Light treatment for postpartum depression

If one good thing came from Tom Cruise's public insult of Brooke Shields - and the cadre of new mothers who have taken antidepressants for postpartum depression (PPD) - it's that people started paying attention to a disorder that is often hidden because of fear and stigma.

Postpartum depression is characterized by any of the following symptoms over a 2-week period or more within the first year after delivery: restlessness, irritability, sadness, hopelessness, feeling overwhelmed, crying a lot, having little energy or motivation, appetite changes, sleep disturbances, difficulty focusing, remembering or making decisions, feeling worthless or guilty, loss of interest in pleasurable activities, withdrawal from friends and family, headaches, chest paints, heart palpitations, hyperventilation, not having interest in the baby, and thoughts of hurting the baby or oneself. There are a number of contributing causes of PPD. These include rapid changes in hormonal levels (specifically progesterone and estrogen) after delivery, low thyroid levels, exhaustion from delivery, broken sleep patterns, feeling overwhelmed by parenting responsibilities, doubting one's ability to be a "good" mother, stress resulting from changes at work and home, feeling a loss of one's pre-pregnancy identity, having less free time, and having less control over time.

The two most common treatments for PPD are talk therapy and antidepressants. Findings from a study released this month, however, show that light therapy may be a promising new treatment, especially for women who refuse medication because they are breastfeeding or simply do not like the idea of taking medicine. Light therapy involves exposure to specific wavelengths of light, or very bright full-spectrum light, for a prescribed amount of time. It has been used successfully to treat a variety of conditions, including acne, seasonal affective disorder, and non-seasonal depression.

Researchers in Canada studied the effects of light therapy on 15 women who had a diagnosis of PPD but who were not taking antidepressants. The women were assigned to one of two treatment groups: 30 minutes of daily light exposure between 7AM and 9AM using a 10,000-lux bright light or 30 minutes of daily light exposure between 7AM and 9AM using a 600-lux red light. After 6 weeks of light therapy, both groups of women showed significant reductions in their depressive symptoms, with an average of 49% improvement. Additionally two women (one in each group) experienced a complete remission, or absence of PPD symptoms.

While these findings are encouraging, this study followed a small number of patients, and the authors acknowledge that more work needs to be done to determine whether this approach is as useful for PPD as it is for seasonal affective disorder. Additionally, none of the patients were suicidal, so nothing can be said about how light therapy might work for women with more severe symptoms. However, the upside is that more treatment options offer women more control over how their depression is managed, which can improve the ability to cope with the disorder.

If you are interested in learning more about light therapy, the Mayo Clinic has a nice piece with information about the risks and benefits. You also can talk to your doctor or mental health care provider about whether light therapy may be worth a try.

What you think about your depression affects how you cope

When you are diagnosed with a mental health problem such as depression, one issue you have to face is how to deal with the diagnosis. Research suggests that women generally use what's called "emotion-focused coping," which includes crying, dwelling on the causes and implications of their depression (aka ruminating), and seeking support from others. (Versus men who cope by distracting themselves with hobbies, sports, alcohol, and drugs.)

A study published this month shows that people's emotional reactions to their depression diagnosis affect how they cope. Researchers interviewed 189 patients (133 women) in a primary care clinic who were taking antidepressants. They found women who believed their depression would have a greater negative impact on their lives used more maladaptive coping strategies, such as blaming themselves, ruminating about their illness, and disengaging from others. On the other hand, women who perceived they had some control over their depression and who believed their depression was caused by an identifiable stressor (such as relationship or job difficulties) used more active coping strategies, such as planning, acceptance, problem-solving, reframing the illness positively, and religious/spiritual supports.

Why do coping strategies matter? The researchers suggest that maladaptive coping may actually worsen depressive symptoms, while active coping may help to lessen them. Further, women in particular may benefit from strategies that increase their active coping skills and improve their sense of control over their disorder.

If you have been diagnosed with depression, it may be helpful to talk to your mental health care provider about how the diagnosis has affected you emotionally. You also may ask your provider to give you more detailed information about your depression, such as: how long you can expect to have symptoms, whether the symptoms will wax and wane or decrease gradually over time, how the symptoms will affect you in the short- and long-term, how the treatment will affect you short-term and over time, and how long your provider expects you will need treatment. The answers to these questions will vary for different people, and also can vary for the same person for different depressive episodes, depending on the severity of the episode. Having open and clear communication with your provider can assist you in developing a sense of control over your depression and help you to manage your illness constructively as you heal.

