Public health policies and practices may negatively affect marginalized populations

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31-Oct-2013

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Contact: Leslie Shepherd
shepherdl@smh.ca
416-864-6094
St. Michael's Hospital

Author says it's important for public health officials to speak to populations that will be affected by a public health policy or program

TORONTO, Oct. 29, 2013--Despite the best intentions of those working in public health, some policies and practices inadvertently further disadvantage marginalized populations, according to a commentary by a researcher at St. Michael's Hospital.

Dr. Diego S. Silva, a scientist in the hospital's Centre for Research on Inner City Health, said there's an emphasis toward social justice in public health, particularly when it comes to people who are marginalized, disadvantaged or vulnerable.

"For example, despite evidence suggesting that people who are homeless are at greater risk of being infected with influenza and suffer greater morbidity than the general population, many pandemic influenza plans provide impracticable advice or otherwise fail to address their specific needs," said Dr. Silva.

The commentary appears online today in the Canadian Journal of Public Health.

In the commentary, Dr. Silva and his colleagues refer to two public health policies case studies that "are intentionally problematic and don't have an easy solution."

In one example, a public health advisory issued by the State Department of Health in Indiana suggests that people who are homeless should be dissuaded from using shelters during flu outbreaks and should instead be treated on the street.

However, "given the cold winters of Indiana, it seems untenable that persons who use shelters will be able to, or ought to, stay away from them without placing themselves in danger of other perils, such as freezing to death," Dr. Silva said.

Dr. Silva said that while it is good advice to urge people to stay home when they are sick, the policy can take on different meanings for various populations.

"What does it mean to 'stay home' if you're homeless?" said Dr. Silva, who has a PhD in public health.

In the second case study, some mental health centres maintain indoor smoking bans on the grounds they reduce the harm associated with second-hand smoke. However, some studies suggest that smoking may have neurological and social benefits for people with schizophrenia.

"Thus even seemingly uncontroversial and commonplace public health programs, like those of tobacco cessation, may have the effect of disproportionately disadvantaging those who are already disadvantaged," he said.

According to Dr. Silva, a greater emphasis on teaching ethics and the philosophy of science is also needed in graduate schools or departments of public health.

Dr. Silva said there needs to be a greater emphasis on teaching ethics and the philosophy of science in graduate schools or departments of public health. He said those in public health schools need to ask more question about ethics and look at what they use as evidence when they make public health policies.

"This is particularly important when thinking about and questioning what constitutes the good and the right in public health, and may help guard against simplistic applications of ethics theories or principles (whether utilitarian or others)," he said.

Dr. Silva said it is important for public health officials to speak to the actual populations that will be affected by a public health policy or program.

"In the public health community, we are intimately aware of people who are marginalized," said Dr. Silva. "The more that we are explicit about the values of public health and its intentions, the more that we will create policies and programs that will better serve marginalized populations."

###

About St. Michael's Hospital

St Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Media contact:

For more information or to interview Dr. Silva, contact:

Leslie Shepherd

Manager, Media Strategy,

Phone: 416-864-6094

shepherdl@smh.ca

St. Michael's Hospital

Inspired Care. Inspiring Science.

http://www.stmichaelshospital.com

Follow us on Twitter: http://www.twitter.com/stmikeshospital

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

PUBLIC RELEASE DATE:

31-Oct-2013

[


| E-mail

]


Share

Contact: Leslie Shepherd
shepherdl@smh.ca
416-864-6094
St. Michael's Hospital

Author says it's important for public health officials to speak to populations that will be affected by a public health policy or program

TORONTO, Oct. 29, 2013--Despite the best intentions of those working in public health, some policies and practices inadvertently further disadvantage marginalized populations, according to a commentary by a researcher at St. Michael's Hospital.

Dr. Diego S. Silva, a scientist in the hospital's Centre for Research on Inner City Health, said there's an emphasis toward social justice in public health, particularly when it comes to people who are marginalized, disadvantaged or vulnerable.

