health

This month, I bring you a guest post which sheds light on current events, events that literally hit home for me when the Planned Parenthood clinic closest to my university was attacked by arsonists. I welcome back Jennifer Rothchild, Ph.D. Associate professor of Sociology and Coordinator of the Gender, Women, & Sexuality Studies (GWSS) Program at the University of Minnesota, Morris, she is one of the founders of the American Sociological Association’s section on the Sociology of Development. She currently researches gender and development, health, childhoods, and social inequalities by examining the intersections of gender, sexuality, and reproductive health in the United States and abroad.

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“Choose mercy! While there is still time!” A man shouted to me as I walked into a Planned Parenthood office. I couldn’t see him, which made the comment oddly affecting. I kept my eyes forward and pushed through the front door.

More than 20 years ago, my friend Kat had told me about her first trip to Planned Parenthood. As she left that building, a woman standing outside approached her, grabbed her shoulders, and cried, “‘DO YOU KNOW WHAT YOU HAVE JUST DONE? DO YOU KNOW WHAT YOU HAVE DONE?’”

I will turn 45 this February, and yesterday was my first visit to Planned Parenthood. Shame on me: a self-proclaimed activist, and a gender and sexuality scholar. Until now, my privilege had allowed me to get all the women’s health care I needed through medical clinics and private practice physicians. All covered by insurance. But I knew Planned Parenthood was always there, should I ever need their services.

I had a health problem, and this time I chose Planned Parenthood because that is what it is: a health clinic. The woman at Planned Parenthood who booked my appointment warned me: “You should know that this clinic will have protesters. Turn into the parking lot, and a volunteer will help you get by the protesters, and then park.”

There are many misconceptions about Planned Parenthood; here are some facts:

• Planned Parenthood services include STD/STI (sexually transmitted disease/sexually transmitted infection) testing and treatment for both men and women, cancer screenings, contraception, abortions, and other health services.
• Abortions make up less than 3% of the services provided by Planned Parenthood.
• Federal funding for Planned Parenthood is only for Title X: restricted to family planning and STI testing.
• Planned Parenthood clinics that provide abortion services do not receive any federal funding, even if those particular clinics also provide services that meet Title X criteria.

On a rainy, cold morning, I arrived at Planned Parenthood, and a volunteer waved me into the parking lot. Next to this volunteer stood a protester, holding a sign about texting a certain number before “aborting.” I wondered if these two women talked to each other as they stood together in the rain?

Once inside, I was overwhelmed by a need to express gratitude to everyone I met. I assumed that most Planned Parenthood patients felt same way, if not always vocalizing their sentiments. But I was wrong. My intake nurse told me that just that morning a patient told her, “I hate who you are. I hate what you do. I don’t want to be here, but I need birth control pills.”

Her story made me wonder about the level of denial and disconnect that must be actively maintained to keep those ideas working side by side. In 2012, Frank Bruni wrote in the New York Times about a doctor who performed abortions:

He shared a story about one of the loudest abortion foes he ever encountered, a woman who stood year in and year out on a ladder, so that her head would be above other protesters’ as she shouted ‘murderer’ at him and other doctors and ‘whore’ at every woman who walked into the clinic.

One day she was missing. ‘I thought, ‘I hope she’s O.K.,’ he recalled. He walked into an examining room to find her there. She needed an abortion and had come to him because, she explained, he was a familiar face. After the procedure, she assured him she wasn’t like all those other women: loose, unprincipled.

She told him: ‘I don’t have the money for a baby right now. And my relationship isn’t where it should be.’

‘Nothing like life,’ he responded, ‘to teach you a little more.’

A week later, she was back on her ladder.

That morning, security was at a premium at the Planned Parenthood clinic: a guard stood at the front door, and I needed to show him identification. I was given a name tag that read only “Jennifer.” A few minutes later, “Jennifer R.” was summoned from the waiting room. I wondered how much money could be saved and put to better use if Planned Parenthood didn’t feel compelled by threats and attacks to spend on security measures.

In the waiting room I saw young and old women, white and black and Latina. There were men, too. I couldn’t imagine the individual stories that brought them to Planned Parenthood. But, I might have assumed they all shared was a lack of access and means to the kind of health care that should be their right. According to a 2012 report from the Government Accountability Office, 79% of people receiving services from Planned Parenthood lived at 150% of the federal poverty level or lower (that comes out to around $18,500 per year for a single adult). These people live in vulnerable conditions, where an unplanned pregnancy could result in future burdens, unfair and disproportionate in consequence.

If Planned Parenthood clinics are shut down, we will see not only tremendously diminished reproductive health but also epidemic numbers of unplanned pregnancies and unsafe abortions, as well as greater needs for social services such as WIC. Concerns for women’s health aside, Planned Parenthood delivers mercy upon people who benefit from its services.

The nurse practitioner spent time talking with me, getting to know me. I told her how grateful I was for the work she did. She graciously explained, “I started working here 15 years ago to educate women about their bodies. Women don’t know their bodies.”

Driving out of the parking lot, I stopped and rolled down my window to thank the same volunteer who had stood in the rain when I arrived, waving me into the parking lot. There was now a different protester. This woman was young, white, blonde, and wearing a pink raincoat. She could have been a twenty-something version of me. In her hand, she clutched a brochure limp from the rain. Her sad gaze followed me as I drove away. I wish she saw and knew the things I understood.

