Media Reporting about Domestic Violence: What’s Missing?

Please welcome Elaine J. Alpert, MD, MPH as today's guest writer. Dr. Alpert is an internationally-respected family violence, sexual assault, and human trafficking education, advocacy, and policy expert. She is an independent curriculum design and policy consultant in all forms of violence prevention, teaches at the University of British Columbia School of Medicine, and provides expertise in Human Trafficking as Senior Global Health Fellow at Massachusetts General Hospital’s Division of Global Health and Human Rights. She also serves as a Trustee of the all-volunteer Steve Glidden Foundation, which provides summer camp scholarships for children who are homeless, refugees, abused, or affected by family or community violence. She can be reached at ealpert@rcn.com. 

I’ve been watching news coverage about Ray Rice’s domestic violence (DV) assault for the past two days now and I have to say that, on balance, I am disappointed.

As a veteran physician, educator and scholar in the fields of domestic violence, sexual assault and, more recently, human trafficking, I’ve been paying attention over the years both to events (often tragic) as they happen, and to trends in both media expertise and public perception. Here are some observations along with a few words on how I think the media can do better:

Media attention ideally should:

• Tell the viewing, listening, reading, or clicking audience what happened (report the news);
• Raise questions that people might not otherwise have considered;
• Educate, inform and raise awareness among the general public; and
• Motivate people to action (for example, by providing ready resources for those at risk, and by showing those who want to help how to do so).

How good a job do our media really do (in general) when reporting about DV? Typically, for a few days after a high profile DV assault or murder, we see coverage about whatever “event” transpired, along with passionate and generally well-meaning attention paid to DV as a whole. Overall, (and not specific to the Rice case), we tend to see variations of:

• Shock or disbelief that such a nice guy could have done such a terrible, unanticipated thing, often supported by “evidence” of niceness – he was a pillar of the community, he walked his dog every morning, he brought the paper to the elderly neighbor’s door, he belonged to the neighborhood watch, etc.  Often these “nice guy” testimonials come from neighbors or passers-by;

• Proclamations that this was either a one-off act of insanity or passion, or at least could not have been predicted  – he must suddenly have lost control, perhaps something happened (provoked him) to make him “lose it,” no one saw this coming, etc. These “no-one-saw-this-coming” testimonials are usually from acquaintances, co-workers, or local officials, often accompanied by assurances that the neighborhood itself is “nice,” “quiet,” or “tranquil,”  or at least full of hard-working, honest and earnest people. Accompanying footage often shows tree-lined streets and picket fences whenever possible;

• A general wringing of hands about difficulty the “victims” (or their children) may encounter moving forward (sometimes accompanied by additional angst about extended family members, pets, or traumatized neighbors). A few even engage in hand-wringing about the future well-being of the perpetrators (think Steubenville). All commentators can participate freely in the wringing-of-hands exercise, including reporters themselves; and

• Assurances that whatever tragic event just transpired was the tipping point and things will be better (this will not happen again, police responses will be improved, weapons will be better regulated, social service referrals will be handled more promptly, etc.). Such assurances usually come from local or statewide officials.

And then, almost like clockwork, once the arraignment (or funeral) has passed, and the world turns its attention to the next short-cycle news event, coverage moves to the next ratings-boosting headline.

Although still early, this pattern is already being replicated in the Ray Rice assault. The current pundits – at least on the news clips I am watching – are predominantly:

1. NFL or other sports experts/journalists talking about how it's important to figure out who in the league knew what, and when they knew it, while proclaiming how shocked they were when these allegations first arose last winter because Rice was – guess what – a pillar in his community;

2. Journalists and authors who are either psychologists or other counselors, or who have had personal experiences with DV and have written (and are, at times, quite obviously plugging) books about what "battered women" are “like” or what they “go through,” earnestly trying to explain Janay Rice’s various (and some would argue, stage-managed) "stand by your man" statements;

3. Legislators who proclaim (sometimes with passion) that DV is bad and VAWA is good; or

4. Lawyers who wonder why Rice was allowed to enter a "diversionary" program and was not jailed for aggravated assault.

Some of this commentary can add value to the societal discussion that needs to take place. Clearly, it is necessary, but it is not sufficient.

