Academic literature on the topic 'HIV-positive men – Texas – Dallas'

Abstract Background While Pre-Exposure Prophylaxis (PrEP) has been shown to be effective in preventing the acquisition of HIV, the cost of care is considerable. Public health efforts should be directed to those at highest risk to minimize the cost of a quality-adjusted life-year (QALY). Given that sexually transmitted illnesses (STIs) increase the risk of acquiring HIV from 5–8 fold, their incidence rates can serve to define populations at highest risk for HIV within the community of men who have sex with men (MSM). Methods A retrospective cohort of PrEP patients with STI screening visits in two clinics in Dallas, Texas from January 2016 through April 2019 were reviewed. Three-site genital and extra-genital testing was routinely performed. Categorical variables were compared using Chi-Square. A binomial regression model was used to evaluate the odds of STI acquisition. Results 201 PrEP patients had 999 screening visits. 17 were in the first quartile, ages (18–24) 35.3% were Black, 70.6% MSM; 105 were in the second quartile, ages (25–37) 23.8% Black, 58.1% MSM; 56 third quartile, ages (38–49) 17.9% Black, 62.5% MSM; 23 patients in the fourth quartile, age ≥50, 8.7% were Black, 47.8% MSM. The younger age group, first quartile contributed 16 person-years (py); the second quartile, 102 py; third quartile, 48 py; fourth quartile, ≥50, 25 py. The incidence rates for Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) from any site were higher in the first quartile, 166/100 py, CI 150–174; second quartile, 92/100 py, CI- 85–96; third quartile, 62/100 py, CI 48–75 than in those in the fourth quartile, ≥50 years old, 44/100 py, CI 27–63. The incidence of any rectal GCor CT in the first quartile, 86/100 py, CI 63–98; second quartile, 53/100 py, CI 43–62; third quartile, 29/100 py, CI 18–43 and those in the fourth quartile, ≥50, 32/100 py, CI 17–52. In a binomial regression model, the odds of acquiring any GC or CT for a PrEP patient ≥50 revealed an adjusted OR of 0.40, CI, 0.20–0.79 (adjusted for race and sexual orientation) P = 0.009 when compared with patients less than 50. Conclusion PrEP patients fifty and older have the lowest odds of acquiring STIs. Younger age groups with higher incidences of STIs may represent those with more episodes of condomless sex, at higher risk for HIV. Disclosures All authors: No reported disclosures.

The relationship between depression and inflammation is currently a topic of much interest. Previous studies have produced mixed results regarding the association between depression and high-sensitivity C reactive protein (hs-CRP). The aim of this report was to determine the association between hs-CRP and depression in a large sample of healthy adults. This is a cross-sectional study of 26,638 healthy adults seen for preventive medical examinations between December 2000 and August 2018 at the Cooper Clinic in Dallas, Texas. Multivariable logistic regression was used to evaluate the association between hs-CRP levels and depressive symptoms as measured by the 10-item Center for Epidemiologic Studies Depression Scale. Covariates included race, age, education, smoking history, alcohol use, menopausal status, body mass index (BMI), and medication use. The Hs-CRP level demonstrated a weakly positive association with depressive symptoms (OR 1.06 per mg/L, 95% CI 1.03 to 1.09 for women; OR 1.05 per mg/L, 95% CI 1.02 to 1.09 for men) that became insignificant when controlling for BMI in women (OR 1.02 per mg/L, 95% CI 0.98 to 1.05) and men (OR 1.02 per mg/L, 95% CI 0.98 to 1.05). Adjusting for antidepressant and statin use did not affect the association between hs-CRP and depressive symptoms in women (OR 0.99 per mg/L, 95% CI 0.96 to 1.03) or men (OR 1.01 per mg/L, 95% CI 0.97 to 1.05). Levels of hs-CRP were not associated with depression independent of BMI in a predominantly white, male population of higher socioeconomic status. This finding suggests that associations between hs-CRP and depression may be explained by obesity, which warrants further investigation into shared pathways between obesity and depression.

AbstractHourly surface temperature differences between Dallas–Fort Worth, Texas, metropolitan and rural sites have been used to calculate the urban heat island from 2001 to 2011. The heat island peaked after sunset and was particularly strong during the drought and heat wave in July 2011, reaching a single-day instantaneous maximum value of 5.4°C and a monthly mean maximum of 3.4°C, as compared with the 2001–11 July average of 2.4°C. This severe drought caused faster warming of rural locations relative to the metropolitan area in the morning as a result of lower soil moisture content, which led to an average negative heat island in July 2011 of −2.3°C at 1100 central standard time. The ground-based assessment of canopy air temperature at screening level has been supported by a remotely sensed surface estimate from the Moderate Resolution Imaging Spectroradiometer (MODIS) on board the Terra satellite, highlighting a dual-peak maximum heat island in the major city centers of Dallas and Fort Worth. Both ground-based and remotely sensed spatial analyses of the maximum heat island indicate a northwest shift, the result of southeast winds in July 2011 of ~2 m s−1 on average. There was an overall positive trend in the urban heat island of 0.14°C decade−1 in the Dallas–Fort Worth metropolitan area from 2001 to 2011, due to rapid urbanization. Superimposed on this trend are significant interannual and decadal variations that influence the urban climate.

