS/HEALTH/MENTALHEALTH-IN-THE-WORKPLACE/

looking to aid their hardworking employees.

Reference: Colletta J. 7 Ways to (Effectively) Address Mental Health in the workplace. Human Resource Executive. Accessed March 27, 2021. https://hrexecutive.com/7-ways-to-effectively-address-mentalhealth-in-the-workplace/

Professional Opinion In America specifically, I don’t believe that mental health in the workplace will improve. I believe mental health will only further deteriorate due to our capitalist society. In capitalist societies, companies are primarily focused on making a profit and in that goal, there is little room to care about the emotional wellbeing of employees. There are oftentimes costs associated with wellness programs and realistically, employers would most likely cut their losses by firing “difficult” employees and hiring individuals whom they feel will pose less of an issue in the workplace. That is happening in retail pharmacies. Pharmacists, interns and technicians are being pushed to their limits in order to accommodate the introduction of the COVID-19 vaccine. However, this does not negate the fact that burn-out is real and at some point, individuals will be pushed to their limits, which can result in mental illness. This is why I am an advocate for unions that have the power to negotiate terms on behalf of workers.

SPRING 2021

Cyberbullying

SA

By Saja Abbas

Who or what is affected Background

Cyberbullying is bullying that takes place over digital devices like cell phones, computers, and tablets. Cyberbullying

Mental health is so important to achieve and

includes sending, posting, or sharing negative, harmful, false,

sustaining well-being, and simultaneously reducing

or mean content about someone else. Being targeted by a

youth depression, anxiety, and suicidal intent

cyberbully may increase your child's risk of anxiety,

continues to be a core underpinning of many

depression, low self-esteem, or even feelings of

public health programs. An organized

worthlessness.Some common long-term effects of

determination of well-being in adolescents is the

cyberbullying include depression, low self-esteem, unhealthy

extent to which an individual feels socially

addictions, trust issues, and poor mental health.

connected with others. Young people increasingly

Cyberbullying can cause psychological effects such as fear,

connect with others online especially now the

destruction of self-esteem, social isolation, poor academic

pandemic due to COVID- 19, many people had to

performance. It can also lead to difficulty in forming healthy

stay home, and the impact of this on young

relationships and most importantly, victims can develop

people’s relationships and well-being is very

severe symptoms of post-traumatic stress, anxiety, and

important to consider. Cyber abuse bullying can

depression which will lead to mental health.

cause serious long-term problems for both the bully and the bullied which can cause mental health. The bullied person can have problems in school, issues with depression, slipping grades, and could even resort to drug use to deal with problems caused by the bullying they experience.

In terms of mental health, it can cause significant emotional, psychological, and physical distress which may experience physical symptoms, mental health issues, and struggle academically.

Solutions

Current

Stopping cyberbullying is to act and don’t respond to

My opinion on this will lead to an issue in the future if we did not

the bully but that doesn’t mean you end the bully

take action because this has the cause and effect of the

however you made the first step to change. Also, they

relationship between two things when one thing makes

should report it to the authorities because most kids

something else happen. For example, if we eat too much food

don’t tell their parents about the bullying online or

and do not exercise, we gain weight. Eating food without

offline, so this is something that parents should pay

exercising is the “cause;” weight gain is the “effect.” There may

close attention to their children’s physical and mental health and ask why they don’t want to go to school or have multiple accounts on social media.

be multiple causes and multiple effects. As youth are spending increasing time in the 24/7 online environment, there is a need to develop initiatives that engage young people and encourage help-seeking online, whilst concomitantly building the capacity of parents and peers to support their well-being.

Because cyberbullying hurts inside and out it’s important to consider in terms of mental health.

References

Frejd SH. Just Between Us. 5 Ways to Stop Cyberbullying. Accessed March 28, 2021. https://justbetweenus.org/life/christianity-and-culture/5-ways-to-stop-cyberbullying/

Kwan I, Dickson K, Richardson M, MacDowall W, Burchett H, Stansfield C, Brunton G, Sutcliffe K, Thomas J. Cyberbullying and Children and Young People's Mental Health: A Systematic Map of Systematic Reviews. Cyberpsychol Behav Soc Netw. 2020; 23: 72-82. 10.1089/cyber.2019.0370.

SPRING 2021

Barriers to Mental Healthcare Treatment & Access

By Cindy Lam Mental illness is a condition that affects a person’s thinking, feeling, behavior, or mood. These conditions deeply impact day-to-day living and may also affect the ability to relate to others. Mental health issues are far more common than most people realize. According to the United States Department of Health and Human Services, 1 in 5 American adults have experienced a mental health issue, and 1 in 25 Americans live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. More than half of the adults with mental illness in the United States do not receive mental healthcare treatment. It is evident that mental health care should be a prominent part of the health care system in the United States. However, current mental health care does not adequately address the complex challenges of mental illness.

Intercultural Issue The lack of mental health treatment and access is an intercultural issue as the experience and manifestation of mental illness are influenced by an individual’s social and cultural background. It can determine how individuals communicate their symptoms, influence their understanding of their illness, and determine the coping strategies they adopt and the type of intervention they seek. There are significant disparities in mental healthcare access among different racial and ethnic groups.

Affected Individuals & Efforts Made The efforts to implement the Affordable Care Act that required medical insurers to provide coverage for behavior and mental healthcare often limits the access to mental health services. The lack of financial resources prevents the individual from seeking help at all and at times can lead to inconsistent or inadequate treatment. Mental healthcare services can be costly even for individuals with insurance or financial assistance. The copays and deductibles can quickly add up when a diagnosis requires regular therapy, complicated medication regimen, or intensive treatment programs. The reason could be due to the lack of mental health professionals that limits individuals from receiving the proper care. According to the data from the Department of Health and Human Services, 55% of United States counties, all of which are rural, do not have a practicing psychiatrist, psychologists, or social workers. Rural areas often have few to no mental healthcare providers at all, let alone providers with specialties. Urban clinics and providers often have a long waitlist causing patients to struggle for months before receiving the basic intake appointment. To make matters worse, inadequate reimbursement from government and private insurance plans means fewer doctors are choosing mental health specialties in school.

While some private clinicians are only accepting new patients who can pay out-of-pocket. The overall shortage of healthcare providers can make it very hard for someone to find affordable mental healthcare close enough to their home or work to get reliable and consistent treatment.

Professional Opinion The United States healthcare system is far from perfect and the toughest challenges belong to the mental health industry.

Understanding what prevents mental healthcare access opens the door to improving that access with better programs and policies. My opinion for mental healthcare treatment and access is that with continuous efforts of mental health professionals and policymakers, improvement is possible.

https://www.psychiatrictimes.com/view/addressing-poverty-andmental-illness Reference Mental health challenges today: Wake forest university. https://counseling.online.wfu.edu/blog/5-challenges-of-mental-health-care-today/. Published July 17, 2020. Accessed March 27, 2021.

Top 5 barriers to mental healthcare access. https://www.socialsolutions.com/blog/barriers-to-mental-healthcare-access/. Accessed March 27, 2021.

