John Schrom

Epidemiologist and political junkie

HIV Prevention 2.0

There’s a definite and urgent need to adapt our HIV prevention strategy to reflect the needs and styles of adolescents and young adults. This is clear from the 9 year history of increasing newly diagnosed HIV cases among young men who have sex with men (YMSM), including the 83% increase in the last year.

I think one of the major adaptations is going to be moving towards user generated prevention. This is beneficial for three reasons: the population is most adept at communicating with each other (i.e., 16 year olds speak “teenager” better than most 40 year olds), there’s an innate prevention activity in developing the message, and these types of media campaigns can be dirt cheap.

There are a couple of agencies that are already doing this. The Minnesota Organization on Adolescent Pregnancy, Prevention & Parenting is having a video contest (PDF) regarding general adolescent health. MTV and funny or die recently had a crazy sex advice contest called Say What. The Minnesota AIDS Project/Pride Alive is collecting 10,000 messages, and trying to distribute them to 1,000,000 people. And, of course, Hennepin County and MDH are moving forward on a video contest (it technically ended, but stay tuned for a few announcements).

I think this is the right way to move. We’ve been living in a Web 2.0 world for half a decade, and we’re all getting used to sharing everything we’re thinking and telling other people what we think about what they’re thinking (this would be a good time to encourage you to follow me on twitter…). So, it seems logical that young adults should want to have input into what messages they think are appropriate, and what HIV prevention strategies they think are reasonable.

So, since these contests seem to be a good idea, I want to ensure we’re doing this appropriately… it sometimes feels like these contests are being run by people that aren’t familiar with technology or social media. Submissions should be made online — having to email someone is just annoying. Ideally, a website should post submissions for ranking and comments by other users, as this would fully capitalize on the potential of internet technologies. Campaigns need to be appropriately incentivized; just because YouTube is free, doesn’t mean a $20 gift card is sufficient. Don’t be too restrictive or too quick to censor. The most effective messages may make you squirm:

So despite my few critiques, I’m hopeful this style of health promotion is effective and am excited about what kinds of messages will be generated!

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by on March 10, 2010No Comments
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A Case for Monogamy?

A new study, set to be released in the March issue of Social Psychology Quarterly, suggests that people with higher IQs are more likely to favor atheism, liberalism, and monogamy (at least among males). “Smart” people are also more likely to align with unconventional philosophies, and demonstrate elitism. Go figure.

These beliefs don’t have a traditional evolutionary advantage, but as we progress there’s less evolutionary pressure to support the status quo. George Washington professor James Bailey says:

“The adoption of some evolutionarily novel ideas makes some sense in terms of moving the species forward [...] It also makes perfect sense that more intelligent people — people with, sort of, more intellectual firepower — are likely to be the ones to do that.”

The difference in IQs wasn’t great — ranging from 6 to 11 points (standard deviations is typically 15). Participants who identified themselves as “very conservative” had an average IQ of 95, compared with 106 among the “very liberal.”

I’m patiently awaiting the release of the full article, to gain a better grasp of their methods and results. Until then, I can make myself seem smarter (and more elitist) by affirming my belief of liberalism and sexual exclusivity.

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by on March 1, 2010No Comments
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Drunk and Horny

I attended the Minnesota YMSM Provider Summit yesterday, and that (alcohol, hormones) emerged as one theme partially attributable to the increase in HIV infections in men under 24. Honestly, I’m just trying hard to find a legitimate and professional excuse to say “horny” in a blog title…

We received an epidemiology update, with additional information from the disease investigator (DI) interviews. The DIs managed to interview about 50% of newly diagnosed cases to obtain additional information about risk factors relating to their infection and recent partners. I’m not sure if that’s a high/low/average rate, and we certainly don’t know if the responding population was different than the non-responders (e.g., were non-responders at higher risk than the responders?).

Minnesota saw 35 more cases of newly diagnosed YMSM in 2009 compared to 2008. That increase was driven largely by African American and white youth. About 20% report only having sex with one person in the last year or since their last negative (whichever is shorter?), and about 50% report having sex with 3-4 in that time period. Approximately 20% of young men had sex with BOTH men and women during that time period. 64% reported anonymous sex, 30% reported meeting partners online, ~60% report infrequent condom use, 13% report non-injection drug use (mostly marijuana, some meth), and 25% report alcohol use.

