Implementation

The intervention that I would set in place for anabolic steroids would be to set up an educational program for any schools that are willing to participate or can accommodate and participate in the program. I believe the most effective way to go about establishing this program is to set aside an hour a week from a class in which every student in the school is required to take before graduation, such as a social science or physical education. Preferably, the high school would require each student to take physical education before graduating and then the program can be established for one hour a week within the class for a semester – approximately nine weeks. This program would target high school students aged 14-18, both males and females. The topics covered in the program would introduce what anabolic steroids are and explain all the negative effects that come from using these steroids. Along with these topics, positive substitutes could also be taught, and having speakers such as current coaches or athletes that are successful without the use of steroids would be a possibility if such opportunities are available. 

There are several barriers to implementation that could arise in trying to set up the intervention. One main intervention is cost, since it would cost a lot of money to set up a program in a large number of schools that would cover the salary of those running the program, as well as the materials and work done within the program itself. This barrier can be dealt with by asking for federal help or heath institutions for help that may support the program, such as the National Institute of Health. Depending on the area, the school system may also be able to contribute to helping establish the program for its students. Another barrier is the infrastructure. Many schools or individual teachers may not want to give up their class time for the program. Many students may also not want to give up an hour from a class like physical education to listen to something that may resemble a lecture. To address this, the schools and teachers can be educated about the increasing prevalence of steroid use within high schools and helping them understand why it is important for their students to participate in such a program. For the students, introducing the program as a fun and interesting experience may help change negative attitudes that some students may initially exhibit. Also, making the program interactive and providing some physical activity such as organized games can make them excited to participate in such a program.

Upon introducing the program to the adult stakeholders, showing data on the current rates of anabolic steroid use and how that number decreases when such programs that educate students on steroids are used can cause them to see the positive points of the program. Also, stressing that most use of steroids begin within the ages of 14-18 can show how crucial this age is for the prevention of steroid use. Having an informational briefing for all of these stakeholders explaining such facts may be an effective way to communicate my strategy, since I would be repeatedly targeting a large group of individuals. As far as the students – those who may or may not use steroids – a similar approach may be used in introducing the program, possibly on the first day of the program, in explaining why it is important and how it will benefit them and will be fun in the process.

At the beginning of the program, I would likely administer a randomized survey among all the students in all the schools participating in the program asking their thoughts on the risks of taking anabolic steroids (are they bad? Is it risky to take?) and then re-administering the same survey amongst the students and seeing how many of their ideas change after the program. Also, taking data on how many students have used steroids each year and then continuously monitoring these numbers for fluctuations after the program has been implemented can be another good way to evaluate the effectiveness of the intervention. My expected outcome would be for the students to associate steroid use with increasing risk and to have less annual anabolic steroid abuse. If such numbers are reported, I will know that the intervention is working; these serve as outcome measures. Process measures could be the ongoing interaction and feedback of the student with the individual running the program classes at that location. 

Interventions

Adolescent anabolic steroid abuse has been a pertinent issue within the last decade in the United States. Due to increased use among teens within the past decade, there have been many implementations as well as programs set in order to try to intervene with this trend. The Anabolic Steroids Control Act of 1990 was the first step towards federal intervention. This act was later amended with the Anabolic Steroid Control Act of 2004 which redefined anabolic steroid to mean any drug or hormonal substance, chemically and pharmacologically related to testosterone (108th Congress, 2004). This law put possession punishable by up to a year in prison and a fine of at least $1000 (Association Against Steroid Abuse). Additionally, selling steroids or even possessing steroids with an intent to sell may face up to five years in prison plus parole and sizable fines . This strategy generally addresses the key determinant of risk factors as well as the ease of attaining steroids.

In addition to this law, there was also prevention programs established for adolescents, targeting mainly teens aged 13-18. The most widespread drug prevention program is ATLAS (Athletes Training and Learning to Avoid Steroids), which is implemented within schools. ATLAS was designed for male high school athletes to attempt to stop drug use and promote healthy diet and exercise alternatives to drugs. The curriculum consists of 10 45-minute interactive classroom sessions and 3 exercise training sessions taught by peer educators, coaches, and strength trainers. In these classes, they discuss sports nutrition, exercise alternatives to anabolic steroids and sports supplements, and the effects of substance abuse in sports (Substance Abuse and Mental Health Services Administration, 2012). With this knowledge, the key determinants of body image and desire to improve performance are addressed since the negatives behind those positives are exposed.