What I do NOT see - and what I think really needs to be featured prominently – is reporting that provides:

1. Commentary from DV experts, including community-based or national experts from DV advocacy organizations, recognized scholars, and those whose expertise is in primary prevention – changing conditions to prevent DV from occurring in the first place. Baltimore (and the DC Metro area) has all of that to offer - and then some.

2. Resource information for the viewer (or reader) on how to get help or how to get involved to help. This can easily be offered as a “crawler” with the vital information scrolling past at the bottom of the screen on TV or as a sidebar in print or on the internet.

At least as far as I have seen, very few "pundits" have talked about how to reach out to, and empower, survivors.  No one (at least on broadcasts I’ve seen) has told viewers who may be in danger that there are vital community-based services in most localities and how to contact them to get help. Not one has talked about the restorative power of support groups (though lots of pundits have talked about how important it is for the Rices to get one or another kind of therapy for things that may or may not have happened in their own childhoods). Not one has talked about how to engage men and other bystanders as active allies to challenge and change entrenched social norms that tolerate and promote violence. And not one has displayed the National DV hotline phone number (1-800-799-7233) or website (http://www.thehotline.org/).

Many years ago, when print media reigned supreme, the Boston Globe included an inset box with every article about DV. The box included a stylized image of a telephone, words identical or similar to “To Get Help,” and a DV hotline number. This boxed information was normally inserted in the final layout process. During a layout makeover several years ago, this vital information got dropped and, to my knowledge, has not been restored.

Including “To Get Help” info about DV in print, on TV news, and on web-based news sources is such a no-brainer. Why not include it automatically in news reporting?

None of this is rocket science – whenever you read about a disaster of any other kind – from Katrina to Sandy to tornadoes – there is ALMOST ALWAYS commentary from experts in the field, accompanied by a box or informational inset that provides information for people who need help or who want to volunteer, contribute or help in some other way.  Why is there a different set of rules for DV?

So we have come a long way I guess, but the media has still not got it quite right – at least not yet.

Janay – if you read this, your local DV organization is ready to reach out to you without judgment, and with compassion, patience, information, empowerment, and support.  If only the TV would tell you the phone number…

"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

• Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.

Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.

• Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.

Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.

• Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".

Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:

• What have been your favorite episodes of "Call the Midwife"?
• What other public health issues are portrayed in the 1950s that still challenge us today?

Seth MacFarlane: An Oscar Host who is Harmful to Comedy and the Public’s Health

This week’s post for Pop Health was co-written by Beth Grampetro, MPH, CHES. Beth has been working in college health promotion for 7 years and her interests include feminism online and in popular culture. You can follow her on twitter @bethg24. 

The role of society is important in public health.  Health is not just influenced by individual decisions and behaviors.  It is also influenced by our interactions with the world around us- our communities, our families, our workplaces, our schools, entertainment, celebrities, and the media.  These interactions can have a very strong influence (good or bad) on the public’s health.

With that in mind, we were horrified to witness host Seth MacFarlane’s monologue and ongoing commentary during Sunday night’s Oscars.  According to Nielsen ratings, approximately 40.3 million viewers tuned in to the Oscar telecast.  This broad audience watched MacFarlane, a widely known celebrity, make jokes about domestic violence, female actresses’ bodies, and various forms of discrimination.

In the opening number, MacFarlane sang a song entitled “We Saw Your Boobs”, about the scenes in various movies where actresses in the audience had appeared topless. While it has been reported that the actresses were in on the joke, it is nonetheless disturbing that this number passed muster- especially given that several of the scenes he referenced were from movies where the actresses he named portrayed rape victims.

Other jokes included a reference to Jennifer Aniston’s past as a stripper, a congratulatory statement about how great all the actresses who “gave themselves the flu” to lose weight looked in their dresses, and a comment about how Latino actors (in this case Javier Bardem, Salma Hayek, and Penelope Cruz) have difficult-to-understand accents “but we don’t care because they’re so attractive.”

