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.

__________

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.

Okay, I’ll admit it – ever the STD researcher, I was tempted to focus on the recent NYT article, “A Vaccine May Shield Boys Too.”* Instead, I dedicate this month’s column to a recent news item that has not attracted a lot of attention: the FDA issued an advisory warning against the use of mesh implants that are routinely used for surgical repairs of pelvic floor damage.  Warning: This post contains medically accurate language which some readers might find disturbing. (It also contains new medical findings that all readers should find disturbing!)

First, it’s important to know what the pelvic floor is and what functions it serves: in addition to this image from 1918’s Gray’s Anatomy, check out a newer medical illustration included in a recent LA Times article.  This muscular structure has the demanding job of supporting the uterus, bladder, urethra, the walls of the vaginal canal and rectum. In other words, it’s pretty darn important.  Without functional pelvic floor muscles, women can experience urinary incontinence, fecal incontinence, and uncomfortable/painful sexual intercourse.  (Not to mention, it’s more than a little disconcerting to have to manually push your prolapsed organs back into place.)

Surgical repairs of this type of damage are often done to correct prolapses of the uterus and surrounding organs which, to put it bluntly, can feel “as if something is falling out of your vagina.”  The problem is that the mesh devices used in many of these surgeries may be harming the sexual and reproductive health of many of the tens of thousands of women who have surgery each year for prolapse.

You might be wondering, how many women are at risk for pelvic organ prolapse?  Cigna say the top risk factors are full-term pregnancies (which stretch the pelvic floor), the strain of childbirth, and having a hysterectomy (surgical removal of the uterus).  On a recent episode of his TV show, Dr. Oz shared the estimate “almost 50% of women will experience some form or prolapse in their lifetime.”

Thousands of women opt for prolapse surgery every year, and many of these surgeries have involved the use of mesh implant devices to support torn/damaged pelvic floor tissue.  As noted in a July 14^th LA Times article, “The advisory was issued after an increase in reported complications involving the device.”  This article also describes complications as including “pain and urinary problems,” as well as, “erosion, when the skin breaks and the device protrudes, and contraction of the mesh that leads to vaginal shrinkage.”  Back in 2008, the FDA’s Public Health Notification and Additional Patient Information documents cited 1,000+ reports of these kinds of serious complications but considered them to be rare.  Fast forward to 2011 when these serious complications “have jumped fivefold,” no longer rare.

So, how does this impact a woman’s sex life?  The FDA notes, “Both mesh erosion and mesh contraction may lead to severe pelvic pain, painful sexual intercourse or an inability to engage in sexual intercourse.”  And, male partners of these women are also at risk: “men may experience irritation and pain to the penis during sexual intercourse when the mesh is exposed in mesh erosion.” 

With the FDA deciding to not remove the mesh implants from the market, did they do enough to protect patients?  Some experts say, “No.”  Dr. Diana Zuckerman of the National Research Center for Women & Families points out that these mesh implants have been used, “despite no clinical trials, no testing on humans to see if they’re actually safe and effective.”  It is time to advocate strongly for research and development of pelvic floor surgical repair techniques which do not involve the use of synthetic mesh implants.

__________

*This article sheds very little new light on a topic I wrote about over a year ago forMs. Magazine and blogged about back in 2009 – Gardasil is not simply the ‘cervical cancer’ vaccine its initial branding advertised; it also offers several potential health benefits for boys and men. 

With the buzz about Michele Bachmann running for the 2012 Republican presidential nomination, many journalists are wondering about the Tea Party’s power.  So, I’m taking a break from blogging about healthy bodies to focus on healthy politics and share a recent email exchange with Tufts sociologist Sarah Sobieraj, Ph.D. whose new book Soundbitten: The Perils of Media-Centered Political Activism (NYU Press) takes readers inside activist groups’ struggles to get their issues and perspectives covered in the news.

 Adina Nack: What is media-centered political activism, and how perilous is it?