Due to the effectiveness that this form of intervention has proven, the first primary intervention that I would recommend is continual education of adolescents in school on anabolic steroids. The key determinant that this desire in gains in body image by adolescents, which generally encompasses increased muscle mass and strength for males and losing weight for females. There have been several studies and intervention programs that show the success of such educational programs. In teaching teens the effects of anabolic steroids through school, a large sample of individuals can be reached and in turn, many students become more cautious when it comes to using anabolic steroids. For example, in the ATLAS program, since its implementation, there have been more than 1,500 football players from 31 high schools in the Portland area that stopped using steroids (Office of Juvenile Justice and Delinquency Prevention, 2011).

The second form of intervention would tackle behavioral key determinants. It has been documented that about 25 percent of male weightlifters that abused steroids reported memories of childhood physical or sexual abuse. Female weightlifters that were raped were also twice as likely to report use of anabolic steroids when compared to those who had not been raped (National Institute on Drug Abuse, 2001). Also, behavioral problems such as substance abuse, fighting, low self-esteem, and depression are common predictors of adolescent steroid use (Irving, Wall, NeumarkSztainer, & Story, 2002). Due to this fact, individual counseling within the school or suggested by the school for students exhibiting such behaviors or students that personally seek out counseling would benefit from trying to fix the internal issues that may be causing them to take anabolic steroids. This serves as secondary intervention for the students that have already started taking steroids.

A third form of intervention would be active drug testing. This would take into consideration the key determinants of risky behavior of adolescents, as well as the ease to attain steroids by teens since there would be consequences behind taking steroids. According to a 2005 "Monitoring the Future Survey", the annual prevalence of steroid use among males gradually increased, from a 1.5% use in 8th grade to 2.5% use in 10th grade to about a 3.3% use in 12th grade.  Also, between 1998 and 2003, the percentage of 12th-grade students who perceived steroids as risky and disapproved their use dropped from 68% to 55%, despite increased health warnings (National Institute on Drug Abuse, 2001). In order to address the fact that adolescents are becoming increasingly comfortable with the idea of steroids alongside the fact that they are easy to attain, random drug tests for athletes that attend competitions would be a major determinant for the adolescent for whether or not it is worth it to take steroids. This would be secondary prevention since the adolescent would have to have taken steroids to be detected and also primary for students that choose not to take steroids because they know such tests will be conducted.

The best form of intervention for anabolic steroid use among adolescents has seemed to point greatly towards prevention through education of the effects of anabolic steroids. Most individuals that abuse steroids have a false perception of what the steroid can do to help, although are not aware of all the negatives associated with anabolic steroid abuse. Since many individuals will not go out and look for counseling, such programs that are taught in schools to a greater population of students would benefit larger numbers. Also, in active drug testing, the issue of invasion of privacy as well as the costs of doing so both financially and morally within the school system would cause trouble when actually trying to implement them. In addition, athletes are not the only individuals that take steroids, so it would not cover everyone that steroids could affect.

References
Association Against Steroid Abuse . (n.d.). Legal ramifications of steroid abuse. Steroid Abuse , Retrieved from http://www.steroidabuse.com/legal-ramifications-of-steroid-abuse.html

Irving, L. M., Wall, M., Neumark-Sztainer, D., & Story, M. (2002). Steroid use among adolescents: Findings from Project EAT. Journal of Adolescent Health, 30, 243–252.