I also wish everyone understood that Planned Parenthood volunteers, nurses, and doctors risk their own safety and well-being because women’s health—and women’s lives—hang in the balance. These women and men are standing up and fighting for me, fighting for you.

“Choose mercy.” Yes, we should.

Valentine’s Day is not the only reason to think about hearts in February, a.k.a. American Heart Month.  This guest-post on women’s heart health by Chloe E. Bird, Ph.D. — senior sociologist at the nonprofit, nonpartisan RAND Corporation and professor at the Pardee RAND Graduate School — discusses findings from a recent RAND pilot study.*  In our email exchange, Chloe emphasized, “…please don’t assume that you, or the women in your life, are too young to be concerned.”

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High-quality routine care for both cardiovascular disease (CVD) and diabetes is at least as relevant to women’s health and survival as it is to men’s.  Yet evidence suggests that women continue to face gaps in even low-cost, routine aspects of care.

CVD is the leading cause of death for women, as well as for men. More than one in three adult women has some form of CVD.  In fact, since 1984, more U.S. women than men have died of CVD, and 26 percent of women over age 45 die within a year of having a recognized heart attack, compared with 19 percent of men. Diabetes is a major cardiovascular risk factor, and it increases risk of CVD more so in women than in men.

Despite improvements over recent decades in care for CVD and diabetes, evidence suggests that the care women receive—and their health outcomes—continue to lag behind those of men, even for routine care such as monitoring and control of cholesterol. Although the American Heart Association’s “Go Red for Women” campaign and efforts by Sister-to-Sister and WomenHeart have done much to raise awareness among both women and their clinicians about CVD, there is still too little attention devoted to preventing heart disease in women.

Part of the problem is that quality of care is not routinely measured and reported by gender. Conventional methods of measuring quality of care focus on average “quality performance scores” across the overall population. Separate assessments and reporting by gender are rare, so the care received by women is generally assumed to be equal to that received by men, despite evidence to the contrary. As a result, the quality gap in care remains largely invisible to individual women, providers, payers and policymakers, even among those seeking to improve women’s health and health care. In cases where gender gaps in care have been monitored and targeted, such as in recent initiatives by the Veterans Health Administration, marked reductions in gender disparities in CVD and other types of care have been achieved; though some gaps persist.

In an examination of gender gaps in cholesterol screening among adults in one large California health plan who had been diagnosed with CVD or with diabetes, we found larger gender differences on average in care for CVD (5 percentage points) than for diabetes (2 percentage points). Although the gaps may appear small among the 30,000 CVD patients and 155,000 diabetes patients whose care we examined, they translate into a significant number of women who were not screened, but who might have been had they been men.

We focused on screening because clinicians agree that CVD and diabetes patients should receive annual screenings for high LDL cholesterol.  Such screening is also the first step in assessing quality of care.  Moreover, research on disparities in care often finds that gaps in screening are associated with larger gaps in treatment and poorer intermediate outcomes.

In our study, gender gaps in cholesterol screening varied geographically and favored men far more often than women. Among CVD patients, there were gaps favoring men in 79 percent of counties. In 35 percent of counties, those gaps were moderate (from 5 to less than 10 percentage points) or large (at least 10 percentage points). In 12 percent of the counties there were small gaps (from 1 to less than 5 percentage points) favoring women. Among patients with diabetes, which has not traditionally been viewed as a man’s disease, there were moderate gaps favoring men in 17 percent of counties and small gaps favoring men in another 40 percent of counties. In contrast, there were large gaps favoring women in 4 percent of counties, moderate gaps in 2 percent, and small gaps in another 12 percent.

Lessons from areas with the highest quality of care and from areas with the fewest gender disparities can motivate efforts to improve care and reduce disparities. Mapping quality of care at specific geographic levels and focusing on the areas of interest to specific stakeholders may prove to be essential to efforts to tackle disparities efficiently and meaningfully.

Without gender-stratified reporting of quality of care, gender gaps are invisible and intractable. Such reporting is essential if health plans, health care organizations, and policymakers are to ensure that overall improvements in care narrow gender gaps.

Health plans should use gender-based analysis and mapping to address gender gaps and to motivate improvements in care, treatment and outcome measures. Similarly, analyses of pooled data from multiple health plans could be used to assess gender disparities in care for CVD and diabetes for managed care patients and determine whether the size and patterns of disparities differ across plans.

Closing the gender gap is crucial if women are to benefit equally from improvements in care for CVD and diabetes.  At the same time, focusing on gender gaps can inform a broader discussion of the prevalence and burden of CVD in women and the need for improvements in prevention, diagnosis and treatment.

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*For more information, check out the online report and videos of her presentation and other researchers’ talks from RAND and UCLA’s recent women’s heart health event.

With the new PBS Frontline documentary Hunting the Nightmare Bacteria premiering this week, I hope that the American public is finally becoming aware of what many in the U.S. and around the world have seen coming for years.  I encourage readers to check out the film and the links available online through PBS. However, I feel ethically bound to issue a ‘trigger warning’ for those who do not want to view a child and young adult being ravaged by diabolical infections.

Are we ready for the post-antibiotic era?  Supposedly, we were all alerted last March when the CDC sounded an alarm – “Action needed now to halt spread of deadly bacteria” – but how many of us heard it?