MENTAL HEALTH IN PEDIATRICS Lindsey McDaniel (P1), Maggie Van Kleek (BSPS Senior), and Emily Schultheis (BSPS Senior) Spring 2021

IN THE ISSUE

Anxiety Depression

ADHD Currently around 17.1 million children deal with a mental illness in the United States. In this paper we will each be discussing a prevalent mental illness in the pediatric population and how it might compare to the same condition in adults and how we can help them deal with it. We will talk about the signs and symptoms, treatment options, and resources available for the child and their parents.

Treatment. Anxiety and Depression Association of America, ADAA. https://adaa.org/living-with-anxiety/children/treatment. Accessed February 20, 2021.

https://childmind.org/our-impact/childrens-mentalhealth-report/2018report/

https://www.health.harvard.edu/blog/anxiety-in-children-2018081414532

Causes Chemical imbalance of serotonin and dopamine Inherited from parents Learned from parent's and family's behavior Traumatic experience

ANXIETY IN PEDIATRICS

by Maggie Van Kleek Anxiety disorder is a mental health disorder that is characterized by worry and fear that affect daily life. About 1 in 10 people under the age of 18 will develop an anxiety disorder. The median age for the onset of childhood anxiety is 11 years old. The most common anxiety in pediatrics are separation anxiety, social anxiety, and phobias. Separation anxiety is when anxiety and stress occurs when they have to be away from their parent or caregiver. Social anxiety is a fear of social situations, like going to school or being

Symptoms Constant worry Clingy behavior Thoughts and fear about their safety Refusing to go to school Frequent stomach aches Muscle aches

in crowds. Phobias are extreme, irrational fears of certain situations or things. Anxiety disorders are diagnosed by first ruling out other health issues and then taking a mental health assessment. The biggest issue with diagnosing anxiety in pediatrics is that they do not have a grasp on how to describe their feelings. They do not realize how abnormal the emotions they are feeling are, so they may not speak up about it. They struggle to realize when something is wrong with what they are

Sleep problems

feeling. In order to combat this struggle, it is important to teach

Lack of concentration

children from a young age how to describe their feelings and to

Inability to relax

speak up when something is feeling different.

Easily startled

Professional Opinion

Acting grouchy Constant nausea

Treatment Cognitive Behavioral Therapy Teaches the patient how to manage the anxiety and mechanisms to cope with it Medicines:

Mental health awareness in pediatrics is an important topic that is not discussed enough. Most people assume that just because kids do not have the responsibilities that an adult has that they can not have the mental health issues associated with that.

These issues are present in people of all ages. It is important to teach young people how to express their feelings at a young age, so that when they feel something bad, they know to tell someone. There needs to be more education on how to help children feeling these mental disorders. Most people would not know what to do, so it is important to continue talking about these issues.

Antidepressant or anti-anxiety medicine Family Therapy: Teaches the parents how to understand their child's feelings and how to help

Anxiety and depression in children. https://www.cdc.gov/childrensmentalhealth/depression.html.

Published December 2, 2020. Accessed February 20, 2021.

Treatment. Anxiety and Depression Association of America, ADAA. https://adaa.org/living-withanxiety/children/treatment. Accessed February 20, 2021.

Treatment. Anxiety and Depression Association of America, ADAA. https://adaa.org/living-withanxiety/children/treatment. Accessed February 20, 2021.

Depression in Pediatrics By: Lindsey McDaniel

DIAGNOSISING DEPRESSION IN KIDS

Depression is a global health issue as it effects nearly 10% of children under 18 and is responsible for over 6,00o suicides in this population every year, A diagnosis can be made by pediatricians, family doctors, and psychiatrist. In most cases, an accurate diagnosis requires gathering information from both the child and the parent or guardian. The Mayo clinics recommends taking the child to their family doctor or pediatrician who is familiar with the child to have an accurate diagnosis or referral to a psychiatrist. Doctors should also rule out physical ailments that can cause depression-like symptoms.

HOW DEPRESSION IMPACTS PEDIATRICS Children with depression can presents as: persistent feelings of sadness or hopelessness low self-esteem feeling inadequate in school or at home excessive guilt weight gain or loss or change in food behaviors changes in sleep decreased energy impaired decision making or risk- taking fear and panic physical pain or discomfort suicidal thoughts or actions

CONTRIBUTING FACTORS Frequent stress Tobacco use Loss of a loved one Behavioral or learning disorders Chronic illness, History of abuse or neglect Identify as LGBT+ History of trauma

Treatment. Anxiety and Depression Association of America, ADAA. https://adaa.org/living-with-anxiety/children/treatment. Accessed February 20, 2021.

Treatment of Depression in Kids

Potential Long-term effects Academic decline Trouble with future personal relationships Recurrent depression later in life Ongoing reckless behavior Increased risk of substance use Economic struggles Weakened immune system

First line treatment: counseling and talk therapy Medication FDA approved in children: Prozac and Lexapro Other commonly used medications: Celexa, Zoloft, Paxil, Pristiq, Cymbalta, Effexor Do not use: Tricyclic antidepressants Warning: Children who take antidepressants should be closely monitored by doctors and caregivers in pediatrics because antidepressants can increase the risk for suicidal thoughts and actions

Treatment. Anxiety and Depression Association of America, ADAA. https://adaa.org/living-with-anxiety/children/treatment. Accessed February 20, 2021.

Diagnosing pediatric depression. Biological psychiatry. https://pubmed.ncbi.nlm.nih.gov/11430846/. Accessed April 10, 2021.

Debunking Myths of Teen Depression. Johns Hopkins. https://www.hopkinsmedicine.org/health/wellness-and-prevention/debunking-myths-of-teen-depression. Accessed April 18, 2021.

Professional Opinion

I believe that mental health in pediatrics is often not discussed until children are in a mental health crisis. Working in an eating disorder facility, I see girls in crisis who are at some of the lowest points of their life. Often, patients talk about how they receive care until it impacted their physical health. As adults face adult problems, it can be hard to understand how children, can be depressed. It is important to validate and acknowledge when children are struggling, no matter how small the problem and help them. I truly do believe that most parents care immensely for their kids and do not mean to invalidate their stressors or not acknowledge their child's depression. As a society, we need to work to educate parents to know when they need to get their children help and have hard conversations about mental health with their kids.

MYTH VS. FACT

ADHD: WHAT IS IT?

by Emily Schultheis

1. Only children in school and older can be diagnosed with ADHD. Myth: At least one symptom has to be present before the age of 7 and most children start school at the age of 6.

2. ADHD is something that a child could have to deal with for the rest of their lives.

Fact: It is manageable with medication and therapy but it is not something people "grow out of" over time.

3. Children just day dream a lot, they'll grow out of it.

Myth: A small amount of daydreaming is normal, but when it affects their daily life and routine that means there could be a bigger issue.

4. ADHD still allows children to focus on activities that do not require organized mental focus.

Fact: Activities like sports, being outdoors, or things that do not require prolonged sitting are good outlets for children with ADHD.

