Strange bedfellows: bridging the worlds of academia,public health and the sex industry to improve sexual health outcomes

The public health response to sexually transmitted infections, particularly HIV, has been and continues to be overwhelmingly focused on risk, disease and negative outcomes of sex, while avoiding discussion of positive motivations for sex (e.g. pleasure, desire, love). Recent advocacy efforts have challenged this approach and organisations have promoted the eroticisation of safer sex, especially in the context of HIV prevention.This paper is a case study of one of these organizations - The Pleasure Project. It gives a brief background on the public-health approach to sex and sexual health, and recommends an alternative approach which incorporates constructs of pleasure and desire into sexual health interventions. The Pleasure Project's aims and unorthodox communications strategies are described, as are the response to and impact of its work, lessons learned and ongoing challenges to its approach.The Pleasure Project combines evidence (rigorous and experimental as well as qualitative and anecdotal) with experiential knowledge from the sex industry and safer-sex promotion to communicate messages about eroticising safer sex to influence researchers, public health practitioners and policymakers, mainstream media and the porn world. There are significant barriers to this work, because it challenges common and entrenched norms and values related to sex and pleasure and their role in the public health sphere. Other barriers include: the limited range of existing rigorous intervention trials which incorporate pleasure constructs; the lack of effective indicators to measure pleasure constructs; limited funding and resources; discomfort among public health practitioners, researchers and donors with concepts of pleasure and sex; and rejection of erotic media as a potential tool for prevention.Despite the backdrop of sex-negative public health practice, there is anecdotal evidence that safer sex, including condom use, can be eroticised and made pleasurable, based on qualitative research by The Pleasure Project and other like-minded organisations. Yet there is a need for more research on the effectiveness of pleasure components in sexual health interventions, particularly in high-risk contexts. This need has become urgent as practitioners look for new ways to promote sexual health and as new prevention technologies (including female condoms and microbicides) are introduced or disseminated.     

Strange bedfellows: the history of collaboration between the Massachusetts Restaurant Association and the tobacco industry

OBJECTIVES: This article examines the historical relationship between the tobacco industry and the Massachusetts Restaurant Association, a nonprofit trade association aligned with the food and beverage industry. METHODS: The study analyzed data from Web-based tobacco industry documents, public relations materials, news articles, testimony from public hearings, requests for injunctions, court decisions, economic impact studies, handbooks, and private correspondence. RESULTS: Tobacco industry documents that became public after various state lawsuits reveal that a long history of collaboration exists between the Massachusetts Restaurant Association and the tobacco industry. For more than 20 years, their joint efforts have focused primarily on the battle to defeat state and local laws that would restrict smoking in public places, particularly in beverage and food service establishments. The resources of the tobacco industry, combined with the association's grassroots mobilization of its membership, have fueled their opposition to many state and local smoke-free restaurant, bar, and workplace laws in Massachusetts. CONCLUSIONS: The universal opposition of the Massachusetts Restaurant Association to smoking bans in food and beverage establishments is a reflection of its historic relationship with the tobacco industry.     

Air pollution and health: bridging the gap from sources to health outcomes: conference summary

