Apparently the Miss USA Pageant Rewards Victim Blaming

During last night’s Miss USA pageant, the top six contestants were each asked a different question about an important cultural or political issue.

For Miss Nevada, Nia Sanchez, Judge Rumer Willis asked a question about sexual assault on college campuses. She asked why Nia thought such crimes have been "swept under the rug for so long" and what colleges can do to combat that. Here is the response from Sanchez:

"I believe that some colleges may potentially be afraid of having a bad reputation and that would be a reason it could be swept under the rug, because they don't want that to come out into the public. But I think more awareness is very important so women can learn how to protect themselves. Myself, as a fourth-degree black belt, I learned from a young age that you need to be confident and be able to defend yourself. And I think that's something that we should start to really implement for a lot of women."

The reason this response is so cringe worthy is that it completely puts the responsibility on women to prevent rape. In other words: If women are confident, learn self-defense, and fight back- rape will be prevented. On the flip side: If they DON’T fight back, somehow it is their fault that the assault occurred. This is a terrible message and one that goes against everything we know about effective prevention.

Last month I wrote about the White House’s new report “Not Alone” and PSA which focuses on protecting students from sexual assault. They both highlight important strategies for preventing assaults which include:

• Identifying evidence-based strategies for preventing sexual violence
• Developing and evaluating new prevention strategies
• Getting everyone to step in (also known as bystander interventions). Everyone is asked to speak out against rape myths and intervene if someone is at risk of being assaulted.
• Enlisting men as allies

Effective strategies focus on making change at the system-level. They focus on changing a culture (campus or beyond) that accepts sexual violence. They fight against rape myths that include: “she was assaulted because she didn’t fight back”. Unfortunately, the Miss USA pageant provided a huge stage (literally and figuratively) for that myth to be perpetuated. And Nia Sanchez was greatly rewarded for promoting this victim blaming myth- she was crowned Miss USA.

Kim Kardashian is a Spokesperson (Again) for a Public Health Issue...Will the Public Buy In This Time?

This afternoon I saw a tweet from Kim Kardashian that read "Recognizing Ovarian Cancer is the 1st step in fighting Ovarian Cancer- please watch and share this video". So my first thought was- "I wonder if this campaign will be more successful than her last?" As you may remember, in December 2010 I blogged about Kim and other celebrities that staged their digital deaths in order to raise money for World AIDS Day. In addition to my concerns about the campaign's design (which included a less than clear cue to action for the audience), its "success" was also questionable because it ended up taking much longer than intended to reach their 1 million dollar goal. So I was quite intrigued to view Kim's newest PSA on YouTube.

The event called "Super Saturday Live" is a collaboration between QVC and the Ovarian Cancer Research Fund (OCRF). On Saturday, July 30, 2011- designer clothes sold on QVC will be 50% off and the net proceeds will be given to OCRF. The PSA informs the audience that this money is necessary because there is currently no good early detection test for ovarian cancer.

I was pleasantly surprised by the PSA. It didn't feel too long (94 seconds). It kept my interest with minimal and appropriate statistics. For example, instead of scaring the audience, the music was upbeat and focused on the positive- a 92% 5-year survival rate when the cancer is detected early. The PSA also had information presented through both audio and visual channels. Finally (and most importantly)- as an audience member, I knew exactly what I was supposed to do. The cue to action was clear. I was to share the video- "like" it, post it, forward it. And finally, I should tweet about #supersaturday. This way the "trend" can get ahead of ovarian cancer.

In addition to the look and feel of the PSA, I think it is important to discuss the strength and popularity of the chosen spokesperson. Just as I mentioned in December, Kim Kardashian is an obvious choice if you are looking for a huge reach. As of tonight, she had 8,380,553 followers on twitter. The PSA already had 5,965 views on YouTube. However, I have my concerns about her genuine interest in this public health issue. Does she have a personal connection or does she just jump on the bandwagon (like in December) for any way to promote her "brand"? I ask because I have concerns due to how she behaves on her E! show- Keeping Up with the Kardashians. For example, just a few weeks ago on the show, Kim had her butt x-rayed to "prove to the media" that it was real (without butt implants). I watched this episode while on the elliptical machine at the gym and felt enraged. First of all, what type of terrible physician allows his time and resources to be taken up with such nonsense? Also, what type of terrible physician agrees to expose Kim, his patient, to needless radiation to help her prove this point? And how much extra time does she (and her sisters) have on their hands to participate in this silly trip to the doctor? If I were the Executive Director of OCRF, even with her extensive popularity, I doubt that I would choose her for a spokesperson.

So let's all check out Twitter on Saturday, July 30th...let's see if #supersaturday is trending and if Kim's "quantity" of followers can help balance out her sometimes lack of "quality" as a spokesperson.

Will New Ads in Georgia "Stop Childhood Obesity" or Increase Stigma and Bullying?

On Friday's Today show, there was an interesting analysis of a new campaign from the Georgia Child Health Alliance (GCHA) aimed at reducing childhood obesity. According to the GCHA website, the Warning: Stop Childhood Obesity media campaign "is part of a large-scale public awareness campaign designed to educate Georgians on the childhood obesity epidemic facing our state. Backed by market research, the campaign’s warning messages about obesity are developed to reach parents and children using communication vehicles such as billboards, television, radio and more".