Sarah Sobieraj: I studied 50 U.S. activist groups from across the political spectrum, expecting to find engagement in a range of political strategies, but nearly every organization had the same strategy – attracting attention from the mainstream news media. They invested astounding amounts of time, money, and energy into media preparation and training, but were largely unsuccessful. This exclusion from mainstream news diminishes the richness of our political discourse, and consequently weakens democratic processes, but I found that the activists’ relentless pursuit of media inclusion also threatens activism.

With news coverage as the raison d’etre, organizers often approached their own members as potential liabilities in need of discipline.  As a result, open communication among fellow activists was often replaced by rigorous attempts to control their speech and behavior. Activists were meticulously schooled on talking points, warned about “entrapment,” and reminded repeatedly to “stay on message” at all costs. In some cases, members were given practice interviews, recorded, and critiqued by their group. This happened in the organizations that allowed participants to speak to reporters; many groups had designated spokespeople and prohibited other members from answering journalists’ questions altogether.  This member management stemmed from desires to control whatever fleeting coverage the group might attract.  This approach was practical but could also be toxic. One activist described feeling like a prop, invited only to show journalists that their group had numbers, but told to keep quiet and stay out of the way.

In addition to creating internal problems, media-centrism also interferes with external communication. Most groups were determined to reach the “general public” and assumed that the news would serve as intermediary, instead of working to reach those in the vicinity of their protests, rallies, and other public events directly. As a result, the organizations perseverated on media strategy – creating photo ops and sound bites, writing press releases and designating spokespeople – but these extensive media trainings inadvertently undermined their abilities to communicate with bystanders. On several occasions, I watched pedestrians approach activists to ask questions only to have an activist respond with a rehearsed one-liner.  Activists were ready with talking points but unable to actually talk. Sometimes media trainings left activists so anxious that they directed bystanders to their website to avoid answering questions.  

AN: Given the slim chances for media attention — why has the Tea Party fared so well?

SS: The Tea Party is not among the groups I studied, but my research offers some clues to their success. Soundbitten shows that journalists have an appetite for activism and a clear idea about what makes activism newsworthy: authenticity.  Authenticity can be communicated to news workers in a variety of ways: including emotionality, spontaneity, and originality – all of which the Tea Party had in excess in their early months. For example, during the Town Hall meetings on health care, their disruptions violated social norms and created tense standoffs between elected leaders and emotion-fueled audience members that didn’t feel staged.  Plus, the activists themselves were unexpected: flag-waving, silver-haired conservatives in orthopedic shoes and athletic socks are not what come to mind when most people think “protester.” The events were perfect fodder for the 24-hour news cycle.  

In contrast, the groups I worked with were passionate about their issues, but many of their events felt formulaic and professionalized – hyper-managed by rational-tongued spokespeople wielding talking points (designed to get journalists to focus on the issues) – or playful and cartoonish, which sometimes captured reporters’ interest but rarely resulted in a serious examination of key issues.

AN: So, did the activists you studied just take the wrong approach to mainstream news media?

SS: Yes and no. In terms of capturing media attention, activists face a daunting catch-22 because of the professional routines and standards of reporting that have emerged in mainstream news organizations. The odds are stacked against them.  Most of the groups I studied failed to see that showcasing their professionalism – striving to appear legitimate by creating press releases on letterhead and answering journalists’ questions with the latest data – was not an effective tactic. Yet, if they cater to journalists’ appetites – for raw emotion rather than research, personal stories rather than publicly minded-speech, etc. – the coverage they receive tends to depoliticize public issues by portraying them as personal troubles.  

So, the activists didn’t approach reporters in the “wrong” way, but there may not be a reliable way to do it “right” in the current journalistic climate. This is a problem, and media reform is critical, but until those reforms take hold, activist groups might consider realigning their strategic emphases.  It might make sense to stop investing the lion’s share of their organizational resources in trying to win this battle. It is easy to forget that the quest for media coverage is a tactic for political change, not simply an end in itself.

In honor of April being STD Awareness Month, I devote this month’s column to a topic that remains near and dear to my heart (and my cervix): HPV, human papillomavirus.  So, it’s a great time to get yourself tested at your local STD testing location, or send an e-card to a loved one who could use a friendly reminder:

This month might have inspired some of you to consider vaccines that offer some protection against HPV: like Gardasil or Cervarix.*  However, don’t get too excited about Gardasil if you happen to be 27 years old (or older) and live in the U.S.  Earlier this month, the FDA decided against expanded the vaccine’s label use for ‘older’ women:

…the Limitations of Use and Effectiveness for GARDASIL was updated to state that GARDASIL has not been demonstrated to prevent HPV-related CIN 2/3 or worse in women older than 26 years of age.