CHILD'S PERSPECTIVE

"I never really finished anything. I always started things and then I’d go

https://www.google.com/url?sa=i&url=https%3A%2F%2Fconnect2local.com%2Fl%2F576180%2Fc%2F577347%2F3-pediatric-signs-of-adhd%2F&psig=AOvVaw05L-gjx6vg6phFPP1cJRO&ust=1618368163135000&source=images&cd=vfe&ved=0CAMQjB1qFwoTCLD1mLCZ-u8CFQAAAAAdAAAAABAD

ADHD or Attention-Deficit Hyperactive Disorder, is a persistant issue of inattention, hyperactivity, and impulsive decision making, and is often undiagnosed in the pediatric population at an early age. The diagnostic criteria is a major part of why it is missed in younger patients. It is focused on behaviors that children may present with in a different way than adults. For example, inattentive ADHD in an adult may present as not completing tasks at their job and for children it could be not completing homework. For hyperactive ADHD in adults it may present as extreme gambling or spending but in children it may be sudden interruptions in conversation. While these are small differences, it causes parents to miss the symptoms and think it is just something their child will grow out of and they will act "normal" once they are older.

Treatment Options Behavioral Training

Changing their environment to eliminate triggers Using positive rewards to encourage appropriate behavior Keeping a consistent set of rules here is key to success in this treatment approach Educational Training

off…. I got distracted very easily doing

Suggesting that the child get involved with special groups at

chores. I don’t know if it was voluntary

school to aid in their learning

distraction…but we definitely fought a

Allowing students to have aids on exams and homework

lot…."

assignments to allow them to succeed Pharmacologic Therapy

"And it would be just, “Clean your room, can you please pick up this, can

Stimulant medications for the attention aspect of the ADHD Alternatives to drug therapy

you get your laundry out of the

Dietary modifications

dryer,...And I would just be like, “Leave

Increase in exercise or a hobby that stimulates the release of

me alone!”

adrenaline

"...people looked at me differently, like,

In my personal opinion, awareness of pediatric mental health is something that needs more

oh, she has a disability, oh, she’s

attention. Parents control the lives of their children when it comes to their health and

stupid, she’s retarded. I mean…I just don’t get things as easily as others.

And I don’t think they understood that."

healthcare so if the parents do not have the resources to see when their child is struggling with a mental illness then it will continue to get missed. There also needs to be more opportunities for children to take charge of their mental health, without the need for a legal guardians signature, health insurance, or the financial means to pay for help. There are hotlines out there but in my opinion these are daunting to use and not personal enough to do much more than give them more resources to get help. The current education system and life of a child is not changing dramatically anytime soon, so the only option is to give them resources to deal with it the stress, anxiety, and troubles life brings them.

Work Cited Anxiety and depression in children. https://www.cdc.gov/childrensmentalhealth/depression.html.

Published December 2, 2020. Accessed February 20, 2021 Debunking Myths of Teen Depression. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/debunking-myths-of-teendepression. Accessed April 18, 2021 Diagnosing pediatric depression. Biological psychiatry. https://pubmed.ncbi.nlm.nih.gov/11430846/.

Accessed April 10, 2021.

Generalized Anxiety Disorder (GAD) in Children and Teens. Cedars Sinai. https://www.cedarssinai.org/health-library/diseases-and-conditions---pediatrics/g/generalized-anxiety-disorder-gad-inchildren.html. Accessed February 20, 2021.

Margolis, C. A Child’s Perspective of ADHD. https://www.additudemag.com/childs-perspective-adhdemotions-video/. ADDitude. Updated on November 4, 2020. Accessed February 22, 2021.

Mayo Clinic Staff. Attention-deficit/ hyperactivity disorder (ADHD) in children. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889. Published June 15, 2015. Accessed February 22, 2021.

Morin, A. 8 Common Myths About ADHD. Understood. https://www.understood.org/en/learningthinking-differences/child-learning-disabilities/add-adhd/common-myths-about-adhd. Accessed February 20, 2021.

Other Concerns and Conditions with ADHD. https://www.cdc.gov/ncbddd/adhd/conditions.html.

CDC. Accessed February 22, 2021.

Smucker, W. Hedeyat, M. Evaluation and Treatment of ADHD. https://www.aafp.org/afp/2001/0901/p817.html. AAFP. Published September 1, 2001. Accessed February 22, 2021.

Treatment. Anxiety and Depression Association of America, ADAA. https://adaa.org/living-withanxiety/children/treatment. Accessed February 20, 2021.

Weir K. Brighter futures for anxious kids. American Psychological Association. https://www.apa.org/monitor/2017/03/anxious-kids. Published March 2017. Accessed February 20, 2021.

ALEXIS ZAVITSKY, BSPS-4 BRICE WUTHRICH, BSPS-4, MEG THARP, BSPS-4 SPRING 2021

Food Insecurity and Lack of Access

Overview:

affects both developing and developed countries. It will explore who is mostly affected by food insecurity, the effects of

NUTRITION

INTERCULTURAL AND GLOBAL HEALTH ISSUE:

This topic will discuss how food insecurity

This monograph will explain the concept

food insecurity on people and

of nutrition divided among three

households, and lastly, current efforts

important categories:

being made to combat food insecurity as well as possible future solutions.

1. Access to nutrition 2. The relationship between nutrition and chronic disease

3. Micronutrients and their importance in diet

Nutrition Related Chronic Disease This topic will discuss the impact of nutrition related chronic disease. More specifically, statistics on the global impact of chronic disease stemming from diet will be presented, as well as global efforts to combat the issue.

Micronutrient Deficiencies This topic will focus on explaining the prevalence and effects of dietary deficiencies in essential vitamins and minerals (collectively referred to as "micronutrients"). Populations and areas of the world which are most affected by this issue as well as methods and effectiveness of deficiency reduction Figure 1. Components of and progress towards global nutrition targets since established by the global nutrition report The global burden of malnutrition at a glance. globalnutritionreport.org. Accessed April 11, 2021 https://globalnutritionreport.org/resources/nutrition-profiles/

efforts will be examined.

Food Insecurity/Access to Nutrition

LEGEND: RED - FOOD INSECURE YELLOW - MODERATELY FOOD INSECURE GREEN - FOOD SECURE

Defined as a lack of access to enough food to live an active, healthy lifestyle. It often results from a lack of financial

Figure 3: FAO Hunger Map 2015 - World. ReliefWeb. Accessed March 1, 2021. https://reliefweb.int/map/world/fao-hunger-map-2015

resources. Unlike hunger, which is measured at the individual level, food insecurity is measured at the household level.

Major Causes

"1 in 4 households globally experienced moderate to severe food insecurity [in 2020]" - NPR

Who is Affected?

Anyone can be affected but most affected populations in US are...

1. Seniors

Efforts to Combat Food Insecurity: Reduce food waste

2. Children

Plant crops that require less water

3. African Americans

Close the agricultural yield gap

4. Rural Communities

(through better utilization of land)

5. Latinos

National and International programs: 1. Feeding America

Figure 2: Misselhorn A, Hendriks S. A systematic review of sub-national food insecurity research in South Africa: Missed opportunities for policy insights. PLOS ONE. 2017;12:e0182399.

