OREGON STATE UNIVERSITY

college of public health and human sciences

Excess omega-3 fatty acids could lead to negative health effects

CORVALLIS, Ore. – A new review suggests that omega-3 fatty acids taken in excess could have unintended health consequences in certain situations, and that dietary standards based on the best available evidence need to be established.

“What looked like a slam dunk a few years ago may not be as clear cut as we thought,” said Norman Hord, associate professor in OSU’s College of Public Health and Human Sciences and a coauthor on the paper.

“We are seeing the potential for negative effects at really high levels of omega-3 fatty acid consumption. Because we lack valid biomarkers for exposure and knowledge of who might be at risk if consuming excessive amounts, it isn’t possible to determine an upper limit at this time.”

Previous research led by Michigan State University’s Jenifer Fenton and her collaborators found that feeding mice large amounts of dietary omega-3 fatty acids led to increased risk of colitis and immune alteration. Those results were published in Cancer Research in 2010.

As a follow-up, in the current issue of the journal Prostaglandins, Leukotrienes & Essential Fatty Acids, Fenton and her co-authors, including Hord, reviewed the literature and discuss the potential adverse health outcomes that could result from excess consumption of omega-3 fatty acids.

Studies have shown that omega-3s, also known as long chain polyunsaturated fatty acids (LCPUFAs), are associated with lower risk of sudden cardiac death and other cardiovascular disease outcomes.

“We were inspired to review the literature based on our findings after recent publications showed increased risk of advanced prostate cancer and atrial fibrillation in those with high blood levels of LCPUFAs,” Fenton said.

Omega-3 fatty acids have anti-inflammatory properties, which is one of the reasons they can be beneficial to heart health and inflammatory issues. However, the researchers said excess amounts of omega-3 fatty acids can alter immune function sometimes in ways that may lead to a dysfunctional immune response to a viral or bacterial infection.

“The dysfunctional immune response to excessive omega-3 fatty acid consumption can affect the body’s ability to fight microbial pathogens, like bacteria,” Hord said.

Generally, the researchers point out that the amounts of fish oil used in most studies are typically above what one could consume from foods or usual dosage of a dietary supplement. However, an increasing amount of products, such as eggs, bread, butters, oils and orange juice, are being “fortified” with omega-3s. Hord said this fortified food, coupled with fish oil supplement use, increases the potential for consuming these high levels.

“Overall, we support the dietary recommendations from the American Heart Association to eat fish, particularly fatty fish like salmon, mackerel, lake trout or sardines, at least two times a week, and for those at risk of coronary artery disease to talk to their doctor about supplements,” he said.

“Our main concern here is the hyper-supplemented individual, who may be taking high-dose omega-3 supplements and eating four to five omega-3-enriched foods per day,” Hord added. “This could potentially get someone to an excessive amount. As our paper indicates, there may be subgroups of those who may be at risk from consuming excess amounts of these fatty acids.”

Hord said there are no evidence-based standards for omega-3 intake and no way to tell who might be at health risk if they consume too high a level of these fatty acids.

“We’re not against using fish oil supplements appropriately, but there is a potential for risk,” Hord said. “As is all true with any nutrient, taking too much can have negative effects. We need to establish clear biomarkers through clinical trials. This is necessary in order for us to know who is eating adequate amounts of these nutrients and who may be deficient or eating too much.

“Until we establish valid biomarkers of omega-3 exposure, making good evidence-based dietary recommendations across potential dietary exposure ranges will not be possible.”

Sanjoy Ghosh from University of BC-Okanagan, Canada and Eric Gurzell from Michigan State University also contributed to this study, which was supported by grants from the National Institutes of Health and the Canadian Diabetes Association.

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Norman Hord, 541-737-5923

California’s new mental health system helps people live independently

CORVALLIS, Ore. – A new analysis by Oregon State University researchers of California’s mental health system finds that comprehensive, community-based mental health programs are helping people with serious mental illness transition to independent living.

Published in the October issue of the American Journal of Public Health, this study has important implications for the way that states finance and deliver mental health programs, and speaks to the effectiveness of well-funded, comprehensive community programs.