However, as of Tuesday, ‘older’ Canadian women now have more options than their U.S. counterparts:

Merck announced that Health Canada has extended the indication of GARDASIL^® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Recombinant Vaccine] in women up to the age of 45. Merck’s HPV vaccine is now approved for girls and women nine through 45 years of age for the prevention of cervical cancer, vulvar and vaginal cancers, precancerous lesions and genital warts caused by the Human Papillomavirus (HPV) types 6, 11, 16, 18.

So, what’s the deal?  According to a Canadian women’s health expert, this is a good decision:

Whatever the reason, there’s a tendency for women to remain at risk of acquiring new HPV infections as they get older. Whether they are changing their social status or not, women should talk to their doctors about the HPV protection provided by the quadrivalent vaccine,” said Dr. Alex Ferenczy, Professor of Pathology and Obstetrics & Gynecology at McGill University.

If I’m correct in inferring that Dr. Ferenczy’s use of the phrase “social status” refers to a woman’s sexual partner/sexual relationship status, then are we to assume that U.S. women between the ages of 27 and 45 are in more stable sexual relationships than their Canadian counterparts?  I’ve yet to read a study that would support this conclusion.

So, as a U.S. woman who happens to be in this age group, I feel it only right to encourage my peers to ask their doctor about Gardasil, especially if they’re “changing their social status.”

For the boys and men out there, remember that the FDA approved Gardasil in October 2009 for protection against two types of HPV which cause genital warts in males ages 9-26.  Then, last December, the FDA approved of GARDASIL for the prevention of anal cancers caused by two different types of HPV in females and males 9-26 years old. 

However, once again, there appears to be possible age-discrimination: men over 26 years old, consider whether Gardasil might offer health benefits for you.

*Note to readers: I respect that many will decide that a vaccine is not right/healthy/safe for themselves or for their family members.  I highlighted the recent news about Gardasil because I believe that everyone deserves access to vaccine updates.  I’ll conclude by quoting myself:

I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.

Yesterday marked the one-year anniversary of President Obama signing the Affordable Care Act.  I encourage everyone to become familiar with what the Act has already accomplished, as well as the plans through 2015 (see an interactive timeline online).

Today, I dedicate this month’s column to reflecting on one of the new consumer protections that is scheduled to become effective January 1, 2014, No Discrimination Due to Pre-Existing Conditions or Gender:

Before the Affordable Care Act became law, insurance companies selling individual policies could deny coverage to women due to pre-existing conditions, such as cancer and having been pregnant. 

A WhiteHouse.Gov fact-sheet describes the ways in which, “The Affordable Care Act Gives Womem Greater Control Over Their Own Health Care.”  When I first read it, even as a feminist medical sociologist familiar with health care inequities, a few lines jumped out at me:

Right now, a healthy 22-year-old woman can be charged premiums 150 percent higher than a 22-year-old man.

Less than half of women have the option of obtaining health insurance through a job.

Today, maternity benefits are often not provided in health plans in the individual insurance market.

I appreciate the many positive effects this law has on women, men and children, but I find myself asking: why did the Affordable Care Act not include this provision — to eliminate discrimination to due to gender — among its original 2010 provisions?  A comparable provision was effective as of September 23, 2010 for children:

…health plans that cover children can no longer exclude, limit or deny coverage to your child under age 19 solely based on a health problem or disability that your child developed before you applied for coverage.

Now, don’t get me wrong, I’m all for protecting children’s rights to receiving coverage.  As a mom, I understand the instinct to want to protect one’s child before one’s self.  However, it feels like the policy-makers did not take into account the body of research on the direct correlations between maternal health and child health.  To put it simply, an unhealthy mom is not good for the health of her child — whether or not her child has excellent or poor health care coverage.