"For example, despite evidence suggesting that people who are homeless are at greater risk of being infected with influenza and suffer greater morbidity than the general population, many pandemic influenza plans provide impracticable advice or otherwise fail to address their specific needs," said Dr. Silva.

The commentary appears online today in the Canadian Journal of Public Health.

In the commentary, Dr. Silva and his colleagues refer to two public health policies case studies that "are intentionally problematic and don't have an easy solution."

In one example, a public health advisory issued by the State Department of Health in Indiana suggests that people who are homeless should be dissuaded from using shelters during flu outbreaks and should instead be treated on the street.

However, "given the cold winters of Indiana, it seems untenable that persons who use shelters will be able to, or ought to, stay away from them without placing themselves in danger of other perils, such as freezing to death," Dr. Silva said.

Dr. Silva said that while it is good advice to urge people to stay home when they are sick, the policy can take on different meanings for various populations.

"What does it mean to 'stay home' if you're homeless?" said Dr. Silva, who has a PhD in public health.

In the second case study, some mental health centres maintain indoor smoking bans on the grounds they reduce the harm associated with second-hand smoke. However, some studies suggest that smoking may have neurological and social benefits for people with schizophrenia.

"Thus even seemingly uncontroversial and commonplace public health programs, like those of tobacco cessation, may have the effect of disproportionately disadvantaging those who are already disadvantaged," he said.

According to Dr. Silva, a greater emphasis on teaching ethics and the philosophy of science is also needed in graduate schools or departments of public health.

Dr. Silva said there needs to be a greater emphasis on teaching ethics and the philosophy of science in graduate schools or departments of public health. He said those in public health schools need to ask more question about ethics and look at what they use as evidence when they make public health policies.

"This is particularly important when thinking about and questioning what constitutes the good and the right in public health, and may help guard against simplistic applications of ethics theories or principles (whether utilitarian or others)," he said.

Dr. Silva said it is important for public health officials to speak to the actual populations that will be affected by a public health policy or program.

"In the public health community, we are intimately aware of people who are marginalized," said Dr. Silva. "The more that we are explicit about the values of public health and its intentions, the more that we will create policies and programs that will better serve marginalized populations."

###

About St. Michael's Hospital

St Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Media contact:

For more information or to interview Dr. Silva, contact:

Leslie Shepherd

Manager, Media Strategy,

Phone: 416-864-6094

shepherdl@smh.ca

St. Michael's Hospital

Inspired Care. Inspiring Science.

http://www.stmichaelshospital.com

Follow us on Twitter: http://www.twitter.com/stmikeshospital

---

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-10/smh-php103013.php
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NYC moves closer to tobacco-buying age of 21

NEW YORK (AP) — Young New Yorkers who want to light up will soon have to wait for their 21st birthdays before they can buy a pack of smokes after lawmakers in the nation's most populous city voted overwhelmingly to raise the tobacco-purchasing age from 18 to 21.

The City Council's vote Wednesday makes New York the biggest city to bar cigarette sales to 19- and 20-year-olds, and one of only a few places throughout the United States that have tried to stymie smoking among young people by raising the purchasing age. The council also approved a bill that sets a minimum $10.50-a-pack price for tobacco cigarettes and steps up law enforcement on illegal tobacco sales.

"We know that tobacco dependence can begin very soon after a young person first tries smoking so it's critical that we stop young people from smoking before they ever start," Mayor Michael Bloomberg said in a statement after the council's vote.

Bloomberg, a strong supporter of tough smoking restrictions, has 30 days to sign the bills into law. The minimum age bill will take effect 180 days after enactment.

The city's current age limit is 18, a federal minimum that's standard in many places. Smoking in city parks and beaches already is prohibited as it is in restaurants.

Advocates say higher age limits help prevent, or at least delay, young people from taking up a habit that remains the leading cause of preventable deaths nationwide.

But cigarette manufacturers have suggested young adult smokers may just turn to black-market merchants. And some smokers say it's unfair and patronizing to tell people considered mature enough to vote and serve in the military that they're not old enough to decide whether to smoke.