Additionally, MDH and Hennepin County put together a couple of small focus groups for HIV+ and college-aged guys. I’ll eventually post the results of the focus groups, but there were a couple of comments that stuck out to me:
“People are dying with HIV, not from it. Honestly I couldn’t care less if I keeled over and died tomorrow, I’ve had a fun run, people have nine lives… and I’m running out.”
“HIV meds or car payment — good campaign message.”
“When you’re 5 years old you start to experiment too, it’s just human sexuality. We’re here to procreate or to get off basically.”
“A lot of people don’t want to hear about [HIV] and right now a big trend is barebacking.”
“A lot of younger people are sluts.”
“I never had unprotected sex and just recently got really drunk and got date raped and am now poz.”

I don’t think any of this information is earth-shattering. However, it does provide a little data around the situation we’re in. We spent the remainder of the day listening to speeches and breakout panels. Ultimately, it was a good day for networking, but there weren’t many (any?) concrete next steps. Personally, I’m still trying to process the conversations that I had yesterday, and am waiting for clear direction and need to emerge. Any guidance or thoughts would be greatly appreciated…

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by on February 27, 2010No Comments
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Minnesota HIV Rates

The Minnesota Department of Health released initial 2009 HIV epidemiology data last week — something that they normally wait until April to do. MDH saw an urgent need to release the information due to the dramatic rise in incidence over the past year, particularly the 83% increase in young men who have sex with men (YMSM).

In response to this spike in incidence, the Department of Health, Department of Human Services (Ryan White Part B Grantee), and Hennepin County (Ryan White Part A Grantee) brought together a group to start raising awareness around this issue and start thinking about new solutions. This group, which I am a part of, has been meeting since November in preparation for a series of events happening at the end of February (not coincidentally the end of Part A’s fiscal year). This includes YMSM focus groups, a provider summit (open to all youth workers), and a youth PSA contest.

Obviously, this increase has been all over the blogs and newspapers in the past weeks. The response from many providers has been: youth like risky behavior, the interwebs gives you AIDS, and USE CONDOMS DAMMIT. Maybe I’m being a little overdramatic.

My point is that I don’t think this is a productive conversation. Adolescents are risky, but not necessarily intentionally so. I doubt any 17 year old is thinking, “if I have sex tonight, I might get HIV … that’s so risky.” No, they’re thinking, “Gee golly, that’s a really hot person that I’d like to touch inappropriately.” The internet doesn’t promote unsafe sex, it provides a medium for people to pursue something they’re pursuing anyway. This goes both ways — there are dating-oriented websites that connect people who may not have otherwise met.

And then there’s condoms. Yes, they’re effective, but they’re only effective if they’re being consistently used. The problem is that it’s really hard to tell a teenager that they need to use condoms for the rest of their life. We can put millions of dollars into education and advertising, but it doesn’t make it any easier to carry out.

I don’t have the solution, but I know we have a problem. We can’t blame the internet for this increase, we can’t blame the youth, and we can’t expect condoms to continue to be the solution. We, as a society, need to figure out a reasonable, life-long prevention plan for not just gay/bi men, but for everyone. I really wish I had a magical answer for this one…

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by on February 10, 20102 Comments
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Awareness Test

I started my new job yesterday, so I’ve spent yesterday and today in the new employee orientation (also known as “on-boarding”). This involves leaders from just about every administrative department coming to talk about what they do.

The patient safety person showed us a video that I thought was interesting. When you watch it, count the number of passes the white team makes. You should probably do that before reading any more of this entry.

So, when I watched it, I counted seventeen. The only problem is that I missed the giant gorilla that dances through the middle of the screen. People, apparently, only look for what they want to see. This becomes a problem when it comes to patient safety — if you’re looking for a certain drug to give to a patient, you might grab one that looks similar and actually read the “correct” drug’s name. This kind of mistake plays a part in many of the 98,000 deaths from medical errors every year.