Cod Liver Oil for Depression

Omega-3 fatty acids have been shown to protect against disease, including coronary heart disease and cancer. A new study shows that omega-3s also may be useful for depression.

Researchers examined a community-based sample of nearly 22,000 people in Norway. They found that people who took daily cod liver oil, which is rich in omega-3s, were significantly less likely to have high depression symptoms than people who did not consume daily cod liver oil. These calculations were adjusted for other factors associated with depression, including age, smoking habits, alcohol use, exercise habits and use of antidepressants and lithium. Additionally, these researchers found that the longer individuals used cod liver oil, the lower their risk for depressive symptoms.

The dose of cod liver oil that was studied was 0.7 - 1.2 grams of omega-3 fatty acids. Of this, 0.3-0.6 was DHA, which can reduce blood triglycerides, and 0.3-0.6 was EPA., which is thought to lower inflammation. Additionally, the cod liver oil supplements contained vitamins A, D, and E.

Based on this study, cod liver oil or another omega-3 fatty acid supplement might be a useful addition to your diet, especially if you have a family or personal history of depression. In addition to supplements, fish such as wild salmon, herring, mackerel, anchovies, and sardines are great sources of omega-3s. Do be mindful, however, that omega-3 supplementation isn't for everyone. There are some risks, including increased bleeding in patients taking aspirin or coumadin, reduced glycemic control in diabetics, and increased susceptibility to bacterial infection due to a suppressed immune system. Be sure to talk to your doctor to weigh the risks and benefits before you add supplements. Meantime, a little extra fish in the diet never hurt anyone.

Depression screening and a note about next week

I had a request for "as much information as I could provide" on women and depression. Next week I'll be doing a 5-part series on recent research on depression, including some new findings on treatment.

If you have requests for future topics, please feel free to send them to me at leighann [at] uky [dot] edu. Meantime, here's an online depression screening tool sponsored by the Department of Psychiatry at New York University's School of Medicine. If you have had a history of depression, or think you might be prone to a depressed mood, you may want to periodically check in with yourself using this tool. It may give you an idea of whether you have symptoms that warrant seeking help from a mental health professional.

If you decide to use this tool, please note the disclaimer on its use, taken from the NYU website [ODST=Online Depression Screening Test]:

"ODST is a preliminary screening test for depressive symptoms that does not replace in any way a formal psychiatric evaluation. It is designed to give a preliminary idea about the presence of mild to moderate depressive symptoms that indicate the need for an evaluation by a psychiatrist."

Is work getting you down?

My colleague and I have done a bit of research on job quality and mental health, so this study caught my attention - especially since it's a study of folks born around the same time I was.

Researchers studied over 800 employed men and women born between 1972 and 1973 in New Zealand. They looked at the stress these folks experienced at work, including psychological job demands (e.g., work load and time pressures), physical job demands (e.g., heavy lifting and work hazards), control over what work gets done and when, and social support from colleagues and supervisors. They also examined their mental health - specifically anxiety and depression.

After adjusting their calculations for income level, a history of a mental health disorder in adolescence, having a generally negative personality, and other job stressors, they found that women who reported having high psychological job demands were 75% more likely to have depression or anxiety than female workers with low psychological job demands. In fact, when they analyzed the data over time, they found that high demand jobs were linked to new cases of depression and anxiety in workers without any history of either disorder prior to entering the labor force.

Most people who work experience job stress at one point or another. However, it's clear from this study that strategies for reducing stress are in order. Yoga, meditation, and breath work are great tools that I use. And anything that gets your heart pumping and gives your head a rest is always good. You also may want to talk to your supervisor about ways to minimize job stress, such as getting more help with job responsibilities or adjusting deadlines if possible. This can help to reduce your risk for depression and anxiety and improve your quality of life and well-being.

Sex after Cancer

Last week I wrote about a study that showed long-time survivors of vaginal and cervical cancers experienced sexual problems, including lack of desire, painful intercourse, and inability to have an orgasm. I'm thrilled to report there are some folks in the field who care about this issue and want to help.

In a study published this month in the Archives of Sexual Behavior, researchers developed and tested a brief (3 session) intervention to treat female sexual arousal disorder (FSAD) in women with gynecologic cancer. FSAD is characterized by the inability to maintain arousal and vaginal lubrication during sex. The one-hour sessions included educational information, cognitive and behavioral therapy, and mindfulness training in three main areas: (1) sexual arousal, (2) orgasm, sexual desire, and sexual distress, and (3) quality of life, depression, and relationship satisfaction.