In November of 2004, California voters passed the Mental Health Services Act, which allocated more than $3 billion for comprehensive community mental health programs, known as Full Service Partnerships (FSP). While community-based, these programs are different from usual mental health services programs in most states because they provides a more intensive level of care and a broader range of mental health services and supports, such as medication management, crisis intervention, case management and peer support.

It also provides services such as food, housing, respite care and treatment for co-occurring disorders, such as substance abuse.

“We found that these programs promoted independent living in the community among people who had serious mental illness but had not been served or underserved previously,” said Jangho Yoon, an assistant professor of health policy and health economist in OSU’s College of Public Health and Human Sciences and lead author of the study. “Overall, it reduced their chance of living on the street or being incarcerated in jails and prisons.”

The researchers looked at data from 43 of California’s 53 counties, resulting in a sample of 9,208 adults over the course of four years. They found that participants who stayed enrolled in the program continuously, without interruption, were 13.5 percent more likely to successfully transition to independent living.

However, they found that non-white patients were less likely to live independently, and more likely to end up in jail or homeless.

“Although FSPs represent the most well-funded comprehensive community-based programs in the country, they are still community programs and therefore program participation is voluntary,” Yoon said.  “My guess is that minorities may not benefit fully from these programs in their communities possibly due to greater stigma, and less family/social supports. But it needs further investigation.”

Patients with schizophrenia and bipolar disorders were also less likely to benefit from the community programs, because of the nature and severity of their mental health issues.

Yoon is an expert on health management policy, specifically policy around the area of mental health. He said other states haven’t followed California’s lead, in part because of the cost of such extensive programming. Yoon said some of the funding made possible by the federal Patient Protection and Affordable Care Act, which includes $460 million for community mental health services for states to use, may help other states to create similar programs.

“Nobody would disagree that the public mental health system has historically been under-funded in the U.S.,” he said. “The message for other states is clear: investment in well-funded, recovery-oriented, comprehensive community mental health programs clearly improves lives of people with serious mental illness, and may also save money from reduced dependency and incarcerations in this population.”

Tim Bruckner of the University of California, Irvine, and Timothy Brown of the University of California, Berkeley, contributed to this study, which was jointly funded by the California Department of Mental Health and the California Health Care Foundation.

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Jangho Yoon, 541-737-3839

Autistic children with better motor skills more adept at socializing

CORVALLIS, Ore. – In a new study looking at toddlers and preschoolers with autism, researchers found that children with better motor skills were more adept at socializing and communicating.

Published online today in the journal Research in Autism Spectrum Disorders, this study adds to the growing evidence of the important link between autism and motor skill deficits.

Lead author Megan MacDonald is an assistant professor in the College of Public Health and Human Sciences at Oregon State University. She is an expert on the movement skills of children with autism spectrum disorder.

Researchers tested 233 children ages 14 to 49 months diagnosed with autism.

“Even at this early age, we are already seeing motor skills mapping on to their social and communicative skills,” MacDonald said. “Motor skills are embedded in everything we do, and for too long they have been studied separately from social and communication skills in children with autism.”

Developing motor skills is crucial for children and can also help develop better social skills. MacDonald said in one study, 12-year-olds with autism were performing physically at the same level as a 6-year-old.

“So they do have some motor skills, and they kind of sneak through the system,” she said. “But we have to wonder about the social implications of a 12-year-old who is running like a much younger child. So that quality piece is missing, and the motor skill deficit gets bigger as they age.”

In MacDonald’s study, children who tested higher for motor skills were also better at “daily living skills,” such as talking, playing, walking, and requesting things from their parents.

“We can teach motor skills and intervene at young ages,” MacDonald said. “Motor skills and autism have been separated for too long. This gives us another avenue to consider for early interventions.”

MacDonald said some programs run by experts in adaptive physical education focus on both the motor skill development and communicative side. She said because autism spectrum disorder is a disability that impacts social skills so dramatically, the motor skill deficit tends to be pushed aside.

“We don’t quite understand how this link works, but we know it’s there,” she said. “We know that those children can sit up, walk, play and run seem to also have better communication skills.