Abstract Background Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non Hodgkin lymphoma, accounting for approximately 3-4% of new primary brain tumors and approximately 1% of all NHL. The overall incidence of PCNSL is approximately 0.43/100,000 per year, but the relative risk of disease among immunocompromised patients is considerably higher; approximately 3600 times that of the general population. Similarly, the average age of onset, race, treatment regimens and overall survival are all markedly different amongst immunocompetent and immunocompromised patients with PCNSL. The standard treatment for immunocompetent includes high-dose methotrexate based regimens with or without whole brain radiation therapy (WBRT). On the contrary, there is little to no prospective data guiding the treatment of immunocompromised patients with PCNSL. The standard therapy for these patients has yet to be defined, leaving the majority to receive the potentially sub-optimal regimens including WBRT in addition to highly active antiretroviral therapy (HAART). The current study reports on survival data from a retrospective cohort of patients with biopsy-proven PCNSL diagnosed at our institution over the last decade stratified by both HIV status and therapy received. Methods Parkland Memorial Hospital is a 950-bed acute care hospital located in Dallas, Texas. It serves as the county hospital for the city of Dallas as well as the primary teaching site of the University of Texas Southwestern Medical Center. After approval by the institutional review board, we identified patients with biopsy proven PCNSL between 1998 and 2012 at Parkland Memorial Hospital through the institution's tumor registry. After patient identification, the medical records were reviewed for the following patient data: age at diagnosis, ethnicity, sex, HIV status, CD4 cell count, HIV viral load, neuroimaging, treatment (radiation therapy and/or chemotherapy), date of death and date of last contact. Survival data and date of death were obtained from our tumor registry, chart reviews, and social security death index searches. Kaplan–Meier survival curves were constructed and compared between the two groups using the log rank test. Results 40 HIV-positive and 21 HIV-negative patients were included in this retrospective analysis. PCNSL was diagnosed by histological evaluation of biopsy specimens in all 61 patients. Patients were stratified based on their HIV status. Baseline demographic information for the two groups is compared in table 1. Median survival was 21.3 months and 4.6 months for the HIV-negative and HIV-positive cohorts respectively. All HIV-negative patients were treated with HD-MTX based regimens in addition to WBRT (MTX+RT). Of the HIV-positive patients: 28 received WBRT plus HAART (RT+HAART), 7 received no treatment and 5 received HD-MTX based regimens plus WBRT and HAART (MTX+RT+HAART). The average CD4 count at diagnosis in patients who did not receive treatment was 9.1, 50.6 in those who received RT+HAART and 155.8 in those who received MTX+RT+HAART although these differences did not meet statistical significance (p=0.056), (Table 2). HIV-positive patients who received RT+HAART had significantly better overall survival (OS) than those who received no treatment (p-value of log-rank test 0.00023) but worse OS than those who received MTX+RT+HAART (p= 0.0121). There was no difference in OS between HIV-positive patients who received MTX+RT+HAART and HIV-negative patients who received MTX+RT (p= 0.778), (figure 1). Conclusions The data from our current study suggests HIV-positive patients with PCNSL can achieve similar overall survival as their HIV-negative counterparts when they receive similar chemotherapeutic regimens. Furthermore, RT+HAART appears to offer inferior OS to MTX+RT+HAART despite similar baseline CD4 counts. Disclosures: No relevant conflicts of interest to declare.

Abstract Background Healthcare-associated respiratory viral infections (HARVI) occur frequently at pediatric hospitals. The spectrum and attributable outcomes of these infections are unknown. Methods Using a matched historical cohort design, HARVI cases identified between July 2013 and June 2018 at a large pediatric referral hospital in Dallas, Texas were defined as patients who tested positive for one of eight respiratory viruses during their hospitalization, had new respiratory symptoms develop during hospitalization, and had symptom onset on a hospitalization day that was greater than the maximum incubation period for the specific respiratory virus. Controls were matched 1:1 for index time, meaning that the control had a hospital length of stay that was at least as long as the length of stay in the matched case prior to viral testing. Controls were also matched for year and month of infection as well as hospital unit and/or age. The primary outcome was additional length of stay following infection or index time. Additional outcomes included transfer to intensive care, need for intubation, hospital charges, and all cause in-hospital mortality. Results Over the 5-year study period, 317 definite HARVI were identified (0.62 per 1,000 admitted patient days), and only 287 (91%) had a matched control to be included in analysis. Among these cases and matched controls, the median time to index time was 19 days (IQR 10-39 days). The most common causative viruses where rhinovirus/enterovirus (188, 65.5%), RSV (30, 10.5%), parainfluenza virus (28, 9.8%), and seasonal coronaviruses (27, 9.4%). Fewer cases than controls were in an intensive care unit at index time (101 [35.2%] vs. 156 [54.4%]) The mean additional length of stay following index time was shorter in cases than controls (35.2 days vs. 48.1 days, difference = -12.9 days, 95% CI -20.95 to -4.82 days). Conclusion Hospital length of stay for cases with HARVI was not longer than for those without HARVI. Possible explanations include confounding and selection bias. Further studies with carefully selected controls are needed. Disclosures All Authors: No reported disclosures

West Nile Virus is a mosquito borne disease that is initially caused in continental US that leads to neurological disease and death. There exists no vaccine or particular antiviral treatment for WNV.The mosquitoes become infected when they bite the infected birds. WNV is confined to the family Flaviviridae containing single stranded positive RNA with 11kb length. The purpose of this paper is to study WNV human cases and WNV positive mosquito traps in Frisco 75035 from Sep-Oct 2019. Also, the paper aims in explaining the current CDC data on WNV cases in detail using descriptive computer statistical analysis method. The data describes the current 2019 WNV neuro cases, WNV non-neuro cases, Death and presumptive viremic blood donors. According to (DSHS, 2019), there is no WNV cases reported yet in Frisco 2019 and one positive WNV case in Dallas county. According to CDC (2019), out of total 777, 98 were presumptive viremic blood donors, 504 was neuro-invasive cases, 273 were non-neuro-invasive cases, and 39 death was reported. Arizona and Colorado have the highest number of WNV Neuro invasive and Non-neuro-invasive cases of 132 and 60. This summary statistics reveals Neuro invasive cases have higher mean of 11.45 to non-neuro-invasive with 6.205. On the T-test it reveals at 95 % confidence level (P=0.007681) a significant difference in total cases versus the presumptive blood donors. It also represents more positive relationship on the scatter plots. According to Texas Department of state Health and Human Services (2019), reported human cases of reportable West Nile Disease of 19; out of which West Nile encephalitis is 15 and West Nile fever is 4. This shows that in Texas there is a drastic reduction of West Nile disease cases reported in 2019 related to good surveillance plans. This review summarizes descriptive statistical analysis of 2019 WNV cases which has shown a new increase in Presumptive viremic blood donors which is the hall mark of this review. Finally, the paper has completed a climatic niche prediction model using Math lab computer software for the future prediction of WNV positive mosquitoes using climatic conditions like high temperature, low temperature, humidity, rainfall, and precipitation.