We’re still in the dark when it comes to nightmare bacteria.  At this point, I’m less convinced that anyone is “hunting” these antibiotic-resistant bacteria and more convinced that these microorganisms are hunting us.  We need to be on the defensive, taking steps to protect ourselves, our loved ones, and our society.

Reading the PBS documentary’s link to “Eight Ways to Protect Yourself from Superbugs,” I found tips that are not new but are important reminders for public health.  I’m a big believer in their recommendation to question the necessity and effectiveness of all prescriptions of antibiotics (e.g., that they cannot cure viral illnesses).  That said,  I’m sad that we still need to teach people how to properly wash their hands, and I’m even more dismayed that we have to recommend that everyone asks their medical providers to wash their hands.  Unfortunately, promoting hand-washing is only a small improvement when proper drying methods are unavailable: studies continue to show that air hand dryers add more bacteria to clean hands.

In the documentary, Arjun Srinivasan, M.D., Associate Director of CDC, warns, “…the more antibiotics we put into people, we put into the environment, the more opportunities we create for these bacteria to become resistant….”  However, the environmental components – government funding for research and surveillance, public health policies, and medical norms – are not fully addressed by this film.  In addition, the causal link to meat and poultry policies/practices is completely absent.  As a medical sociologist, my critique of this documentary is that it spends a lot of time on horrific case studies and too little time on the structural and social causes, consequences, and solutions to this crisis.

For a more complete picture, see the CDC’s report with graphics that illustrate the dynamics of drug resistance.  I was stunned by chilling estimates: annually, antibiotic resistance will cause over 2 million Americans to become ill and will result in at least 23,000 deaths.  In the early years of the HIV/AIDS epidemic, activists rallied public support and political action with the message that “Silence Equals Death” – what message will wake up Americans to the realities of our new nightmare?

This month’s column features a new guest author: Adrienne Trier-Bieniek, Ph.D. is a sociologist and author of the new book Sing Us a Song, Piano Woman: Female Fans and the Music of Tori Amos (Scarecrow Press).

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I have spent the better part of the last five years trying to understanding how women use music to heal after  experiencing trauma.  When I was interviewing women for my book, Sing Us a Song, Piano Woman, one comment stuck in my head from a woman named Madeline.  Madeline talked about how she used to be into music by hair-metal bands.  She said, “Growing up, all my favorite bands were male artists.  Um, maybe it’s just that now I see that their message is from their point of view.  And I internalize that and maybe that’s why I made all the shitty choices that I made.  I think that maybe the reason that I only listen to female artists is because I just would rather have their messages in my head.” And this comment wasn’t rare.  Many women said that they found empowerment/comfort/salvation in music written and performed by another woman.

Now, I am totally aware that women can listen to male bands to feel support and vice versa.  However, one thing that I think it missing from conversations about feminism and pop culture is how women use music by feminist musicians as a way to heal after they have experienced trauma. This was the premise of my research for Sing Us a Song, Piano Woman.  The women I spoke with selected Tori Amos’s music as their self-care guide.  They were very much aware that this help was coming from a feminist performer and, because of that, found her music to sit close to home.

From this study I took away a few helpful tips for connecting feminism with music and healing that I would like to share.  In no particular order:

– Find an anthem:  I don’t think it gets much better than listening to powerful women belt out songs like it is the last time they will have the opportunity to sing in their lives.  Whether it’s Sister Rosetta Tharpe, Aretha, Tori Amos, Ani DiFranco, Janelle Monae, Beyonce etc.  Feminist musicians approach their songs with an eye toward empowerment, equality and expressing the experiences of women.  One of the reasons many of the women I spoke with enjoyed Tori’s song “Spark” was because it addressed her experience with miscarriage.  Healing from the loss of a child is hard, but hearing a performer address her emotions can be helpful.  So find your feminist anthem.  (I have many.  Some, like Aretha’s “Respect” and Ani’s song “Alla This” I will gladly cop to.  Others are embarrassing but help me get through the day!)

– Create While you Listen:  In 2007 I was a grad student at Virginia Tech  when my college became the site of the worst school shooting in U.S. history.  One activity that got me through was creating art while listening to Tori’s music and trying to use the lyrics to illustrate my feelings.  Many of the women I spoke with did the same thing with writing, crafting, singing and dancing.  Song lyrics became immortalized through their bodies, art and voices.  What is even more important is that this exercise requires you to think about the lyrics you are repeating to yourself.  What do they mean?  Are they empowering?  Of course we all can rattle off songs meant for entertainment.  But if there was ever a chance to think about the impact of music on our identities, it is when we are expressing ourselves through art and being vulnerable.

– The Feminist Standpoint:  Ok, stick with me.  In sociology (my field), the feminist standpoint basically says that women’s stories are often ignored in a culture.  So, I would encourage you to take an anthem song and use it to tell your story.  Anthems are great backdrops for activism.  They can help with speaking out about being raped, having an eating disorder, having a miscarriage etc. And, speaking out is a huge step toward breaking the culture of silence that surrounds these experiences.  I, like many of you, have found a new hero in Wendy Davis (the Texas legislator who stood for 11 hours to strike down anti-abortion laws).  She used her voice and inspired the band The Bright Light Social Hour to record this song called “Wendy Davis.”