The brief intervention indeed helped. The women experienced improved sexual response, including genital arousal (yes, they actually checked this with a probe, some erotica, and a locked door - see the article if you're interested in more details), orgasm, and satisfaction with sex. Additionally, the women had less depression, and greater overall quality of life.

The downside of this study is that it was small - only 22 women participated - so they need to repeat the study with larger and more diverse groups of women to ensure this positive effect was not just the result of giving the program to a group of highly motivated women. Meantime, I'm just happy that someone is taking the time, energy and effort to develop such an intervention. They've been taking care of men's sexual health after cancer for a good decade now - it's about time we catch up.

Marital silence can be deadly

Every marriage has conflict - that's just part of being married. However a new study shows that over time women who do not speak up during marital conflicts are four times as likely to die than women who express themselves openly during arguments. These same women are also more likely to have depression and irritable bowel syndrome.

These findings emerged from a 10-year study that examined heart health and overall death rates for 3,682 men and women. The researchers adjusted their calculations for other risk factors of heart disease and death, including age, blood pressure, body mass index, smoking, diabetes, and cholesterol levels. Interestingly, other aspects of marriage, including self-rated marital happiness, marital satisfaction, and types and numbers of disagreements were not related to heart disease or death in women.

It seems there is a health promotion theme this week: speak up! to your partner, to your doctor. Stating openly and honestly what you're thinking and how you're feeling can improve your health and help you live longer. And if you're not feeling confident about your ability to speak your mind the next time you have a spat with your spouse, here are some tips to start. If these suggestions seem out of reach, a professional counselor also may help. Take the steps necessary to build confidence in your ability to constructively speak your mind - your quality of life and longevity may depend on it.

Eat Better, Breathe Easier

Most everyone knows that eating a diet high in fruits, vegetables, whole grains, and lean meats reduces the risk of a number of diseases, including cancer and obesity. A study published this month shows that a healthy diet also reduces the risk of chronic obstructive pulmonary disease, or COPD. COPD occurs when the tubes that carry air in and out of the lungs are partially blocked, making it difficult to breathe. This finding is especially significant for women, because the COPD death rate for women nearly tripled between 1980 and 2000.

Smoking and second-hand smoke exposure are the main culprits of COPD, but not all smokers contract COPD. Additionally, this new study shows that even exsmokers had a lower risk of contracting COPD if they primarily consumed healthy foods. Also interesting: lean women (those with a body mass index less than 21) who consumed a higher fat diet with more refined sugars were more likely to contract COPD whether or not they exercised regularly.

Often smoking and poor eating habits go hand-in-hand, so it's clear that women who smoke are at an even greater risk for developing COPD than previously thought. However, these new findings also suggest that even women who used to smoke can help reduce their future risk for COPD by improving their diets. There are a number of resources available to improve eating habits. Here's a sample. Also visit with your doctor, who may be able to tell you about local resources in your community.

As for smoking...let's all breathe easier.

Dr. X, You're Fired! (No, this isn't a post on Donald Trump)

There was an interesting article on CNN this week about knowing when to find a new doctor. I thought I'd share, as there are some key points to consider when evaluating your relationship with your physician. The experts quoted suggest you should fire your doctor when:

(1) You don't think your doctor is listening to you.
(2) Your doctor becomes annoyed, frustrated, condescending, or expresses dislike when you ask questions.
(3) Your doctor can't explain what's going on with you in a way that you understand.
(4) You feel badly when you leave the doctor's office.
(5) You don't like your doctor, or you think your doctor doesn't like you.

As women we sometimes find it difficult to speak up for ourselves. However, it's very important that we do, especially because some diseases (like heart disease) look symptomatically different for women than men. Doctors don't always listen, either. One of the experts quoted wrote in a recent book about a case he had as a young doctor. A female patient complained about indigestion that he chalked up to complaining and whining. It turned out the woman had a torn aorta and she died.

So be proactive about your health and frank with your doctor about what you're feeling. Your health depends on it. And if your doctor makes you feel badly for expressing concerns or doesn't listen to what you're saying, it's time to move on.

Weight Matters in Pregnancy: Part III

Last week I wrote two posts about how excess weight during pregnancy may result in poor infant outcomes, including large for gestational age newborns and a variety of birth defects. A study published this week provides further evidence for watching weight before and during pregnancy - only this time the evidence focuses on moms.