My thesis is that new media, starting with analog broadcast and going through digital convergence, blur the line between work time and free time. The technology that we are adopting has transformed free time into potential and actual labour time. At the dawn of the modern age, work shifted from tasked time to measured time. Previously, tasked time intermingled work and leisure according to the vagaries of nature. All this was banished when industrial capitalism instituted the work clock (Mumford 12-8). But now, many have noticed how post-industrial capitalism features a new intermingling captured in such expressions as "24/7" and "multi-tasking." Yet, we are only beginning to understand that media are driving a return to the pre-modern where the hour and the space are both ambiguous, available for either work or leisure. This may be the unfortunate side effect of the much vaunted "interactivity." Do you remember the old American TV show Dobie Gillis (1959-63) which featured the character Maynard G. Krebs? He always shuddered at the mention of the four-letter word "work." Now, American television shows makes it a point that everyone works (even if just barely). Seinfeld was a bold exception in featuring the work-free Kramer; a deliberate homage to the 1940s team of Abbott and Costello. Today, as welfare is turned into workfare, The New York Times scolds even the idle rich to adopt the work ethic (Yazigi). The Forms of Broadcast and Digital Media Are Driving the Merger of Work and Leisure More than the Content It is not just the content of television and other media that is undermining the leisured life; it is the social structure within which we use the media. Broadcast advertisements were the first mode/media combinations that began to recolonise free time for the new consumer economy. There had been a previous buildup in the volume and the ubiquity of advertising particularly in billboards and print. However, the attention of the reader to the printed commercial message could not be controlled and measured. Radio was the first to appropriate and measure its audience's time for the purposes of advertising. Nineteenth century media had promoted a middle class lifestyle based on spending money on home to create a refuge from work. Twentieth century broadcasting was now planting commercial messages within that refuge in the sacred moments of repose. Subsequent to broadcast, home video and cable facilitated flexible work by offering entertainment on a 24 hour basis. Finally, the computer, which juxtaposes image/sound/text within a single machine, offers the user the same proto-interactive blend of entertainment and commercial messages that broadcasting pioneered. It also fulfills the earlier promise of interactive TV by allowing us to work and to shop, in all parts of the day and night. We need to theorise this movement. The theory of media as work needs an institutional perspective. Therefore, I begin with Dallas Smythe's blindspot argument, which gave scholarly gravitas to the structural relationship of work and media (263-299). Horkheimer and Adorno had already noticed that capitalism was extending work into free time (137). Dallas Smythe went on to dissect the precise means by which late capitalism was extending work. Smythe restates the Marxist definition of capitalist labour as that human activity which creates exchange value. Then he considered the advertising industry, which currently approaches200 billion in the USA and realised that a great deal of exchange value has been created. The audience is one element of the labour that creates this exchange value. The appropriation of people's time creates advertising value. The time we spend listening to commercials on radio or viewing them on TV can be measured and is the unit of production for the value of advertising. Our viewing time ipso facto has been changed into work time. We may not experience it subjectively as work time although pundits such as Marie Winn and Jerry Mander suggest that TV viewing contributes to the same physical stresses as actual work. Nonetheless, Smythe sees commercial broadcasting as expanding the realm of capitalism into time that was otherwise set aside for private uses. Smythe's essay created a certain degree of excitement among political economists of media. Sut Jhally used Smythe to explain aspects of US broadcast history such as the innovations of William Paley in creating the CBS network (Jhally 70-9). In 1927, as Paley contemplated winning market share from his rival NBC, he realised that selling audience time was far more profitable than selling programs. Therefore, he paid affiliated stations to air his network's programs while NBC was still charging them for the privilege. It was more lucrative to Paley to turn around and sell the stations' guaranteed time to advertisers, than to collect direct payments for supplying programs. NBC switched to his business model within a year. Smythe/Jhally's model explains the superiority of Paley's model and is a historical proof of Smythe's thesis. Nonetheless, many economists and media theorists have responded with a "so what?" to Smythe's thesis that watching TV as work. Everyone knows that the basis of network television is the sale of "eyeballs" to the advertisers. However, Smythe's thesis remains suggestive. Perhaps he arrived at it after working at the U.S. Federal Communications Commission from 1943 to 1948 (Smythe 2). He was part of a team that made one last futile attempt to force radio to embrace public interest programming. This effort failed because the tide of consumerism was too strong. Radio and television were the leading edge of recapturing the home for work, setting the stage for the Internet and a postmodern replication of the cottage industries of pre and proto-industrial worlds. The consequences have been immense. The Depression and the crisis of over-production Cultural studies recognises that social values have shifted from production to consumption (Lash and Urry). The shift has a crystallising moment in the Great Depression of 1929 through 1940. One proposal at the time was to reduce individual work hours in order to create more jobs (see Hunnicut). This proposal of "share the work" was not adopted. From the point of view of the producer, sharing the work would make little difference to productivity. However, from the retailer's perspective each individual worker would accumulate less money to buy products. Overall sales would stagnate or decline. Prominent American economists at the time argued that sharing the work would mean sharing the unemployment. They warned the US government this was a fundamental threat to an economy based on consumption. Only a fully employed laborer could have enough money to buy down the national inventory. In 1932, N. A. Weston told the American Economic Association that: " ...[the labourers'] function in society as a consumer is of equal importance as the part he plays as a producer." (Weston 11). If the defeat of the share the work movement is the negative manifestation of consumerism, then the invasion by broadcast of our leisure time is its positive materialisation. We can trace this understanding by looking at Herbert Hoover. When he was the Secretary of Commerce in 1924 he warned station executives that: "I have never believed that it was possible to advertise through broadcasting without ruining the [radio] industry" (Radio's Big Issue). He had not recognised that broadcast advertising would be qualitatively more powerful for the economy than print advertising. By 1929, Hoover, now President Hoover, approved an economics committee recommendation in the traumatic year of 1929 that leisure time be made "consumable " (Committee on Recent Economic Changes xvi). His administration supported the growth of commercial radio because broadcasting was a new efficient answer to the economists' question of how to motivate consumption. Not so coincidentally network radio became a profitable industry during the great Depression. The economic power that pre-war radio hinted at flourished in the proliferation of post-war television. Advertisers switched their dollars from magazines to TV, causing the demise of such general interest magazines as Life, The Saturday Evening Postet al. Western Europe quickly followed the American broadcasting model. Great Britain was the first, allowing television to advertise the consumer revolution in 1955. Japan and many others started to permit advertising on television. During the era of television, the nature of work changed from manufacturing to servicing (Preston 148-9). Two working parents also became the norm as a greater percentage of the population took salaried employment, mostly women (International Labour Office). Many of the service jobs are to monitor the new global division of labour