Most affected global regions (as seen in

2. The World Food Program

map):

3. Action Against Hunger

doi:10.1371/journal.pone.0182399

1. Central to Southern Africa

Effects of Food Insecurity:

2. Southern Asia 3. Central America

- Prevents growth and learning in children - Leads to chronic diseases and health complications - Nutritional deficiencies

"In my opinion, lack of resources is not a problem that leads to food insecurity, but rather lack of ability to effectively distribute the resources world wide. There is enough food produced in the world, but only certain populations get the food, and unfortunately, most of the remaining food is wasted rather than distributed to the remaining populations."

- Lexi Zavitsky

Nutrition Related Chronic Disease The interconnection between nutrition and chronic disease has been vastly researched and validated. This issue targets millions of individuals across the globe.

Figure 5: Afshin A, Sur PJ, Fay KA, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019;393(10184):1958-1972. doi:10.1016/S0140-6736(19)30041-8

Who is Affected?

All regions of the globe are affected by Disease related to nutrition, but areas

Main Causes

differ by the type of disease.

Efforts to Combat Nutrition Related Chronic Disease:

Central Asia reported to have the

While most countries have local efforts to

most deaths due to diet-related

promote proper nutrition, global efforts

cardiovascular disease

revolve around the WHO's Global Strategy

Eastern Asia reported to have the

on Diet, Physical Activity, and Health.

most deaths due to diet-related cancer cases

Main Objectives:

Mexico reported to have the most

Reduce risk for non-communicable

deaths due to diet-related type 2

diseases that stem from diet

diabetes

Increase awareness and understanding of the influences of diet and physical

*Although most metrics were reported in

activity on health

terms of deaths, the countries above had

Encourage development of action plans

many more instances of DALYs (Disability

to improve diets and activity at all levels

Primary culprits of nutrition related chronic

Adjusted Life Years, which measures

Monitor scientific data and influences

disease are diets high in sodium and/or low

years of life lost due to disease.

on diet and activity

Figure 4: Afshin A, Sur PJ, Fay KA, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019;393(10184):19581972. doi:10.1016/S0140-6736(19)30041-8

in whole grains Cardiovascular disease (10 million), Cancer (900K), and Type 2 Diabetes (300K) were main causes of death

Personally, the key to combating nutrition related chronic disease stems from the promotion of education. Furthering education on diet and physical activity can explain why certain foods should be avoided in excess, what issues they cause, and the impact those issues have on an individual.

- Brice Wuthrich

Micronutrient Deficiencies Coined "hidden hunger" because of its ability to negatively affect even wellfed individuals, deficiency in micronutrients affects individuals across

Ways to Reduce or Prevent Micronutrient Deficiencies:

Why is hidden hunger a problem?

Taking multivitamins Supplementation campaigns (efforts to administer micronutrient supplements to at-risk populations) Food fortification (the process of adding micronutrients to food, i.e. iodized salt, folic acid and iron added to bread) (12)

Deficiencies in micronutrients can lead to issues such as: immunodeficiency physical and mental developmental delays (especially in children) blindness and vision problems

the globe.

general diminished quality of life and ability to complete daily tasks

What are Micronutrients?

Micronutrients are essential components of the human diet necessary for proper physiologic functioning, which are consumed in small quantities.

Though all people can experience negative effects from prolonged inadequate intake of or access to micronutrients, children and pregnant women are most drastically affected by this issue due to the role micronutrients can plan in proper growth and development (13).

Nations most affected by hidden hunger can be seen in

Figure 6.

Much of what contributes to high rates of hidden hunger can

Some of the most common and most

iron, zinc, calcium, iodine, and important vitamins such as Vitamin A, BVitamins, and Vitamin C. important micronutrients include

simply include lack of access to quality food sources due to financial and/or infrastructure barriers. However, even the most wealthy countries can still be affected by this.

Efforts to reduce the prevalence and/or effects of micronutrient deficiencies have shown positive effects suggesting they are indeed effective in combatting this issue.

Figure 7 shows the

positive effect on growth seen in schoolchildren taking a zinc + multivitamin supplement, a change in height of 3.6 cm +/- 0.6 cm

Global Hidden Hunger Scores Among Preschool-Aged Children (determined based on prevalence of stunting, anemia due to iron deficiency, and Vitamin A deficiency)

for children with no supplementation, and 4.9 +/- 1.3 cm for children taking a zinc + multivitamin supplement.

No supplement

Where can Micronutrients be Found?

With zinc + multivitamin 0

Fruits, vegetables, nuts and seeds,

1

2

3

4

5

Figure 7. Rerksuppaphol S, Rerksuppaphol L. Effect of zinc plus multivitamin supplementation on growth in school children.

Pediatr Int. doi: 10.1111/ped.13011. Published August 31, 2016. Accessed March 24th, 2021.

beans and legumes, whole wheat, fish, eggs, high-quality meat, and dairy can all be excellent sources of micronutrients.

Are prevention strategies effective?

Figure 6. Ritchie H, Roser M. Micronutrient Deficiency. Our World in Data. https://ourworldindata.org/micronutrient-deficiency. Published August 11, 2017. Accessed February 26, 2021.

"I personally see this as a drastically overlooked issue for which there is insufficient research. I believe every country in the world can be affected like this and it can be extremely beneficial to even be slightly more aware of your personal micronutrient access and intake." - Meg Tharp

References 1. Gundersen C, Ziliak JP. Food Insecurity And Health Outcomes. Health Aff (Millwood). 2015;34(11):1830-1839. doi:10.1377/hlthaff.2015.0645 2. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation, Geneva, 28 January - 1 February 2002. Accessed February 18, 2021. https://www.who.int/publications-detail-redirect/924120916X 3. Morley J. Protein-Energy Undernutrition (PEU) - Nutritional Disorders. Merck Manuals Professional Edition. Accessed February 18, 2021. https://www.merckmanuals.com/professional/nutritional-disorders/undernutrition/protein-energy-undernutrition-peu 4. Elliot K. Food Security in Developing Countries: Is There a Role for the WTO? Center For Global Development. Accessed February 18, 2021. https://www.cgdev.org/publication/food-security-developing-countries-there-role-wto 5. Bjarnadottor, A. 7 Nutrient Deficiencies That Are Incredibly Common. Healthline. https://www.healthline.com/nutrition/7-common-nutrient-deficiencies. Accessed February 24, 2021.

6. Publishing HH. The larger role of micronutrients. Harvard Health. https://www.health.harvard.edu/staying-healthy/the-larger-role-of-micronutrients. Accessed February 26, 2021.

7. Department Pby SR, 27 N. Global Hunger Index 2020: countries most affected by hunger. Statista. https://www.statista.com/statistics/269924/countries-most-affected-byhunger-in-the-world-according-to-world-hunger-index/. Published November 27, 2020. Accessed February 26, 2021.

8. Ritchie H, Roser M. Micronutrient Deficiency. Our World in Data. https://ourworldindata.org/micronutrient-deficiency. Published August 11, 2017. Accessed February 26, 2021.

