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Mr Epidemiology

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epidemiology

City of Philadelphia successfully passes a soda tax

Last week, Philadelphia became the first major city to pass a “soda tax.” While other cities have tried and ultimately failed to pass similar pieces of legislation, Philadelphia was successful. So what made Philadelphia different?

Picture from Flickr user Scribe215
Picture from Flickr user Scribe215

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Is plain cigarette packaging just smoke and mirrors?

The Marlboro Man is one of the most iconic advertising images from the 20th century. The cowboy, depicted in some rustic setting, was single-handedly responsible for turning Marlboro’s annual sales from $5 billion a year to over $20 billion a year in the two years after the campaign was introduced. Since the success of that campaign, anti-smoking activists have tried several different ways to limit cigarette advertising. The latest salvo comes in the form of last week’s WHO statement on plain packaging, where they recommended plain packing as part of “comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.” Plain packing standardizes how cigarettes are sold, keeping the picture health warnings, but making the brand names, pack size, colour scheme all identical to limit their appeal.

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Perhaps there is a drug that can prolong your life. It’s called money

A wise man once said that “mo’ money, mo’ problems” (Wallace, 1997). However, despite increases in supposed problems, one of the major benefits is increased life expectancy.

New research published in JAMA last week examined how big a difference earning more money makes in life expectancy, as well as how this changes by geographic location across the United States. Researchers collected tax records from 1.4 billion individuals from 1999 to 2014 aged 40 to 76. Of these, around 4 million men died, compared to 2.7 million women (mortality rates of 596.3 and 375.1 per 100 000 respectively). They examined these data to look at what predicted life expectancy at age 40, after adjusting for race and ethnicity.

What makes New York different to other US cities? | Photo credit Kah-Wai Lin
What makes New York different to other US cities? | Photo credit Kah-Wai Lin (click for more)

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Basic Income: A radical idea for eliminating poverty

The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)
The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)

I imagine most of my readers have never heard of Dauphin, Manitoba. A small, farming community in Canada, Dauphin is a town that was part of an experiment back in the 1970s. The “mincome” project was launched in 1974, and offered everyone a minimum income. Unfortunately, the project was shut down in 1979 with a change in the government, and so the effects weren’t long term enough. The purpose of the mincome project was to see what would happen if a “top up” was offered to everyone. Dr. Evelyn Forget has been studying records from those years, and following up on people to see how it impacted their life. Would people stop working? Would there be higher rates of employment? How would people respond?

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The Zika Virus – what do you need to know?

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Countries and territories with active Zika virus transmission (CDC)

The more I read up on a topic, the more complicated it ends up being. As you start trying to unravel the ball of yarn, every thread leads to three more, and each of those lead to three more. The Zika virus has highlighted that in a very tangible way.

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Level up! Mr Epid is now Dr Epid!

My old lab got me a cake to celebrate!
My old lab got me a cake to celebrate!

I’m back! I took an extended hiatus from the blog while I finished up my PhD, but, at the end of March, I successfully defended my PhD, and after making the changes suggested by the examining committee I submitted in the middle of April and started working. Those of you following along on Twitter will recognize the change in my Twitter handle from @MrEpid to @DrEpid; those of you who know me in real life will have heard me go on about it for the last few months as I prepare. For those wondering, I will eventually change the URL of my blog as well so they all match 🙂

For those unaware of the process, the PhD defence is an oral exam. At Queen’s (the process may differ at other universities), you submit your thesis, and then have to wait (a minimum) of 25 business days for the exam. The exam consists of 4 examiners; an examiner external to your university, one external to your department, one from your department, and the final examiner is your department head (or a department head delegate). You also have a chair from another department from your institution, as well as your supervisors there. After you give a 15-20 minute presentation, the examiners ask their questions. Typically, there are two rounds of questions, after which you leave, and the examiners deliberate. You’re then called back in, and they let you know their decision, and any changes you have to make before submitting your final thesis. My examiners were amazing, and while the questions were tough, they were fair. I actually really enjoyed the discussion I had with my examiners during my defence, and they ranged from the details of my analysis, to the concept of “ethnic identity” and what it actually means in terms of my research.