After reviewing long-term medical data from over 37,000 women who had live births in Israel, the researchers found that women who were diagnosed with gestational diabetes (diabetes during pregnancy) had increased risk for later cancer of the pancreas. They did not find the same cancer risk for women who had insulin-dependent (type I) diabetes.

What does this have to do with obesity, you ask? One of the primary risk factors for gestational diabetes is a high body mass index (BMI). And research shows that more and more women are being diagnosed with gestational diabetes - which is not surprising given the growing problem of overweight and obesity in the United States. So, I’ve said it before and I’ll say it again: If your BMI is high and you’re thinking about pregnancy, you may want to talk to your doctor about how to lose weight first. It’s a decision that will improve not only your baby’s health, but your own.

Making Babies Part II - Alternative Therapies

I had a request for information about yoga for infertility, so I did some investigating. When I say investigating, it means I checked PubMed, which is considered "the source" for medical research. Here's what I found.

To date, no published studies have actually documented yoga in relation to fertility outcomes (so here's a novel study idea for the complementary and alternative medicine [CAM] researchers out there). However, a single article on yoga and meditation for infertility published in the journal Fertility and Sterility did suggest that yoga and meditation can help patients to handle the challenges of fertility treatments, including developing patience (which is a requirement when first attempts at assisted pregnancy fail), reducing overall stress, and growing more in touch with their bodies.

Studies have documented, however, the use of acupuncture as an adjunct therapy to infertility treatments, and specifically IVF. A recent review of these studies suggested that acupuncture may indeed be a useful aid in improving the success rate of IVF, as well as improving the quality of life of women who undergo it.

According to another review of the effectiveness of vitamins and herb supplements, too few studies have been conducted on how well they work for infertility. However, the author noted preliminary evidence suggests chasteberry, antioxidants, and Fertility Blend may have some benefit.

One thing that is important, couples who decide to use CAM therapies in conjunction with fertility treatments should inform their doctors, so they can be certain doctor-prescribed therapies are not contraindicated with the naturopathic remedies. Also, while there are no published studies on the subject, if you do want to try yoga for infertility you might find some ideas here.

(Note: As stated in my sidebar, always check with your doctor before starting any physical activity.)

Making Babies - Assisted Reproductive Technology Style

Anyone who has had fertility issues knows that it is a huge investment emotionally, physically, psychologically, and financially. Of the many things to think about when undergoing fertility treatment, one issues has been how to factor in the relationship between fertility treatments today and possible breast cancer tomorrow. Does the benefit of having a child outweight the risk of possible future disease that may take you from your child at some point?

A new study may help couples answer this question. Danish researchers reviewed records of over 54,000 women who received fertility treatments to investigate the suspected link between fertility drugs and breast cancer. They found there was no overall increase in breast cancer risk after using the most common of fertility drugs, including gonadotrophins (e.g., Factrel, Lutrepulse, Relisorm), clomiphene citrate (clomid), human chorionic gonadotropin (e.g., Novarel, Ovidrel, Pregnyl, Profasi), or gonadotropin-releasing hormone (e.g., Lupron, Synarel). There also was no relationship with how many cycles the woman received fertility treatments.

The study did show, however, that women who used progesterone were three times as likely to develop later breast cancer risk. There also was a slightly elevated breast cancer risk for women who had never had children and used gonadotropins.

If you are considering or undergoing fertility treatments and you are using some of the more common drugs, hopefully this study will give you some peace of mind. However, if you're being prescribed progesterone or gonadotropins, this study suggests that a frank discussion with your doctor about the risks and benefits is in order. Your future health may depend on it.

What's sex got to do with it?

Apparently a lot, according to a new study published in Gynecologic Oncology this month. In the first (!!) study of its kind, researchers examined the sexual health and functioning of long-time survivors of vaginal and cervical cancers. Compared to similar women without cancer, the cancer survivors were more likely to experience a variety of sexual problems, including lack of desire, painful intercourse, inability to have an orgasm, vaginal dryness, and anxiety about their sexual performance. Further, despite the fact that most of these women had their sexual organs removed or destroyed during their cancer treatments, only one-third of doctors actually talked to these women about their sexual health.

The lack of talking isn't for lack of wanting to talk either - at least not on the patients' part. Most of the cancer survivors surveyed believe sex is an important part of life and they want their doctors to discuss their sexual health. So why aren't they?

