Spring 2007 Volume 26 Issue 1
A P u b l i c a t i o n o f t h e H e a l t h E d u c a t i o n D e pa r t m e n t
NYC Bans Trans Fat
by Juan Leal Public hearings were held at the New York City Department of Health and Mental Hygiene regarding the proposed ban on trans fat use by restaurants. Mayor Michael Bloomberg and NYCDOHMH Commissioner Thomas Frieden are proponents of the ban citing empirical evidence that links trans fat to increased risk of cardiovascular disease. Heart disease is currently the number one killer of Americans, claiming an estimated 725,000 lives annually. Hydrogenated fats provide more texture than liquid fats do to baked products, such as pie-crusts and cookies. This is the reason restaurateurs have continContinued on page 4
INSIDE Just Exactly What Is In Your Stash?
Over-the-Counter Abortion Pill
Got Milk vs. Milk’s Gotta Go…
Health & Wellness Club News
New Birth-control Implant: Is It Safe?
by Philip A. Belcastro, Ph.D. The FDA has approved Implanon which is a matchstick-size rod that steadily releases a small amount of progestin (synthetic progesterone) into the woman’s body. Physicians using a local anesthetic insert the rod just under the skin in the upper arm. It is designed to last for up to three years. Implanon replaces Norplant which consisted of six matchstick-size rods. Sales of Norplant were halted in 2000 due to concerns regarding its effectiveness and side effects such as excessive bleeding and headaches. Organon, the manufacturer of Implanon, reports that it is much safer and more effective than Norplant. However, several studies in countries using Implanon for years report serious side effects, relatively high discontinuation rates and difficulty in removing the implant. While there are relatively few American studies of Implanon there are however several overseas studies. Continued on page 3
HEALTHNOTES is edited by Professor Philip A. Belcastro, Ph.D., Chair of the
Health Education Department Borough of Manhattan Community College/CUNY 199 Chambers Street New York City, New York 10007 212-220-1453 Contributing Editors Dana Ethan Gloria McNamara Kindly contact the Health Education Department for comments or to add your name to the recipient list.
Just Exactly What Is In Your Stash? by Philip A. Belcastro, Ph.D.
Did you know that street drugs are composed of a multitude of impurities, adulterants and bogus substitute chemicals? Lead, gypsum, incense, rosin, stearic acid and rat poison (strychnine) are just a few of the hundreds of possible chemicals purposely or inadvertently added to illegal drugs sold on the street. Street buyers have little if any notion that illicitly purchased street drugs are toxicological concoctions comprised from a menu of hundreds of adulterants such as: acetaminophen, acetylcodine, ammonium hydroxide, amydricaine, azopridine, benzocaine, belladonna, boric acid, bromodiphenhydramine, caffeine, codeine, cotton fibers, diazepam, dilantin, dolomite, ephedrine, ethanol, ether, glucose, ibuprofen, inositol, intercaine, lidocaine, isopropanol, mannitol, meprobamate, methaqualone, methadone, pentobarbital, phenobarital, trazodone, phenylpropanolaime, piperocaine, procaine, procainamide, propoxyphene, quinine, quinidine, scopolamine, silicon dioxide, sodium cyclamate and sodium acetate. The majority of street drugs, especially cocaine, heroin and marijuana are cut, often several times by the drug supplier. For example heroin 2
manufactured overseas will contain the novel recipes of the dealer’s point of origin, coupled with the United States wholesale dealer’s recipe, to be followed by the local dealer further cutting and lacing lots for street consumption. Street heroin laced with procaine is likely to have origins from Turkey. Heroin laced with Phenobarbital may have Iranian and Pakistani roots with the Phenobarbital originating from European medical manufacturers. Such additive branding of heroin in part explains why users prefer heroin from certain locales. In one analysis of illicitly purchased cocaine 50 percent of the samples contained an active ingredient other than the advertised product. There is a substantial body of published anecdotal comments and investigative studies that have reported idiosyncratic, regional, fad, common, and undetermined toxins in illicitly purchased street drugs. For example: the Centers for Disease Control reported a 60 percent, by weight, lead contamination of methamphetamine in Oregon; another study reported scopolamine poisoning (Transderm Scop) with substances advertised as cocaine; and yet another study reported hydrogen cyanide poisoning with illicitly purchased substances advertised as phencyclidine (PCP aka Angel Dust) in New York. Continued on page 7
Continued from page 1 Implanon’s most common side effects are: acne, breast pain, headaches, weight gain, irregular, unpredictable or no menstrual bleeding, mood swings and an increased risk for blood clots. One study reports that ovarian cysts or enlarged ovarian follicles were common in women using Implanon. Ovarian cysts or enlarged ovarian follicles developed in: 5.2% of women in the first 3 months of use; 7.2% of women in the first 6 months of use; and 26.7% women in the first 12 months of use (Hidalgo et el., 2006). These side effects and adverse effects of Implanon were responsible for the relatively high discontinuation rates in women overseas. In one study half the women users had Implanon removed 9.2 months after insertion. The reasons most cited by women for having Implanon removed were: infrequent bleeding (28%); amenorrhea (no bleeding) (33%), prolonged bleeding (15%), metromenorrhagia (frequent and heavy bleeding) (16%); dizziness (12%), acne (11%), mood swings (8%) and headache (5%) (Bitzer, 2004). (Note: women reported more than one of the preceding reasons.) Another study reports that one out of four women had Implanon removed before one year of use and three out of every five women had Implanon removed before two years of use. One way to decrease the chances of a woman prematurely discontinuing Implanon is to first begin taking a