This study was coauthored by Catherine Lord of Weill Cornell Medical College and Dale Ulrich of the University of Michigan. It was supported by the National Institutes of Health, the Simons Foundation, First Words and Blue Cross Blue Shield Foundation of Michigan.

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Megan MacDonald, 541-737-3273

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Megan MacDonald
Researcher Megan MacDonald practices important motor skills, like throwing a ball, with a child. (photo courtesy of OSU College of Public Health and Human Sciences)

Working longer may lead to a longer life, new OSU research shows

CORVALLIS, Ore. – Working past age 65 could lead to longer life, while retiring early may be a risk factor for dying earlier, a new study from Oregon State University indicates.

The researchers found that healthy adults who retired one year past age 65 had an 11 percent lower risk of death from all causes, even when taking into account demographic, lifestyle and health issues. Adults who described themselves as unhealthy were also likely to live longer if they kept working, the findings showed, which indicates that factors beyond health may affect post-retirement mortality.

“It may not apply to everybody, but we think work brings people a lot of economic and social benefits that could impact the length of their lives,” said Chenkai Wu, the lead author of the study. He conducted the research as part of his master’s thesis at OSU, where he is now a doctoral student in the College of Public Health and Human Sciences.

The findings were published recently in the Journal of Epidemiology and Community Health. Co-authors include Associate Professor Robert Stawski and Assistant Professor Michelle Odden of OSU and Gwenith Fisher of Colorado State University. The research was supported by a grant from the National Institute on Aging.

The research was the basis for Wu’s master’s thesis in human development and family science; he’s now pursuing a doctorate in epidemiology.

Wu took an interest in the effects of retirement on health in part because of China’s mandatory laws, which are often debated. Retirement age is also an issue for debate elsewhere around the world, including the United States, he said.

“Most research in this area has focused on the economic impacts of delaying retirement. I thought it might be good to look at the health impacts,” Wu said. “People in the U.S. have more flexibility about when they retire compared to other countries, so it made sense to look at data from the U.S.”

Wu examined data collected from 1992 through 2010 through the Healthy Retirement Study, a long-term study of U.S. adults led by the University of Michigan and funded by the National Institute on Aging. Of the more than 12,000 initial participants in the study, Wu narrowed his focus to 2,956 people who began the study in 1992 and had retired by the end of the study period in 2010. 

Poor health is one reason people retire early and also can lead to earlier death, so researchers wanted to find a way to mitigate a potential bias in that regard.

To do so, they divided the group into unhealthy retirees, or those who indicated that health was a factor in their decision to retire – and healthy retirees, who indicated health was not a factor. About two-thirds of the group fell into the healthy category, while a third were in the unhealthy category.

During the study period, about 12 percent of the healthy and 25.6 percent of the unhealthy retirees died. Healthy retirees who worked a year longer had an 11 percent lower risk of mortality, while unhealthy retirees who worked a year longer had a 9 percent lower mortality risk. Working a year longer had a positive impact on the study participants’ mortality rate regardless of their health status.

“The healthy group is generally more advantaged in terms of education, wealth, health behaviors and lifestyle, but taking all of those issues into account, the pattern still remained,” said Stawski, senior author of the paper. “The findings seem to indicate that people who remain active and engaged gain a benefit from that.”

Additional research is needed to better understand the links between work and health, the researchers said. As people get older their physical health and cognitive function are likely to decline, which could affect both their ability to work and their longevity.

“This is just the tip of the iceberg,” Stawski said. “We see the relationship between work and longevity, but we don’t know everything about people’s lives, health and well-being after retirement that could be influencing their longevity.”

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Chenkai Wu, wuche@oregonstate.edu; Robert Stawski, robert.stawski@oregonstate.edu, 541-737-9052

Mobility plays important role in development for toddlers with disabilities

CORVALLIS, Ore. – Typical toddlers simultaneously spend about three hours a day in physical activity, play and engagement with objects such as toys, while their peers with mobility disabilities are less likely to engage in all of those behaviors at the same time, new research from Oregon State University shows.