that allows industrialised nations to consume while emerging nations produce. (Chapter seven of Preston is the most current discussion of the shift of jobs within information economies and between industrialised and emerging nations.) Flexible Time/ Flexible Media Film and television has responded by depicting these shifts. The Mary Tyler Moore Show debuted in September of 1970 (see http://www.transparencynow.com/mary.htm). In this show nurturing and emotional attachments were centered in the work place, not in an actual biological family. It started a trend that continues to this day. However, media representations of the changing nature of work are merely symptomatic of the relationship between media and work. Broadcast advertising has a more causal relationship. As people worked more to buy more, they found that they wanted time-saving media. It is in this time period that the Internet started (1968), that the video cassette recorder was introduced (1975) and that the cable industry grew. Each of these ultimately enhanced the flexibility of work time. The VCR allowed time shifting programs. This is the media answer to the work concept of flexible time. The tired worker can now see her/his favourite TV show according to his/her own flex schedule (Wasser 2001). Cable programming, with its repeats and staggered starting times, also accommodates the new 24/7 work day. These machines, offering greater choice of programming and scheduling, are the first prototypes of interactivity. The Internet goes further in expanding flexible time by adding actual shopping to the vicarious enjoyment of consumerist products on television. The Internet user continues to perform the labour of watching advertising and, in addition, now has the opportunity to do actual work tasks at any time of the day or night. The computer enters the home as an all-purpose machine. Its purchase is motivated by several simultaneous factors. The rhetoric often stresses the recreational and work aspects of the computer in the same breath (Reed 173, Friedrich 16-7). Games drove the early computer programmers to find more "user-friendly" interfaces in order to entice young consumers. Entertainment continues to be the main driving force behind visual and audio improvements. This has been true ever since the introduction of the Apple II, Radio Shack's TRS 80 and Atari 400 personal computers in the 1977-1978 time frame (see http://www.atari-history.com/computers/8bits/400.html). The current ubiquity of colour monitors, and the standard package of speakers with PC computers are strong indications that entertainment and leisure pursuits continue to drive the marketing of computers. However, once the computer is in place in the study or bedroom, its uses fully integrates the user with world of work in both the sense of consuming and creating value. This is a specific instance of what Philip Graham calls the analytical convergence of production, consumption and circulation in hypercapitalism. The streaming video and audio not only captures the action of the game, they lend sensual appeal to the banner advertising and the power point downloads from work. In one regard, the advent of Internet advertising is a regression to the pre-broadcast era. The passive web site ad runs the same risk of being ignored as does print advertising. The measure of a successful web ad is interactivity that most often necessitates a click through on the part of the viewer. Ads often show up on separate windows that necessitate a click from the viewer if only to close down the program. In the words of Bolter and Grusin, click-through advertising is a hypermediation of television. In other words, it makes apparent the transparent relationship television forged between work and leisure. We do not sit passively through Internet advertising, we click to either eliminate them or to go on and buy the advertised products. Just as broadcasting facilitated consumable leisure, new media combines consumable leisure with flexible portable work. The new media landscape has had consequences, although the price of consumable leisure took awhile to become visible. The average work week declined from 1945 to 1982. After that point in the US, it has been edging up, continuously (United States Bureau of Labor Statistics). There is some question whether the computer has improved productivity (Kim), there is little question that the computer is colonising leisure time for multi-tasking. In a population that goes online from home almost twice as much as those who go online from work, almost half use their online time for work based activities other than email. Undoubtedly, email activity would account for even more work time (Horrigan). On the other side of the blur between work and leisure, the Pew Institute estimates that fifty percent use work Internet time for personal pleasure ("Wired Workers"). Media theory has to reengage the problem that Horkheimer/Adorno/Smythe raised. The contemporary problem of leisure is not so much the lack of leisure, but its fractured, non-contemplative, unfulfilling nature. A media critique will demonstrate the contribution of the TV and the Internet to this erosion of free time. References Bolter, Jay David, and Richard Grusin. Remediation: Understanding New Media. Cambridge, MA: MIT Press, 2000. Committee on Recent Economic Changes. Recent Economic Changes. Vol. 1. New York: no publisher listed, 1929. Friedrich, Otto. "The Computer Moves In." Time 3 Jan. 1983: 14-24. Graham, Philip. Hypercapitalism: A Political Economy of Informational Idealism. In press for New Media and Society2.2 (2000). Horkheimer, Max, and Theodor W. Adorno. Dialectic of Enlightenment. New York: Continuum Publishing, 1944/1987. Horrigan, John B. "New Internet Users: What They Do Online, What They Don't and Implications for the 'Net's Future." Pew Internet and American Life Project. 25 Sep. 2000. 24 Oct. 2001 <http://www.pewinternet.org/reports/toc.asp?Report=22>. Hunnicutt, Benjamin Kline. Work without End: Abandoning Shorter Hours for the Right to Work. Philadelphia: Temple UP, 1988. International Labour Office. Economically Active Populations: Estimates and Projections 1950-2025. Geneva: ILO, 1995. Jhally, Sut. The Codes of Advertising. New York: St. Martin's Press, 1987. Kim, Jane. "Computers and the Digital Economy." Digital Economy 1999. 8 June 1999. October 24, 2001 <http://www.digitaleconomy.gov/powerpoint/triplett/index.htm>. Lash, Scott, and John Urry. Economies of Signs and Space. London: Sage Publications, 1994. Mander, Jerry. Four Arguments for the Elimination of Television. New York: Morrow Press, 1978. Mumford, Lewis. Technics and Civilization. New York: Harcourt Brace, 1934. Preston, Paschal. Reshaping Communication: Technology, Information and Social Change. London: Sage, 2001. "Radio's Big Issue Who Is to Pay the Artist?" The New York Times 18 May 1924: Section 8, 3. Reed, Lori. "Domesticating the Personal Computer." Critical Studies in Media Communication17 (2000): 159-85. Smythe, Dallas. Counterclockwise: Perspectives on Communication. Boulder, CO: Westview Press, 1993. United States Bureau of Labor Statistics. Unpublished Data from the Current Population Survey. 2001. Wasser, Frederick A. Veni, Vidi, Video: The Hollywood Empire and the VCR. Austin, TX: U of Texas P, 2001. Weston, N.A., T.N. Carver, J.P. Frey, E.H. Johnson, T.R. Snavely and F.D. Tyson. "Shorter Working Time and Unemployment." American Economic Review Supplement 22.1 (March 1932): 8-15. <http://links.jstor.org/sici?sici=0002-8282%28193203%2922%3C8%3ASWTAU%3E2.0.CO%3B2-3>. Winn, Marie. The Plug-in Drug. New York: Viking Press, 1977. "Wired Workers: Who They Are, What They're Doing Online." Pew Internet Life Report 3 Sep. 2000. 24 Oct. 2000 <http://www.pewinternet.org/reports/toc.asp?Report=20>. Yazigi, Monique P. "Shocking Visits to the Real World." The New York Times 21 Feb. 1990. Page unknown. Links http://www.pewinternet.org/reports/toc.asp?Report=20 http://www.pewinternet.org/reports/toc.asp?Report=22 http://www.atari-history.com/computers/8bits/400.html http://www.transparencynow.com/mary.htm http://www.digitaleconomy.gov/powerpoint/triplett/index.htm http://links.jstor.org/sici?sici=0002-8282%28193203%2922%3C8%3ASWTAU%3 E2.0.CO%3B2-3 Citation reference for this article MLA Style Wasser, Frederick. "Media Is Driving Work" M/C: A Journal of Media and Culture 4.5 (2001). [your date of access] < http://www.media-culture.org.au/0111/Wasser.xml >. Chicago Style Wasser, Frederick, "Media Is Driving Work" M/C: A Journal of Media and Culture 4, no. 5 (2001), < http://www.media-culture.org.au/0111/Wasser.xml > ([your date of access]). APA Style Wasser, Frederick. (2001) Media Is Driving Work. M/C: A Journal of Media and Culture 4(5). < http://www.media-culture.org.au/0111/Wasser.xml > ([your date of access]).