It's no secret that we Americans have a lot of hang-ups when it comes to sex. Just take a look at your neighborhood abstinence-only (sex) education program ("zippers closed, buttons buttoned") to see that. But we're talking about consenting adult women (average age = 49 years), nearly three-fourths of whom were married and several more who were in long-term partnerships. In my view, doctors need to step it up and take responsibility for initiating conversations about sexual health with female patients. Further, these conversations need to occur not only with cancer survivors, but with all women across the lifespan, and especially as women age and hormonal shifts affect sexual health and functioning.

While I would like to think my call to arms will inspire physicians to talk to their patients about sex and sexual functioning, it's clear from this study that women unfortunately can't depend on their doctors to initiate such conversations. Rather, women need to be proactive partners in their health care, and sometimes this means bringing up difficult conversations. ("Well, Dr. X, I'm not having orgasms when I make love to my husband.") Women deserve to enjoy sex in the same way as men - and the way that little blue pill flies off the shelves, my guess is men are enjoying it fully, doctor-approved.

Moms Get "A" for Minding Children's Health

Single moms often receive a lot of flack for, well, being single moms, whereas single dads are patted on the back for "stepping up" to their parenting responsibilities. A study published online this week should give single moms a boost, however. Apparently, when it comes to their children's health, single moms are way ahead of single dads in terms of health behaviors.

Researchers examined data from over 62,000 children (0-17 years) in the United States. They found that only 1/2 of children in single-father families saw a doctor for a check-up. Conversely, more than 2/3 of children in single-mother households received a "well-child" check-up. Further, children in single-mother families had a lower risk of drug use, had fewer problems in school, and exhibited fewer risky behaviors compared to children in single-father families - all this despite the fact that single moms are more likely to be poor, which is a risk factor for both limited health care access and a variety of health problems.

Why are moms better than dads at getting their kids in for a check-up? The authors of the study suggest that single moms may have a better grasp of the public programs available to them. The authors also suggest that dads may be bigger risk-takers, whereas moms don't want to take a chance with their children's health. Clearly, this is an area for more research. Meantime, single moms everywhere should be applauded for taking care of their children's health.

Weight Matters in Pregnancy: Part II

If my previous post on weight matters in pregnancy didn't convince you that starting your pregnancy obese can be bad for your baby, findings from a study published this week just might.

Researchers reviewed the birth outcomes of more than 4,000 women in eight states over a five-year period. They found that mothers who were obese (defined as a body mass index of 30 or greater) prior to pregnancy were significantly more likely to have infants with birth defects, including spina bifida, heart deformities, malformed rectums, hypospadias (abnormal opening of the urethra in males), short or missing limbs, hernias in the diaphragm, and abdominal wall defects. These researchers made sure that this was an obesity issue by not including infants whose birth defects had a known or suspected genetic cause and adjusting their calculations for women who took folic acid, which has been shown to reduce some birth defects.

I may sound like a broken record here, but the evidence continues to mount regarding the need to address overweight and obesity, especially among women of childbearing age. Additionally, given that: (1) Kentucky's rate of neural tube defects (such as spina bifida) is 1.5 times the national average; (2) birth defects are the leading cause of infant mortality in Kentucky; and (3) we already know that we're the fifth heaviest state in the nation, we've got some work to do if we want to meet our goals for improved birth outcomes in the Commonwealth.

FREE Antibiotics (yes, your contacts are working)

Although this blog is primarily dedicated to relaying research findings, every now and then a story will capture my interest that I have to share.

This week, Publix (a major supermarket in the South and one I used to frequent when I lived in Athens, GA) announced that they will be offering a FREE prescription drug program at all of its 684 pharmacies for the 7 following antibiotics: Amoxicillin, Cephalexin, Sulfamethoxazole / Trimethoprim (SMZ-TMP), Ciprofloxacin (excluding ciprofloxacin XR),
Penicillin VK, Ampicillin, and Erythromycin (excluding Ery-Tab).

Anyone (that's right, anyone - no income or insurance requirements to be met) who has a prescription can receive up to 14 day's worth of the above antibiotics, which will be filled free of charge. Furthermore, Publix is not limiting the number of prescriptions customers may fill. So if you get a sinus infection every month for the rest of the year and need antibiotics each month, you can get your medicine for free each time. (Of course, if that's the case, I might recommend a new doctor.)

