First World Health Problems

Catalyst VOlume 10

I am a first generation American, as both of my parents immigrated here from Myanmar, a third world country. There had been no occurrence of any Inflammatory Bowel Disease (IBD) in my family, yet I was diagnosed with Ulcerative Colitis at the beginning of my sophomore year of high school. Since IBD is known to be caused by a mix of genetic and environmental factors,^1,2 what specifically triggered me to develop Ulcerative Colitis? Was it the food in America, the air I was exposed to, a combination of the two, or neither of them at all? Did the “environment” of the first world in the United States cause me to develop Ulcerative Colitis?

IBD is a chronic autoimmune disease, characterized by persistent inflammation of the digestive tract and classified into two separate categories: Ulcerative Colitis and Crohn’s Disease.³ Currently, there is no known cure for IBD, as its pathogenesis (i.e. the manner in which it develops) is not fully understood.¹ Interestingly, the incidence of IBD has increased dramatically over the past century.¹ A systematic review by Molodecky et al. showed that the incidence rate of IBD was significantly higher in Western nations. This may be due to better diagnostic techniques or the growth of environmental factors that promote its development. This could also suggest that there may be certain stimuli in first world countries that can trigger pathogenesis in individuals with a genetic predisposition to IBD.

Environmental factors that are believed to affect IBD include smoking, diet, geographic location, social status, stress, and microbes.¹ Smoking has had varying effects on the development of IBD depending on the form; smoking is a key risk factor for Crohn’s Disease, while non-smokers and ex-smokers are usually diagnosed with Ulcerative Colitis.⁴ There have not been many studies investigating the causal relationship between diet and IBD due to the diversity in diet composition.¹ However, since IBD affects the digestive system, diet has long been thought to have some impact on the pathogenesis of the disease.¹ In first world countries, there is access to a larger variety of food, which may impact the prevalence of IBD. People susceptible to the disease in developing countries may have a smaller chance of being exposed to “trigger” foods. In addition, IBD has been found in higher rates in urban areas versus rural areas.^1,4,5 This makes sense, as cities have a multitude of potential disease-inducing environmental factors including pollution, poor sanitation, and microbial exposure. Higher socioeconomic status has also been linked to higher rates of IBD.⁴ This may be partly due to the sedentary nature of white collar work, which has also been linked to increased rates of IBD.¹ Stress used to be viewed as a possible factor in the pathogenesis of IBD, but recent evidence has indicated that it only exacerbates the disease.³ Recent research has focused on the microorganisms in the gut, called gut flora, as they seem to have a vital role in the instigation of IBD.¹ In animal models, it has even been observed that pathogenesis of IBD is not possible in a germ-free environment.¹ The idea of the importance of microorganisms in human health is also linked to the Hygiene Hypothesis.

The Hygiene Hypothesis states that the lack of infections in western countries is the reason for an increasing amount of autoimmune and allergic diseases.⁶ The idea behind the theory is that some infectious agents guard against a wide variety of immune-related disorders.⁶ Animal models and clinical trials have provided some evidence backing the Hygiene Hypothesis, but it is hard to causally attribute the pathogenesis of autoimmune and allergic diseases to a decrease in infections, since first world countries have very different environmental factors than third world countries.⁶

The increasing incidence of IBD in developed countries is not yet fully understood, but recent research points towards a complex combination of environmental and genetic factors. The rise of autoimmune disease diagnoses may also be attributed to better medical equipment and facilities and the tendency of people in more developed countries to regularly get checked by a doctor. There are many difficulties in researching the pathogenesis of IBD including isolating certain environmental factors and obtaining tissue and data from third world countries. However, there is much promising research and it might not be long until we discover a cure for IBD.

References

1. Danese, S. et al. Autoimm Rev 2004, 3.5, 394-400.
2. Podolsky, Daniel K. N Engl J Med 2002,  347.6, 417-29.
3. Mayo Clinic. "Inflammatory Bowel Disease (IBD)." http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/definition/con-20034908 (accessed Sep. 30, 2016).
4. CDC. "Epidemiology of the IBD." https://www.cdc.gov/ibd/ibd-epidemiology.htm (accessed Oct.17, 2016).
5. Molodecky, N. et al. Gastroenterol 2012, 142.1, n. pag.
6. Okada, H. et. al. Clin Exp Immuno 2010, 160, 1–9.

Tactile Literacy: The Lasting Importance of Braille

Catalyst Volume 10

On June 27th, 1880, a baby girl was born. At nineteen months old, the little girl contracted a severe fever, and once the fever dissipated, she woke up to a world of darkness and silence. This little girl was Helen Keller. By the age of two, Helen Keller had completely lost her sense of sight and hearing.

Over a century later, it is estimated that 285 million people are visually impaired worldwide, of which 39 million are blind.¹ Blindness is defined as the complete inability to see with a corrected vision of 20/200 or worse.² For Keller to absorb the information around her, she relied on the sensation of touch. The invention of the braille alphabet by Frenchman Louis Braille in the early 1800s allowed Keller to learn about the world and to communicate with others. Like Keller, the majority of the visually impaired today rely on braille as their main method of reading.