9. Díaz JR, de las Cagigas A, Rodríguez R. Micronutrient deficiencies in developing and affluent countries. Eur J Clin Nutr. 2003;57 Suppl 1:S70-S72. doi:10.1038/sj.ejcn.1601820 10. Prevent iron deficiency anemia during pregnancy. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art20114455. Published October 25, 2019. Accessed February 26, 2021.

11. Vitamin B12 Deficiency Anemia. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/vitamin-b12-deficiencyanemia#:~:text=Key%20points%20about%20vitamin%20B12%20deficiency%20anemia&text=get%20enough%20oxygen.-,Without%20enough%20oxygen%2C%20your%20body%20 can%27t%20work%20as%20well,fatigue%2C%20and%20increased%20heart%20rate. Accessed February 26, 2021.

12. Allen L, de Benoist B, Dary O, Hurrell R. Guidelines on food fortification with micronutrients. https://www.who.int/nutrition/publications/guide_food_fortification_micronutrients.pdf.

Published 2006.

13. Vitamin A Deficiency in Children. UNICEF DATA. https://data.unicef.org/topic/nutrition/vitamin-a-deficiency/. Published November 11, 2020. Accessed February 26, 2021.

14. Verchot M. 5 Ways to Improve Global Food Security. Treehugger. Accessed February 28, 2021. https://www.treehugger.com/ways-improve-global-food-security-4858809 15. Misselhorn A, Hendriks S. A systematic review of sub-national food insecurity research in South Africa: Missed opportunities for policy insights. PLOS ONE. 2017;12:e0182399. doi:10.1371/journal.pone.0182399 16. Woods M. Common Solutions to Food Insecurity Worldwide. The Borgen Project. Published February 1, 2018. Accessed February 28, 2021. https://borgenproject.org/commonsolutions-to-food-insecurity-worldwide/ 17. Food Insecurity in America: Causes and Solutions | Feeding America. Accessed February 28, 2021. https://www.feedingamerica.org/hunger-in-america/food-insecurity 18. Peace Corps. Global Issues: Food Security. Accessed February 28, 2021. https://www.peacecorps.gov/educators/resources/global-issues-food-security/ 19. Global Strategy on Diet, Physical Activity and Health - 2004. Accessed February 28, 2021. https://www.who.int/publications/i/item/9241592222 20. Afshin A, Sur PJ, Fay KA, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet.

2019;393(10184):1958-1972. doi:10.1016/S0140-6736(19)30041-8 21. FAO Hunger Map 2015 - World. ReliefWeb. Accessed March 1, 2021. https://reliefweb.int/map/world/fao-hunger-map-2015 22. Country Nutrition Profiles. Accessed April 12, 2021. https://globalnutritionreport.org/resources/nutrition-profiles/ 23. Food Insecurity In The U.S. By The Numbers. NPR.org. Accessed April 12, 2021. https://www.npr.org/2020/09/27/912486921/food-insecurity-in-the-u-s-by-the-number

Figure 1. New report: 2021 social media marketing predictions | IMPACT 1

Social Media and its Impact on Mental Health, Health Literacy and Access, and Human Trafficking

By Nicole Redden (BSPS), Frank Zahariadis (BSPS), Tianqi Zhao (BSPS) Spring 2021

Social media got its start in 1997 and has now, as of 2021, grown to over 4.2 billion users worldwide.2 Nearly 70% of adults and a little over 80% of teens use social media, according to the Pew Research Center. With over half of the world's population using social media platforms such as Facebook, Instagram, and TikTok, there is bound to be an impact to our global health. Social media is slowly consuming our lives to the point where we are losing about a day a week. The positive and negative impact of social media is affecting the mental health of all of its users. A novel strategy to promote health literacy and provide access to health care involves utilizing social media. Social media as a new tool has been used to recruit victims by traffickers. However, it is also a powerful platform to reduce human trafficking.

Social Media and its Impact on Mental Health NICOLE REDDEN

Social media is affecting the mental health of all of its users in both beneficial and harmful ways. According to the American Psychiatric Association, one in three adults see the use of social media as having a negative impact, while only 5% see it as having a positive impact on mental health.3 Also, about 88% of adults think social media use in younger children and teens is particularly concerning.3 Since mental health is such a broad topic, we are going to break it down specifically into the areas of procrastination, body image and self-esteem issues, addiction, and suicide.

Procrastination

Figure 2. Social Media Addiction - Addiction Center 10

We are all guilty of procrastination at some point in our lives, but is social media the culprit behind it? There have been many studies completed to see if there's a connection between social media and procrastination. A German study of more than 800 early and middle-aged adolescents found that procrastination was linked with increased social media multitasking and uncontrolled social media use.4 It was then discovered that the participants' academic performance decreased in correlation to increasing time spent on social media.4 A 2020 US study showed college-aged students using social media to procrastinate at a higher rate than any other age group, which led to an increase in anxiety and depression.5 In the UK, about 53% of teenagers said they get distracted by social media, which leads to them getting stressed about schoolwork.6

Body Image and Self-esteem Issues

Comparing, over-analyzing, hating one's body, or overall just not feeling good about yourself can be linked back to social media use. Children are creating social media accounts earlier and earlier in life, causing them to develop body image and self-esteem issues at a younger age than ever before. According to a Pakistani study published in 2017, students aged 18-25 who used social media more, specifically Facebook, had lower selfesteem than the groups that used it less.7 One study based in the UK followed 14-15 year old's for three years to study the correlation between their social media use and body image. It was found that 40% of the participants had seen pictures on social media that caused them to compare and worry about their bodies.8

Figure 4. How does social media affect mental health? - Today News Spot 14

Figure 3. Don't depend on social media for happiness | The Daily Illini 13

Addiction Social media plays an increased role in addiction, anywhere from the glorification of drugs and alcohol to the newly evolving social media addiction itself. It is finding ways to grab hold of teenagers in the worst way possible. One study was conducted on college-aged students, and it showed a correlation between alcohol-related content on social media and an increase in underage drinking.9 Most people cannot be without their phones, constantly getting gratification through their accounts on various social media platforms. This is why social media addiction is being reviewed by American Psychiatric Association to be included in the DSM-5 as early as 2022.10

Suicide

Both low self-esteem and addiction lead to increases in suicide, but how does social media play into it? In the U.S., teens spend on average three hours a day on social media, causing an increase in mental health issues ranging from anxiety up to suicidal ideations.11 Suicide is the second-leading cause of death for people ages 10-24, and it has nearly tripled in the 10-14 year range.12 Figure 5. Suicide often not preceded by warnings - Harvard Health Blog 15

Solutions and Opinions

There isn’t a quick fix to this, but there has been some progress such as the body positivity movement and possibly of getting social media addiction into the DSM. Using social media intentionally and setting time limits can be beneficial to your mental health. Social media affects our mental health in ways that we cannot even grasp yet. In that respect, I don’t believe social media is a place for young children. It is hard to put an age on it, though. Parents are giving children phones and iPads at such young ages, so they will keep getting exposed earlier in life. Social media can sometimes be used for good, but it also can be an incredibly toxic environment. As a society, we have become too sensitive, which is why social media is harming our mental health. We are letting someone else define what is standard and acceptable when we should not care at all.