From the Today show segment (which featured the campaign's Director, a child actor featured in the ads, and a child psychologist) we learned that this media campaign is part one of a three part campaign. The three parts were briefly outlined:

1- Raise awareness about childhood obesity; letting kids voice their struggle in their own words.
2- "Activate"- focus on healthy eating and activity
3- Focus on real solutions

While the GCHA outlines their strategic mission for this campaign, they are hearing some major objections to their approach and it continues to grab national headlines. The major concerns voiced by objectors such as Rebecca Puhl (a weight discrimination expert from Yale University), are that the ads will increase stigma for overweight kids (which could increase their experience of bullying) and that the ads will be ineffective due to their fear-based approach. In my review of the ads, I have mixed (mostly negative) feelings about their development and implementation:

• Strike One: The goal of this campaign is listed as "raising awareness". These may be my two least favorite terms in all of public health. "Raising awareness" is too vague and does not lend itself to being evaluated. In actuality, campaign developers usually want to "increase knowledge" or "change perceptions" or "change behavior" (e.g., calling the 800 number on the screen). These are all things which can actually be measured and should be stated more clearly.

• Strike Two: When the Today show asked the Campaign director about the audience for these ads, he replied "parents, kids, and educators". Again, this is way too vague. Your message and call to action (i.e., what you want the viewer to do after watching the ad) would be completely different for each of those audiences. For example, you may want educators to reach out to the parents of overweight kids in their classes or you may want kids to tell an adult if they are being bullied about their weight. These messages need to be tailored to each audience.
  

• Strike Three: These ads definitely fall into the "fear-based" category. As you watch them, the ads read "WARNING" in bold red letters and you hear a "boom" (kinda like on "Law & Order) as the statistics run across the screen. As I have mentioned in previous blog posts, fear-based approaches have been found to be ineffective in other areas of prevention (e.g., alcohol and other drugs).

• In terms of redeeming factors, it does seem that the campaign was developed using formative research which included focus groups with overweight kids. The results of these focus groups were used to develop the dialogue read by child actors in the ads so that it would be "in their words". If kids are the audience for these ads, then the age appropriate priorities and dialogue (with the inclusion of child actors) is positive. From health behavior theory (e.g., Social Learning Theory), we know that kids will respond better if they relate to those in the ads.
  

Of course, it is unclear if they also focus group tested the ads and billboards after initial development, before they were rolled out. It is also unclear how they are being evaluated and what the ultimate goals are (beyond "increased awareness"). I'll be interested to see parts two and three rolled out and hope to include follow up thoughts here on Pop Health.

No Matter How Graphic The Images, Fear Based Messages Will Continue To Be Ineffective For Prevention

All over the news in the past week, we have seen samples of the new graphic images being proposed for addition to cigarette packages. They include corpses and people dying of cancer. However, just because these images and warnings are larger and more graphic, does not mean that they will be effective in smoking prevention.

A story ran today on Boston.com called "Will graphic cigarette warnings help- or hurt?" Two experts in tobacco prevention are quoted regarding their concerns about the new images. Gregory Connelly of the Harvard School of Public Health points to the results coming from Canada after using similar images. Smokers there simply purchased sleeves to cover up the images on their cigarette packs. Also, the smoking rate did not go down. The second expert is a wonderful professor of mine from the Boston University School of Public Health, Dr. Michael Siegel. Dr. Siegel writes regularly regarding this topic on his blog, "The Rest of the Story: Tobacco Analysis and Commentary". In the Boston.com article, he states "I do not actually think it's going to have much of an impact". His argument- the images are too late. The smokers are seeing the images after they have already purchased cigarettes. And (drum roll please....) people already know smoking is bad for them.

As someone who grew up during the "This is your brain. This is your brain on drugs. Any questions?" era...I wonder why we have not made much progress since then? Numerous studies have shown that scare tactics (or fear appeals) are not effective for preventing or producing sustained reductions of Alcohol, Tobacco, or other Drug use among youth. In addition to the issues outlined above, there is another problem with the fear based approach:

Although the fear based messages may increase knowledge (e.g., if they did not know it already, smokers will learn that cigarettes are bad for them from the graphic images)- knowledge does not equal behavior change. Especially when you are dealing with an addictive behavior. Addictive behaviors like smoking and drug use are impacted by much more than a rational weighing of pros and cons. There is the biological component of addiction, local-state-national prevention policies, social norms around the behavior, consequences experienced (or not experienced), ease of access to the substance, social support for quiting, money to support the addiction, etc. As you can see, knowledge alone will not change this kind of complex behavior.

Many of the most successful prevention strategies around this and other public health issues will continue to be a refocus from increasing individual knowledge to changing an environment that supports the behavior. In other words, laws that create smoke-free workplaces and crack down on establishments that sell cigarettes to underage kids will always be more effective at keeping the population healthy versus trying to educate (or scare) one individual at a time.