The study shows the marked differences in play and activity among toddlers with and without disabilities. It also underscores the need for young children with disabilities to have opportunities to play and explore in the same manner as their peers, said the study’s lead author, Sam Logan.

“Whatever typically-developing kids do should be the gold standard for all children, including those with disabilities,” said Logan, an assistant professor of kinesiology in the College of Public Health and Human Sciences. “The ability to move independently is a mechanism for a host of developmental benefits for children.”

Physical activity has important physiological benefits for children, but it also is a vehicle through which children can engage with their peers and interact with their surroundings, Logan said. One way researchers are now encouraging children with mobility disabilities to move more is through the use of modified toy ride-on cars.

Past research has shown that independent mobility is linked to cognitive, social, motor, language and other developmental benefits in young children. Being pushed in a stroller or being carried from one place to another is fundamentally different from having active control over one’s own exploration, which is where the developmental gains are seen, he said.

The latest study, published recently in the journal Pediatric Physical Therapy, compared the activity of typically-developing toddlers to those with disabilities, with a particular focus on the co-occurrence of play, physical activity and engagement with objects such as toys.

The researchers found that typically-developing toddlers spent about an hour per day in direct play interactions with their peers, while toddlers with disabilities affecting mobility spent less than 20 minutes and as few as six minutes per day in similar interactions. 

The toddlers with disabilities also had less variety in the types of physical activity they engaged in and were less likely to interact with objects such as toys, Logan said. One of the goals for physical therapists and other clinicians should be to encourage more simultaneous activity, he said.

“Moving is not the objective, but if you’re not able to move independently, then play with peers or interaction with toys is even more difficult,” Logan said. “So how can we help these kids move more for play?”

One challenge is the lack of commercially-available devices to help toddlers with mobility issues to get around on their own, Logan said. Power wheelchairs can be costly and typically aren’t available for children until they are older, and may not always be an option at all for children who are expected to eventually be able to walk.

Some low-cost interventions are emerging to help address this issue. Logan is a leader of the Go Baby Go program, which provides children with movement disabilities modified ride-on toy cars.

The cars give children independence at a much younger age, allowing them the mobility needed to increase their interaction with peers and other objects, Logan said. The modified cars have proven effective even among children with complex medical issues, he said.

A case study on the cars’ use among children with complex medical issues, including use of tracheotomy tubes and ventilators for aid in breathing, was also published recently in the journal Pediatric Physical Therapy.

The three children featured in the study, ranging in age from 6 months to 5 years of age, learned to drive modified ride-on cars independently. The children used the cars to explore their environment and some of the children also participated in play-based activities using the cars.

“The car becomes a tool,” Logan said. “It’s not just about getting from point A to point B. “It’s about how the child is using the car to play and interact with peers and objects.”

Together, the two studies provide further evidence of the benefits of mobility for children with disabilities and the effectiveness the modified cars in helping children gain that mobility, Logan said.

His latest research is focused on modified cars that require children to stand to operate them, which helps build muscle strength and prepare children for walking, and further reduces barriers for play and socialization with peers.

“The expectation should be that they have the same opportunities for mobility and play as any other kids,” Logan said. “Even the most complicated medical cases should not be barriers for play.”

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Sam Logan, 541-737-3437, sam.logan@oregonstate.edu

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Toddler using a modified toy car
GoBabyGo at Oregon State


Researcher Sam Logan

Sam Logan

No evidence that water birth poses harm to newborns, new OSU study finds

CORVALLIS, Ore. – There is no evidence that water births, where a baby is intentionally born under water in a tub or pool, poses any increased harm to the child, Oregon State University researchers have found.

Researchers examined outcome data for more than 6,500 midwife-attended water births in the United States and found that newborns born in water were no more likely to experience low Apgar scores, require transfer to the hospital after birth or be hospitalized in their first six weeks of life, than newborns who were not born in water.

The results were published this week in the Journal of Midwifery and Women's Health. The study is believed to be the largest study of water births to date and the first to examine the practice in the United States, said lead author, Marit Bovbjerg, an epidemiology instructor in the College of Public Health and Human Sciences at OSU. 