Social Media and its Impact on Health Literacy and Health Care Access Frank Zahariadis With the increase in social media accounts and increased hours using social media, it is evident that it can be utilized in professional matters such as health literacy and health access. Aggregated social media use, meaning information from multiple social media sources, is unifying them into one presentation. For example, an individual can be an aggregated social media user by drawing knowledge from Twitter, Instagram, and Tiktok to explain preventative measures against COVID-19 during the pandemic. It is crucial to understand how significant social media is currently and its potential to benefit health care professionals and patients worldwide.

Successes of Social Media in Health Literacy: Social media use correlates to increased eHealth literacy and knowledge of diseases and other global or local health concerns in multiple studies. During the current pandemic, countries with solid mobile or digital communication like China have utilized social media as means for authorities to inform the public about preventative behaviors for the disease16. In a study conducted in 2020 with 802 participants, it was concluded that social media was a successful means for sharing information and increasing the overall eHealth literacy of users and knowledge of diseases and preventative behaviors for COVID-19. In the United States, a study was conducted in 2019 to measure the success of implementing social-media-based diabetes management intervention compared to telephone-based management intervention17. This study showed that social media was more effective in reducing disadvantages that patients faced due to low health literacy and improving these patients’ self-care relative to their condition.

Figure 6: Simple Slope Test on Chinese Netizens in 202016 Both of these studies indicate that utilizing social media to promote health literacy and provide information about health care access has been more effective than using other options such as through the telephone. This hints at the potential for using social even more prominently for health care globally. With some patients participating in aggregated social media use, it is paramount that health care professionals take advantage of this form of communication.

Social Media application by organizations:

Figure 7: Social Media Post by PAHO and WHO18

The image on the left is a social media post from the Pan American Health Organization and World Health Organization on Instagram and Twitter18. These are two credible sources of information on social media. Credibility is a major concern when acquiring information about health care and diseases. Luckily, organizations like the NIH and the CDC of multiple countries provide guidelines on how to determine if a social media account is a credible source. This image provides information on how preexisting conditions have impact on an individual’s susceptibility to having a sever case of COVID-19. Posts like these are used by government agencies and non-profit organizations like the Red Cross to promote health literacy as well as provide means for accessing health care.

Opinion: Overall, it is important for social media users and organizations to efficiently utilize their time on social media to promote health literacy and improve health care access. Given we are over a year into the COVID-19 pandemic, we are required to adapt to these circumstances in which people are isolated and distant. It is time to take advantage of the technology we are provided to promote the well-being and health of all people in the world. Social media is accessible or used by most Americans and citizens of any country with an internet connection available, meaning health care providers can use different media to provide information to patients. While some accounts or social media users can give false information about health care that would negatively impact social media users’ health literacy, there are guidelines to avoid these accounts and posts. It should not be challenging to identify reliable sources that can be utilized for communicating important information relating to health care.

Social Media and its Impact on Human Trafficking Tianqi Zhao

Human trafficking is a hidden criminal activity that use people for profit. The common means are force, fraud and deception.

The traffickers lure the victims and force them into labor or commercial sexual exploitation. They usually utilize people who are susceptible, vulnerable or desperate of various reasons, including financial hardship, unstable homelife, seeking for better life. It is difficult that victims seeking for help due to language barriers, fear or traffickers or law enforcement. According to the report from UN office, the number of detected trafficking victims since 2018 are 49032 cases19.

Human Trafficking is a Global Issue because more than 120 countries have reported and detected19. In North, Central and South America, most trafficking victims are forced into sexual exploitation. Comparing to Africa and Asia, the most common form is forced labor. Sexual exploitation occupies 50% of detected trafficking cases; Forced labor is about 38%; The other forms of exploitation are 12%, such as criminal activity, begging, baby soldier and selling19.

Figure 8. Main forms of exploitation and profiles19

People who are vulnerable and therefore easier to be exploited or utilized20. The major factors to people’s vulnerability are their social status and personal level, including their political instability, poverty, gender inequality and so on20.

Trafficking occurs to children and adults. In sexual exploitation, 92% of victims are female. In forced labor, 59% are male.19

Targeted People

Figure 9. shares of detected victims in sexual exploitation and forced labor19

Has been used to recruit victims now as a new tool. There are two strategies: “fishing and hunting”19. “Hunting” is the way that pursing a victim on social media, initially as a friendly introduction and them becomes more aggressive as the relationship develops. The trafficker intends to generate a romantic online relationship with the victim, such as flattery, promising, financial assistance23.

The relationship will culminate and then eventually exploit profits from the victim. The common apps are Tinder, Soul or Meetme.com. “Fishing” is about posting a fake job advertisement and waiting for the potential victims. Those jobs are usually high-rewarded, stable and long-term, often occurring in fishing industry and transnational construction.

Social Media

Figure 10. Cyber flows19

United Nation as one of the biggest national organization establishes a Solutions and Opinions project called GLO.ACT21 to prevent, suppress and punish human trafficking in four countries: Islamic Republic of Afghanistan, Islamic Republic of Iran, Republic of Iraq and Islamic Republic of Pakistan21. In addition, Polaris22 is organization that using data to reduce and prevent sex and labor trafficking in the US. In my opinion, individual’s power is infinite. We all should participate in against human trafficking because we all know how harmful it is. The company and government should enhance the supervision on social media, especially for teenagers. Using technology that associate with data and AI can maximumly eliminate and reduce the human trafficking and their criminal organization.

Figure 11. Polaris project22

Figure 12. GLO ACT. 21

References 1) Pritchard K. New report: 2021 social media marketing predictions. IMPACT. https://www.impactplus.com/blog/social-media-predictions -2021. Published December 26, 2020. Accessed March 28, 2021.

2) Tankovska H. Social media usage in U.S. Statista. https://www.statista.com/statistics/273476/percentage-of-us-population-with-a- socialnetwork-profile/#:~:text=This%20equals%20approximately%20223%20million%20U.S.%20social%20media% 20users%20as%20of% 202020.&amp;text=According%20to%20estimates%2C%20the%20number,the%20American%20market%20leader%20Facebook. Published March 22, 2021. Accessed March 24, 2021.

3) Americans are Concerned about Potential Negative Impacts of Social Media on Mental Health and Well-being. https:// www.psychiatry.org/newsroom/news-releases/americans-are-concerned-about-potential-negative-impacts-of-social-media-on-mentalhealth-and-well-being. Published May 19, 2019. Accessed March 28, 2021.

4) Reinecke L, Meier A, Beutel ME, et al. The Relationship Between Trait Procrastination, Internet Use, and Psychological Functioning: Results From a Community Sample of German Adolescents. Frontiers in psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6004405/. Published June 11, 2018. Accessed March 28, 2021.