MacFarlane also tried some jokes that had men as their targets but still managed to get mud on a few women in the process. He joked that Rex Reed was going to review Adele’s performance (a reference to Reed’s recent movie review in which he called Melissa McCarthy a “hippo”) and made a joke about 9-year-old nominee Quvenzhané Wallis dating George Clooney. Some defenders of MacFarlane’s performance argued that these jokes were meant to be about the men in question, but ignored the fact that they were made at the expense of women and girls.

The Oscars are billed as “Hollywood’s Biggest Night”, and it’s incredibly disappointing to see what is the biggest event for the entertainment industry turned into the worst office party in history, complete with a leering coworker who’s creating a hostile environment.  If MacFarlane succeeded at anything, it was reminding women that they’re expected to always be thin, be pretty, and be willing to shut up and take it, lest they spoil the whole evening.

There is evidence to show that (unfortunately) these types of jokes and messages that devalue women are believed and internalized within our communities.  For example, a 2009 study by the Boston Public Health Commission found that over half of teens surveyed blamed the singer Rihanna after she was beaten by her boyfriend Chris Brown.  In addition, research shows that a mere 3-5 minutes of listening to, or engaging in, fat talk can lead some women to feel bad about their appearance and experience heightened levels of body dissatisfaction.

Research also tells us that these internalized messages and social norms are correlated with serious public health outcomes.  For example, the CDC outlines the risk factors for sexual violence perpetration.  Under society level factors we find (among others):

• Societal norms that support sexual violence
• Societal norms that support male superiority and sexual entitlement
• Societal norms that maintain women's inferiority and sexual submissiveness
• Weak laws and policies related to gender equity

So the issue is much bigger than if Seth MacFarlane was funny or made a good Oscar host.  The issue is about the quality of the role models we choose to represent our communities and the messages they send.  These messages can have a broad and long lasting influence on public health.  We hope the Academy will choose wisely next year.

Chris Brown's Return to the Grammys: The Other Public Health Story

Sunday's Grammys were a mixture of high and low notes (pun intended), as the joy was often overshadowed by the death of Whitney Houston.  As someone who grew up in the 80's singing her songs, I too was quite shocked and saddened.  Despite broad speculation of an overdose, I'll wait to post on Whitney until we have a confirmed cause of death.

However, there was a second public health story on Sunday night.  It was the three year anniversary of Chris Brown assaulting Rihanna...and he made his return to the stage.  While Grammy executive producer Ken Ehrlich has defended the decision to bring Brown back and believes that he deserves a second chance, the warm sentiment was certainly not felt by all.  I personally turned the TV off when he began his performance.  My facebook and twitter feed blew up with comments from friends and colleagues like, "I'm no math wiz, but I'm pretty sure domestic abuser + 2 years= still a domestic abuser".  Many celebrities (both Grammy attendees and beyond) voiced the same sentiments on twitter.  For example, Wil Wheaton said simply, "everyone who apparently forgot what Chris Brown did to Rihanna should read the police report on exactly what he did."

Do you think that Chris Brown was worthy of a second chance at the Grammys? 

In addition to a discussion of giving second chances, remembering, or forgetting what he did...we must also discuss those who actually encourage what he did.  While there were outraged tweets during his performance, there were also those providing support.  The tweets that I found most disturbing were those from young women poking fun at the assault and saying that they would be happy to have it happen to them anytime.  For example, one woman said, "chris brown could beat me all he wants, he is flawless."

One of the biggest problems in our society is that we have a culture of violence where intimate partner violence is acceptable and abusers are not held responsible for their actions.     

What do you think we can do to stop the culture of violence?

In my opinion, Chris Brown is still the same angry and aggressive person that he was 3 years ago.  For example, instead of rising above and ignoring any negativity, he continues to lash out.  He took to his twitter after the ceremony to address his "haters".  He said, "HATE ALL YOU WANT BECUZ I GOT A GRAMMY Now! That's the ultimate F*** OFF!"  The tweet has since been deleted and he tried again with a slightly less offensive message.  But I don't buy it.  

