Michelle Obama Visits DC’s Upper Cardozo Health Center- Learns About the “We Can” Program

Michelle Obama addressing Unity staff and clients. In the lower left is Jessica Wallace- program coordinator for We Can. Top left- a photo I took during one of our classes. Photo by Unity.

Michelle Obama- the first place you visited in DC was a health center, then you planted an organic garden on the White House lawn, to top things off you appeared on my favorite childhood show, Sesame Street, to deliver a public health message.

I wondered how you could make me happier.

Well- now you’ve done it. On June 29 Mrs. Obama came to Upper Cardozo Health Center, a FQHC (Federally Qualified Health Center) filled with dedicated professionals devoted to serving DC residents, especially the Latino population.

Here she announced FQHCs like Upper Cardozo would receive $851 million to “address immediate and pressing health center facility and equipment needs and increase access to health care for millions of Americans.”

Upper Cardozo alone will receive $2.5 million to build 20 (much needed) exam rooms to reach %24 more patients. Currently Upper Cardozo’s staff provide a phenomenal level of care in a very cramped space in Columbia Heights.

Michelle also learned about Upper Cardozo’s “We Can” program, the intervention I’ve been assisting with under the direction of project coordinator and physician assistant Jessica Wallace.

“We Can” is a public health program developed by the National Heart, Lung, and Blood Institute that incorporates the entire family in reducing childhood obesity. Two of the women in the photo are program participants.

At Upper Cardozo’s “We Can” program we provide weekly classes where families learn to change to healthier habits, such as:

• Restricting soda intake
• Switching from whole milk to skim
• Enjoying a minimum of one hour of physical activity a day
• Portion control
• Limiting “screen time” to one hour a day

At class families enjoy healthy snacks, take part in fun activities like Capoeira, and learn about healthy living. Nurses help participants track their blood pressure, BMI, and weight through the sessions.

Thanks to the enthusiasm of Ms Wallace and the other Upper Cardozo staff, the program has continued to increase in participation and popularity.

Childhood obesity is one of Michelle’s issues has been taking on while in the White House.  Although I wasn’t there for her visit, those in attendance at the meeting enjoyed her warm presence. One of the programs youth participants, Christian, even received a hug from Mrs. Obama for his 15th birthday.

In the field of public health we are often fighting an uphill battle.  The “We Can” program provides a positive atmosphere for addressing and combating the childhood obseity epidemic. The stimulus bill includes one billion for programs addressing prevention and wellness. Mrs. Obama’s visit further energized the dedicated participants and staff who support “We Can.”

Thank you Mrs. Obama for thinking locally and taking the time to see the great work going on at DC’s Upper Cardozo Health Center!  Hope to see you at the ribbon cutting ceremony for the new exam rooms!

For More Information:

Learn how the stimulus will be used for health centers here

Fun and interesting blog on the “Obama Foodscape” here

Read the White House press release here

Read the First Lady’s remarks here

See more photos from the special day here

Public Health Interventions Giving Up on Dad?

Should public health interventions tailor interventions to mothers to the point of excluding fathers? Photo by Ctd 2005 on Flickr.

One of the requirements to graduate from an MPH program is the completion of 120 hours working with an agency on a project.  The staff at Upper Cardozo have been kind enough to let me complete my required practicum hours at their wonderful clinic.

For the past month or so I’ve been working on a literature review on childhood obesity interventions for the health center.  I love going through research, learning what works, and what doesn’t.

However, with Father’s Day approaching, I couldn’t help but notice the absence of fathers.  Instead- many public health  programs focus only on mothers, as if the inclusion of fathers is hopeless.  Sadly even those programs labeled “family intervention” often just means mom plus the kids.

For example:

• Families on the Move- an adaptation of the SHAPEDOWN program for Latino families.  In both feasibility study focus groups only mothers were interviewed.(1) 
• Parents as Teachers High 5 Low Fat Program- dietary intervention for African American families.  Over 98% of parent participants were female.
• Move America- Family pedometer step counting program combined with calorie reduction.  Among those that completed the post-intervention assessment only 32% were fathers.(2)

It’s not that public health practitioners have something against dad. 