National Institute on Drug Abuse. (2001). Anabolic steroid abuse . National Insititute on Drug Abuse Research Report series, NIH Pub Number: 06-3721, Retrieved from http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse

Office of Juvenile Justice and Delinquency Prevention. (n.d.). Ojjdp model programs guide . (2011).Athletes Training and Learning to Avoid Steroids (ATLAS), Retrieved from http://www.ojjdp.gov/mpg/Athletes Training and Learning to Avoid Steroids (ATLAS)-MPGProgramDetail-592.aspx

S. 2195--108th Congress: Anabolic Steroid Control Act of 2004. (2004). In www.GovTrack.us. Retrieved April 6, 2013, from http://www.govtrack.us/congress/bills/108/s2195 

Substance Abuse and Mental Health Services Administration. Intervention summary. (2012). ATLAS (Athletes Training and Learning To Avoid Steroids), Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=77

Stakeholders

Stakeholders are individuals that share a stake in an issue at hand that are affected by a particular problem or are affected by what the solution would bring as far as new changes. My problem definition is 'Increasing Hormonal complications Associated with Anabolic Steroid use in the United States among adolescents from 2000 to 2013.' Since my problem definition states the main target - adolescents - the stakeholders would be those most associated with adolescents, meaning the adolescents themselves, their parents, the adolescents' sports coaches and sports teams associated with the individual (if any), and sports divisions that are associated with athletes in this age range.

In order to address the problem of anabolic steroids, there will be stakeholders that would have to be negotiated with as implementations against anabolic steroid use would be set in place. Since steroids are generally not viewed as a positive advantage my sports leauges or by people in general, the focus of the stakeholders that would retaliate against public health implementations are the adolescents themselves that are using these steroids. The motivation for using anabolic steroids range from generally becoming stronger, either for a particular sport or for reasons of appearance, financial gain, and to have a competitive edge in the world of sports. If the anabolic steroids were taken away, the adolescents would, in a sense, have to work on a 'leveled playing field,' and not perform or not look at the high extremes that they would have if on the anabolic steroids.

Some interventions that I would put in place is to possibly provide incentives for those adolescent athletes that perform well in sports without taking steroids. This could be carried out by creating scholarships or grants that would require a drug test before receiving the award, as well as actively seeking out exceptional adolescent athletes and recognizing them for their work. More severe effects would be to enforce punishments for adolescents that use anabolic steroids, such as having to pay a fine or being forced to attend a program for a designated number of hours that would outline the dangers and negatives of using steroids. Another good intervention would be to provide education on steroids to younger populations. In fact, this is an implementation that has been used by the federal government. The program states that the Secretary of Health and Human Services shall award grants to public and nonprofit private entities to enable such entities to carry out science-based education programs in elementary and secondary schools to highlight the harmful effects of anabolic steroids (108th Congress, 2004). In this way, the intervention would be more of a preventative action rather than punishing students already taking the steroids. 

In addressing the adolescents concerns of not having their peak performance as part of my designated solution, the scholarships for clean athletes would take care of the financial incentive as well as add a new light to reason why to train without steroids. Also, by teaching the negative effects of steroids to adolescents, both in appearances and in negative health effects with continual use over time, individuals would hopefully identify that the gains of anabolic steroids are not worth the detrimental effects of hormonal imbalances and therefore unusual changes to the body in the short term and such diseases such as cancer in the long term. 

References 

S. 2195--108th Congress: Anabolic Steroid Control Act of 2004. (2004). In www.GovTrack.us. Retrieved April 6, 2013, from http://www.govtrack.us/congress/bills/108/s2195 

Key Determinants

My problem definition for my paper was as follows: Increasing Circulatory Risks Associated with Pre-workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013. However, due to the fact that it is a topic of recent emergence, not much research has been done on this problem and there are not many sources of statistical data available for reference. As a result, I am modifying my problem definition around the use of performance enhancing drugs – specifically anabolic steroids. My new problem definition is Increasing Hormonal complications Associated with Anabolic Steroid use in the United States among adolescents from 2000 to 2013.