progestin-only birth-control pill. This allows an opportunity for a prospective user to see how well her body tolerates the hormone. A prospective user may discover she does not tolerate progestin well. If that is the case then she can avoid the expense and the surgical procedures to both insert and remove Implanon. As with all implants the surgical insertion as well as the timing of the insertion are key factors to reducing adverse side effects. Thus an experienced physician should be selected. Organon is training health care providers on insertion procedures for Implanon. Nevertheless a preliminary medical evaluation and consultation to see if the woman is a good candidate for Implanon is necessary. This should include a complete medical history and a pregnancy test. References Bitzer, J., Tschudin, S., Alder, J. et al. (2004).Acceptability and side-effects of Implanon in Switzerland: a retrospective study by the Implanon Swiss Study Group. European Journal of Contraceptive Reproductive Health Care. 9(4):278-284. Hidalgo, M., Lisondo, C., Juliato, C. et al. (2006). Ovarian cysts in users of Implanon and Jadelle subdermal contraceptive implants. Contraception. 73(5):532-536. Professor Philip A. Belcastro, Ph.D. is the Chair of the Health Education Department at BMCC/CUNY. HEALTHNOTES SPRING 2007
Continued from page 1 ued to use trans fats even though they negatively affect one’s health. The Department of Health would like to put an end to this practice. The health of the public is at risk when trans fats are used, and these officials have taken an oath to protect the health of the citizens of New York City. A trans fat ban seems like the logical solution. However, many restaurant owners presented their case to postpone the ban, citing the need for more time to modify recipes and use the existing inventory of trans fats. Let us know what you think; write to H&W Club - Box H2002 Student Government Office, BMCC, 199 Chambers Street, New York, NY 10007. Juan Leal is Liberal Arts major at BMCC/CUNY.
Over-the-Counter Morning After Pill by Gloria McNamara
In November, the morning-after pill (Plan B-Contraceptive Pill) became available for the first time in New York pharmacies to individuals 18 years or older without a physician’s prescription. Proof of identification, however, including date of birth is required. For those individuals seventeen years or younger, a medical prescription is still required. The “morning-after pill” is a form of emergency birth-control that consists of two large doses of levonorgestrel (LEE-voe-nor-jes-trel) designed to prevent a pregnancy or terminate a pregnancy. Levonorgestrel is a progestin which is the synthetic form of progesterone. This is an effective form of emergency contraception if Plan B is taken prior to ovulation, which is the point in a woman’s menstrual cycle when an egg is released from the ovary into the fallopian tube. If Plan B is taken after ovulation has occurred, the effect of the hormone will be to prevent the fertilized egg (embryo) from implanting in the uterus. Plan B is not effective if the fertilized egg (embryo) has implanted into the uterus. Thus the first dose is taken within 72 hours of unprotected sex,
followed by the second dose 12 hours later. Plan B should not be used if the woman suspects or knows she is already pregnant. The morning-after pill is appropriate for emergencies such as a failure of a birth control method (e.g., condom failure; birth control pills missed for 2 or more days) or unprotected intercourse. A word of note: Plan B should not be used as a regular form of birth-control. It is not intended to replace oral contraceptives (pill). Side effects include nausea, dizziness, headache, vomiting, breast tenderness, and irregular menstrual bleeding. Diabetic women may experience negative side effects due to their diabetes and thus these women should consult with their physician. It is reportedly 98% to 99% effective in preventing pregnancies. However Plan B seems to be less effective in Chinese women. Following this emergency contraceptive treatment, a barrier method such as a condom should be used during intercourse until the next
period occurs. Menses may occur as early as seven days after treatment. If the woman’s period does not come within 21 days of this treatment she may be pregnant. While Plan B is available overthe-counter it does not preclude the woman from consulting with a physician. At the very least the woman should consult with her pharmacist. The woman may experience bleeding following treatment and interpret that her pregnancy has ended. The bleeding may in fact be a symptom of an ectopic pregnancy which is a risk when using Plan B. An ectopic pregnancy is when the embryo is growing in the fallopian tube or an organ other than the uterus. A pregnancy test following the self-administering of Plan B is a wise precaution and allows for a follow-up consultation with a physician. Professor McNamara is a faculty member of the Health Education Department at BMCC/CUNY.