Finding feminism in music (for both female and male artists) is key to changing the ways pop culture stereotypes women.  Finding feminism in music to help us heal from trauma is key to finding empowerment in vulnerable moments.  What do you listen to?

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– Crossposted from Feministing with permission –

I’m happy to bring you this guest post co-authored by two researchers at the nonprofit, nonpartisan RAND Corporation: Chloe E. Bird, senior sociologist and co-author of Gender and Health: The Effects of Constrained Choices and Social Policies (Cambridge University Press, 2008), and Tamara Dubowitz, policy researcher. In this post they discuss recent studies which examine the impact of neighborhood environments on health and health disparities.

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If you had good options about what to eat but made bad choices and became obese, then the fault would be yours. But, what happens when you don’t have good options?

That’s the problem in America today – being overweight is not all your fault. You don’t make the decisions to put transfats, high-fructose corn syrup and excess salt in your food, or unhealthy snacks in the vending machine at work. You don’t dictate that the equivalent of 54 sugar cubes get put into an extra-large soda. These are so-called constrained choices – ones you don’t get to make. Yet, you live with the consequences.

We believe it is time to consider who determines the options for us and what can be done to put better ones on the table. We can’t all afford to buy only organic foods or even have access to them. And, we probably don’t make it a pastime to follow the latest research on nutrition. But, we can take a moment to think before we order a second soda.

And, we can choose to call on those who determine the options to shoulder part of the responsibility for America’s obesity epidemic and to stop the name-calling – like labeling medical researchers “food nannies” when they ask restaurants to deliver sensible portions, priced right. We need to hold vending-machine companies and their managers to account if they stock only junk food in those little compartments.

Consider a few statistics. The latest figures indicate that two of three adults and one of three children and adolescents in the United States are overweight or obese. The impending health and economic consequences are staggering. According to the Institute of Medicine, the medical costs alone of obesity-related diseases and disabilities exceed $190 billion a year. These costs comprise more than 20 percent of national health care spending. The number keeps rising. Want your health care costs to spike further? Then, keep eating the constrained choices that are not healthy.

RAND research, using data from the Women’s Health Initiative study, found that living where there is a higher density of fast food outlets is associated with higher blood pressure and risk of obesity; while, a greater density of grocery stores is associated with lower blood pressure and lower risk of obesity. These relationships hold even after taking into account women’s characteristics and socioeconomic status of their residential neighborhoods.  In other words, where you live can affect your weight and your health.

Moreover, another recent RAND study found that 96% of main entrées at all restaurants studied—including delivery, family style, upscale, fast food, buffet, and fast casual—exceed the daily limits for calories, fat, saturated fat, and sodium recommended by the U.S. Department of Agriculture.

Policy approaches to reduce obesity are not magic bullets. If we want to reverse the obesity epidemic, then we need environments which assure that we have good food options and the opportunity to choose them.

We will be more successful at stemming the growing tide of obesity and improving our own health if everyone accepts their share of responsibility for the obesity epidemic. We need to ask our favorite restaurants, the food vendors near where we work, even grocery stores to give us better options. We can always ignore them, if we wish, but then that’s our choice. Right now, too many bad choices are being made for us.

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Cross-posted on RAND’s blog

Last year, I read about a case of a nurse who alleged being sexually harassed by a doctor during her job interview, and a couple of months later I was struck by a report from the Netherlands about the high rate of sexual harassment experienced by female nursing and healthcare workers. Although cases like these make it seem like doctors and managers are the primary perpetrators of sexual harassment, reports show that it is patients who sexually harass nurses most often.

With a recent study suggesting that nurses simply distance themselves from patients who are sexually inappropriate, how do nurses maintain quality health care of these patients? A new book, Catheters, Slurs, and Pick-up Lines: Professional Intimacy in Hospital Nursing (Temple University Press) sheds light on female nurses’ experiences of being sexually harassed by patients.  For this month’s column, I had the chance to ask the author, sociologist Lisa Ruchti, Ph.D. of West Chester University, about nurses experiences of “intimate conflicts” with patients.

Adina Nack: Why did you decide to study the dynamics of patient-nurse interactions?

Lisa Ruchti: I initially thought that nurses’ experiences of sexual harassment by patients would be similar to waitresses’ experiences of sexual harassment by customers because they are each one type of women’s work. Instead, I found that nurses did not refer to their encounters as ‘sexual harassment’ because work culture affects definitions of sexual harassment (other sociologists have found this too; for example, Christine Williams and Kirstin Dellinger).  In nursing, it was the fact that nurses provided both professional and intimate care that contributed to differences in how and when nurses said they were sexually harassed. I became intrigued with the function of intimacy in professional care work and wanted to learn more.

AN: I’m intrigued by the concept of “professional intimacy” – how is this experienced by nurses?

LR: In my work, I found that nurses negotiated a cycle of what I call “professional intimacy” with patients. I also found that negotiating intimate conflict with patients is inextricably a part of how nurses gain their trust. Nurses start with gaining the intimate trust of their patients. This trust sometimes escalates to patients having feelings of familiarity for their nurses, which leads to conflict for the nurse. These conflicts include patients feeling entitled to service beyond the scope of care in nursing, angry verbal interactions, and/or sexualized entitlement. This conflict can also be unavoidable such as the ways that nurses negotiated the sexual encounters between patients and their visitors. Nurses negotiate care through this conflict to renew trust to ensure that quality health care is administered.