In the United States, an estimated 1 to 3 million people have used anabolic steroids. An estimated 4% to 12% of US high school boys and up to 3.3% of high school girls have used anabolic steroids, confirmed by  2003 Centers for Disease Control report. In a recent study of substance abuse by the National Collegiate Athletic Association (NCAA), an overall usage rate of 1.1% was found across all 3 of its divisions (Cheatham, 2008). These numbers have all been found through surveys given to the respective athletes, but anecdotal infomation suggests more widepread abuse. The purpose of anabolic steroids is to increase their muscle mass and strength; the main anabolic steroid hormone produced by the body is testosterone. For athletes actively taking 6 to 12 week cycles of anabolic steroids, their bodies reacted with negative hormonal effects to their bodies (Cheatham, 2008). In one study of male bodybuilders, more than half had testicular atrophy, which is the shrinking of the testicles, and/or gynecomastia, the development of breasts.  In the female body, anabolic steroids cause masculinization. Breast size and body fat decrease, the skin becomes coarse, the clitoris enlarges, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects become irreversible  (Mayo Clinic Staff, 2012).

The choice of using anabolic steroids is a choice, but there are several factors. The most pertinent to the use of anabolic steroids within adolescents are biological, behavioral, environmental, economic, and political.

In biological key determinants, pre-existing health issues pose as a post-event problem. There have been studies indicating if an individual has a family history of cancer, taking anabolic steroids increases the risk of contracting cancer, particularly liver tumors and cancer and specifically prostate cancer in males. Gender roles also play a large role in biological key determinants. For both male and female users, they may use steroids to improve performance and to improve recovery (The Hormone Health Network, 2009). However, for males it may be more to gain muscle mass, while for females they may try to lose weight, since these are one of the effects of the steroid. Generally, the relative risk for anabolic steroid use is 2 to 3 times higher in men (American Academy of Pediatrics , 1997).

Behavioral key determinants are likely the largest reason for anabolic steroid use. One reason for steroid abuse found is due to sexual trauma. In one series of interviews with male weightlifters, 25 percent who abused steroids reported memories of childhood physical or sexual abuse. Similarly, female weightlifters who had been raped were found to be twice as likely to report use of anabolic steroids compared with those who had not been raped. Moreover, almost all of those who had been raped reported that they markedly increased their bodybuilding activities after the attack. They believed that being bigger and stronger would discourage further attacks because men would find them either intimidating or unattractive ( National Institute on Drug Abuse, 2001). Additionally, some adolescents abuse steroids as part of a pattern of high-risk behaviors. According to a 2005 "Monitoring the Future Survey", the annual prevalence of steroid use among males gradually increased, from a 1.5% use in 8th grade to 2.5% use in 10th grade to about a 3.3% use in 12th grade ( National Institute on Drug Abuse, 2001).

There is also an economic key determinant, which is more prevalent in older adolescent elite athletes in which they take anabolic steroids in order to receive financial gain through securing a spot on a particular team or receiving sponsorship. Also, physically demanding jobs may push an individual to take anabolic steroids. According to the Department of Defense, 3.8% of active duty personnel reported ever using steroids, while 1.9% reported using this within the past year and 1.1% within the past month. The US census has recorded that there are currently 1,468,364 active duty personnel in the United States military (Pearson Education, Inc, 2007).

 Moreover, there are political factors that have tried to control the use of steroids: the Anabolic Steroid Control Act of 2004. While this is not a solid for why someone may want to use anabolic steroids, the implication of the law creates a reason to use it. This policy  amends the Controlled Substances Act to redefine anabolic steroid to mean any drug or hormonal substance, chemically and pharmacologically related to testosterone, as well as directs the Secretary to take action in creating incentives for athletes to not use steroids (108th congress, 2004). Despite this, there are large sales within the black market of illegal anabolic steroids; therefore their is loose policy implementation acquiring these steroids are not an issue for anyone that wants to take them.

The last key determinant has to do with environmental factors. Within sports, there is a very popular culture of competitiveness, and athletes have to go the extra mile in order to secure the position that they desire. In such an environment, the use of performance-enhancing drugs has become increasingly common (Morente-Sánchez, 2013). As athletic competition continues to intensify, athletes strive to higher levels of performance to achieve success. There are surrounding pressures from not only the athlete and the team, but also from their coaches and parents.  However, no longer is this just a problem of the elite athlete; today, the perception that anabolic steroids correlate with athletic success can be found among collegiate and scholastic athletes as well. Also, it is important to keep in mind that 30% to 40% of anabolic steroid users do not participate in a school-sponsored sport. More likely, these users participate in bodybuilding or weightlifting.