For those of you interested in a more in-depth analysis of the original media coverage of the assault, I'll offer a publication.  This article was written by some fantastic colleagues at Boston University School of Public Health:

Rothman, EF, Nageswaran, A, Johnson RM, Adams, KM, Scrivens, J, Baughman, A. (in press).  U.S. tabloid magazine coverage of a celebrity dating abuse incident: Rihanna and Chris Brown.  Journal of Health Communication. Available online ahead of print.

If you or someone you know needs help, please call the National Domestic Violence Hotline at:  1-800-799-SAFE (7233)

Courteney and David: A Poorly Designed PSA That Makes Me Want to "Scream"

So Courteney Cox and David Arquette are having a tough week. First they announced their separation and now I have to highlight the poor design of a recent public service announcement (PSA) in which they starred. I must say- they made a much better team on the set of their "Scream" movies.

A recent Newsweek article entitled "Can PSAs End Domestic Violence?" discussed the Cox/Arquette PSA and outlined the challenges of using this particular health communication channel to address the public health problem of domestic violence. The article quotes a wonderful professor of mine (thank you Dr. Emily Rothman for posting this link), so I decided to check the PSA out for myself. Overall, my impression was not good. Let's compare the PSA to some best practices and/or guidelines and see how it holds up. A great resource on this (and all aspects of program planning) comes from the Community Toolbox:

1. PSA Length
A typical PSA runs about 30 seconds. This video runs 1 minute, 50 seconds. And the viewer does not even know what the video is about (cue a random segment about "furry" sex) until the timer hits 1 minute, 25 seconds. They could have very easily lost viewers by that point (either due to boredom, confusion, or because they were offended by the "furry" segment).

2. PSAs Should Have a Clear Message and Call To Action (i.e., what do you want the viewer to do after they see your video?)
So I was a little surprised that the video did not include any specific hotline numbers. In case the audience included victims of DV, you would think that it would be a priority to list those resources. Instead, the only "action" that I could see outlined was how to donate to "OPCC"...and it was unclear what that organization was. So I followed the instructions at the end of the video that gave their Facebook address. Again, there is a huge logo that says "OPCC" (still not sure what that is, so I probably won't give money) and finally (in much smaller writing) some hotline numbers on the left. I went one more step and went to the Ocean Park Community Center (OPCC) website, where it still wasn't immediately clear how this organization supported domestic violence prevention. Apparently, this PSA was to support one of the community programs called Sojourn (a women's shelter)...but geez- how hard was that to figure out!!!???

3. Like any good health communication product, there should be a clear target audience
I have no idea who the audience was for this PSA. This is a direct result of the lack of a clear "call to action". This video had no idea who they expected as an audience or what they wanted those individuals to do. Before the video starts, we are told "this is not for kids" (again- due to the "furry"). So kids are excluded as a possible audience- which is a shame because young adults are also victims of domestic violence. I'm assuming that domestic violence victims themselves are not the audience, since the video did not include any links to DV hotlines/shelters. I doubt the audience was supposed to be DV perpetrators, because I doubt that they would be giving donations. So maybe the intended audience was just potential donors? It is unclear.

4. Evaluation
Ahh! I know I'm a broken record about this issue on my blog. As Dr. Rothman states in the Newsweek article, "there haven't been that many well-designed, rigorous evaluations of the ad's effectiveness". The OPCC spokesperson says that it has been effective because "people are talking about the ad" (how do we know?) and Facebook traffic was up (as of tonight, just 365 people had "liked" the page). But even if "talk" is increased, is that really changing the attitudes or behaviors that were (maybe) targeted by this PSA? If they had clearer goals and a call to action (e.g., The audience for this PSA is women who are victims of DV and the behavior we want to see is an increase in calls to our hotline)- it would be much easier to evaluate. And that evaluation would go well beyond "awareness".