AN: How do nurses experience conflict when providing care to patients?

LR: The majority of the 45 nurses I interviewed avoided describing patient care as involving conflict. They used words like nurture, kindness, and compassion to make it seem like nurses “being caring” was a natural personality characteristic characterized by goodness. Feminist philosopher Eva Kittay discusses this in her work: patients are not usually described as anything other than “needy,” and we don’t tend to think of needy people as causing conflicts for those who provide their care. My focus on identifying conflict is as much about seeing patients clearly as it is about seeing the work of nurses clearly.

AN: You make a key point about not only a nurse’s sex but also her race/ethnicity shaping her experiences of patients’ harassment – can you give a couple of examples of how nurses described these interactions?

LR: It is one thing for nurses to manage sexually explicit language or touches; it is quite another when those are combined with racial slurs and epithets.  Imagine that a nurse not only walks in to check on a patient and sees himmasturbating, but she is also called a “dirty foreigner.” Or, a nurses isgiving a patient a bath, and the patient says you remind him of his mammy. It was incredibly important for me to look at the function of multiple identities since I was looking at intimate care as something that is constructed in interaction between patients and nurses and informed by social ideologies. Intersectionality is an incredibly useful tool when explaining complex social experiences.

AN: As a medical sociologist, I was instantly hooked by your book’s title, but I can also see why many of us — not just nurses — should read your book. 

LR: Thanks, I wrote it not just to give voice to nurses but also because almost all of us have all been patients or visited loved ones in hospitals. Many of us have or will have long medical journeys at some point in our lives, and this book can help us understand a vital part of that journey. If we can better understand the lives of those who are taking care of us, then we can help ensure that quality care occurs when we need it.  Other studies have documented how much nurses care about patients, and it’s time for us to listen to their stories – we need to understand their experiences of caring for us.

2011 brought us two top-selling autobiographical takes on female aging. Jane Fonda’s Prime Time asks readers to explore everything from friendship to fitness to sex, with a goal of having us accept that “people in their 70s can be sexually attractive and sexually active.”  Betty White’s If you Ask Me (And Of Course You Won’t) offers readers a candid and often humorous take on the last 15 years of her life. White warns of the pitfall of our youth-centric culture: “So many of us start dreading age when we’re in high school. And I think that’s really a waste of a lovely life.”  While these celebrity authors paint provocative personal portraits of aging, I’m drawn to the new book by Colgate sociologist Meika Loe, Ph.D.: Aging Our Way: Lessons for Living from 85 and Beyond (Oxford University Press) charts her three-year journey following the lives of 30 diverse “elders” (women and men ages 85 to 102 years old), most of whom were aging at home and making it work.

Adina Nack: How did your last book on the Viagra phenomenon lead you to your new book on the ‘oldest old’?

Meika Loe: For The Rise of Viagra I interviewed elder men and elder women partners of Viagra users. It became clear that ageism impacted their lives and was a key ideology that propelled the Viagra phenomenon forward. Afterwards, I missed those interactions with elders and wanted to know more about their experiences aging at home. Aging Our Way ended up being a book that focuses more on elder women’s experiences, voices that had been marginalized, if not completely absent, from the media coverage of the Viagra phenomenon.  In the 85+ age group, women outnumber men by almost 3 to 1, and close to 80% of elders living at home alone are women. Too many people assume that research on elders is sad and depressing, in comparison to research on Viagra. To the contrary! I find elders’ stories inspirational. Aging Our Way features the lessons I learned from them – lessons for all ages.

AN: Aside from the Viagra interviews, what inspired you to focus on this group of people who are all more than twice your age?

ML: I was extremely close with my grandparents and great-grandparents growing up. More recently, I rent a room from a village elder in the small town where I work. Living with her, an invisible world opened up to me – a world of widows caring for one another and collectively attending to quality of life, mostly in the absence of biological kin.  Like, Carol, my seventy-something landlady, who gets a check-in call from octogenarian Joanne every morning at 8 a.m. Then Carol calls 98-year-old Ruth. All of these widows have lived alone in their homes within 10 square blocks of each other for decades, and now they constitute a social family. Once in a great while, when Carol cannot reach Ruth, she’ll grab the extra key and head to her home to make sure everything is okay. One time she found Ruth on the floor.

AN: That must have been scary – so, even with this type of ‘morning phone tree’, isn’t isolation a problem for these women and men aging alone?

ML: Yes, like most of us, elders attempt that delicate balancing act between dependence and independence every day. So, while many of these elders value independent-living, they’re also adept at building social networks. Ruth H. is committed to making a new friend every year of her life: she reaches out to my campus’s Adopt-a-Grandparent group and has five student walking partners this year, all new friends. That said, aging alone comes with its share of isolation and risk, and I’m reminded of Elizabeth, a Navy veteran and high school English teacher who insisted on living alone in her home, amidst her longtime friends and neighbors, despite her children’s pleas for her to move to Georgia. Elizabeth recently passed away during Hurricane Irene. She was inspecting her basement for flooding and must have fallen. This is such a sad story, but Elizabeth would not have wanted it any other way: she said she wanted to die with her boots on.

AN: Do women have an advantage over men when it comes to longevity and aging?