“The findings suggest that water birth is a reasonably safe, low-intervention option for women who face a low risk of complications during the birthing process,” Bovbjerg said. “These are decisions that should be made in concert with a medical professional.”

Co-authors of the study are Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts, and Courtney Everson, a former OSU graduate student who recently completed her doctorate.

For the study, researchers analyzed birthing outcome data collected from 2004 through 2009 by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats. Most of the nearly 17,000 women in the study were attended by Certified Professional Midwives, who provided detailed reports on their cases from their medical records.

More than 6,500 women in the database gave birth in water, either at home or in a free-standing birthing center. The outcomes in those births were compared to the outcomes for non-water births. The study compared only births at home or in a birthing center and not those in hospitals. 

The researchers found that babies born in water were no more likely to require transfer or admission to a hospital, nor were the mothers who gave birth in water. However, the researchers found an 11 percent increase in perineal tearing among mothers who gave birth in water.

“For some women, that potential risk of tearing might be worth taking if they feel they will benefit from other aspects of a water birth, such as improved pain management,” Bovbjerg said. “There is no one correct choice. The risks and benefits of different birthing options should be weighed carefully by each individual.” 

The researchers’ findings are congruent with outcomes reported in other water birth studies, Cheyney said, but are contrary to the American College of Obstetricians and Gynecologists’ and the American Academy of Pediatrics’ Committee Opinion.

“Those groups support laboring in water, but caution against giving birth while immersed,” Cheyney said. “Our findings suggest that water birth is a reasonably safe option for low-risk women, especially when the risks associated with pharmacologic pain management, like epidural anesthesia, are considered.”

The researchers have shared their findings with a group that is developing a clinical bulletin designed to inform health care providers about the practice of water birth in both hospital and out-of-hospital settings.

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Melissa Cheyney, 541-737-4515, melissa.cheyney@oregonstate.edu; Marit Bovbjerg, 541-737-5313, Marit.Bovbjerg@oregonstate.edu

Exercise DVDs could be psychologically harmful for users

CORVALLIS, Ore. – Using fitness DVDs to work out at home may seem like a good way to get started on new exercise goals this year, but those DVDs may also include negative imagery and demotivating language.

A study of 10 popular commercial exercise DVDs showed that the imagery in the fitness videos may be perpetuating and reinforcing hyper-sexualized and unrealistic body images, said Brad Cardinal, a kinesiology professor in the College of Public Health and Human Sciences at Oregon State University. 

In addition, researchers found that one in every seven motivational statements on the DVDs was actually a demotivating statement that could reduce the effectiveness of the workout, diminish the user’s hope and potentially cause psychological harm, said Cardinal, the lead author of the study.

“These findings raise concerns about the value of exercise DVDs in helping people develop and commit to a workout program,” said Cardinal, who is a national expert on the benefits of physical activity. “There are a lot of exaggerated claims through the imagery and language of ‘do this and you’ll look like me.’ ” 

The findings are being published in the latest issue of the Sociology of Sport Journal. Co-authors of the study are: OSU graduate students Kim A. Rogers, Brian Kuo, Rosalee L. Locklear and Katelyn E. Comfort; and Professor Marita K. Cardinal of Western Oregon University.

Fitness DVDs are a $250 million a year industry but there is no scientific evidence about their safety and effectiveness or the accuracy of the information contained in them, and the industry is largely unregulated, Cardinal said. 

For the study, the researchers reviewed 10 popular, instructor-led fitness DVDs, evaluating both the imagery used in the videos as well as the motivational language used by the instructors. The goal was to better understand the visual and auditory messaging and how it might affect users.

Researchers found that most of the instructors and models were slim, female and white, and they typically wore revealing attire. That sends a subtle message about what people who are fit should look like, Cardinal said. This perpetuates objectification of the female body in particular and emphasizes physical appearance as opposed to improved health, he said.

The researchers also found that a quarter of the language used by instructors was motivational, but one of every seven motivational statements was considered negative. Negative statements included phrases such as “say hello to your sexy six-pack,” “you better be sweating,” and “you should be dying right now.” 