In conclusion, with such determinants such as the ease of access to anabolic steroids and the strong desire for enhanced performances by athletes, the most rational solution for this complex issue would be to send out a campaign targeted to adolescents educating them on the harms of steroids, provide some sort of incentives to athletes that do not use anabolic steroids, and possibly regulate the distribution of these drugs better.

References 

American Academy of Pediatrics . (1997). Adolescents and anabolic steroids: A subject review. Committee on Sports Medicine and Fitness, 99(6), 904 -908. doi: 10.1542/peds.99.6.904

Cheatham, S. A. (2008). Performance-enhancing drugs and today’s athlete: A growing concern. Orthopedics,31(10), Retrieved from http://www.healio.com/orthopedics/sports-medicine/journals/ortho/{93d32e5b-a2c8-4c5c-8e0c-d600a3fee2b3}/performance-enhancing-drugs-and-todays-athlete-a-growing-concern

The Hormone Health Network. (2009). Hormone abuse overview. Abuse , Retrieved from http://www.hormone.org/Abuse/overview.cfm

Mayo Clinic Staff. (2012). Performance-enhancing drugs: Know the risks. Healthy Lifestyle: Fitness, doi: Mayo Clinic

Morente-Sánchez, Z. M. (2013, March 27). Doping in sport: A review of elite athletes' attitudes, beliefs, and knowledge.. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23532595

National Institute on Drug Abuse. (2001). Anabolic steroid abuse . National Insititute on Drug Abuse Research Report series, NIH Pub Number: 06-3721, Retrieved from http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse

Pearson Education, Inc. (2007). Active duty military personnel, 1940–20111. Military Affairs , Retrieved from http://www.infoplease.com/ipa/A0004598.html

S. 2195--108th Congress: Anabolic Steroid Control Act of 2004. (2004). In www.GovTrack.us. Retrieved April 6, 2013, from http://www.govtrack.us/congress/bills/108/s2195

Increasing Circulatory Risks Associated with Pre-workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013

My previous problem definition was Increasing Health Risks Associated with Pre-workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013. I modified this problem definition in order to make it more specific into the Increasing circulatory Risks associated with Pre-workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013 in order to specify the problem that is most pertinent with this issue. This is a rising topic that is under surveillance, since it was not questioned or studied previous to this year after several people having reported heart attacks, heart palpitations, and increased blood pressure due to the use of pre-workout supplements. The purpose of surveillance is to have an ongoing and systematic collection of health data in order to evaluate and act on public health policy accordingly. Although pre-workout supplements have been used for decades, surveillance was not implemented until April of last year when the Food and Drug Administration sent warnings to ten different companies that manufactured pre-workout supplements with the ingredient dimethylamyamine (DMAA) questioning the safety of this ingredient, as well as asking if it was even considered a dietary supplement. The FDA gave the companies 15 days to provide evidence that this powerful ingredient was suitable for distribution. The companies, however, could not provide such evidence and as a result, supplements that contained this ingredient were not available for sale through popular sources, such as Amazon.

Concerning DMAA, the acceptance of this ingredient as a dietary supplement is generally accepted because it is labeled to come from geranium plants. However, in July of 2012, the Department of Chemistry and Biochemistry from the University of Texas at Arlingon ran a study to try to detect 1,3-dimethylamyamine from eight different samples of different geographical origins (China and Middle East) and found that no significant amount of DMAA was found in these plants. This article provides support that this product is likely a chemically synthesized supplement and therefore does not safely fall under the category of a dietary supplement.

However, there is a general lack of knowledge from the public between differentiating which pre-workout supplements have DMAA and which don’t. DMAA may also not be the only cause of irritants to the circulatory system. For other supplements to compete in the market without this chemical, many companies substitute this by adding 100+ mg of caffeine per scoop to their product, which could also increase blood pressure or cause other side effects.