"New York City already has the highest cigarette tax rate and the highest cigarette smuggling rate in the country," said Bryan D. Hatchell , a spokesman for R.J. Reynolds Tobacco Company, which makes Camel and other brands. "Those go hand in hand and this new law will only make the problem worse."

Another anti-smoking initiative pushed by the Bloomberg administration was previously shelved ahead of Wednesday's vote: forcing stores to keep cigarettes out of public view until a customer asks for them.

Newsstand clerk Ali Hassen, who sells cigarettes daily to a steady stream of customers from nearby office buildings, said he didn't know if the new age restrictions would do any good.

While he wouldn't stop vigilantly checking identification to verify customers' age, Hassen doubted the new rules would thwart determined smokers.

"If somebody wants to smoke, they're going to smoke," he said.

Similar legislation to raise the purchasing age is expected to come to a vote in Hawaii this December. The tobacco-buying age is 21 in Needham, Mass., and is poised to rise to 21 in January in nearby Canton, Mass. The state of New Jersey also is considering a similar proposal.

"It just makes it harder for young people to smoke," said Stephen McGorry, 25, who started smoking at 19. He added that had the age been 21 when he took up the habit, "I guarantee I wouldn't be smoking today."

Associated PressSource: http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2013-10-31-Smoking-Minimum%20Age/id-625b4242b79f4612b4e88ba0db82c1fd
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China, other Asians angry over embassy spy reports

In this photo taken Monday, Dec. 29, 2008, a man digs a trench near a mushroom shaped heating exhaust shaft near the newly constructed US embassy in Beijing, China. China and Southeast Asian governments demanded an explanation from the U.S. and its allies on Thursday, Oct. 31, 2013 following media reports that American and Australian embassies in the region were being used as hubs for Washington's secret electronic data collection program. (AP Photo/Ng Han Guan)

In this photo taken Monday, Dec. 29, 2008, a man digs a trench near a mushroom shaped heating exhaust shaft near the newly constructed US embassy in Beijing, China. China and Southeast Asian governments demanded an explanation from the U.S. and its allies on Thursday, Oct. 31, 2013 following media reports that American and Australian embassies in the region were being used as hubs for Washington's secret electronic data collection program. (AP Photo/Ng Han Guan)

SYDNEY (AP) — China and Southeast Asian governments demanded an explanation from the U.S. and its allies on Thursday following media reports that American and Australian embassies in the region were being used as hubs for Washington's secret electronic data collection program.

The reports come amid an international outcry over allegations the U.S. has spied on the telephone communications of as many as 35 foreign leaders.

A document from National Security Agency leaker Edward Snowden, published this week by German magazine Der Spiegel, describes a signals intelligence program called "Stateroom" in which U.S., British, Australian and Canadian embassies secretly house surveillance equipment to collect electronic communications. Those countries, along with New Zealand, have an intelligence-sharing agreement known as "Five Eyes."

"China is severely concerned about the reports, and demands a clarification and explanation," Chinese Foreign Ministry spokeswoman Hua Chunying said.

Australia's Fairfax media reported Thursday that the Australian embassies involved are in Jakarta, Bangkok, Hanoi, Beijing and Dili in East Timor; and High Commissions in Kuala Lumpur and Port Moresby, Papua New Guinea. The Fairfax report, based on the Der Spiegel document and an interview with an anonymous former intelligence officer, said those embassies are being used to intercept phone calls and internet data across Asia.

In a statement, Indonesia's Foreign Minister Marty Natalegawa said his government "cannot accept and strongly protests the news of the existence of wiretapping facilities at the U.S. Embassy in Jakarta."

"It should be emphasized that if confirmed, such action is not only a breach of security, but also a serious breach of diplomatic norms and ethics, and certainly not in tune with the spirit of friendly relations between nations," he said.

The Snowden document said the surveillance equipment is concealed, including antennas that are "sometimes hidden in false architectural features or roof maintenance sheds."

Des Ball, a top Australian intelligence expert, told The Associated Press he had personally seen covert antennas in five of the embassies named in the Fairfax report.