I want to thank everyone for their support over the past 4 and a bit years. As per prior precedents (Janiszewski, 2010; Saunders, 2013), I will be copy-pasting the acknowledgements section from my thesis below. I’d also like to thank the PLOS Blogs network, especially Victoria Costello for giving me the opportunity to join the network, and Travis and Peter for their support and encouragement when I started blogging. In addition, thank you to my co-authors Beth and Lindsay here who picked up the slack when I took a hiatus this year to focus on finishing up.

Finally, a special thank you to all the readers of the blog. It’s been a privilege to write for you, and it means a lot when you tell me how much you enjoy my work. Thank you, and I’m looking forward to getting back into writing more regularly.

Acknowledgements

I would like to start by thanking my supervisors, Dr. Will Pickett and Dr. Ian Janssen. I am grateful to have had the opportunity to learn from you both, and appreciate your support through my PhD journey. Your honesty, integrity, and willingness to always provide me feedback and support was always appreciated. Will, I look forward to our teams meeting in the playoffs again (hopefully with better results for me this time!)

I would also like to thank those in the Department of Community Health and Epidemiology/Public Health Sciences and the Clinical Research Centre for their support, with a special thank you to Lee Watkins and Deb Emerton for their help. Thank you also to the Clinical Research Centre Student Group. Your antics, customized t-shirts, snack breaks, and random dance parties always kept me entertained, and it’s been a pleasure working with all of you. The Thought Tub is richer for having you.

This work would not have been possible without the financial support of Queen’s University, the Ministry of Colleges, Training and Universities Ontario Graduate Scholarship, and the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.

I would also like to thank my friends and colleagues, especially Anne, Kim, Raymond, Sarah, Alison, Hidé and Marion who have been unwavering in their support over the years. I also owe a special debt of gratitude to Rim, Lydia, Liam, Hoefel, Brian and the Gong Show/Danger Zone family for ensuring that I always get some physical activity, and that yes, I do even lift.

Finally, thank you to my family. Your love, support, guidance, and willingness to listen to me at all times of the day have allowed me to complete this project. Thank you.

“Oh no! What happened?” “W220.2XD: Walked into lamppost, subsequent encounter.”

Last week, I ran across this very entertaining piece over in Healthcare Dive about the new ICD-10 codes. The International Classification of Diseases (ICD) is an incredibly useful tool in public health that basically can reduce an injury to a series of numbers. As you can imagine, this is very powerful when it comes to determining if something is on the rise. Researchers can easily count the number of times something occurs, and if it’s up from previous years, there might be something there.

Part of the beauty of the ICD-10 codes is how specific they are. The previous system, ICD-9 (creative, I know) wasn’t nearly as specific as they only had 13,000 codes compared to the 68,000 in ICD10. With the advent of ICD-10, The Powers That Be have gone into painstaking detail breaking down injuries, diseases and other maladies into incredible precise codes that can be used by researchers and public health professionals.

Today, we’re going to go through my favourite ones.

Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic
Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic

W55.89XA: Other contact with other mammals
There are many codes for contact with mammals. Raccoons, cows, pigs and cats are all represented. However, the mighty seal is not covered, which made Buster Bluth very sad. He would have suffered from W55.89XA.

 

W61.12XA: Struck by macaw, initial encounter. ​

Look like our patient
*puts on sunglasses*
Is a little Macaw-struck
YEAHHHHHHHHHHHHHHHHHHHHHHHHHHH

(The other option here was for an AC/DC reference…)

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Bullet Points: This article has no waiting period

In December of 2012, I was asked my thoughts on the Sandy Hook shooting on Twitter, and if I was going to write about it through a public health lens. I said no – I didn’t want to weigh in so soon, and I didn’t really know where to start. Sandy Hook capped off a year where 130,437 people were shot by firearms. Of these, 31,672 people died, with almost 60% listed as suicides. Since that exchange, there have been several more mass shootings (defined as 4 or more fatalities in one instance – not including the shooter), and I kept surfing the internet to explore the arguments on both sides of the gun control debate. As pointed out by Kathleen Bachynski over on The 2×2 Project’s series on gun violence, aptly titled “Fully Loaded“, if “measles or mumps killed 31,672 people a year, we would undoubtedly consider the situation to be a public health emergency.”