BackgroundIn the past twenty years the discourse of the weight-centred health paradigm (WCHP) has attained almost complete dominance in the sphere of public health policy throughout the developed English speaking world. The national governments of Australia and many countries around the world have responded to what is perceived as an ‘epidemic of obesity’ with public health policies and programs explicitly focused on reducing and preventing obesity through so called ‘lifestyle’ behaviour change. Weight-related public health initiatives have been subjected to extensive critique based on ideological, ethical and empirical grounds (Solovay; Oliver; Gaesser; Gard; Monaghan, Colls and Evans; Wright; Rothblum and Solovay; Saguy; Rich, Monaghan and Aphramor; Bacon and Aphramor; Brown). Many scholars have raised concerns about the stigmatising and harmful effects of the WCHP (Aphramor; Bacon and Aphramor; O'Dea; Tylka et al.), and in particular the inequitable distribution of such negative impacts on women, people who are poor, and people of colour (Campos). Weight-based stigma is now well recognised as a pervasive and insidious form of stigma (Puhl and Heuer). Weight-based discrimination (a direct result of stigma) in the USA has a similar prevalence rate to race-based discrimination, and discrimination for fatter and younger people in particular is even higher (Puhl, Andreyeva and Brownell). Numerous scholars have highlighted the stigmatising discourse evident in obesity prevention programs and policies (O'Reilly and Sixsmith; Pederson et al.; Nuffield Council on Bioethics; ten Have et al.; MacLean et al.; Carter, Klinner, et al.; Fry; O'Dea; Rich, Monaghan and Aphramor). The ‘war on obesity’ can therefore be regarded as a social determinant of poor health (O'Hara and Gregg). Focusing on overweight and obese people is not only damaging to people’s health, but is ineffective in addressing the broader social and economic issues that create health and wellbeing (Cohen, Perales and Steadman; MacLean et al.; Walls et al.). Analyses of the discourses used in weight-related public health initiatives have highlighted oppressive, stigmatizing and discriminatory discourses that position body weight as pathological (O'Reilly; Pederson et al.), anti-social and a threat to the viable future of society (White). There has been limited analysis of discourses in Australian social marketing campaigns focused on body weight (Lupton; Carter, Rychetnik, et al.).Social Marketing CampaignsIn 2006 the Australian, State and Territory Governments funded the Measure Up social marketing campaign (Australian Government Department of Health and Ageing "Measure Up"). As the name suggests Measure Up focuses on the measurement of health through body weight and waist circumference. Campaign resources include brochures, posters, a tape measure, a 12 week planner, a community guide and a television advertisement. Campaign slogans are ‘The more you gain, the more you have to lose’ and ‘How do you measure up?’Tomorrow People is the component of Measure Up designed for Indigenous Australians (Australian Government Department of Health and Ageing "Tomorrow People"). Tomorrow People resources focus on healthy eating and physical activity and include a microsite on the Measure Up website, booklet, posters, print and radio advertisements. The campaign slogan is ‘Tomorrow People starts today. Do it for our kids. Do it for our culture.’ In 2011, phase two of the Measure Up campaign was launched (Australian Government Department of Health and Ageing "Swap It, Don't Stop It"). The central premise of Swap It, Don’t Stop It is that you ‘can lose your belly without losing all the things you love’ by making ‘simple’ swaps of behaviours related to eating and physical activity. The campaign’s central character Eric is made from a balloon, as are all of the other characters and visual items used in the campaign. Eric claims thatover the years my belly has ballooned and ballooned. It’s come time to do something about it — the last thing I want is to end up with some cancers, type 2 diabetes and heart disease. That’s why I’ve become a Swapper! What’s a swapper? It’s simple really. It just means swapping some of the things I’m doing now for healthier choices. That way I can lose my belly, without losing all the things I love. It’s easy! The campaign has produced around 30 branded resource items including brochures, posters, cards, fact sheets, recipes, and print, radio, television and online advertisements. All resources include references to Eric and most also include the image of the tape measure used in the Measure Up campaign. The Swap It, Don’t Stop It campaign also includes resources specifically directed at Indigenous Australians including two posters from the generic campaign with a dot painting motif added to the background. MethodologyThe epistemological position in this project was constructivist (Crotty) and the theoretical perspective was critical theory (Crotty). Multimedia critical discourse analysis (Machin and Mayr) was the methodology used to examine the social marketing campaigns and identify the discourses within them. Critical discourse analysis (CDA) focuses on critiquing text for evidence of power and ideology. CDA is used to reveal the ideas, absences and assumptions, and therefore the power interests buried within texts, in order to bring about social change. As a method, CDA has a structured three dimensional approach involving textual practice analysis (for lexicon) at the core, within the context of discursive practice analysis (for rhetorical and lexical strategies particularly with respect to claims-making), which falls within the context of social practice analysis (Jacobs). Social practice analysis explores the role played by power and ideology in supporting or disturbing the discourse (Jacobs; Machin and Mayr). Multimodal CDA (MCDA) uses a broad definition of text to include words, pictures, symbols, ideas, themes or any message that can be communicated (Machin and Mayr). Analysis of the social marketing campaigns involved examining the vocabulary, grammar, sentence structure, visuals and overall structure of the text for textual, discursive and social practices.Results and DiscussionIndividual ResponsibilityThe discourse of individual responsibility is strongly evident in the campaigns. In this discourse, it is ultimately the individual who is held responsible for their body weight and their health. The individual responsibility discourse is signified by the discursive practice of using epistemic (related to the truth or certainty) and deontic (compelling or instructing) modality words, particularly modal verbs and modal adverbs. High modality epistemic words are used to convince the reader of the certainty of statements and to portray the statement-maker as authoritative. High modality deontic words are used to instil power and authority in the instructions.The extensive use of high modality epistemic and deontic words is demonstrated in the following paragraph assembled from various campaign materials: Ultimately (epistemic modality adverb) individuals must take responsibility (deontic modality verb) for their own health, including their and weight. Obesity is caused (epistemic modality verb) by an imbalance in energy intake (from diet) (epistemic modality verb) and expenditure (from activity) (epistemic modality verb). Individually (epistemic modality adverb) we make decisions (epistemic modality verb) about how