He declined to go into further detail or specify which embassies those were. But Ball said what Der Spiegel has revealed is hardly surprising or uncommon. Many countries have routinely used embassies as bases to covertly listen in on phone calls, and reports of such surveillance have been public for decades, he said.

"We use embassies to pick up stuff that we can't pick up from ground stations here in Australia — and lots of countries do that," said Ball, a professor with the Australian National University's Strategic and Defence Studies Centre.

According to the Snowden document, the spying sites are small in size and staff. "They are covert, and their true mission is not known by the majority of the diplomatic staff at the facility where they are assigned," it said.

The Department of Foreign Affairs and Trade declined to comment on the reports. Australian Prime Minister Tony Abbott said only that the government had not broken any laws.

"Every Australian governmental agency, every Australian official, at home and abroad, operates in accordance with the law," Abbott told reporters. "And that's the assurance that I can give people."

Still, there was predictable outrage in the countries named in the document.

Malaysian Home Minister Ahmad Zahid Hamidi said his government viewed the allegations as a serious matter and would investigate whether the U.S. Embassy in Kuala Lumpur was being used for spying. The country's opposition party issued a statement Thursday urging the Malaysian government to lodge a protest with both the U.S. and Australian embassies.

Thailand's National Security Council Secretary-General, Lt. Gen. Paradorn Pattanathabutr, said the government told the U.S. that spying was a crime under Thai laws, and that Thailand would not cooperate if asked to help eavesdrop.

Asked about the Australian embassy allegations, he said Australians are not capable of doing such sophisticated surveillance work.

"When it comes to technology and mechanics, the U.S. is more resourceful and more advanced than Australia," he said. "So I can say that it is not true that the Australian embassy will be used as a communications hub for spying."

___

Associated Press writers Thanyarat Doksone in Bangkok, Niniek Karmini in Jakarta, Sean Yoong in Kuala Lumpur and researcher Zhao Liang in Beijing contributed to this report.

Associated PressSource: http://hosted2.ap.org/APDEFAULT/3d281c11a96b4ad082fe88aa0db04305/Article_2013-10-31-Asia-US-Spying/id-4fed2ce3688c4b3191aa38b2ec1e1877
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Why First-Born Kids Do Better in School

Forgiving parents are strict with their first born because they hope to establish a perception that will influence the behavior of their younger children as well.

Photo by Thinkstock

Time and again, research has shown that first-born children are better at a lot of things than their younger siblings. First-borns do better on IQ tests and are more likely to become president of the United States than their kid brothers or sisters. And, at the other end of the spectrum, first-borns are less likely to do drugs and get pregnant as teenagers.

So it probably won’t surprise anyone that first-borns do better in school than their younger siblings, a finding documented in a recent study I wrote with Juan Pantano, an assistant professor of economics at Washington University in St. Louis.

But why birth order appears to matter so much for school achievement level is much less clear.

Many theories have been posited, ranging from genetics to the stability of family life to the teaching dynamics among siblings. Pantano and I offer a different explanation: It comes down to parents’ reputations for maintaining discipline with their kids. Reputations matter for politicians, teachers, and even used car salesmen. Less obvious, but still important, is a parent’s reputation in their children’s eyes.

The basic idea is this: There are two types of parents—those who in our study we call “unforgiving” in that they will punish poor school performance, regardless of the child’s birth order, and those who are “forgiving,” meaning they don’t like to punish any of their children, regardless of birth. The latter type of parent faces a dilemma. If they don’t punish their oldest child’s poor behavior, all of their children will know that mom and dad are pushovers who don’t punish for poor grades. As a result, all the children of forgiving parents will tend to not work hard in school. To avoid this situation, forgiving parents are strict with their first born, hoping to establish a perception that will influence the behavior of their younger children as well. The younger children, seeing their big brother or sister punished, will be less likely to slack off in school because they can’t be sure that mom and dad aren’t really unforgiving types. Call it “trickle down” discipline—you put the most energy into the first-born, trying to set the tone for all. (As Slate’s Matthew Yglesias put it, it’s a cost/benefit calculation. The cost is the disciplining, which most parents don’t enjoy doling out.)