ML: Social epidemiologists Lorber and Moore have shown that women live longer but not necessarily healthier lives. Traditional gender roles take their toll: often, women prioritize caring for others for so long that their own health suffers.  Perhaps as a result, women have higher rates of chronic illness and depression. At the same time, many of the women I followed are enjoying a chapter in their lives where they can focus on themselves, their communities, their gardens, and their own health. Shana, 95, says things like “Now I am finally living for myself. Now I can focus on me.” Most women have lifelong gendered skill-sets for self-care: systems for food preparation, cleaning, bathing, budgeting, and reaching out to others. The men I followed are less adept at those skills: they had never been expected to cook and clean. So men, like Glenn, told me about having to learn these skills after the loss of their spouses.

AN: Does caretaking of others really end at age 85?

ML: Caretaking continues, often in new and familiar ways.  I think of Olga, age 97, caring for her grandson every weekend and putting aside a few dollars every day for her daughter who is battling cancer.  In her subsidized senior housing community, she delivers hot meals, hems pants, and runs errands. By caretaking, Olga feels a sense of community, a web of support. When she needs assistance, she has options and knows where to turn. So contrary to expecting nonagenarians to be sickly and dependent, many not only receive but also give care.

AN: Talk of cutting Social Security and Medicare has been in the news – how did you see these programs impacting elders’ lives?

ML: I have to admit – in my 30s, I see money going out of my paycheck—and I remind myself that that money is put aside for when I need it – I just hope it will be there! Through this research I saw how and why programs like Medicare and Social Security matter. For example, Juana worked in factories her whole adult life, and her small Social Security check keeps her hovering above the poverty line, able to afford rice and beans for the family and to pay for cable TV so she can watch her beloved Yankees.  Medicare covers annual doctor’s visits that likely keep her from spending time in the emergency room, a more expensive cost for society. Like most elders, she depends on Social Security for a significant portion of her income.

AN: Why should we all – not just the elders in the U.S. – read your book?

ML: Undergrads come to my Sociology of Aging course with all sorts of preconceived notions. They dread aging, seeing it as synonymous with depression, disease, and death. Our ageist society has taught them that aging equals loss, and they’re surprised to learn about elders who are aging on their own terms: coordinating self-care, combating isolation and loneliness, and exercising autonomy and control – sometimes in the face of disabilities and chronic illnesses. We all benefit from learning creativity, connectivity and resiliency from our elders. They teach us crucial lessons about all stages in life: living in moderation, designing comfortable spaces, constructing social families, appreciating humor and touch, and building social capital.  And, let’s face it, if we’re lucky, then we will all be elders soon enough.

I respect that some of you are anti-vaccines–or just anti-Gardasil—but I hope that some Girl with Pen readers will join me in cheering what I consider a better-late-than-never decision by the CDC’s Advisory Committee on Immunization Practices. It has officially recommended that boys and men ages 13-to-21 be vaccinated against the sexually transmitted disease HPV (human papillomavirus) to protect from anal and throat cancers.

There are many reasons this makes good sense. As I wrote in the Winter 2010 issue of Ms., there’s overwhelming evidence that HPV can lead to deadly oral, anal and penile cancers–all of which affect men and all of which are collectively responsible for twice as many deaths in the U.S. each year as cervical cancer. However, vaccines are a touchy topic, and I want to be clear that I’m not advocating in favor of or against anyone’s decision to get an HPV vaccination. I do strongly advocate for boys and girls, men and women, to have equal access to Gardasil and any other FDA-approved vaccine. Private insurers are required to cover HPV vaccines for girls and young women with no co-pay under the 2010 health reform legislation, and with this decision, that coverage requirement will extend to boys and young men, effective one year after the date of the recommendation. And, whether or not you or your loved ones get vaccinated against HPV, we will all benefit from more vaccinations, considering the extent of this sexually transmitted epidemic/pandemic, which affects as many as 75 percent of adult Americans and can be spread by skin-to-skin genital or oral contact (yes, that includes “French kissing”).

However, the media coverage of the recommendation includes a line of reasoning that I, as a sexual health educator and researcher, find offensive, ignorant, and inaccurate. The New York Times wrote: “Many of the cancers in men result from homosexual sex.” Really? What counts as “homosexual sex”? Most public health experts and HIV/AIDS researchers view “homosexuality” primarily as a sexual orientation, sometimes as a social or political identity, but not as a type of intercourse. Anyone who studies U.S. sexual norms knows that oral sex and anal sex–the behaviors cited as increasing risks of HPV-related oral and anal cancers–are not restricted to men who have sex with men. In fact, the NYT article itself asserts, “A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex” –so you don’t have to identify as a “homosexual” man to be at risk; you don’t even have to be a man.

Nevertheless, the New York Times goes on to muse that “vaccinating homosexual boys would be far more cost effective than vaccinating all boys, since the burden of disease is far higher in homosexuals.” Thankfully, the author also thought to check this idea with a member of the CDC committee, who seemed to grasp the ethical and practical challenges of making a recommendation based on a boy’s or man’s “homosexuality.” Kristen R. Ehresmann, Minnesota Department of Health and ACIP member, is quoted as cautioning, “But it’s not necessarily effective or perhaps even appropriate to be making those determinations at the 11- to 12-year-old age.”