 

Those kinds of phrases focus on outcomes, encourage social comparison, and don’t take into account individual differences in health or fitness, Cardinal said. “Tough love” phrases and strategies can also have a harmful effect because they can lead to injuries or other adverse health outcomes, he said.

Such messages could be particularly harmful to users who are turning to exercise DVDs to start a new fitness routine or who are uncomfortable in a gym or fitness class setting, Cardinal said. The exercise videos were marketed to novice exercisers while the movement skills tended to be designed for intermediate or advanced levels of fitness, and the instructors’ verbal messages sometimes taunted observers to keep up. 

“You’re inviting into your home these images and messages that could make you feel bad about yourself, and ultimately hinder your efforts to improve your health,” he said. “If the experience is not positive, the likelihood the person is going to continue with an exercise program diminishes.”

Cardinal urged potential fitness DVD consumers to be mindful of the potential pitfalls of the product when selecting and using exercise videos. 

“Buyers should beware when making these purchases,” he said. “Remember that we all have different body shapes and styles, and our bodies may respond differently to the exercises being shown. Don’t expect to get the same results as what you see on the screen or compare yourself to others.”

The findings indicate that there is a need to further study commercial fitness DVDs, Cardinal said. Along with the language and imagery used in the videos, researchers should consider studying the effectiveness and safety of the types of exercises and techniques used, he said. In addition, many of the instructors appear to have little or no credentials in fitness instruction, he said. 

“We don’t think the videos are very psychologically safe,” Cardinal said. “There are also questions about some of the exercises, which could lead to injuries and pose a real danger to the user.”

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Brad Cardinal, 541-737-2506, brad.cardinal@oregonstate.edu

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Brad Cardinal

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Injuries among Dungeness crab fishermen examined

CORVALLIS, Ore. – Commercial Dungeness crab fishing on the West Coast is one of the highest risk occupations in the United States, based on fatality rates. But non-fatal injuries in the fishery appear to go largely unreported, a new study from Oregon State University shows.

While the fatality rates in the Dungeness crab fleet have been reported in the past, the incidence of non-fatal injuries have not been previously studied, said Laurel Kincl, an assistant professor of environmental and occupational health and safety in the OSU College of Public Health and Human Sciences.

“The commercial Dungeness fishing fleet, which operates along the coast of Oregon, Washington and Northern California, is a vital economic commodity,” she said. “Injuries can be life-threatening and life-altering, leading to disability, decreased quality of life and lost wages.”

Understanding the type and nature of fatalities and injuries, including describing and categorizing the types of injuries, is the first step in identifying safety issues and pinpointing areas for prevention, she said.

Kincl and a team of researchers examined 12 years of death and injury data, and found that 28 people died while commercially fishing for Dungeness crab from 2002-2014. In that same period, 45 injuries were reported to the U.S. Coast Guard.

The fatality rate among Dungeness crab fishermen is several times higher than the national rate for commercial fishing. But the injury rate among Dungeness fishermen is much lower than injury rates in other commercial fishing fleets that have been studied.

“Fatal injuries are tracked in a national system, but non-fatal injuries are not,” Kincl said. “We knew there was likely underreporting, but we had no idea how low the injury numbers were until now.”

The findings, published in the latest issue of the journal International Maritime Health, are the first step to better understanding fishing injuries among Dungeness crab fishermen. The research is part of an OSU-led research project to identify and reduce the risks of injuries in the industry, Kincl said.

The Fishermen Led Injury Prevention Program, or FLIPP, is designed to take a new approach to fishing industry injury prevention by working with commercial Dungeness crab fishermen to identify and reduce injury risks. The project is supported by a three-year, $825,000 grant from the National Institutes for Occupational Safety and Health. Kincl is the principal investigator.

The lead author of the paper, Samantha Case, is a researcher in the NIOSH office in Alaska. Other co-authors are OSU Associate Professor Viktor Bovbjerg; OSU doctoral student Laura Syron and Devin Lucas, who earned his doctorate at OSU and works at NIOSH.

The researchers found that the majority of the fatalities, about 71 percent, occurred during vessel disasters, such as boats capsizing or sinking. The other deaths were the result of a fisherman drowning or falling overboard. Fractures were the most commonly reported injury, at 40 percent, followed by hypothermia, lacerations and digit amputations.