HEALTHNOTES SPRING 2007
Got Milk vs. Milk’s Gotta Go… by Jenni Shepherd
Milk is a common component in the diet of most people living in developing nations. With valuable nutritional content including calcium, milk has become a very marketable product. Calcium is a mineral responsible for several functions including the building and repairing of teeth and bones. It can be found in many sources including dairy products, calcium fortified soy milk, dark leafy greens, and dried beans. Calcium intake is a highly debated topic. Pro-milk groups have long marketed milk as a tool for preventing bone loss (osteoporosis) when consumed in the recommended quantity of three 8-ounce glasses per day.
Health & Wellness Club News by Melonee Murray
The Health & Wellness Club promotes awareness of health-related issues, such as nutrition, fitness and sexuality among BMCC students as well as offers students the opportunity to implement healthful behaviors. The club’s activities include weekly exercise classes and workshops on various health topics. The primary exercise instructor is Jamie Dowd 6
Evidence supporting or disproving this theory is not conclusive. Several organizations are currently studying the amount of calcium required for bone health but it is too early to form a solid conclusion. In the meantime, the FDA recommends a daily calcium intake of 1000-1300mg per day. While whole milk has the highest concentration of readily available calcium it may be more healthful to choose other sources for calcium. As with all animal products whole milk is very high in fat, particularly in saturated fat which can increase the risk of heart disease. Saturated fats contribute to excess body fat and are responsible for the increase of LDL or bad cholesterol which causes plaque build-up in arteries. Therefore, milk and dairy choices should be of the low-fat type such as 1% or
who possesses a Bachelor of Science degree from Indiana University, with an area of concentration in dance, movement and exercise. Club members are currently learning the Pilates technique, which focuses on increasing muscle strength and tone of the body’s core. Students meet for Pilates instruction every Wednesday at 2 pm in room N410 for one hour. Students really enjoy the camaraderie of working out together. Incentive gifts, such as tee shirts, gym bags and caps are provided to those
skim. Plant-based foods such as kale, collard greens and black-eyed peas are all healthful sources of calcium with little fat and nearly undetectable amounts of saturated fat. While whole milk does have its nutritional benefits such as calcium, it also has its downside which is its high saturated fat content. When choosing milk choices should be of the low-fat type. By using plantbased foods for our calcium source we can keep the calcium benefits without subjecting ourselves to the dangers of a diet high in fat. This coupled with regular exercise will lead not only to good bone health but good cardiovascular health as well.
Continued from page 2 The wholesale contamination of illicitly purchased street drugs remains an undisclosed fact especially to the buyer. To be sure illicit drugs are prepared by criminals in clandestine facilities that add, substitute or adulterate their wares with toxic chemicals. The truly frightening part is that the purchaser of these street drugs will go on to smoke, inject, sniff or swallow these toxic brews into their body. Just how pure are street drugs? Maybe the purchaser should ask, “Just how much of this stuff is what I think it is?”
Jenni Sheperd is a Liberal Arts Major & tutor in the Health Education Department at BMCC/CUNY.
attending a substantial number of exercise sessions. Also club members have attended workshops offered by the Department of Health Education faculty regarding sexuality, CPR, body composition and eating disorders. The club’s plans for the Spring semester include a film festival, featuring a documentary about crystal methamphetamine, a continuation of weekly exercise classes, and contributions to HEALTHNOTES. Please join us. For more information contact: H&W Club, Box H002, Student
Government Office @BMCC 199 Chambers St., NY, NY 10007 or call Professor McNamara (faculty advisor) at 212-220-7213. Melonee Murray is the President of the BMCC Health and Wellness student club and a Liberal Arts major. Ms. Murray works for Equinox Fitness Centers as a licensed massage therapist and plans to pursue her education in a physician’s assistant program.
HEALTHNOTES SPRING 2007