Still stuck on the question of sexual orientation, that NYT author seeks to console potentially “uncomfortable” parents of boys by reassuring them that “vaccinating boys will also benefit female partners since cervical cancer in women results mostly from vaginal sex with infected males.” So, is the message, if you don’t want to imagine your son having oral or anal sex with a male partner, then you can focus on the public health service you are providing for girls and women who have male partners?

Instead of contributing to a homophobic panic, I thought it might be helpful to field a few frequently-asked-questions:

Q: Do you have to have a cervix to benefit from the “cervical cancer” vaccine? A: No. Despite its early branding, Gardasil has always been an HPV vaccine. Physiologically speaking, boys and men could have been benefiting from the vaccine since its initial FDA approval.

Q: Why are they recommending vaccinations for girls and boys as young as 11? A: Vaccines only work if given before contact with the virus. Reliable data on age of first “French” kiss is not available, but recent surveys show that about 25 percent of girls and boys in the U.S. have had penile-vaginal intercourse before their 15th birthdays.

Q: Are you too old to benefit? A: If you have not yet been exposed to all four of the HPV strains covered by Gardasil, then you can still gain protection. The more challenging question is: How would you know? The only ways to test for HPV (and then HPV type) is by tissue samples being sent to a lab. Most HPV infections are asymptomatic.

Q: What’s the risk of not getting vaccinated? A: We know that U.S. cervical cancer rates have dramatically decreased in recent decades due to improvements in screening, such as the Pap smear, and better treatment options. However, rates of HPV-related oral and anal cancers are reported to be increasing–and our screening options for these types of cancers are not as effective, affordable or accessible as those for cervical cancer.

Q: So, what can an unvaccinated person do to protect him/herself from a cancer-causing strain of HPV? A: Abstain from behaviors that can transmit the virus, such as deep/open-mouthed kissing, and use barrier methods when engaging in vaginal, anal or oral sex.

If this last answer strikes you as unreasonable, then mobilize your political energies to advocate for increased funding for HPV research. We need and deserve better ways to be tested and treated for the types of HPV that have been linked to serious and potentially fatal cancers. And, as my own research has shown, we have to get rid of the harmful stigma surrounding HPV and other sexually transmitted infections. We need to stop linking STDs to immorality. You can help by making sure your community supports medically accurate, age-appropriate sexuality education. And if you or a loved one wants more information about sexual health, then check out these free online resources.

(Originally posted on Ms. blog, cross-posted at AdinaNack.com)

For this month’s column, I spoke with Patricia A. Adler, Professor of Sociology at the University of Colorado, Boulder. She and her husband Peter Adler, Professor of Sociology at the University of Denver, co-authored a new book that offers an ethnographic perspective on a controversial health topic. The Tender Cut: Inside the Hidden World of Self-Injury (NYU Press) invites readers to go beyond predominant medical and psychological perspectives by offering a nuanced analysis of self-injury as a sociological phenomenon.

Their book is the culmination of 135 in-depth, life-history interviews conducted over ten years with self-injurers from across the world, as well as analysis of tens of thousands of emails and Internet messages. Their participants were engaging in self-injury, the intentional non-suicidal harm of one’s own body, including but not limited to include cutting, branding, burning, branding, and scratching. 

AN: In your book, you describe a broad range of motivations for self-injury. Can you explain the most typical reasons?

PA: Most of the people we interviewed saw it as a way to cope, to function when they were facing tough times. Many started in their teens when they were trying to cope with negative life circumstances.

AN: Did you find that sex and gender made a difference – did the self-injury types or reasons differ between men and women?

PA: Yes, men and women differed in the ways that they self-injured and their motivations. Men were injuring their bodies because of feelings of rage and anger and were more likely to use dull or rusted instruments to make bigger injuries on parts of their body that would be easily visible. If a man did small self-injuries and tried to hide them, then other guys would be likely to ridicule him. Women were more likely to use sharp, small blades on parts of their body that they could easily conceal because society judges women’s bodies, and they wanted to be able to hide it. They tended to self-injure because of negative feelings about themselves.

AN: It’s fascinating that sex and gender factors into others’ reactions to the self-injurers: that those who acted in ways that matched their gender norms – who were seen as being appropriately masculine or feminine – received less ridicule. Do you think mental health and medical practitioners understand self-injury as a gendered phenomenon?

PA: I think that mental health practitioners probably regard self-injury as they do eating disorders, as a generally female behavior. They may see a guy here and there, but I doubt that any practitioner sees enough to recognize this pattern. And some of the books I’ve read from the clinic people who do see larger numbers have presented cases of men who injure in ‘feminine’ ways. So I don’t think they’re attuned to this gendered pattern.

AN: Most media coverage of self-injury approaches it as a psychological problem, often as a physically dangerous type of addiction. Can you explain the sociological perspective you present on self-injury?

PA: It is common for self-injurers to be told that they have a mental disorder and that it is an addictive practice. We looked at a range of people who self-injure and found that their motivations did not necessarily reflect mental illness. A lot of regular teenagers and adults who were structurally disadvantaged were using it to find relief. Then there are those who have severe mental disorders before they start self-injuring. Some of the people we interviewed were mentally ill, but our research suggests that many of them are not. We intentionally chose the word “tender” in the book’s title because cutting may be a coping mechanism that makes some people feel empowered with a sense of control over their pain. The self-injury gave some people relief from emotional pain that they needed to get through challenging times. Our book is nonjudgmental, providing a “voice” for the experiences of a broad population of self-injurers: comprising people who have genuine mental disorders, as well as those who just have temporary situational life troubles, and everything in between.