As a researcher who studies low-income families, I am thrilled that Publix has taken this step. There are so many documented cases of families choosing among rent, food, and medicine. In fact, next week a student and I will be presenting on unmet health care needs at a conference on rural women's health sponsored by the Office of Women's Health. One of our findings in this low-income group was that the women with acute needs (i.e., unexpected illness or injury) did not fill their prescriptions. There will be more to come on our research next week. For now, I'm excited about this trend of companies stepping up to help families meet their economic and health care challenges. And, if you live in Alabama, Florida, Georgia, South Carolina, or Tennessee, find the Publix nearest you and take advantage of this great opportunity.

Om Sweet Om

As a long-time yoga practitioner and instructor, I am always interested in new research on the benefits of yoga practice. Two recent studies suggest that yoga can both boost your mood and improve your migraines.

In one recent study, researchers compared the effects of one hour of reading to one hour of practicing yoga on brain functioning. They found the yoga practitioners had a 27% increase in GABA levels, while the readers experienced no change. GABA is the primary inhibitory neurotransmitter in the central nervous system, and low levels of GABA are associated with mood disorders, including depression, anxiety, and manic-depression (bipolar).

In a randomized controlled trial of yoga versus self-care for migraine sufferers, the patients who were randomly assigned to yoga showed significant improvements over those assigned to self-care in headache intensity, frequency, and pain levels. The yoga practitioners also had significant reductions in symptoms of anxiety and depression and use of migraine medications compared to those in the self-care group.

Other research suggests that yoga can improve quality of life in breast cancer patients, decrease seizure activity in individuals with drug-resistant epilepsy, improve gastrointestinal symptoms in adolescents with irritable bowel syndrome, and improve chronic lower back pain. Sound too good to be true? Learn more and judge for yourself. Meanwhile I'll keep doing my sun salutations. Namaste.

Weight Matters in Pregnancy

Ask the average woman how much weight she should gain during pregnancy, and she'll probably respond 25-35 pounds. This Institute of Medicine guideline has been the practice for nearly 20 years. However, this recommendation is for normal weight women (i.e., body mass index [BMI] 18.5-24.9). The IOM also recommends that overweight and obese women limit their gestational weight gain according to their prepregnancy BMI.

A recent study, however, shows that many overweight and obese women are not limiting their weight gain during pregnancy, and this can have serious consequences for both the mother and newborn. In their study of over 7,500 women, researchers found that 64.3% of overweight and 52.9% of obese women gained more weight during pregnancy than recommended by the IOM for their BMI. Further, overweight and obese women were more likely to deliver by C-section and give birth to infants who were large for gestational age, with associated complications including the infant’s anterior shoulder becoming stuck above the pubic bones during delivery, birth canal lacerations, and fetal hypoglycemia (low blood sugar). Overweight/obese women also were less likely to initiate or continue breastfeeding beyond 10 weeks.

So if you are planning to become pregnant in the next year, take a look at your BMI. If you're above 25, talk to your doctor about steps to lose weight. Further, once you become pregnant, keep an eye on your diet and the scale. Pregnant women need only an additional 300 calories per day. By watching your weight before and during pregnancy, you'll not only improve your own health, but you'll also improve the health of your baby.

Stop Smoking, Start Gaining?

Many women who smoke say they are afraid to stop smoking for fear of gaining weight. However, new research suggests that reductions in smoking rates had less than a 1% effect on increased rates of obesity nationwide. Further, a forthcoming study shows that among weight-concerned smokers trying to quit, nicotine has only a small and temporary effect on weight maintenance.

What does contribute to weight gain? A social network analysis of over 12,000 people between 1971 and 2003 showed that friends and family are key. Individuals were 57% more likely to become obese if a friend became obese, 40% more likely if a sibling became obese, and 37% more likely if a spouse became obese. Further, same sex friends and family members had more influence on weight gain than opposite sex friends and family members.

So if you're worried about how quitting smoking might affect your waistline, fret no more. And whether you smoke or not, do take a look around your inner circle. If you see women friends and family members packing on the pounds, you may want to suggest a walk as opposed to a meal when spending time together.

ATTENTION MOMS: GOT STRESS?