5) Ellwood B. Students who procrastinate by using Facebook instead of studying show increased anxiety, study finds. PsyPost. https:// www.psypost.org/2020/08/students-who-procrastinate-by-using-facebook-instead-of-studying-show-increased-anxiety-study-finds57723#:~:text=View%20All%20Result-,Students%20who%20procrastinate%20by%20using%20Facebook%20instead,show% 20increased%20anxiety%2C%20study%20finds&text=New%20research%20published%20in%20Com puters,for%20a%20final%2C% 20enhances%20anxiety. Published August 19, 2020. Accessed March 28, 2021.

6) Alblwi A, McAlaney J, Thani DASA, Phalp K, Ali R. Procrastination on social media: predictors of types, triggers and acceptance of countermeasures. Springer. https://link.springer.com/article/10.1007/s13278-021-00727-1. Published February 8, 2021. Accessed March 28, 2021.

7) Jan M, Soomro SA, Ahmad N. Impact of Social Media on Self-Esteem. European Scientific Journal. https://eujournal.org/index.php/esj/ article/view/9815. Published August 31, 2017. Accessed March 28, 2021.

8) Body image in childhood. Mental Health Foundation. https://www.mentalhealth.org.uk/publications/body-image-report/childhood. Published August 6, 2020. Accessed March 28, 2021.

9) Steers M-LN, Ward RM, Neighbors C, Tanygin AB, Guo Y, Teas E. Double Vision on Social Media: How Self-Generated AlcoholRelated Content Posts Moderate the Link between Viewing Others’ Posts and Drinking. Journal of Health Communication. 2021:1-7. doi:10.1080/10810730.2021.1878311 10) Hilliard J. Social Media Addiction. Addiction Center. https://www.addictioncenter.com/drugs/social-media-addiction/. Published March 25, 2021. Accessed March 28, 2021.

11) Gramigna J. Social media use may play important role in youth suicide, expert says . Healio. https://www.healio.com/news/ psychiatry/20201005/social-media-use-may-play-important-role-in-youth-suicide-expert-says. Published October 5, 2020. Accessed March 28, 2021.

12) Squires A. Social Media, Self-Esteem, and Teen Suicide. PCC Blog: Focusing on timely issues affecting independent pediatric practices. https://blog.pcc.com/social-media-self-esteem-and-teen-suicide. Published 2018. Accessed March 28, 2021.

13) Watts J. Don't depend on social media for happiness. The Daily Illini. https://dailyillini.com/opinions/columns-opinions/2017/10/24/dontdepend-social-media-happiness/. Published October 26, 2017. Accessed March 28, 2021.

14) How Does Social Media Affect Mental Health? Today News Post. https://todaynewsspot.com/how-does-social-media-affect-mentalhealth/. Published August 8, 2019. Accessed March 28, 2021.

15) Skerrett PJ. Suicide often not preceded by warnings. Harvard Health Blog. https://www.health.harvard.edu/blog/suicide-often-notpreceded-by-warnings-201209245331. Published August 5, 2019. Accessed March 28, 2021.

16) Li X, Liu Q. Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: CrossSectional Study on Chinese Netizens. Journal of medical Internet research. https://pubmed.ncbi.nlm.nih.gov/33006940/. Published October 9, 2020. Accessed February 28, 2021.

17) Kim SH, Utz S. Effectiveness of a Social Media–Based, Health Literacy–Sensitive Diabetes Self‐Management Intervention: A Randomized Controlled Trial. Sigma Theta Tau International. https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/jnu.12521. Published October 17, 2019. Accessed February 25, 2021.

18) Social media cards: Noncommunicable diseases and COVID-19. PAHO/WHO | Pan American Health Organization. https:// www.paho.org/en/topics/coronavirus-infections/coronavirus-disease-covid-19-pandemic/social-media-cards. Published 2020. Accessed March 23, 2021.

References 19) United Nation Office on Drugs and Crime. Global Report on Trafficking in Person 2020. Accessed April 7, 2021. https:// www.unodc.org/unodc/data-and-analysis/glotip.html.

20) Prevention VSand C. What Makes Someone Vulnerable to Human Trafficking? Province of British Columbia. https://www2.gov.bc.ca/ gov/content/justice/criminal-justice/victims-of-crime/human-trafficking/human-trafficking-training/module-1/vulnerabilities. Published June 20, 2019. Accessed March 28, 2021.

21) Glo.ACT - Global Action against Trafficking in Persons and the Smuggling of Migrants. United Nations : Office on Drugs and Crime. https://www.unodc.org/unodc/en/human-trafficking/glo-act/index.html. Accessed March 29, 2021.

22) The Big Fights. Polaris. https://polarisproject.org/the-big-fights/. Published February 26, 2021. Accessed March 29, 2021.

23) Human Trafficking and Social Media. Polaris. https://polarisproject.org/human-trafficking-and-social-media/. Published August 5, 2020.

Accessed March 29, 2021.

IS INCREASING USE OF SOCIAL MEDIA CREATING A NEW GLOBAL HEALTH ISSUE? By: Thamonphog (Om) Permsukkunakorn (BSPS) Yuanrui (Gray) Zhao (BSPS) Leeann Cecil (BSPS)

What is Social Media?

Defined as Websites and applications that enable users to create and share content or to participate in social networking.

The use of Social Media is increasing In 2012, only 5% of adults were using social media; this had shot up to nearly 70% at the last count (2018) and it is even higher in younger adults, at 90%.

How is this affecting Global Health?

- Misinformation & Disinformation: false or manipulative information through online sites or social media can lead to negative consequences - Poor Sleep: People who frequently use social media have a high tendency Towards poor sleep -Body Image: Social Media is Spreading images of unrealistic perceptions of the “Ideal Body”, which is leading to users trying to obtain this certain body type in extremely unhealthy ways.

Who does this effect?

-Anyone that uses social Media -Facebook -2.6 billion users -Most used social media Network(SMN) in 154 out of 167 countries -We Chat -1.2 Billion Users in China -VKontakte -400 Million users -Russia’s most popular SMN

An Analysis of Social Media as Global Issue Spring 2021

SOCIAL MEDIAS EFFECT ON MISINFORMING THE PUBLIC

Om Permsukkunakorn

What is Misinformation and Disinformation?

If misinformation and disinformation are both false information being spread to the public, is there a difference? To start off, misinformation is information that is incorrect and is erroneously released to the public, but there is no intention to manipulate or mislead anyone. Misinformation can also include information that was once beneficial by the current evidence in the scientific community, but is actually not correct when new evidence comes out. An example of misinformation would be the thalidomide incident in the 1960s where thalidomide was first used as a drug to help against sickness for pregnant women. The information and research available at that time on thalidomide demonstrated that thalidomide was safe, but it was actually harmful for children where it caused malformations when new evidence was discovered. On the other hand, disinformation is different from misinformation where the purpose of disinformation is to intentionally create false information in order to deceive or manipulate the public into believing an opinion or preventing the public from knowing the truth.

Prevalence in Social Media Misinformation and disinformation have been prevalent throughout many years in social media. There was a study done in 2018 in the Journal of Health Policy and Technology where 40% of the health information online related to diseases through social media or links from websites were classified as false information or “fake news.” Not only that there is still a lot of misinformation, but another problem is that false information travels quicker than correct information. A 2018 study that was done in the journal “Science,” demonstrated how incorrect information has a 70% chance more to be retweeted on Twitter and this information can reach people six times as fast. This illustrates how misinformation is still prevalent today and spreading throughout social media.