much we eat (epistemic modality verb) and how much activity we undertake (epistemic modality verb). Each of us can control (epistemic modality) our own weight by controlling (deontic modality) what we eat (deontic modality verb) and how much we exercise (deontic modality verb). To correct (deontic modality verb) the energy imbalance, individuals need to develop (deontic modality verb) a healthy lifestyle by making changes (deontic modality verb) to correct (deontic modality verb) their dietary habits and increase (deontic modality verb) their activity levels. The verbs must, control, correct, develop, change, increase, eat and exercise are deontic modality verbs designed to instruct or compel the reader.These discursive practices result in the clear message that individuals can and must control, correct and change their eating and physical activity, and thereby control their weight and health. The implication of the individualist discourse is that individuals, irrespective of their genes, life-course, social position or environment, are charged with the responsibility of being more self-surveying, self-policing, self-disciplined and self-controlled, and therefore healthier. This is consistent with the individualist orientation of neoliberal ideology, and has been identified in various critiques of obesity prevention public health programs that centralise the self-responsible subject (Murray; Rich, Monaghan and Aphramor) and the concept of ‘healthism’, the moral obligation to pursue health through healthy behaviours or healthy lifestyles (Aphramor and Gingras; Mansfield and Rich). The hegemonic Western-centric individualist discourse has also been critiqued for its role in subordinating or silencing other models of health and wellbeing including Aboriginal or indigenous models, that do not place the individual in the centre (McPhail-Bell, Fredericks and Brough).Obesity Causes DiseaseEpistemic modality verbs are used as a discursive practice to portray the certainty or probability of the relationship between obesity and chronic disease. The strength of the epistemic modality verbs is generally moderate, with terms such as ‘linked’, ‘associated’, ‘connected’, ‘related’ and ‘contributes to’ most commonly used to describe the relationship. The use of such verbs may suggest recognition of uncertainty or at least lack of causality in the relationship. However this lowered modality is counterbalanced by the use of verbs with higher epistemic modality such as ‘causes’, ‘leads to’, and ‘is responsible for’. For example:The other type is intra-abdominal fat. This is the fat that coats our organs and causes the most concern. Even though we don’t yet fully understand what links intra-abdominal fat with chronic disease, we do know that even a small deposit of this fat increases the risk of serious health problems’. (Swap It, Don’t Stop It Website; italics added)Thus the prevailing impression is that there is an objective, definitive, causal relationship between obesity and a range of chronic diseases. The obesity-chronic disease discourse is reified through the discursive practice of claims-making, whereby statements related to the problem of obesity and its relationship with chronic disease are attributed to authoritative experts or expert organisations. The textual practice of presupposition is evident with the implied causal relationship between obesity and chronic disease being taken for granted and uncontested. Through the textual practice of lexical absence, there is a complete lack of alternative views about body weight and health. Likewise there is an absence of acknowledgement of the potential harms arising from focusing on body weight, such as increased body dissatisfaction, disordered eating, and, paradoxically, weight gain.Shame and BlameBoth Measure Up and Swap It, Don’t Stop It include a combination of written/verbal text and visual images that create a sense of shame and blame. In Measure Up, the central character starts out as young, slim man, and as he ages his waist circumference grows. When he learns that his expanding waistline is associated with an increased risk of chronic disease, his facial expression and body language convey that he is sad, dejected and fearful. In the still images, this character and a female character are positioned looking down at the tape measure as they measure their ‘too large’ waists. This position and the looks on their faces suggest hanging their heads in shame. The male characters in both campaigns specifically express shame about “letting themselves go” by unthinkingly practicing ‘unhealthy’ behaviours. The characters’ clothing also contribute to a sense of shame. Both male and female characters in Measure Up appear in their underwear, which suggests that they are being publicly shamed. The clothing of the Measure Up characters is similar to that worn by contestants in the television program The Biggest Loser, which explicitly uses shame to ‘motivate’ contestants to lose weight. Part of the public shaming of contestants involves their appearance in revealing exercise clothing for weigh-ins, which displays their fatness for all to see (Thomas, Hyde and Komesaroff). The stigmatising effects of this and other aspects of the Biggest Loser television program are well documented (Berry et al.; Domoff et al.; Sender and Sullivan; Thomas, Hyde and Komesaroff; Yoo). The appearance of the Measure Up characters in their underwear combined with their head position and facial expressions conveys a strong, consistent message that the characters both feel shame and are deserving of shame due to their self-inflicted ‘unhealthy’ behaviours. The focus on ‘healthy’ and ‘unhealthy’ behaviours contributes to accepted and contested health identities (Fry). The ‘accepted health identity’ is represented as responsible and aspiring to and pursuing good health. The ‘contested health identity’ is represented as unhealthy, consuming too much food, and taking health risks, and this identity is stigmatised by public health programs (Fry). The ‘contested health identity’ represents the application to public health of Goffman’s ‘spoiled identity’ on which much stigmatisation theorising and research has been based (Goffman). As a result of both lexical and visual textual practices, the social marketing campaigns contribute to the construction of the ‘accepted health identity’ through discourses of individual responsibility, choice and healthy lifestyle. Furthermore, they contribute to the construction of the spoiled or ‘contested health identity’ through discourses that people are naturally unhealthy and need to be frightened, guilted and shamed into stopping ‘unhealthy’ behaviours and adopting ‘healthy’ behaviours. The ‘contested health identity’ constructed through these discourses is in turn stigmatised by such discourses. Thus the campaigns not only risk perpetuating stigmatisation through the reinforcement of the health identities, but possibly extend it further by legitimising the stigma associated with such identities. Given that these campaigns are conducted by the Australian Government, the already deeply stigmatising social belief system receives a significant boost in legitimacy by being positioned as a public health belief system perpetrated by the Government. Fear and AlarmIn the Measure Up television advertisement the main male character’s daughter, who has run into the frame, abruptly stops and looks fearful when she hears about his increased risk of disease. Using the