Instead- many studies have shown a strong link between the knowledge/health of mothers and the health of their children.  When money is tight, it often seems best to focus funding on where it will have the greatest impact.

Unfortunately designing programs for mothers isn’t a holistic solution to public health problems.  For example, in a cross sectional obesity study among New York Latino women and their children, dads still influenced the eating habits of their children, even if they didn’t live at home.(3)  

In an effort to maintain a connection with their children, many brought unhealthy “treat” foods to share with their kids.  Even if an intervention was successful in changing the mother’s behavior in feeding her children- half of the problem would still persist.

After searching ERIC, MEDLINE, and Scoupus I was only able to locate one intervention that focused on fathers- the REAL Men HIV prevention program.  Sons of fathers who participated in the program were more likely to remain abstinent, and those who were sexually active were significantly more likely to use protection.  The program was found to be more effective than similar family based programs, including those that were just for mother/daughter pairs.(4)

However, with the emphasis on targeting mothers, the opportunity to include dads and multiply program benefits is missed.  

Participants in the BOUNCE program- an exercise intervention for Latino mothers and daughters- reported an increase in engaging in physical activity together, such as playing basketball.(5)  I thought back to the fathers in the NYC study- why not encourage them to play with their children instead of bonding through excess calories? 

As public health professionals we need to reconsider the value we place on fathers.  If program attendance was low among mothers the program would be appropriately adapted.  The same would be true if moms found the program uninteresting or useless.  The input of fathers must be sought out and paid attention.  Men must be included from the initial program planning to final implementation in order to develop programs that are truly for the entire family.  

Do you know of a family based intervention where fathers had a significant presence?  Are you aware of another intervention focusing on dads?  Email me at elpisandjustice@gmail.com and I’ll gladly update the post!

(1)  James. K.S et al. Family Based Weight Management with Latino Mothers and Children.  Journal for Specialists in Pediatric Nursing. 2008: 249-262

(2) Rodermel, S.J.  Small Changes in Dietary Sugar and Physical Activity as an Approach to Preventing Excessive Weight Gain: The America on the Move Study.  Pediatrics.  2007; 120; e869-879

(3) Kaufman, L. and Karpati, A.  Understanding the sociocultural roots of childhood obesity: Food practices among Latino families of Bushwick, Brooklyn.  Social Science and Medicine. 2007; 64; 2177-2188

(4) Dilorio, C. et al.  REAL Men: A Group-Randomized Trial of an HIV Prevention Intervention for Adolescent Boys.  American Journal of Public Health.  2007; 97; 1084-1089

(5)  Olvera, N.N. et al.  A Healthy Lifestyle Program for Latino Daughters and Mothers: the BOUNCE Overview and Process Evaluation.  Ameican Journal of Health Education. 2008; 39; 283-295.

Sonia Sotomayor- Bringing Diabetes to the Bench

Latinos are 1.5 times more likely than non-Hispanic whites to develop diabetes. Her disease may likely come up in Ms Sotomayor's confirmation hearing. Photo by upsidedownsphere on Flickr.

President Obama’s speech announcing Sonia Sotomayor celebrated her life’s many challenges and successes.

Obama’s nomination may bring the first Latino to the bench of the Supreme Court.  If she is confirmed, I’m glad the newst portrait of the justices will better reflect the multi-ethnic face of America.

From living in a South Bronx housing project to becoming a judge on Court of Appeals for the Second Circuit of New York, Ms Sotomayor’s has come from little and achieved much.

One of Sonia’s long term challenges has been dealing with diabetes.  At the age of 8 she was diagnosed with the disease. Unfortunately, unlike Lady Justice, diabetes is not one for blind impartiality.  Some communities are more greatly affected than others.

The Latino community bears a disproportionate burden. The problem is exacerbated by Latinos having the lowest rates of health insurance coverage in the country.

Compared to non-Hispanic whites:

• Hispanics are 1.5 times more likely to have Type 2 Diabetes
• Mexican Americans are 1.7 more likely to have Type 2 Diabetes
• Residents of Puerto Rico are 1.8 times more likely to have Type 2 Diabetes

National data specific to this community is limited.  It wasn’t until 1997 the CDC started collecting data on Hispanics.