??Air Pollution and Health: Bridging the Gap from Sources to Health Outcomes,?? an international specialty conference sponsored by the American Association for Aerosol Research, was held to address key uncertainties in our understanding of adverse health effects related to air pollution and to integrate and disseminate results from recent scientific studies that cut across a range of air pollution-related disciplines. The Conference addressed the science of air pollution and health within a multipollutant framework (herein ??multipollutant?? refers to gases and particulate matter mass, components, and physical properties), focusing on five key science areas: sources, atmospheric sciences, exposure, dose, and health effects. Eight key policy-relevant science questions integrated across various parts of the five science areas and a ninth question regarding findings that provide policy-relevant insights served as the framework for the meeting. Results synthesized from this Conference provide new evidence, reaffirm past findings, and offer guidance for future research efforts that will continue to incrementally advance the science required for reducing uncertainties in linking sources, air pollutants, human exposure, and health effects. This paper summarizes the Conference findings organized around the science questions. A number of key points emerged from the Conference findings. First, there is a need for greater focus on multipollutant science and management approaches that include more direct studies of the mixture of pollutants from sources with an emphasis on health studies at ambient concentrations. Further, a number of research groups reaffirmed a need for better understanding of biological mechanisms and apparent associations of various health effects with components of particulate matter (PM), such as elemental carbon, certain organic species, ultrafine particles, and certain trace elements such as Ni, V, and Fe(II), as well as some gaseous pollutants. Although much debate continues in this area, generation of reactive oxygen species induced by these and other species present in air pollution and the resulting oxidative stress and inflammation were reiterated as key pathways leading to respiratory and cardiovascular outcomes. The Conference also underscored significant advances in understanding the susceptibility of populations, including the role of genetics and epigenetics and the influence of socioeconomic and other confounding factors and their synergistic interactions with air pollutants. Participants also pointed out that short- and long-term intervention episodes that reduce pollution from sources and improve air quality continue to indicate that when pollution decreases so do reported adverse health effects. In the limited number of cases where specific sources or PM_2.5 species were included in investigations, specific species are often associated with the decrease in effects. Other recent advances for improved exposure estimates for epidemiological studies included using new technologies such as microsensors combined with cell phone and integrated into real-time communications, hybrid air quality modeling such as combined receptor- and emission-based models, and surface observations used with remote sensing such as satellite data.     

The importance of community mobilization in interventions to improve sexual,reproductive, and maternal health outcomes: A review of the evidence

Community participation, engagement, and mobilization are common components of many sexual, reproductive, and maternal health (SRMH) programs, but little consensus exists among researchers on how critical these program components are. Using principles of realist review, we reviewed a spectrum of community mobilization interventions to evaluate their use in improving five SRMH areas. Consistent with theoretical assumptions, we found that actively involving community members in leading intervention activities and/or taking ownership tends to produce better SRMH outcomes than simply relying on community members as implementers. Despite this, many fewer programs exist with this meaningful level of engagement than with more cursory engagement.     

National environmental public health tracking program: bridging the information gap

In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program's academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.     

Adolescents' perceptions of maternal disapproval of sex: relationship to sexual outcomes.

PURPOSE: To examine the relationship between adolescents' perceptions of maternal abstinence attitudes, adolescent-maternal relationship satisfaction, and the occurrence in the ensuing 12 months of: (a) sexual intercourse, (b) the use of birth control at intercourse, and (c) the occurrence of pregnancy. We also examined the accuracy of adolescents in perceiving the attitudes of their mothers as well as factors that predicted underestimations of these attitudes. Finally, the study evaluated the relative predictive power of adolescent perceptions of maternal abstinence attitudes and the actual maternal abstinence attitudes. METHODS: This was a prospective study using a subsample of the Longitudinal Study of Adolescent Health database, which is a nationally representative school-based sample. The sample for the present study was approximately 10,000 adolescents in grades 7 to 11 who completed 2 interviews in their homes at a 1-year interval. Mothers of the adolescents were interviewed only during Wave 1. Interviews covered a variety of topics, including adolescent risk behaviors and family relationships. Measures at Wave 1 were used to predict outcomes at Wave 2, employing logistic and multiple regression techniques. RESULTS: Adolescents' perceptions of maternal attitudes toward the adolescents' engaging in sexual intercourse, and adolescent satisfaction with the maternal relationship were predictive of the occurrence of sexual intercourse between Wave 1 and Wave 2, as well as the occurrence of pregnancy. The more disapproving adolescents perceived their mothers to be toward their engaging in sexual intercourse and the more satisfied adolescents were with their relationship with their mothers, the less likely adolescents were to initiate sexual activity or to become pregnant. Only relationship satisfaction was predictive of the use of birth control, such that more satisfied adolescents were more likely to use birth control at their most recent intercourse. The correlation between adolescent perceptions of maternal abstinence attitudes and actual maternal attitudes was .26. Adolescent perceptions of maternal attitudes tended to be a more consistent predictor of outcomes than actual maternal attitudes. CONCLUSIONS: The results are consistent with a growing body of literature that suggests the importance of adolescents' perceptions of maternal attitudes in determining sexual risk behaviors. Adolescents may misperceive the attitudes of parents, suggesting the need for communication between parent and teen.