discursive practice of claims-making, the authoritative external source informs the man that the more he gains (in terms of his waist circumference), the more he has to lose. The clear implication is that he needs to be fearful of losing his health, his family and even his life if he doesn’t reduce his waist circumference. The visual metaphor of a balloon is used as the central semiotic trope in Swap It, Don’t Stop It. The characters and other items featuring in the visuals are all made from twisting balloons. Balloons themselves may not create fear or alarm, unless one is unfortunate to be afflicted with globophobia (Freed), but the visual metaphor of the balloon in the social marketing campaign had a range of alarmist meanings. At the population level, rates and/or costs of obesity have been described in news items as ‘ballooning’ (Body Ecology; Stipp; AFP; Thien and Begawan) with accompanying visual images of extremely well-rounded bodies or ‘headless fatties’ (Cooper). Rapid or significant weight gain is referred to in everyday language as ‘ballooning weight’. The use of the balloon metaphor as a visual device in Swap It, Don’t Stop It serves to reinforce and extend these alarmist messages. Further, there is no attempt in the campaigns to reduce alarm by including positive or neutral photographs or images of fat people. This visual semiotic absence – a form of cultural imperialism (Young) – contributes to the invisibilisation of ‘real life’ fat people who are not ashamed of themselves. Habermas suggests that society evolves and operationalises through rational communication which includes the capacity to question the validity of claims made within communicative action (Habermas The Structural Transformation of the Public Sphere; Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society). However the communicative action taken by the social marketing campaigns analysed in this study presents claims as uncontested facts and is therefore directorial about the expectations of individuals to take more responsibility for themselves, adopt certain behaviours and reduce or prevent obesity. Habermas argues that the lack or distortion of rational communication erodes relationships at the individual and societal levels (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Structural Transformation of the Public Sphere). The communicative actions represented by the social marketing campaigns represents a distortion of rational communication and therefore erodes the wellbeing of individuals (for example through internalised stigma, shame, guilt, body dissatisfaction, weight preoccupation, disordered eating and avoidance of health care), relationships between individuals (for example through increased blame, coercion, stigma, bias, prejudice and discrimination) and society (for example through stigmatisation of groups in the population on the basis of their body size and increased social and health inequity). Habermas proposes that power differentials work to distort rational communication, and that it is these distortions in communication that need to be the focal point for change (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Theory of Communicative Action: The Critique of Functionalist Reason; Habermas The Structural Transformation of the Public Sphere). Through critical analysis of the discourses used in the social marketing campaigns, we identified that they rely on the power, authority and status of experts to present uncontested representations of body weight and ‘appropriate’ health responses to it. In identifying the discourses present in the social marketing campaigns, we hope to focus attention on and thereby disrupt the distortions in the practical knowledge of the weight-centred health paradigm in order to contribute to systemic reorientation and change.ConclusionThrough the use of textual, discursive and social practices, the social marketing campaigns analysed in this study perpetuate the following concepts: everyone should be alarmed about growing waistlines and ‘ballooning’ rates of ‘obesity’; individuals are to blame for excess body weight, due to ignorance and the practice of ‘unhealthy behaviours’; individuals have a moral, parental, familial and cultural responsibility to monitor their weight and adopt ‘healthy’ eating and physical activity behaviours; such behaviour changes are easy to make and will result in weight loss, which will reduce risk of disease. These paternalistic campaigns evoke feelings of personal and parental guilt and shame, resulting in coercion to ‘take action’. They simultaneously stigmatise fat people yet serve to invisibilise them. Public health agencies must consider the harmful consequences of social marketing campaigns focused on body weight.ReferencesAFP. "A Ballooning Health Issue around the World." Gulfnews.com 29 May 2013. 17 Sep. 2013 ‹http://gulfnews.com/news/world/other-world/a-ballooning-health-issue-around-the-world-1.1189899›.Aphramor, Lucy. "The Impact of a Weight-Centred Treatment Approach on Women's Health and Health-Seeking Behaviours." Journal of Critical Dietetics 1.2 (2012): 3-12.Aphramor, Lucy, and Jacqui Gingras. "That Remains to Be Said: Disappeared Feminist Discourses on Fat in Dietetic Theory and Practice." The Fat Studies Reader, eds. Esther Rothblum and Sondra Solovay. New York: New York University Press, 2009. 97-105. Australian Government Department of Health and Ageing. "Measure Up." 2010. 3 Aug. 2011 ‹https://web.archive.org/web/20110817065823/http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/About+the+campaign-lp›.———. "Swap It, Don't Stop It." 2011. 20 Aug. 2011 ‹https://web.archive.org/web/20110830084149/http://swapit.gov.au›.———. "Tomorrow People." 2010. 3 Aug. 2011 ‹https://web.archive.org/web/20110821140445/http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/tp_home›.Bacon, Linda, and Lucy Aphramor. "Weight Science: Evaluating the Evidence for a Paradigm Shift." Nutrition Journal 10.9 (2011). Bacon, Linda, and Lucy Aphramor. Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. Dallas: BenBella Books, 2014. Berry, Tanya R., et al. "Effects of Biggest Loser Exercise Depictions on Exercise-Related Attitudes." American Journal of Health Behavior 37.1 (2013): 96-103. Body Ecology. "Obesity Rates Ballooning – Here's What You Really Need to Know to Lose Weight and Keep It Off." 2009. 9 Jun. 2011 ‹http://bodyecology.com/articles/obesity-rates-ballooning.php›.Brown, Harriet. Body of Truth: How Science, History and Culture Drive Our Obsession with Weight – and What We Can Do about It. Boston: Da Capo Press, 2015. Campos, Paul. The Obesity Myth. New York: Gotham Books, 2004. Carter, Stacy M., et al. "The Ethical Commitments of Health Promotion Practitioners: An Empirical Study from New South Wales, Australia." Public Health Ethics 5.2 (2012): 128-39. Carter, Stacy M., et al. "Evidence, Ethics, and Values: A Framework for Health Promotion." American Journal of Public Health 101.3 (2011): 465-72. Cohen, Larry, Daniel P. Perales, and Catherine Steadman. "The O Word: Why the Focus on Obesity Is Harmful to Community Health." Californian Journal of Health Promotion 3.3 (2005): 154-61. Cooper, Charlotte. "Olympics/Uhlympics: Living in the Shadow of the Beast." thirdspace: a journal of feminist theory & culture 9.2 (2010). Crotty, Michael. The Foundations of Social Research: Meaning and Perspective in the Research Process. 