In addition to the risk data we also know:

• Compared to non-Hispanic whites, Latinos are 4 times more likely to hospitalized for uncontrolled diabetes
• When adjusted for age, the death rate for Latinos due to diabetes is 50% greater than that of non-Hispanic whites

This disparity is due to a combination of  factors including environmental, social, and financial.  A report by the Robert Wood Johnson Foundation found that Latinos who were more acculturated to the US lifestyle were more likely to adopt “less desirable dietary habits.” Many Latinos face language barriers when seeking medical care.  Also, Latinos are more likely to forgo medical care due to financial constraints.

In light of such statistics, it is a triumph Ms Sotomayor has control over her diabetes. The complications of diabetes can be devastating, including nerve damage, loss of eyesight, increased risk of heart disease, and kidney disease.

However, the risks associated with diabetes are no grounds to deny confirmation to Ms Sotomayor.  Some are hoping she will break the “diabetes glass ceiling” by being confirmed as a Supreme Court justice.  My hope is those who conduct her hearing see her as more than a disease or a label- but as an extremely competent and experienced woman our highest court so desperately needs!

For More Information:

Publications on diabetes prevention, treatment, and management through the National Diabetes Education Program

Are you at risk for diabetes?  Information in English and Spanish

Become active in advocating for Latino civil rights with the National Council of La Raza

The Más que comida, es vida. (It’s more than food. It’s Life.) campaign offers healthy modifications of traditional foods

A Test For Your Unconscious- How Do You See Black and White?

Does your unconscious mind see everyone equally? Take the Implicit Association Test and see what your mind is up to. Photo on Flickr by blmurch.

I love to travel. Fortunately I have the resources to travel. I love to travel, I love to learn about other cultures, and learning Mandarin was one of the best things I did in college.

I love these things because I love being taken out of my comfort zone. Being immersed with others can change your perceptions for the better and help eliminate personal prejudices/stereotypes. I consider myself to be relatively unbiased, or at least I strive to be… but am I?

Today I took the Implicit Association Test, part of Project Implicit maintained by Harvard, University of Washington, and University of Virginia. According to the website “the IAT was originally developed as a device for exploring the unconscious roots of thinking and feeling.” Many of the quizzes are devoted to uncovering racial biases.

You can take the “Race IAT” quiz here.

What does this have to do with public health?

A developing field in public health is how racism and perceptions of discrimination can affect health. The hypothesis is those who perceive they are being discriminated against will be more likely to have negative health outcomes, such as increased incidence of heart attack, diabetes, and hypertension. Increased stress levels may be to blame.

The literature is scattered. Some show an association, some do not. Research is further complicated by the difficulty of measuring both levels of discrimination and specific health outcomes. Of course people in the US are not just black/white, but many shades in between. Unfortunately our culture still puts people in one box or the other.

I’ve had people tell me racism and discrimination are no longer a part of US culture. I won’t go into that here. Recent polls show the imbalance of how discrimination is perceived between groups.

“According to a 2003 Gallup poll, two in five of blacks said that they felt discriminated against at least once a month, and one in five felt discriminated against every day. But, a CNN poll from last January found that 72 percent of whites thought that blacks overestimated the amount of discrimination against them, while 82 percent of blacks thought that whites underestimated the amount of discrimination against blacks.”

~excerpt from Charle’s Blow’s Op-Ed in the New York Times

I took the quiz. It took about 10 minutes. Can’t say I was pleased with the results. However, it was eye opening, interesting, and I realize I have more work to do. While taking the quiz I constantly felt the tug of bias drilled into me by the media.

I also thought about how Obama has helped slightly turn the tide. Instead of African American faces being tied to negativity, Obama provided a fresh breath of air by associating color with words such as: hope, inspiration, entrepreneurial, motivated, and successful.

For More Information:

Want another source for quizzes? Go here.

Understanding Prejudice, funded by the National Science Foundation

Charles Blow’s blog, By the Numbers is posted here.