Well, duh, you say. Just the fact that you are a mom means you have stress. It's also not news to you that more stress means worse mental health. However, researchers have found that the source of your stress matters. Using nationally representative data, these researchers identified three key predictors of poor mental health:

(1) lack of support, including nobody to provide you emotional help with parenting or give you a break when you need it;

(2) spending too much time with your child. That's right too much time - moms who think they don't spend enough time with their kids don't experience the same negative mental health effects; and

(3) difficulty paying for child care. Other financial difficulties, such as trouble paying for medical care or supplies for the child, lack of health insurance for the child, and missed or delayed health care for the child did not produce the same negative mental effects.

Further, these authors found that having more than one stressor exponentially increased the likelihood that moms experience poor mental health. Moms with two or more stressors were nearly 12 times as likely to have poor mental health compared to moms with no stressors (apparently these women exist, but I have yet to meet them).

So what does this all mean for moms out there? It means get help when you need it - ask your partner, your family, your friends. It means there really is too much time with your child and not enough time for yourself, so don't feel guilty about taking me-time when you need it. (Recall the last flight you took....first put the oxygen mask on yourself, then help children and disabled passengers.) It means as a society we need to do a much better job of helping working moms with childcare strategies they feel good about. Co-op (pdf) anyone?

Mandate HPV Vaccine for Boys?

A new research finding on HPV is certain to add to the controversy about whether young women should be mandated to receive the HPV vaccine. Wait - did I say young women? It seems this new finding implicates young men. Dr. Laura Koutsky, a researcher at the University of Washington who led some of the original research and clinical trials that resulted in Gardasil, Merck's HPV vaccine, has discovered the presence of HPV under the fingernails of young men.

I'm going to be completely transparent here and say that when I first heard about states (including my own) wanting to mandate the HPV vaccine for school-age girls, I was none too pleased. Don't get me wrong, I'm not against vaccines in general. I have no problem vaccinating against chicken pox, tetanus, diphtheria, pertussis, flu, etc. for a couple of reasons. One - in most cases we're talking about airborne diseases, and two - we're not focusing on one sex or the other - both male and female children and adolescents receive them equally.

I DO have a problem mandating a new vaccine for girls only for a disease that until now was assumed to be contracted solely through sexual contact. Why? For a number of reasons. First, and perhaps most importantly, I believe this is a collaborative decision (read choice) for the parents, the physician, and the patient to make that should involve a very important discussion. By mandating this vaccine, we're removing a potential opportunity for parents to have the "sex talk" with their pre-teens. As dreaded as this talk may be to some parents, allowing families to make the decision about the HPV vaccine opens up an important opportunity to discuss: (1) how HPV gets transmitted (SEX); (2) how you can protect yourself (CONDOMS, ABSTINENCE, TALKING WITH YOUR PARTNER ABOUT PREVIOUS PARTNERS); and (3) the fact that this is just one STD of many (HIV, HERPES, GONORRHEA, CHLAMYDIA, to name a few) that the vaccine doesn't protect you from. My fear is that mandating this vaccine may facilitate parents avoiding "the talk" by giving them a false sense of security about their child's health.

Second, I feel uncomfortable mandating a vaccine that is so new to the market. Despite the best attempts at ensuring the safety of a product, there are enough cases of other products deemed to be safe in clinical trials that ultimately were found to cause severe adverse reactions, including death in some cases. Think Vioxx (another Merck product, by the way), Fen-Phen, and Rezulin among others. I'm uncomfortable with taking the decision-making out of parents' hands when we have no long-term data on the vaccine's safety. I think we need to trust parents and physicians to evaluate the data on their own terms and decide independently whether this is the route they want to choose for their daughters and patients. Not to mention, if there were significant adverse events associated with the vaccine over the long-term, is the government agency that mandated the vaccine going to take responsibility for any adverse outcomes? Somehow I doubt it.

Third (and this is the feminist in me talking) I just don't believe that we'd be mandating a vaccine for young men only. This is why Dr. Koutsky's finding is so important. One of the clear principles of epidemiology is to identify the source of an infection and at-risk populations in order to implement control and prevention strategies. With this principle in mind, scientific evidence that reveals the presence of HPV under the fingernails of young men suggests we need to be targeting young men in our control and prevention strategies - not just rushing to vaccinate all young girls and holding young boys unaccountable for their role in HPV transmission. While the HPV vaccine has some very positive potential, for now I'd like parents to retain the choice about whether to vaccinate until we see more long-term safety data on the vaccine and more research on prevention strategies for young men, including a vaccine for pre-teen boys. If and when such a vaccine hits the market, I'll be interested in seeing how many folks want to mandate it for boys.