Working with Oregon Sea Grant and community researchers in local fishing communities, Kincl and her colleagues are meeting with focus groups of fishermen and surveying fishing crews along the Pacific coast to learn more about safety and injuries in the industry.

“No one has ever gone up and down the coast and learned from the fishermen,” Kincl said. “What are they doing to stay safe? Are there things that can be improved? How can we share that information among the various crews?”

By the end of the project, researchers plan to come up with and test several interventions that could help reduce injuries among crab fishermen.

“We want to identify some things that might work, but we don’t want to tell them what to do,” Kincl said. “We want to let them decide what would be most helpful.”

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Laurel Kincl, 541-737-1445, Laurel.kincl@oregonstate.edu

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Crab pots on the Oregon Coast

 

Public Health and Sea Grant

Researcher Laurel Kincl

Laurel Kincl Lab

Safe spaces play important role in community-based HIV prevention, research finds

CORVALLIS, Ore. – The creation and sustainment of “safe spaces” may play a critical role in community-based HIV prevention efforts by providing social support and reducing environmental barriers for vulnerable populations, a new study from an Oregon State University researcher has found.

Safe spaces often are run by community-based organizations working with vulnerable populations. They can be used to provide social support and services such as job and education assistance and health testing and treatment. Such spaces appear to be an important but under-used public health tool for prevention and treatment of HIV, said Jonathan Garcia, lead author of the study and an assistant professor in OSU’s College of Public Health and Human Sciences.

“These safe spaces serve as surrogate homes, creating an environment with a brotherhood or family undertone for men who have often been marginalized by their families and communities and do not trust public institutions such as churches, schools or law enforcement agencies,” he said. “Often they have no other place to go.”

Garcia studies how social experiences influence health, with a focus on developing new public health approaches to address needs of vulnerable populations and communities. His latest research was published recently in the journal PLOS ONE.

Co-authors of the paper are Caroline Parker, Richard G. Parker and Patrick A. Wilson and Jennifer S. Hirsch of Columbia University and Morgan M. Philbin of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute. The research was supported by a grant from the National Institute of Mental Health.

For the study, researchers spent nearly a year conducting observations and in-depth interviews with 31 black men who were gay or bisexual, or who may not have identified as such but who had sex with other men. They also interviewed 17 others with knowledge of the men and the safe spaces they frequented in the New York City area. 

They focused on black men who have sex with other men because that population is considered particularly vulnerable to HIV, Garcia said. While these men make up just 2 percent of the U.S. population, they accounted for about 75 percent of new HIV infections between 2008 and 2010.

About half of the men interviewed were homeless or were living in unstable housing situations and nearly half were unemployed. About two-thirds of the men had some kind of health insurance, with 17 receiving federal Medicaid. 

The researchers found that these men were using safe spaces as places to hang out and connect, but they also served to address vulnerabilities, including exposure to violence; lack of social support; feelings of fear or mistrust against institutions or law enforcement; and limited employment opportunities.

Addressing those issues and providing a safe, community environment provides a better basis for which men are open and amenable to seeking HIV testing and treatment, Garcia said. 

“The meaning of safety is different for people who don’t feel like they are safe at home, or that the police are on their side,” Garcia said. “Safe spaces help create that feeling of security not found elsewhere.”

The findings are already being used to help shape a clinical trial that is now under way. Men who are at substantial risk of exposure to HIV are given daily HIV medication even though they have not contracted the disease. The goal of this pre-exposure prophylaxis, or PREP, is to prevent HIV infection from taking hold if the person is exposed. The trial incorporates the use of safe spaces, both in person and in online settings, for the men receiving the treatment, Garcia said. 

Safe spaces also could be used in prevention and treatment of other diseases that carry a stigma, including sexually-transmitted infections and Hepatitis C, which is common among intravenous drug users, he said.

One problem facing organizations that operate safe spaces is funding, Garcia said. The safe spaces often are the first thing eliminated when a group or organization experiences a funding shortfall. The rationale is to use funds first on treatment or prevention services. 