Call it “trickle down” discipline—you put the most energy into the first-born, trying to set the tone for all.

It is only later that these forgiving parents, who really don’t like to punish any of their children, start slacking off in their parenting. So the outcome of this strategic parenting is that while all children benefit from the first born’s punishments, the impact is greatest on the eldest child.

In our study, Pantano and I looked at data from the children of female respondents who themselves were members in the National Longitudinal Survey of Youth begun in 1979. We focused on families with more than one child. The survey included detailed information on parenting, and we were able to look at parenting rules as reported by mothers and by their children.

While the data does not contain complete information on grades, it does include information on mothers’ perceptions of their children. In some cases we were able to link mothers’ perceptions to actual performance, and found their perceptions to be accurate. For the purposes of this study, however, the mothers' perceptions still gave us a clear picture of birth-order trends.

Mothers were asked, “Is your child one of the best students in class, above the middle, in the middle, below the middle, or near the bottom of the class?” Based on these mothers’ responses, we found a clear association exists between birth-order and school performance. While 34 percent of first-born children were considered “one of the best in the class,” only 27 percent of those who were fourth in the birth order received such recognition. On the other end of the spectrum, only 7.3 percent of first-borns were considered “below the middle or at the bottom of the class,” while mothers classified 11.7 percent of fourth-borns this way.

After establishing the existence of birth-order effects, we then used the data to explore whether differing parental treatment based on birth order affected how children performed at school. We found that first-borns were more likely to face daily homework monitoring than younger siblings. Again, the reputation model is at play here. The eldest children get the most monitoring in the hopes that younger siblings will observe that poor school performance leads to closer monitoring or loss of privileges, and will then have additional incentives to do well in school.

Perhaps the most interesting feature of the data we use is that mothers were asked hypothetical questions about their children’s performance in school and how they would react.

For each of their children, mothers were asked, “If [your child] brought home a report card with grades lower than expected, how likely would you be to keep a closer eye on [his/her] activities?”

This question lets us look directly at parenting strategy. We found that the more younger siblings a child has, the greater the likelihood that parents will closely supervise the oldest child after that child performs lower than expected on a report card. In fact, with each additional younger sibling, the chances of increased supervision rose by 2.2 percentage points.

So what’s the takeaway? While it is often thought that different levels of attainment across birth order are determined at birth and thus unavoidable, our results suggest otherwise. Rather, our findings show that it matters how parents establish discipline and priorities for their children when they are young. Our evidence strongly suggests that the better performance in school by first-borns and the poorer performance by later-borns is the result of differential parenting.

So, the next time you first-borns complain that mom and dad never let you get away with what your younger siblings did, you can be assured that you’re right. And you’re better off because of it.

Source: http://www.slate.com/articles/double_x/doublex/2013/10/birth_order_and_school_performance_first_borns_do_better_in_school_because.html
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Some Syrians lose themselves in music as war rages

DAMASCUS, Syria (AP) — As cannons thundered and mortar shells exploded nearby, the young Syrian woman in a slinky dark dress and stylish bob performed a song by pop star Adele, taking refuge behind a microphone from the civil war raging outside.

Performing with a guitarist at a cafe in the heart of the historic Old Town of Damascus, Reem Khunsar lost herself in the lyrics. About a failed love, they also struck a chord closer to home: "Who would have known how bittersweet this would taste?"

While most people in the Syrian capital lock themselves fearfully in their homes at night, young Syrians dressed in tight jeans and designer clothes go wild at the handful of clubs still operating in a city once renowned for its nightlife.

"The war can't stop life," declared Oday Al-Khayyatt, as he took in the music scene at the Roma cafe. "You hear bad news in Syria, dangers, war and death. But in our reality, we are still alive."

Such revelries show the human side of a conflict that has killed more than 120,000 people as the Syrian civil war grinds into its third year.