The technological advances of smartphones, artificial intelligence, and synthetic speech dictations have opened a whole new world for blind readers. With the advent of the electronic information age, it’s easy to think that blind people don’t need to rely on braille anymore to access information. In fact, braille literacy rates for school-age blind children have already declined from 50 percent 40 years ago to only 12 percent today.³ While current low literacy rates may be in part due to the inclusion of students with multiple disabilities that inhibit language acquisition, these statistics still reveal a major concern about literacy amongst the visually impaired. To substitute synthetic speech for reading and writing devalues the importance of learning braille.

“There are many misunderstandings and stereotypes of braille readers,” says Dr. Robert Englebretson, Professor of Linguistics at Rice University. “When a person reads, they learn about spelling and punctuation, and it’s the exact same for tactile readers. Humans better process information when they actively process it through reading instead of passively listening.”

Dr. Englebretson is also blind, and one part of his research agenda is a collaborative project with Dr. Simon Fischer-Baum in Psychology and pertains to understanding the cognitive and linguistic importance of braille to braille readers. He explores the questions surrounding the nature of perception and reading and explores the ways the mind groups the input of touch into larger pieces to form words.

In order to understand how written language is processed by tactile readers compared to visual readers, Dr. Englebretson conducted experiments to find out if braille readers exhibit an understanding of sublexical structures, or parts of words, similar to that of visual readers. An understanding of sublexical structures is crucial in recognizing letter groupings and acquiring reading fluency. Visual readers recognize sublexical structures automatically as the eye scans over words, whereas tactile readers rely on serially scanning fingers across a line of text.

To explore whether the blind have an understanding of sublexical structures, Dr. Englebretson studied the reaction time of braille readers in order to judge their understanding of word structures. The subjects were given tasks to determine whether the words were real or pseudowords, and the time taken to determine the real words from the pseudowords were recorded. The first experiment tested the ability for braille readers to identify diagraphs or parts of words, and the second experiment test the ability for braille readers to identify morphemes, or the smallest unit of meaning or grammatical function of a word. For braille readers, Dr. Englebretson and his team developed a foot pedal system that enabled braille readers to indicate their answer without pausing to click a screen as the visual readers did. This enabled the braille readers to continuously use their hands while reading. From the reaction times of the braille readers when presented with a morphologically complex word, the findings show evidence of braille readers processing the meaning of words and recognizing these diagraphs and morphemes.⁴

“What we discovered was that tactile readers do rely on sublexical structures and have similar cognitive processes to print readers,” says Dr. Englebretson. “The belief that braille is old-fashioned and not needed anymore is far from the truth. Tactile reading provides an advantage in learning just as visual reading does.”

Dr. Englebretson also gathered a large sample of braille readers and videotaped them reading using a finger tracking system. Similar to an eye tracking system that follows eye movements, the finger tracking system used LED lights on the backs of fingernails to track the LED movements over time using a camera. The movements of the LED lights on the x-y coordinates are then plotted on a graph. This system can track where each finger is, how fast they are moving, and the movements that are made during regressions, or the right-to-left re-reading movement of the finger.⁵ While this test was independent from the experiment about understanding sublexical structures, the data collected offers a paradigm for researchers about braille reading.

The outcome of these studies has not only scientific and academic implications, but also important social implications. “At the scientific level, we now better understand how perception [of written language] works, how the brain organizes and processes written language, and how reading works for tactile and visual readers,” says Dr. Englebretson. “Through understanding how tactile readers read, we will hopefully be able to implement policy on how teachers of blind and visually impaired students teach, and on how to guide the people who are working on updating and maintaining braille.”

With decreasing literacy rates among braille readers, an evidence-base approach to the teaching of braille is as critical as continuing to implement braille literacy programs. With an understanding of braille, someone who is blind can not only access almost infinite pages of literature, but also make better sense of their language and world.

References

1. World Health Organization. http://www.who.int/mediacentre/factsheets/fs282/en/ (accessed Jan. 9, 2017).
2. National Federation of the Blind. https://nfb.org/blindness-statistics (accessed Jan. 9, 2017).
3. National Braille Press. https://www.nbp.org/ic/nbp/braille/needforbraille.html (accessed Jan. 10, 2017).
4. Fischer-Baum,S.; Englebretson, R. Science Direct. 2016, http://www.sciencedirect.com/science/article/pii/S0010027716300762 (accessed Jan. 10, 2017)
5. Ulusoy, M.; Sipahi, R. PLoS ONE. 2016, 11. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148356 (accessed Jan. 10, 2017)

The Secret Behind Social Stigma

Catalyst Volume 10

How do you accurately quantify something as subjective and controversial as discrimination? What about stigma - a superficial mark imposed upon a prototypical group of individuals? How do you attempt to validate what is seemingly invisible? Dr. Michelle “Mikki” Hebl and her team in the Industrial/Organizational (I/O) department of social psychology at Rice University attempt to answer these questions.