“Safe spaces are recognized as something important but are more unofficial,” he said. But the spaces can play such a critical role in educating and providing health services to the affected men that eliminating the spaces could reduce the effectiveness of health programs, Garcia said.

“If that support is what they are lacking, then providing it is likely to help them continue to seek treatment and services,” he said.

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Jonathan Garcia, 541-737-1609, jonathan.garcia@oregonstate.edu

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Jonathan Garcia

Jonathan Garcia

Changing habits to improve health: New study indicates behavior changes work

CORVALLIS, Ore. – Improving your heart health may be as simple as making small behavioral changes – a new study of behavioral health interventions suggests that they are effective at helping people alter their lifestyles and lead to physical changes that could improve overall health.

The findings also indicate a shift is needed in the way such interventions are evaluated by researchers and used by health care providers, said Veronica Irvin of Oregon State University, a co-author of the study just published in the Annals of Behavioral Medicine

Behavioral treatments such as individual counseling or group training to improve nutrition or physical activity, reduce or stop smoking, or adhere to a drug treatment plan, often are overlooked because medical care providers tend to believe it is too difficult for people the make changes to their established lifestyles, said Irvin, an assistant professor in the College of Public Health and Human Sciences at OSU.

But large clinical drug trials for potential new medications often fail to show that those treatments make patients better, and drugs sometimes are associated with undesirable side effects, she said. Modification of health behavior is another option for health providers and their patients, Irvin explained, but is underutilized in clinical medical practice as well as in public health policy because many providers remain unconvinced that people can change their behavior to improve their health. 

She and her co-author, Robert M. Kaplan of the Agency for Healthcare Research and Quality, conducted a comprehensive and systematic review of large-budget studies funded by the National Institutes of Health that involved behavioral interventions such as individual counseling or group training to improve nutrition or physical activity, reduce or stop smoking, or adhere to a drug treatment plan.

More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. Greater improvements were observed when the intervention simultaneously targeted two behaviors, such as nutrition and physical activity, which are considered lifestyle behaviors. 

“This research suggests that behavioral interventions should be taken more seriously,” Irvin said. “It indicates that people are able to achieve realistic behavioral changes and improve their cardiovascular health.”

But the researchers also noted that few of the studies documented morbidity and mortality outcomes that are often required for drug trials. Previous research by Irvin and Kaplan found that most drug trials fail to reduce mortality. Behavioral interventions should be studied in a similar fashion, Irvin said. 

“There are more positive outcomes with these trials, but they don’t often measure mortality,” Irvin said.

“The next step for behavioral trials should be to measure results using clinical outcomes, such as the number of heart attacks and hospitalizations, experienced by participants.”  

Most behavior interventions reviewed for the study showed benefits using surrogate markers for these kinds of clinical events. For example, treatments for high cholesterol have the goal of reducing heart attacks and extending life. Measures of cholesterol are surrogate markers because they are believed to be related to the clinical goal of reducing deaths. 

But the surrogate markers are not always predictive of clinical outcomes, which is a potential concern for medical researchers. Future behavioral trials should investigate these clinical events as they would be in a traditional drug trial, Irvin said.

In this study, 17 trials reported a morbidity outcome, with seven showing a significant effect on reducing morbidity outcomes such as hospitalization or cardiovascular events. 

Irvin and Kaplan began work on the study while the two worked together in the National Institutes of Health’s Office of Behavior and Social Science Research. They reviewed all large-budget clinical trials evaluating behavioral interventions for the treatment or prevention of cardiovascular disease that had received funding from the National Heart, Lung and Blood Institute or the National Institute of Diabetes & Digestive and Kidney Diseases between 1980 and 2012.

In all, 38 studies were included in the research. They were did not include 20 large-budget trials from the period in this study because no results from those trials have been published. 

This underscores the need for more publication of research even if the outcomes were not as expected, Irvin said. Publishing these null outcomes prevents the unnecessary replication of studies and also may inform doctors and patients about which treatments are not likely to be helpful.

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Veronica Irvin, 541-737-1074, Veronica.Irvin@oregonstate.edu

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