Friday, August 21, 2009

Army to offer mental health prevention

Just as congress and, seemingly, every conservative pundit on the planet are up in arms over the prospect of systematic, government-sponsored, proactive or preventive health programming, the Army has quietly moved on its own. Click here or the title for a recent NYT piece describing the plan by the U.S. Army to enroll literally every soldier, family member, and civilian employee in a basic anxiety/depression, aggression and suicidality prevention program. (Enter "army mental health" in the NYT search field to get a host of articles on mental health issues in the military).

The program will be put on by Seligman's group at Penn, using basic CBT reframing and "self-talk" -type procedures. It also appears to be a train-the-trainer delivery model, wherein Sargents and similar level personnel will deliver the actual trainings. This piece is interesting both from a simple peer-delivery perspective, and in terms of facilitating buy-in by the very strata of Army personnel who are stereotyped as least amenable to "touchy-feely" interventions. There also appears to be a major research component, consisting of standard scales administered in a pre- post- design.

Mental health issues in the Army have reached "critical mass" for some time, so they are simply impossible to ignore no matter how stigmatized that entire discourse is in military culture. Vietnam might also have been such a period. However, with the draft soldiers were not required to do the multiple tours that have been so debilitating for Iraq vets: Veterans of Vietnam fell apart after they left the service, not during.

Were other areas of government - and conservatives in general - only as willing to read the data and act on it. Charles Kruthhamer recently had a column denigrating the prospect of preventive care in Obama's health plan, Fox News conservatives have convinced much of the population (even those who lack health care!) that government-run health care could not be other than a disaster, and mental health care continues to be a luxury for a substantial majority of even the insured population.

The military has shown this sort of courage before. The Army was one of the first areas of government to decree racial integration, which was reviled by conservatives at the time as an "experiment" that would certainly fail and was no business of the military anyway. The VA system is one of the first (and largest?) health systems in the U.S. to completely computerize their records, far, far ahead of the private sector. And where are some of the clearest and most credible calls for integrating gays into the military? By military brass. The same civilian conservative politicians who decry health care reform as "socialist" and leading to "death panels" are also the most aggressive homophobes on gays in the military.

I have not found any journal articles on the program, nor seen any actual materials - if any of you come across some please pass along.



Tuesday, August 11, 2009

Withdrawal increasing as STI/pregnancy prevention?

A recent blog post on XX, a women's -oriented web magazine (here) describes data showing that younger women are increasingly using withdrawal rather than condoms for contraception and STI prevention. Apparently there are some data suggesting that withdrawal is almost as effective as condoms in preventing pregnancy, and is strongly preferred, sensation-wise. Of course many STIs are not well prevented by withdrawal.

Is this a variation on the "safer sex burnout" that has been obvious among MSM - particularly younger MSM - for a number of years? Or does it represent a lessening of completely casual sex and an increasing trust in male partners (who, after all, have to do the pulling...). It would be interesting to see data on the social and sexual contexts within which women make a decision to insist on a condom or trust her partner to pull out at the critical time.

If accurate, this trend flies in the face of research and public health efforts to develop more women-controlled contraception and STI prevention devices. Of course by "women-controlled" is meant not just the technology - such as recent major efforts toward microbicides - but the context within which the women is empowered to make key sexual decisions.

Are younger women as tired of condoms as gay men have become and backsliding to an earlier health perspective, or are they now in enough sexual control that they can tell their male partner to pull out on time and fully expect him to actually do so?

Thoughts on this?

(I know the paper posting mechanism is still bad, but the "comments" link works fine).