high school never ends

Bowling for Soup had it right. In their 2006 single “High School Never Ends”, the pop-punk band sang, “And you still don’t have the right look, and you don’t have the right friends, nothing changes but the faces, the names, and the trends…high school never ends.” Whether a person’s role in that social hierarchy can change is a question I’ll leave for another day, but I think we can all agree that several years out of high school, the hierarchy still exists.

You see it all the time. Instead of going to the office today, my division of about 12 people had a day-long retreat. It wasn’t quite as cheesy as it sounds – no trust falls or awkward icebreakers, thank goodness – but there was time for a little reflection and honesty. During a discussion of lessons learned this year, one of my coworkers said her biggest lesson was that she “just didn’t fit in.” As I’d gotten to know her over the previous months, I had sensed a frustration in her general demeanor and under-the-breath comments, but to hear it stated so candidly and in words a teenager might use made it much more real, and much more poignant. It wasn’t a matter of time, I knew. She’d worked there for years and felt that way; I’d worked there eight months and felt perfectly at home.

It’s just as apparent in our personal lives. Last year, one of my friends often confided in me about the group of students in her graduate program. Of the 20 or 25 students, there was a “core group” of about six or seven, and my friend began the program as one of them. They’d spend nights and weekends at each other’s apartments, and as my friend said with some hesitation, spent a good part of their conversations making fun of their classmates. As the year went on, she told me about how one girl got systematically excluded from the group. Whether it was consciously planned or unspoken, that girl gradually stopped being invited, her calls stopped being returned, and she eventually found other friends. Hearing the story, I felt like it was something out of Mean Girls, but these students were in their early twenties at least.

Sadly, but perhaps not too surprisingly, my friend was the next one to be pushed out of the group. I saw her spend several Friday and Saturday evenings choosing outfits but waiting for a phone call to be returned before changing into them – a phone call that many nights, never came. Like her classmate before her, she eventually decided to find others who appreciated her more.

But that insecurity never goes away, I realized. This past weekend, the core group seemed to change their mind about my friend, and invited her out with them for the first time in several months. She was genuinely excited about it – and she is not an excitable girl. I watched the same scene from last year play out again as she mused over what to wear and when to leave, and crossed my fingers that they’d be nice this time. Luckily, they were, but what struck me more than their sudden change of mind was her sudden change of mind. Once they wanted her back, last year’s inexplicable rejection seemed forgotten. I cautiously asked her about it, and she explained to me that while she did remember what happened, “with this group, it’s better to be in than out.”

It’s a pragmatic answer, yes, but there’s no way feelings don’t get involved. You could see it in my coworker’s avoidance of eye contact while she admitted to feeling left out, and in my friend’s disappointment in not being called back. And yet we persist in wanting to be part of these groups that reject us – why? And why do we blame ourselves for what is more likely the sum of group dynamics, chance, and self-preservation? I’m definitely guilty of it myself. When I get rejected from anything, be it a romantic prospect or a job interview, the first thing I do is wonder what I did wrong. The second thing I do is resolve to win the person over. It’s completely unhealthy, and we should be beyond it, and we know it.

Easier said than done, though, right?

another great quote

From a seminar on health communication I went to a few days ago...

"The internet is the first thing humanity has built that humanity doesn't understand. It's the biggest experiment in anarchy we've ever had." --Eric Schmidt, Google

the great text purge

I was chatting with a friend yesterday, catching up about our respective weekends when she gave me some unfortunate news:

[friend]: i got dumped again last week

She explained the story, we commiserated about the inexplicable things guys can do, and then began discussing future steps and attractive new prospects. And then she said something that got me thinking:

[friend]: and then i was cleaning out texts from him

Oh man, I thought, understanding how that goes. With the evolution of mobile technology, email accounts with unimaginable capacity, and Facebook records and traces going back a few years, severing a relationship is no longer so simple as the stereotypical exchanging of borrowed items after a break - that cathartic throwing out of pictures together, old gifts, and other mementos. These days, there's a whole host of other records of the past, mostly casual little things you wouldn't ordinarily bother to save if your computer or cell phone didn't do it for you.

It's usually a good thing - great when you want to return to and savor a funny moment or an unexpectedly sweet conversation. But what happens when you don't? It's an interesting dilemma. One option is to go through the electronic equivalent of throwing everything out and delete all texts and emails, de-friend him (or her) on all the social networks, and so on. Unless it was a real heartbreak, though, that seems a little extreme. And presumably, the relationship was good for most of its duration. Wouldn't deleting absolutely everything be a rejection of those good times, too?