In the world of social psychology, where human interactions are often unpredictable, researchers must get creative to control variables as much as possible while simultaneously mimicking real-life situations. Dr. Hebl integrates both laboratory procedures and field studies that involve standardized materials. “My research is fairly novel,” she notes. Unlike the majority of existing stigma and discrimination research, which depends on self-reported assessments, her studies examine real, non-simulated social interactions. Although her approach seeks to provide more realistic and unbiased settings, “it’s messier,” she adds, laughing about the many trials discarded due to uncontrollable circumstances. That attitude— optimistic, determined, and creative—is held proudly by Dr. Hebl. It is clear that her lab’s overall mission—to reduce discrimination and increase equity—is worth undertaking.

Dr. Hebl and her team focus on a form of behavior they call “interpersonal discrimination,” a type of discrimination that occurs implicitly while still shaping the impressions we form and the decisions we make.¹ This kind of bias, rooted in stereotypes and negative social stigma, is far more subtle than some of the more well-known, explicit forms of discrimination. For example, in a field study evaluating bias against homosexual applicants in Texas, Dr. Hebl found that the members of both the experimental and control group, who were wearing hats that said “Gay and Proud” and “Texan and Proud” respectively, did not experience formal bias when entering stores to seek employment. For example, none of the subjects were denied job applications. What she did find, however, was a pattern of interpersonal reactions against the experimental group. Discrete recording devices worn by the subjects revealed a pattern of decreased word count per sentence and shorter interactions for the stigmatized group. Their self-reports further indicated on average a higher perceived negativity and lower perceived employer interest.1 In another study evaluating obesity-related stigma, results showed that obese individuals - in this case subjects wearing obese prosthetic suits - experience similarly negative interactions.²

While many of her studies evaluated biases in seeking employment, Dr. Hebl also explored the presence of interpersonal discrimination against lesser-known groups that experience bias. One surprising finding indicated negative stigmatization against cancer survivors.³ In other studies, the team found patterns relating to stereotypicality; this relatively new phenomena explores the lessened interpersonal discrimination against those who deviate from the stereotypical prototype of their minority group, i.e. a more light-skinned Hispanic male.⁴ A holistic review of her research reveals a pattern of discrimination against stigmatized groups on an implicit level. Once researchers like Dr. Hebl find these patterns, they can investigate them in the lab by further isolating variables to develop a more refined and widely-applicable conclusion.

What can make more subtle forms of bias so detrimental is the ambiguity surrounding them. When someone discriminates against another in a clear and explicit form, one can easily attribute the behavior to the person’s biases. On the other hand, when this bias is perceived in the form of qualitative behavior, such as shortened conversations and body language, it raises questions regarding the person’s intentions. In these cases, the victim often internalizes the negative treatment, questioning the effect of traits that they cannot control—be it race, sexual orientation, or physical appearance. This degree of uncertainty raises conflict and tension between differing groups, thus potentially hindering progress in today’s increasingly diverse workplaces, schools, and universities.⁵

Dr. Hebl knew that exploring the presence of this tension between individuals was only the first step. “One of the most exciting aspects of social psychology is that just learning about these things makes you inoculated against them,” she said. Thus emerges the search for practical solutions involving education and reformation of conventional practices in the workplace. Her current work looks at three primary methods: The first is acknowledging biases on an individual level. This strategy involves individuation, or the recognition of one’s own stigma and subsequent compensation for it.⁶ The second involves implementing organizational methods in the workplace, such as providing support for stigmatized groups and awareness training.⁷ The third, which has the most transformative potential, is the use of research to support reformation of policies that could protect these individuals.

“I won't rest…until we have equity,” she affirmed when asked about the future of her work. For Dr. Hebl, the ultimate goal is education and change. Human interactions are incredibly complex, unpredictable, and difficult to quantify. But they influence our daily decisions and actions, ultimately impacting how we view ourselves and others. Social psychology research suggests that biases, whether we realize it or not, are involved in the choices we make every day: from whom we decide to speak to whom we decide to work with. Dr. Hebl saw this and decided to do something about it. Her work brings us to the complex source of these disparities and suggests that understanding their foundations can lead to a real, desirable change.

References

1. Hebl, M. R.; Foster, J. B.; Mannix, L. M.; Dovidio, J. F. Pers. Soc. Psychol. B. 2002, 28 (6), 815–825.
2. Hebl, M. R.; Mannix, L. M. Pers. Soc. Psychol. B. 2003, 29 (1), 28–38.
3. Martinez, L. R.; White, C. D.; Shapiro, J. R.; Hebl, M. R. J. Appl. Psychol. 2016, 101 (1), 122–128.
4. Hebl, M. R.; Williams, M. J.; Sundermann, J. M.; Kell, H. J.; Davies, P. G. J. Exp. Soc. Psychol. 2012, 48 (6), 1329–1335.
5. Szymanski, D. M.; Gupta, A. J. Couns. Psychol. 2009, 56 (2), 300–300.
6. Singletary, S. L.; Hebl, M. R. J. Appl. Psychol. 2009, 94 (3), 797–805.
7. Martinez, L. R.; Ruggs, E. N.; Sabat, I. E.; Hebl, M. R.; Binggeli, S. J. Bus. Psychol. 2013, 28 (4), 455–466.