Despite this, there have also been several studies to support the extraordinary progress that pre-workout supplements cause. In November 2012 in the Department of Nutrition, Food and Exercise Sciences, Institute of Sports Science and Medicine at Florida State University, a group of 24 men were split into two groups and were put to six weeks of resistance training, one group taking the popular pre-workout supplement NO shotgun, and the other group taking a placebo. At the end of the experiment, it resulted that there were no differences in testosterone balances or blood hormones, but the men that were taking the NO shotgun had a great increase in their 1RM weights (one rep max) for upper and lower body strength, and that the participants taking multi-ingredient performance supplements, NO shotgun in this case, significantly increased peak anaerobic power while the men in the placebo group remained relatively unchanged. The Department of Health, Human Performance, and Recreation at Baylor University previously did a similar study with the same supplement in 2009 and concluded that heavy resistance training combined with this multi-ingredient performance supplement is not associated with any negative side effects and did not abnormally impact the chemistry of the participants. Quite on the contrary, the NO shotgun effectively aided in increasing muscle mass and strength, as well as the muscular process in building protein (Willoughby ).

From these sources, I believe that I can conclude at one point for now, and that is that there is not enough research to completely represent pre-workout supplements as a whole. There are large cons with not much research to support the point since it has not been previously done, as well as large pros that shows the positive effects of pre-workout supplements but even these studies have mostly been done within the past year. With more research that I will do on the topic, I will hopefully find more sources of research done on supplements to have a more clear idea of which standpoint – whether to support or oppose pre-workout supplements – is better.

Works Cited

Willoughby, Darryn S. "Effects of 28 days of resistance exercise and consuming a commercially available pre-workout supplement, NO-Shotgun®, on body composition, muscle strength and mass, markers of satellite cell activation, and clinical safety markers in males." Journal of the International Society of Sports Nutrition. (2009): n. page. Web. 30 Mar. 2013. <http://www.jissn.com/content/6/1/16>.

Ormsbee, MJ. "The effects of six weeks of supplementation with multi-ingredient performance supplements and resistance training on anabolic hormones, body composition, strength, and power in resistance-trained men.." PubMed. Department of Nutrition, Food and Exercise Sciences, Institute of Sports Science and Medicine, The Florida State University, 15 Nov 2012. Web. 30 Mar 2013. <http://www.ncbi.nlm.nih.gov/pubmed/23153110>.

Rovell, Darren. "Vendor Stocks Fall, Amazon Acts as FDA Questions Pre-Workout Ingredient." Headlines from CNBC. CNBC, 01 May 2012. Web. Web. 30 Mar. 2013. <http://www.cnbc.com/id/47244948>.

Increasing Health Risks Associated with Pre-workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013

The problem definition that I have chosen to write for my paper addresses the following: Increasing Health Risks Associated with Pre-Workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013. I am seeking to find out what health risks have increased in the United States as a result in the increase of the use of pre-workout supplements by many athletes throughout the United States during this time period. I chose this time period since pre-workout supplements were relatively known in 2005 and have completely boomed now in 2013.

As an athlete, I find this to be a very relevant to today's society due to the booming craze of fitness and gaining muscle mass quickly. Many physical people - from body builders to sports athletes to soldiers in the military - use pre-workout supplements to give them that extra boost needed to perform at optimum levels or even out of the ordinary for that particular person. It is common to read advertisements of pre-workouts stating to cause "explosive workouts," "supercharged endurance," and "ultimate concentrated power in one drink." While to the athletes that are consuming these products to perform better only look at the grandiosity of the drink, they may not necessarily be thinking about all the chemicals that are being consumed at once (Beta Alanine, 1,3-dimethylamylamine, Germanium, Creatine Nitrate, and over 100 milligrams of caffeine, to name a few). Again, this is relevant since there are many popular exercise programs that are being reached to not only athletes, but also regular people that have never exercised before such as CrossFit, Zumba, and P90x. Such programs and supporting sponsors are now widely recognized and praised in the media, shedding more light on companies that produce these supplements.

To address why this is important comes from recent findings that the FDA has been investigating. While these pre-workouts have been on the market for years, not enough attention has been paid to them by federal regulators to follow their ingredients - until 2012, that is. Last year it was found that the ingredients such as 1,3-dimethylamylamine and Germanium found in the most popular and potent pre-workouts caused heart attacks and increased blood pressure due to its powerful effect on the heart and nervous system. While there are small warning labels that subtly hint as to not using these products if there are any health problems previous to the consumption of the powder, there is no warning stating flat out the risks associated with taking these pre-workouts. The general population of America that participates in serious physical exercise is a large community impacted by this.