Unfortunately, the alternative can be just as awkward. Having a former love interest's texts lounge around your inbox and their gchat status hover at the top of your contacts list is an unnecessary (and just plain annoying) reminder that they still exist, especially in the immediate aftermath. Later, though, it becomes part of your history. Once you're over it, remembering a date who thought you looked great that night or some affectionate teasing about your rival sports teams - it can be nice.

So comment away, kids. What approach do you take?

Today calls it quits. now it's your turn, viewers.

(second migrated post from Target Population. original post available here.)

I was sipping my coffee and watching the Today Show earlier this week when hosts Matt Lauer and Meredith Vieira introduced a new miniseries within the show called “Today Calls it Quits” (available here on AOL Video). As I saw over the next several minutes, the series – produced in partnership with national nonprofit the American Legacy Foundation – aimed to help smokers kick the habit by providing medical information about the dangers of smoking and the benefits of quitting, concrete solutions and tips, and helpful resources.

As a public health student and former American Lung Association intern, I was immediately intrigued. In its first installment on January 29, 2009, the show followed two current smokers through interviews and laboratory demonstrations in a doctor’s office. Their experiences were interspersed with conversations with other health personnel that explained the immediate and long-term benefits of quitting smoking. At one point, after seeing on a filter the chemical effects of smoking a single cigarette, self-proclaimed social smoker Maurizio reacted simply but honestly. “Wow,” he said, pausing for a moment, “that scares me.”

Maurizio’s reaction and self-preservation speak to just one of the benefits of quitting that the American Legacy Foundation hopes to convey in the series, according to their press release. With two initial installments broadcasted on January 29 and 30 and on-air follow-ups scheduled for March, the series profiles three parents and other adults who aim to quit for other reasons as well, such as setting a good example for their children. In addition to TV, the effort includes online components and partners as well, including placement on the Today Show’s homepage, online chatting capability, and links to quit plan website BecomeAnEX.org.

The kind of information presented on Tuesday’s installment was nothing new – a filter blackened by exposure to cigarette smoke is a familiar image from our elementary school science and health classes, and I recognized the benefits of quitting from a popular poster accompanying the 2004 Surgeon General’s Report. What was new about the campaign, however, was its form. Antismoking public service announcements (PSAs) have been around for ages, as have socially conscious episodes addressing health issues as part of popular sitcoms and family dramas. Much has been said in recent years about the health communication potential of telenovelas – how they have been used to bring up issues and convey health information, and how they can further be leveraged.

But this was my first exposure to health messaging within a fact-based show. Its placement caught me off guard, as I’m sure it did others, and in our era of media oversaturation, getting the audience’s attention by surprising them is a great first step. It included the personal stories of a variety of individuals, aiming for and achieving relatability. The resources included at the end of the segment gave viewers something concrete and measurable to do. All in all, it seems to be a promising, innovative effort and I’m curious to see what will come of it.

first, do no harm. what next?

(migrating over a couple of my entries from my grad school's public health blog, Target Population)

When entering medical school, one of the first principles taught to aspiring physicians is primum non nocere, or as we may more commonly know it, “first, do no harm.” While it obligates doctors to avoid intentionally or unnecessarily risking their patients’ well-being – something we can all agree is positive – determining what sort of treatment they are obligated to provide is a little trickier.

CNN reported on a recent study in the Journal of General Internal Medicine, which found that 45% of internists in the Chicago area had used a placebo in clinical practice at some point in their career. Placebos, usually in the form of sugar pills or another inert agent, are traditionally used as controls in studies testing the effectiveness of new treatments. The aim is to avoid patients reporting symptom improvement simply because they received medication and expect to feel better.

This “placebo effect” was mentioned in the scientific literature as early as 1920, and has been documented and tested since Henry Beecher’s 1955 paper “The powerful placebo.” Its strength is still being debated, but according to the JGIM study, 96% of physicians believed that placebos could have therapeutic effects, and up to 40% believed that positive physiological effects were possible for certain health conditions.

However, the fact remains that only 4% of those who used placebos in clinical practice admitted it to the patients involved. While knowing that your medication is inert would certainly diminish its potential effectiveness as a placebo, what about the motives involved? The majority of physicians administered them to patients who were upset, in order to calm them down. But once the patient is calmed down, what prevents doctors from admitting to the treatment after the fact? The ethics of keeping the patient in the dark even then is at questionable at best.