Additionally, that exercise was used in a cyclist awareness campaign in the UK. Here’s one of the other ads that, perhaps, more dramatically demonstrates this effect (as if a dancing gorilla wasn’t dramatic enough):

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by on January 20, 2010No Comments
filed in Psychology
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Grand Rounds

Abdominal x-ray

You’re looking at an x-ray of the abdominal area, and there’s something in there that shouldn’t be…can you guess what it is?

I found this in a journal (Surgical Rounds) that we get at work. It details a case of an 85 year old man who showed up in the ER complaining of acute abdominal pain. They ended up taking a look, and finding a perforated colon. No explanation. They stitch him up, and he shows up again about 2 years later. This time, there’s a “bar of soap” stuck up there (the patient says it helps with his impacted stools). They could feel it when they push around on his tummy, and so they took that x-ray. Turns out, it wasn’t a bar of soap.

I don’t want to ruin the surprise. Feel free to guess, or if that’s too much work, you can read the case report (and other information about perforated colons and sexual activity).

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by on January 16, 2010No Comments
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High Schoolers on Twitter

One of the three high schools I attended (don’t ask) is apparently jumping on the Web 2.0 bandwagon with the help of the U of Mn. Roosevelt High School is somehow integrating Twitter and other social media websites with their English class to help engage students. Very interesting idea. Perhaps most interesting for me was seeing my Open English teacher, Delainia Haug, teaching the class. She’s probably one of the best and most enthusiastic teachers I had during my high school career.

I couldn’t find much about the DigMe program in particular, but here’s the video from the U:

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by on January 16, 2010No Comments
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I’m good enough, smart enough…

Apparently, for minority children, self-affirmation has a significant effect on their GPA. A two-year follow-up study was published last week in Science. This study had children, starting in 7th grade, write about relationships, interests, and personal values. Students in the test group showed as much as a 0.41 increase in their GPA compared to the control group. This relationship was not found in white students. Researcher Geoffrey Cohen explains why:

“It takes the sting out of potential failure. ‘I feel like, Even if I do poorly here on this test or in school, I am still fundamentally a good person. It anchors my sense of self-integrity.’”

Another study released last week suggests that Facebook users have lower grades than non-users. Although the researcher admitted to Time that it could be bad students are attracted to Facebook:

“Maybe [Facebook users] are just prone to distraction. Maybe they are just procrastinators.”

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by on October 25, 2009No Comments
filed in Mental Health
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Mercury in HFCS

Apparently one-third of high fructose corn syrup (HFCS) containing products are contaminated with mercury. The worst offender? Chocolate milk. Well, dairy products in general (60% contained mercury). Mercury was also found in every food/drink category tested, including dressings, syrups, snacks, and soups. On the bright side, only 16% of beverages (e.g. non-diet soda) contained mercury. For the record, the levels found were below the EPA requirements — if that makes you feel any safer…

Mercury is used to produce “caustic soda” which is in turn used to help separate the corn starch from the kernels. Mercury plants have a pretty bad record for keeping track of where their mercury goes:

The nine mercury cell plants operating in 2003 reported consuming 38 tons of mercury, but emitting just eight tons into the environment. What happened to the other 30 tons? The plants cannot account for it.

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by on October 25, 2009No Comments
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What HIV Problem?

A new study by the Kaiser Foundation found that people are becoming less concerned about HIV. The percent of respondents reporting HIV/AIDS as the top health concern in the US dropped from 44% in 1995 to 6%.

While the majority of people understand how HIV is transmitted, there are still a significant handful of people that don’t. Did you know you can get HIV from…

  • sharing a drinking glass (20%, up from 15% in 2000)
  • using a toilet seat (12%)
  • swimming in a pool (7%)

Just to be clear, you can’t get HIV from any of the above routes. Well, maybe you could in an extreme situation – but as a general rule, I don’t think people would sit on a bloody toilet seat. It’d be interesting to see the survey broken down by risk factor, as I’d imagine hope that people at high risk (e.g., MSM, IDU) would better be able to identify the routes of transmission than people at very low risk.

Nonetheless, this survey underscores the importance of continued public health efforts, including President Obama’s HIV campaign, NineAndAHalfMinutes.org.

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by on October 25, 2009No Comments
filed in HIV/AIDS
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