The Damascus nightclub scene often gets mentioned by the Syrian state news agency SANA on its English-language Twitter feed, drawing ridicule from observers outside the country. But people still brave the dangers to come to the cafes to take their mind off what is happening.

At the Roma Cafe, couples smiled as they danced on the black-and-white checkered dance floor. Some smoked flavored tobacco from water pipes. Women, some in big hair and low-cut dresses and others wearing headscarves, chatted as they mingled by the bar. There were no liquor bottles in sight, though some patrons were able to buy alcohol.

"There is a big difference between now and before the war," conceded Titar Sahinian, another young singer. "People are afraid to come out of their houses ... but they still come.

"Of course, it's all devastating. We can't pretend that nothing is happening. But at the same time we can't stop living," she said.

As she spoke, the sound of government cannons pounding rebels just a few miles away echoed down the stone walls of the ancient quarter. Nearby, so-called Popular Committees, local hard-line militiamen brandishing Kalashnikov assault rifles, threw up impromptu roadblocks, searching cars for bombs.

They also kept a close watch on the young revelers, many of whom said they believe the militiamen, die-hard supporters of President Bashar Assad and his embattled government, don't approve of the Damascus nightlife.

"We were afraid of being attacked" by the popular committee militiamen, Roma cafe owner Rami Dahbour said. "We were threatened once. But nothing happened, and we are no longer affected by the threat."

Several mortars launched from rebel positions on the outskirts of Damascus have rained down near the cafe. Still, the singing goes on.

Khunsar said she feels like she is giving hope to the people who come to listen.

"Here in Syria we have not given up," she said. "We hope that everything will go back to where it was before."

As she threw herself into the Metallica classic, "Nothing Else Matters," those in the cafe joined in: "Life is ours and we live it our way, I don't just say, and nothing else matters."

___

Associated Press writers Darko Bandic and Dusan Vranic contributed to this report.

Source: http://news.yahoo.com/syrians-lose-themselves-music-war-rages-184727305.html
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Kendra Wilkinson Confirms Second Pregnancy: "Round Two! Here We Go!"

It's official! Kendra Wilkinson has confirmed that she and her husband Hank Baskett are expecting their second child together. The former Playboy model announced the baby news via Twitter on Thursday, Oct. 31.

PHOTOS: Kendra's first pregnancy

"Round two. Here we go!!" the 28-year-old wrote to her over 2 million followers. Alongside the caption, the blonde beauty shared a picture of herself makeup-free holding up her pregnancy test marked "pregnant," with a big smile on her face.

Wilkinson also confirmed the news during a TODAY show appearance with Kathie Lee Gifford and Hoda Kotb the same day. "Kendra on Top, naughty, naughty, that's what got me pregnant with baby number two," she teased. "We planned this to be right after the season, so I'll have time to puke. You know, be in a cave." She added: "I'm really at a great stage. Not physically. I'm in the bathroom every 10 minutes," she said of her morning sickness.

PHOTOS: Stars without makeup!

Us Weekly exclusively broke news earlier this month that the reality star and 31-year-old former NFL player -- married since June 2009 — were expecting again. "She and Hank have been planning a second baby for a while," an insider revealed to Us, "and they are very excited."

PHOTOS: Kendra and Hank's wedding album

Wilkinson previously told Us in August they were ready to also give their son Hank Baskett IV, almost 4, a younger sibling. "We are trying, we are going to start now," she said at the Hollywood premiere of Disney's Planes on Aug. 5. "This is my first official announcement! We are very excited about making the decision to try!"

Source: http://www.usmagazine.com/celebrity-moms/news/kendra-wilkinson-confirms-second-pregnancy-round-two-here-we-go-20133110
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Final 'Catching Fire' Trailer Takes Fans Inside The Arena

Latest clip for 'Hunger Games' sequel offers an unprecedented peek at the Quarter Quell.


By Amy Wilkinson

Source:
http://www.mtv.com/news/articles/1716318/hunger-games-catching-fire-quarter-quell-arena.jhtml

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