For example, a 2005 article in the journal PEDIATRICS documents research findings that,

“Maternal depressive symptoms in early infancy contribute to unfavorable patterns of health care seeking for children.” 

Another 2005 article examined the psychological and physical health of adult caregives of children with cerebral palsy and found that:

The psychological and physical health of caregivers, who in this study were primarily mothers, was strongly influenced by child behavior and caregiving demands…These data support clinical pathways that require biopsychosocial frameworks that are family centered, not simply technical and short-term rehabilitation interventions that are focused primarily on the child.

It’s easy to imagine the ways in which a child’s health might suffer if her/his primary caretaker has poor mental and physical health.  And, solely providing health care to the child did not necessarily improve the health outcomes of the caregiving moms.

One more example along the lines of the effects of maternal depression is the case of pediatric asthma.  A 2007 article in the Journal of Health Economics reports a study which shows:

…treatment of mother’s depression improves management of child’s asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.

Our health care system will likely save more money once we end insurance company discrimination on the basis of sex/gender.  Now, I recognize that not all women are mothers, but the overwhelming majority of mothers are women.  So, if the gendered division of labors in most families remains such that moms are primarily in charge of maintaing and protecting the health of their children, then wouldn’t we want these caregivers to have access to affordable, quality health care before 2014? 

That said, I am grateful that this law passed and hope that we will continue to work on ways to strengthen coverage for all Americans.

I have said it before about sexually transmitted diseases and HPV vaccines, and now I will say it again about brain trauma and football — men’s health is a feminist issue. 

Back in 2007, a NYT article covered “Wives United by Husbands’ Post-N.F.L. Trauma” whose activism motivated the NFL creating the “88 Plan” to provide dementia benefits.  Then, in 2008, a LA Times op-ed proclaimed, “The NFL’s in denial about depression.”  This week, the NYT article “A Suicide, a Last Request, a Family’s Questions” added yet another tragedy to the growing number of media stories about the physically and psychologically devastating consequences for NFL players. 

As I read it, I found myself flashing back to when I was an undergrad and first read sociologist Michael Messner‘s academic article, “When bodies are weapons: Masculinity and violence in Sport.” What does it mean for boys and men — and for all of us — when   not only normalize but also reward boys and men for using their bodies as weapons?

Check out the abstract (bold font added for emphasis):

This paper utilizes a feminist theoretical framework to explore the contemporary social meanings of sports violence. Two levels of meaning are explored: first, the broad, socio-cultural and ideological meanings of sports violence as mediated spectacle; second, the meanings which male athletes themselves construct. On the social/ideological level, the analysis draws on an emergent critical/feminist literature which theoretically and historically situates sports violence as a practice which helps to construct hegemonic masculinity. And drawing on my own in-depth interviews with male former athletes, a feminist theory of gender identity is utilized to examine the meanings which athletes themselves construct around their own participation in violent sports. Finally, the links between these two levels of analysis are tentatively explored: how does the athlete’s construction of meaning surrounding his participation in violent sports connect with the larger social construction of masculinities and men’s power relations with women?

Mainstream U.S. society continues to validate a very narrow construction of socially acceptable masculinity.  When I teach the Sexuality and Society course at CLU, I ask my undergrad students to tell me the traits of an “ideal” man.  Each time, a new group of students generate basically the same list which includes being heterosexual, tall, muscular/physically strong, and a “protector.”  With this clear and consistent construction of masculine bodies, it’s not a surprise that the NFL continues to attract players who are willing to sacrifice their health and fans who enjoy the spectacle. 

The lure of the N.F.L. — the glory of hyper-masculinity — masks the still unmeasurable damage that these players (and their families) endure.  Their sacrifices allow ‘armchair athletes’ to vicariously revel in battles on the gridiron.  These warriors, ill-protected by sports gear masquerading as armor, are paying steep prices for embodying unrealistic and unhealthy ideals of what it means to be a man in the U.S.  

As research studies work to document the ways in which this sport consistently results in life-changing injuries (and sometimes life-ending conditions), we owe it to boys and men to challenge the status quo.  But, how can we hope to do this if, as one political science blogger suggested, “Americans have begun to construe access to football spectating as a social right“?