Misinformation and Disinformation as Global Issue Misinformation and disinformation has also become a global issue where social media platforms across different countries are also affected. In China, there was official data released in 2018 that showed 6.7 million reports of false and illegal information through different sites and social media platforms such as Weibo and WeChat. In 2020 of Poland, there was disinformation spread online through social media regarding Coronavirus and 23,000 protective masks not being delivered by the government. In addition, there has also been conspiracy theories regarding COVID-19 through Russia's social media platform called Vkontakte in 2020 as well.

Negative Effects & Consequences Misinformation and disinformation can lead to many different misconceptions about public health, especially COVID-19. From the figure to the right, the Pew Research center did a study and the results illustrated that approximately ⅓ of the US residents in the study believed that the virus was created in the lab intentionally. This is one of the misconceptions regarding COVID-19. These misconceptions can have a large negative impact as it can lead to the creation of a social stigma on public health. The false information could lead people to hide illness or stop people from seeking healthcare immediately as well as hindering people from practicing proper hygiene and health care. This can also lead to less compliance with quarantine isolation, social distancing, and possible rejection of vaccination.

Schaeffer, K. (2021, March 2). Nearly three-in-ten Americans believe COVID-19 was made in a lab. Pew Research Center. https://www.pewresearch.org/facttank/2020/04/08/nearly-three-in-ten-americans-believe-covid-19-was-made-in-alab/.

Possible Approaches & Solutions As the amount of people using social media grows every year, there have been different solutions made such as improving online health literacy where there are new resources online to help teach the public. There has also been a stronger quality of sources from accredited organizations like the World Health Organization and health professionals as well as an increase in frequency of correction of false information online. In addition, other countries like China have created a specific platform called “Piyao” which was designed to target and identify false information by using AI.

Although there have been many approaches to tackling this problem, not every misinformation and disinformation can be identified alone by the accredited health organizations or health professionals. The health organizations and professionals could publish more white papers or infographics regarding public health in order to spread awareness. However, I believe that people as a community need to be more overall aware of the information posted online through websites or social media and always make sure that they check to see if the source is reliable.

- Om Permsukkunakorn

POOR SLEEP

Yuanrui (Gray) Zhao

Browsing social media before falling asleep might feel relaxing, Research shows that more people around the world are suffering from poor sleep due to social media usage before sleep. With the increase of time people spend on social media, everyone could be a potential victim in this case. In the following paragraph, I will talk about how your bedtime social media habits might be stopping you from a good night sleep.

Displacing sleep First, Browsing social media before sleep displaces your bedtime.How many times have you thought you’d just quickly check your social media account before going to sleep, only to find yourself falling down a rabbit hole of entertaining videos, photos and funny comments And just like that, an hour or even two have passed. When you finally put down our phones, it also takes you longer to fall asleep, the quality of sleep is reduced and you wake up feeling sleepy and unrefreshed. Short duration of sleep often leads to later wake-up times and has a negative effect on time available to complete your work over the next day.

49%

Promoting cognitive arousal

The first step to creating an Secondly, by looking at social media before sleep, you effective project plan is to set a are providing endless stimulation signalling your brain baseline. The baseline is the and body to remain active and keep engaged. It’s not foundation on which the other simply the fact that you’re looking at social media project elements will be built on. which keeps you awake, the type of content has a big This must include a scope impact too for example, a heated debate on a subject statement. you’re passionate about keeps you more awake than passively scrolling through a news feed. This really comes down to how much involvement the interaction calls for.

Social media has many

Disrupting Circadian Rhythms: Last but not least, It’s well-established that phone screens emit mostly blue light, which expresses melatonin production and keeps us productive and focussed. This blue light is perfectly suited for daytime phone usage, but, at midnight, this is not ideal. Basically, exposure to light tells us to be awake, so looking at bright light from a phone just before bed is telling your body it is still time to be awake and not sleep time. This also forms a toxic cycle where Difficulty sleeping leads to increase use of social media (use social media to kill time when having trouble falling asleep) which may in return lead to more problems sleeping .

positive points, but we need to be mindful of how long we spend on it before sleep.Reducing exposure to social media can help you to disconnect and may improve your sleep quality;Instead of scrolling through your phone, screen-free time, like reading physical book, will help you prepare for sleep.

CONSEQUENCES WITH BODY IMAGE

Is Social Media causing its users to struggle with body image issues?

Body Image is defined as the subjective picture or mental image of one’s body.

Social Media Sites often promote unrealistic perception of the “Ideal Body” with trends like #fitspiration or #thinspiration Studies have shown a positive correlation between time spent on social media and negative body image thoughts. Which then leads to a higher risk of developing illnesses such as Eating disorders and other body dysmorphic disorders (such as Muscle dysmorphia or “snapchat” Dysmorphia)

Eating Disorders -Characterized as a severe change in eating habits and thoughts and emotions around food -affects people of all ages, races, sizes, genders, sexual orientations and backgrounds -roughly 9% of the world's population is affected by an eating disorder.

-Eating disorders are the second deadliest mental illness, taking around 10,200 lives each year.

-26% of people with eating disorders attempt suicide

Snapchat dysmorphia -Filters supplied on social media sites, such as snapchat, are being used as peoples inspiration for elective cosmetic surgery -1 in 50 patients that receive plastic surgery are struggling with this Illness

Muscle Dysmorphia -often characterized by anabolic steroid abuse, overexercise and an obsession to achieve the “ideal lean and muscular male body” -Nearly 427,000 UK males experienced muscle Dysmorphia

IT IS TIME TO START STRICTLY REGULATING POSTS AND ADVERTISEMENTS ON SOCIAL MEDIA THAT PROMOTE UNHEALTHY BODY EXPECTATIONS AND PROMOTE HEALTHY LIVING IN ALL BODY SIZES. -LEEANN CECIL

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Misinformation & Disinformation: Bridgman, A., Merkley, E., Loewen, P. J., Owen, T., Ruths, D., Teichmann, L., & Zhilin, O. (2021, January 26). The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media: HKS Misinformation Review. Misinformation Review. https://misinforeview.hks.harvard.edu/article/the-causes-and-consequences-of-covid-19misperceptions-understanding-the-role-of-news-and-social-media/.

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Schaeffer, K. (2021, March 2). Nearly three-in-ten Americans believe COVID-19 was made in a lab. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/04/08/nearly-threein-ten-americans-believe-covid-19-was-made-in-a-lab/.

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AN ANALYSIS OF SOCIAL MEDIA CAMPAIGN JAN - MARCH 2020

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Brucculieri J. Snapchat Dysmorphia’ Points To A Troubling New Trend In Plastic Surgery. HuffingtonPost. https://www.dryagoda.com/wpcontent/uploads/2018/02/HuffingtonPostCom-February-22-2018.pdf. Published February 22, 2018. Accessed February 23, 2021.

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