Smith_&_Wesson_Model_29_retouched
The Smith & Wesson Model 29 became a classic after the Dirty Harry movies starring Clint Eastwood were released

The issue is, I’m not inherently against owning firearms. Sure, I don’t understand it, and it makes little to no sense to me how owning a gun makes you feel safer given how every other country in the Western world doesn’t and they seem to be getting along just fine, but that’s not the point. Many gun owners own firearms for self-defence, but use them mainly for fun and recreation – shooting targets and hunting are two of the major uses. More importantly though, Americans don’t want to give up their firearms, and that attitude isn’t going away any time soon: Anyone who thinks advocating for a universal ban on firearms in the US is wasting their time.

For more, click here.

Going to #CPHA2014

Toronto_at_Dusk_-a
The 2014 CPHA conference will be held in Toronto, ON | Picture courtesy Wikimedia
Commons

Next week, I (Atif) will be heading to the Canadian Public Health Association Conference, where I’ll be presenting at two different points.

I’ll be chairing a session titled “Youth Injury Prevention in Canada – Where should we direct our intervention resources.” It promises to be an interesting presentation, where we’ll be discussing injury in Canada, and where to start tackling the problem of injury. This session is scheduled for Wednesday, May 28th from 1:30pm – 3:00pm.

Injury represents one of the most important negative health outcomes experienced by young people in Canada today. Injuries inflict a large burden on children and adolescents and their
families and communities. Injury events are costly in so many ways, whether measured in premature mortality, or the pain, disability, lost productivity and emotional consequence of non-fatal events.

This panel will be made up of child injury researchers and advocates who will make their case for different forms of injury prevention intervention. At the end of this panel, delegates will: understand more about the burden of youth injury in Canada; be aware of at least four different avenues for injury prevention intervention (primordial intervention, context-level interventions, safe sport and peer-influence interventions); have identified the rationale, strengths and limitations of each intervention approach; and have learned more about ways to undertake and gain support for youth injury prevention (from the CPHA conference program).

logo_e
Click to go to the conference website

My second presentation is one of the studies from my PhD, titled “The influence of location of birth and ethnicity on BMI among Canadian youth.” This is a study that’s in press (woo!), and represents my own research focus. This one will be in the Kenora Room, on Thursday May 29th 2014, from 11:00am to 12:30pm.

Background:
Body mass indices (BMI) of youth change when they immigrate to a new country. This occurs by the adoption of new behaviors and skills, a process called acculturation.

Objectives:
We investigated whether differences existed in BMI by location of birth (Canadian vs foreign born) across 7 ethnic groups, both individually and together. We also examined whether time since immigration and health behaviors explained any observed BMI differences.

Methods:
Data sources were the Canadian Health Behaviour in School-Aged Children Study and the Canada Census of Population. Participants were youth in grades 6-10 (weighted n = 19,272). Sociodemographic characteristics, height, weight, and health behaviors were assessed by questionnaire. WHO growth references were used to determine BMI percentiles.

Results:
Foreign-born youth had lower BMI than peers born in Canada, a relationship that did not decrease with increased time since immigration. Similarly, East and South East Asian youth had lower BMI than Canadian host culture peers. Finally, Arab/West Asian and East Indian/South Asian youth born abroad had lower BMI than peers of the same ethnicity born in Canada. These differences remained after controlling for eating and physical activity behaviors.

Conclusions:
Location of birth and ethnicity were associated with BMI among Canadian youth both independently and together.

Implications:
Our findings stress the importance of considering both ethnicity and location of birth when designing and implementing interventions. While currently either one or the other is addressed, our study shows there is heterogeneity in BMI by specific ethnic groups depending on whether they were born in Canada or not.

As always I’ll be trying to livetweet the conference. I’ll be using the #CPHA2014 hashtag, so feel free to follow along online! As always, there are a wide range of presentations and workshops, so I’m excited to attend.

If you’re attending the conference, leave a comment with details of your own presentation so that other readers can attend your talks. And if you see me at the conference, be sure to say hi!

This was posted simultaneously on my blog PLOS Blogs Public Health Perspectives

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