I’m collaborating on a study of traumatic childbearing experiences, so I’ve been thinking a lot about the types of injuries that can occur as a result of pregnancies, labors, and different types of deliveries.  My research partner forwarded me a recent blog post on a board-certified urogynecologist’s website titled “Cesarean on Demand Does Not Eliminate Risk of Prolapse.”  This post highlights the findings of a 2009 research article published in the International Urogynecology Journal. In this research, three groups of women were studied: “vaginal delivery with sphincter tear (n = 106), vaginal delivery without sphincter tear (n = 108), and cesarean without labor (n = 39).” [The numbers reflect how many women were in each of the three groups.]

Now, I’m no urogynecologist, but I found it hard to believe that c-sections “on demand” (a.k.a. without labor) would not at least reduce the risk of pelvic floor damage, including pelvic organ prolapse (pelvic organs “slipping out of place” when the supportive muscles and ligaments are weakened or torn).  Prolapse can greatly impact the health and quality of life: for example, women with prolapse may suffer one or both types of incontinence and/or painful sexual intercourse.

I recognize that many medical practitioners, authors and laypeople have come to believe we have too high a rate of c-sections here in the U.S.  Research studies, such as the one celebrated in the recent blog post, call into question whether there are any health benefits of c-sections without labor.  As a medical sociologist who teaches research methods, I consider it to be of utmost importance to discuss research findings with the highest degree of accuracy.  No study is perfect: no study is without bias and no study is without limitations.  So, I read the complete research article to find out if it truly supported the blog author’s contention that these researchers “found NO DIFFERENCE in moderate prolapse between the three groups.” 

I was struck by significant methodological flaws and limitations which, while acknowledged by the authors of the original article, were glossed over or flat out ignored by the author of the blog post.  I found myself asking several questions:

Question #1: how healthy were the women before this childbearing experience?  No one knows: the researchers admit, “our findings cannot be attributed with certainty to delivery method, since some women may have developed prolapse before delivery or pregnancy and prolapse was not assessed prior to delivery in this population.” 

Question #2: who were the women who participated in this study?  The women for this study were recruited from prior studies performed through the Pelvic Floor Disorders Network, specifically from the follow-up study to their CAPS Study (which focused on “fecal and urinary incontinence after childbirth”).  How can we rule out a self-selection bias of those women who said “yes” when they were recruited to this initial study?  Could it be certain women who had C-sections, perhaps those feeling some pelvic/vaginal discomfort immediately following delivery were more likely to say “yes” because they saw value in being interviewed about incontinence?

Question #3: did the researchers recruit enough women for each of the three groups to be able to answer their main question?  No.  The authors wrap up their article by noting that “further research would be required to determine whether cesarean delivery before labor reduces the incidence of pelvic organ prolapse.”  So, this research doesn’t actually determine anything about what they claim as their primary research question.  Why not?  The short answer is that they never got enough women to participate.  The authors claim that they would have needed 132 women per group in order to test the statistical significance of the difference in rates of stage II prolapse between those women who had C-sections without labor and those women who had vaginal deliveries.  While they got reasonably close to their sample size goal of 132 for the two vaginal delivery groups (106 and 108), they only got 39 women to participate in the C-section group.  Is this acceptable?  Statistical significance is key to evaluating any study because it means that the results are “probably true (not due to chance).”  The researchers finally own up to the likely irrelevance of their study towards the end of the published journal article: “Furthermore, our sample size was not sufficiently large to exclude a significant difference between groups.”  In plain language: they didn’t study enough women to know whether or not there are not real differences between the health outcomes for women who have c-sections without labor and those experience other types of labor and delivery.

Question #4: can the researchers say anything definitive that might help improve women’s health?  Hmmm.  The only factor they definitively connect with less pelvic floor damage is lower birth weight: I’m betting that it won’t surprise many to find out that smaller babies causes less damage.  But, what are we supposed to do with this finding? 

The author of that recent blog post dares to call it a “beautifully executed study,” and that’s why I had to wrote this post: to help those of us who are not medical researchers better understand what we should value and what we should question when it comes to research studies that can impact women’s health.