1st ed. Crows Nest: Allen and Unwin, 1998. Domoff, Sarah E., et al. "The Effects of Reality Television on Weight Bias: An Examination of the Biggest Loser." Obesity 20.5 (2012): 993-98. Freed, Megan. "Uncommon Phobias: The Fear of Balloons." Yahoo Voices 2007. 17 Sep. 2013 ‹http://voices.yahoo.com/uncommon-phobias-fear-balloons-338043.html›.Fry, Craig L. "Ethical Issues in Obesity Interventions for Populations." New South Wales Public Health Bulletin 23.5-6 (2012): 116-19. Gaesser, Glenn A. "Is It Necessary to Be Thin to Be Healthy?" Harvard Health Policy Review 4.2 (2003): 40-47. Gard, Michael. The End of the Obesity Epidemic. Oxon: Routledge, 2011. Goffman, E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall, 1963.Habermas, Jürgen. The Theory of Communicative Action: Reason and the Rationalisation of Society. Vol. 1. Cambridge: Polity Press, 2004. ———. The Theory of Communicative Action: The Critique of Functionalist Reason. Vol. 2. Cambridge: Polity Press, 2004.———. The Structural Transformation of the Public Sphere. Cambridge: Polity Press, 2002.Jacobs, Keith. "Discourse Analysis." Social Research Methods: An Australian Perspective, ed. Maggie Walter. South Melbourne, Vic.: Oxford University Press, 2006. Lupton, Deborah. "'How Do You Measure Up?' Assumptions about 'Obesity' and Health-Related Behaviors and Beliefs in Two Australian 'Obesity' Prevention Campaigns." Fat Studies 3.1 (2014): 32-44. Machin, David, and Andrea Mayr. How to Do Critical Discourse Analysis: A Multimodal Introduction. London: Sage Publications 2012. MacLean, Lynne, et al. "Obesity, Stigma and Public Health Planning." Health Promotion International 24.1 (2009): 88-93. Mansfield, Louise, and Emma Rich. "Public Health Pedagogy, Border Crossings and Physical Activity at Every Size." Critical Public Health 23.3 (2013): 356-70. McPhail-Bell, Karen, Bronwyn Fredericks, and Mark Brough. "Beyond the Accolades: A Postcolonial Critique of the Foundations of the Ottawa Charter." Global Health Promotion 20.2 (2013): 22-29. Monaghan, Lee F., Rachel Colls, and Bethan Evans. "Obesity Discourse and Fat Politics: Research, Critique and Interventions." Critical Public Health 23.3 (2013): 249-62. Murray, Samantha. The 'Fat' Female Body. London: Palgrave Macmillan, 2008. Nuffield Council on Bioethics. Public Health: Ethical Issues. London: Nuffield Council on Bioethics, 2007. O'Dea, Jennifer A. "Prevention of Child Obesity: 'First, Do No Harm'." Health Education Research 20.2 (2005): 259-65. O'Hara, Lily, and Jane Gregg. "The War on Obesity: A Social Determinant of Health." Health Promotion Journal of Australia 17.3 (2006): 260-63. O'Reilly, Caitlin. "Weighing In on the Health and Ethical Implications of British Columbia's Weight Centered Health Paradigm." Simon Fraser University, 2011. O'Reilly, Caitlin, and Judith Sixsmith. "From Theory to Policy: Reducing Harms Associated with the Weight-Centered Health Paradigm." Fat Studies 1.1 (2012): 97-113. Oliver, J. "The Politics of Pathology: How Obesity Became an Epidemic Disease." Perspectives in Biology and Medicine 49.4 (2006): 611-27. Pederson, A., et al., eds. Rethinking Women and Healthy Living in Canada. Vancouver, BC: British Columbia Centre of Excellence for Women's Health, 2013. Puhl, Rebecca, and Chelsea Heuer. "Obesity Stigma: Important Considerations for Public Health." American Journal of Public Health 100.6 (2010): 1019. Puhl, Rebecca M., T. Andreyeva, and Kelly D. Brownell. "Perceptions of Weight Discrimination: Prevalence and Comparison to Race and Gender Discrimination in America." International Journal of Obesity 32 (2008): 992-1000.Rich, Emma, Lee Monaghan, and Lucy Aphramor, eds. Debating Obesity: Critical Perspectives. Basingstoke: Palgrave MacMillan, 2011. Rothblum, Esther, and Sondra Solovay, eds. The Fat Studies Reader. New York: New York University Press, 2009. Saguy, Abigail. What's Wrong with Fat? New York: Oxford University Press, 2013.Sender, Katherine, and Margaret Sullivan. "Epidemics of Will, Failures of Self-Esteem: Responding to Fat Bodies in The Biggest Loser and What Not to Wear." Continuum 22.4 (2008): 573-84. Solovay, Sondra. Tipping the Scales of Justice: Fighting Weight-Based Discrimination. New York: Prometheus Books, 2000.Stipp, David. "Obesity — Not Aging — Balloons Health Care Costs." Pacific Standard 2011. 17 Sep. 2013 ‹http://www.psmag.com/health/obesity-aging-cause-ballooning-health-care-costs-31879/›.Ten Have, M., et al. "Ethics and Prevention of Overweight and Obesity: An Inventory." Obesity Reviews 12.9 (2011): 669-79. Thien, Rachel, and Bandar Seri Begawan. "Obesity Balloons among Brunei Students." The Brunei Times 2010. 17 Sep. 2013 ‹http://www.bt.com.bn/news-national/2010/02/10/obesity-balloons-among-brunei-students›.Thomas, Samantha, Jim Hyde, and Paul Komesaroff. "'Cheapening the Struggle:' Obese People's Attitudes towards the Biggest Loser." Obesity Management 3.5 (2007): 210-15. Tylka, Tracy L., et al. "The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss." Journal of Obesity (2014): 18. Article ID 983495.Walls, Helen, et al. "Public Health Campaigns and Obesity – A Critique." BMC Public Health 11.1 (2011): 136. White, Francis Ray. "Fat, Queer, Dead: ‘Obesity’ and the Death Drive." Somatechnics 2.1 (2012): 1-17. Wright, Jan. "Biopower, Biopedagogies and the Obesity Epidemic." Biopolitics and the ‘Obesity Epidemic’: Governing Bodies. Ed. Jan Wright and Valerie Harwood. New York: Routledge, 2009. 1-14.Yoo, Jina H. "No Clear Winner: Effects of the Biggest Loser on the Stigmatization of Obese Persons." Health Communication 28.3 (2013): 294-303. Young, Iris Marion. "Five Faces of Oppression." The Philosophical Forum 19.4 (1988): 270-90.

To date, traditional behavioral interventions have done little to reduce the prevalence and transmission of HIV among African American men who have sex with men (AAMSM), a highly at risk group. Some researchers theorize that the lack of success may be because these interventions do not address contextual factors among AAMSM. Community-based participatory research (CBPR) is one approach to research with the potential to lead to effective interventions in the future. CBPR is a collaborative, mixed-methods and multidisciplinary, approach to scientific inquiry, which is conducted with, and within, the community. The current study follows the CBPR approach to engage and develop a relationship with the African American communities in the Dallas/Fort Worth Metroplex. Contextual issues were discussed in order to identify emerging themes regarding HIV health related issues among AAMSM to provide the groundwork for continued CBPR research and future interventions with AAMSM in the Dallas/Fort Worth Metroplex. To accomplish this goal, researchers began the CBPR process by conducting interviews and focus groups with a sample of approximately 62 (34 from key informant interviews, 28 from focus groups [gender balanced]) AIDS service organization leaders and workers, advocates, medical doctors and community members with first-hand knowledge of HIV health issues in the AAMSM community. Transcripts of these interviews and focus groups were analyzed to identify emerging themes at the societal (religious doctrine, African American Culture, age-related norms and stigma), community (education, religious views/policy and community norms) and individual (disclosure, personal identity, sexual behavior/risk, accessing care and communication) levels. This data was used to create a holistic narrative report that will be used to direct the community advisory board (CAB) and guide future research and interventions.