AN: From the medical and psychological perspectives, a key focus in on how to help self-injurers stop “dangerous” behaviors. So, what did you learn about the ways and reasons why self-injurers stop?

PA: Many self-injurers stop when they are able to escape from the circumstance that caused them to initially start. So, transitioning from high school to college can be a time when young people stop. For others, it takes getting a good job, finding a partner who will not tolerate it, or becoming a parent and not wanting their children to see them self-injuring.

AN: In other published interviews, you’ve made the somewhat controversial point that not every self-injurer will need to invest in professional medical and mental health treatment in order to quit. What are some of the other ways that those you interviewed found to be helpful when they decided they wanted to stop self-injuring?

PA: Solutions from the medical-psychological community include everything from specialized clinics, which can be very expensive, to outpatient therapy, and drugs. Those who found therapy to be effective were those whose therapists addressed the reasons the person began self-injuring in the first place, rather than those who focused on self-injuring as the problem to be treated. Most of the people who self-injure are not trying to self-destruct; they’re trying to self-soothe. And, we also found many turning to free online support groups to connect with people like themselves who had either stopped self-injuring or could give advice on how to better manage the negative aspects of self-injury. In addition, some people just stopped on their own or with the encouragement and support of friends.

AN: As experts on deviant subcultures, would you say that the Internet has helped to create communities of self-injurers?

PA: Yes, the Internet has helped to build a kind of self-help community for self-injurers. Peer support groups have emerged organically, and people are sharing their experiences with each other in cyber-communities. These online relationships help them manage stress so that they function better in their daily lives.

AN: What role do you think the media played in transforming self-injury into a sociological phenomenon?

PA: It was initially shocking but not necessarily more shocking that the many other ways the people try to relieve their pain. The stories often showed that self-injury was not a suicide attempt and wasn’t necessarily because the person had serious psychological problems. Once the media started to cover self-injury stories of celebrities, then it became more acceptable because young people could relate to these people. Now, it’s so common in high schools that teens are more willing to disclose their self-injuries to their friends, and their friends often see it as “that thing that people do” if they’re unhappy, as a temporary coping mechanism. We see this behavior as highly “socially contagious”—the media, along with word of mouth, has contributed to its spread.

In The Tender Cut, we describe how media coverage of celebrities who self-injured, the accessibility of the Internet, and shifts in cultural norms made it possible for loner deviants to join Internet self-injury subcultures. These subcultures represent a range of levels of acceptance of self-injury and often help people to realize that their behaviors do not necessarily mean that they are mentally ill or bad people. This helps them manage the stigma of society judging people negatively for relieving emotional pain by inflicting physical pain on themselves. Our longitudinal data shows that many who began self-injuring as teenagers eventually outgrow it and lead functional lives.

Is the legality of abortion in the U.S. a moot point if too few ob-gyns are willing to perform the medical procedures?  A recent post on FREAKONOMICS inspired me to find out more about a new article in the journal Obstetrics & Gynecology titled “Abortion Provision Among Practicing Obstetrician-Gynecologists.”

This group of researchers mailed surveys to practicing ob-gyns and reported on the data from 1,800 who responded. The article’s main findings are as follows: “Among practicing ob-gyns, 97% encountered patients seeking abortions, whereas 14% performed them.” Their analysis of the data revealed that male physicians were less likely to provide abortions than female physicians. Age was also a factor, with younger physicians being more likely to provide abortions.

The new article’s abstract states, “…physicians with high religious motivation were less likely to provide abortions.” I wonder if the large numbers of ob-gyns who do not provide abortions speaks to moral judgments that this medical procedure is a sin. So, the legality of abortion may be rendered pointless by physicians who may be making decisions based on religious doctrine? Access to abortion remains limited by the willingness of physicians to provide abortion services, particularly in rural communities and in the South and Midwest.” Does a woman’s geographic location doom her to restrictions on her ability to obtain a medical procedure that is protected by law?

During my study of women and men living with genital herpes and HPV/genital warts infections, I coined the term moral surveillance practitioner to describe the doctor-patient interaction style of health care providers who conveyed a sense of disapproval, judgment, condemnation, and even disgust to their patients who had sought their sexual health services.  In the case of STDs, these practitioners tended to blame their patients for having contracted a medically incurable infection because of their own “bad” and sinful sexual behaviors.

It would be interesting to see if a companion study to the newly published one, perhaps a qualitative interview study, would reveal a more nuanced understanding of the attitudes and values that ob-gyns hold about their female patients who seek abortion services.  With women’s physical and/or mental health often hanging in the balance of the ability to receive a legal abortion, we deserve to know more about the large number of ob-gyns whose moral opinion may be taking precedence over their ethical obligation to, in the words of the Hippocratic Oath, “First, do no harm”…in this case, to do no harm to their female patients who may be harmed by not having a medically safe, legal abortion.

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Note: If you’re curious about physicians’ insights and experiences in providing (or not providing) abortion care, then check out two recent books: Carole Joffe’s Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us and Lori Freedman’s Willing and Unable: Doctors Constraints in Abortion Care. And, for more of the latest research on reproductive health care and policy, explore the work of UC San Francisco’s reproductive health think tank ANSIRH.