Personally, I find this topic interesting to investigate because I am one of those people that did not know anything about what I was drinking but focused mainly on what extreme results I could get from the pre-workout. The first time that I took a strong pre-workout, I vomited for a week straight until my stomach adjusted to all the chemicals but I thought nothing of it, since my physique quickly strengthened and I was physically faster and stronger. I have tried and regularly used over eight different pre-workouts enthusiastically and I love the results that I get from them, so it pains me to find out that these could be potential contributors of damage to my health. I work as a CrossFit trainer, so I facilitate others in learning how to do high intensity workouts with a blend of Olympic and power weightlifting, cardio, and gymnastics, and it has become culture for everyone I work out with to drink the pre-workout, work out to the point physical exhaustion, and then repeat it the next day. As a CrossFit trainer, a competitive athlete within CrossFit, a weightlifter, and member of a Women's Rugby team, I think that those with such a deep admiration for work out supplements, such as myself, should know not only the good results that such supplements can provide, but also the negative effects that can result from their regular use.

Film: Contagion

                

The film Contagion deals with a woman (Beth), who returns from a trip from Hong Kong and then she and several others from the area she visited become sick and die within a period of three days. This sickness begins as an outbreak and then grows exponentially around the world. The Centers For Disease Control and Prevention work arduously to find replicate it and create a vaccine for the disease, but it mutates quickly and takes a long time to finally make a successful vaccine. Meanwhile, there is panic around the U.S. due to the negative media and large death toll. I thought the movie was, in all honesty, quite scary. It emphasized on   that public health tells us to do – wash hands, don’t sneeze on your hands, don’t touch your face too much – and the like. Also, it also showed the many complicated processes that go in to trying to attack such a serious problem as a pandemic. This week in lab we learned how to properly state a “problem definition” and then work from there to solve the specifics on this problem. In the movie, however, there were so many factors to worry about and try to track since it was such a large population of people and the disease was spreading extremely rapidly while the issues of rising death tolls, panic in reaction to social media and harder and harder ethical decisions continued to occur. It made me think of how hard it is to address and try to solve such an issue is with all the factors surrounding the problem going on around it. This was my first time seeing this movie.

There were several public health concepts in the film. Initially there was an outbreak with Beth when she returned and started spreading the disease, which is a sudden and violent start of something unwelcome, in this case being the infection. Following that, when more cases were heard about the same symptoms and similar death, it was made apparent that this was a threat to others and an outbreak investigation began in which the members of the CDC would form a hypothesis for what could be happening, test or try to find the cause of the outbreak, and then take appropriate measures as needed. Once there were clear indications of who had the infection and who didn't, many people were put in isolation, either to avoid those who had the disease or not infect those who did not have it. We saw this with Mitch and his daughter as they separated themselves from others as much as possible avoiding physical contact. Lastly, large areas of affected people were quarantined, meaning placed together away from others without the infection, so that the infection would be concentrated in one area and can also be triaged and treated with ease. The area in which Mitch and his daughter lived was quarantined and blocked off; no one was allowed to leave or enter this area since it was immensely infected.

One of the main points which stood out to me from chapter 29 was expect the unexpected. Be ready to respond to unanticipated problems. Obviously this infection was an unanticipated problem. However, one of the actions that the public health agencies could have taken for better preparation was to pay more attention to the infection as the outbreak started. In 2009 in the United States there was an outbreak of swine flu, otherwise known as H1N1. Fortunately, the case was not as critical as anticipated; that was because the infection was isolated quickly. The infection in Contagion, however, was not isolated quickly and therefore spread all over the country. The book also says that warnings should be issued and evacuations ordered by the appropriate agencies. The warnings should be delivered in a manner that will prompt appropriate action by the population. In the film we saw that there was massive panic due to uncertainty and sudden quarantine of large areas. If communication was done more clearly from the CDC and government agencies to the people, then such reactions might not have occurred and the infection could have been controlled in a more organized manner.