In Honor of The World Cup: My Favorite Public Health Themed "Things Tim Howard Could Save"

As the World Cup came to a close this afternoon, I had fun revisiting my favorite #ThingsTimHowardCouldSave. For those of you that missed this fun Twitter hashtag: Back on July 1st, the United States Men's National Soccer Team played Belgium in the World Cup. Although the US lost the match, its goal keeper Tim Howard was amazing with 16 saves. His performance inspired an outpouring of memes that speculated on things that Tim Howard could save around the world. 

Since I am fascinated by strategies for using popular culture to engage people in public health, I was happy to see my colleagues join in and use Tim Howard to draw attention to:

(1) Substance Abuse

(2) Global Vaccines & Immunization

(3) Infectious Diseases and Various Disasters 

This isn't the first time that I've written about public health agencies aligning with a trending topic in order to engage a new or broader audience. What do you think?

• Is this an effective way to engage a larger audience?
• How should public health agencies evaluate such efforts? What metrics are important?
• Should agencies dedicate staff (on an ongoing basis) to monitoring such popular culture trends in order to develop timely social media content? Why or why not?
• Please share other examples of Tim Howard/Public Health tweets that I may have missed!

Research Notes: The Angelina Effect

The second most popular Pop Health post of 2013 was "Angelina Jolie's 'Medical Choice' Dominates the Internet" (May 14, 2013).  In that post, I highlighted several public health implications of her op-ed that were being discussed in the media coverage-

(1) Angelina as a "champion" for breast cancer prevention: would her celebrity status help or hurt the cause?
(2) Legal and policy issues with BRCA genetic testing.
(3) Health communication (specifically regarding risk perception).
(4) Reviewing the evidence base for recommending BRCA testing or preventative mastectomies.

When celebrity health stories such as this are publicized, I always keep my eyes peeled to see if any evaluation research or subsequent stories follow.  So I was thrilled to see a peer-reviewed paper released last week that examined the impact of her op-ed.  Authors of "The Angelina Effect: Immediate Reach, Grasp, and Impact of Going Public", conducted a survey which asked participants to report their understanding, reactions, perceptions, and subsequent activities related to the story.  The researchers were especially interested in the public's ability to distinguish the genetic context of Angelina's risk of Breast Cancer from the lower risk that characterizes the vast majority of women who do not carry a BRCA mutation.

Some key findings:

• Approximately 75% of sampled adults were aware of Angelina's choice to undergo a double mastectomy to reduce her risk of developing Breast Cancer.

• Of those aware of her story, only 3.4% indicated that they had read her op-ed originally posted in the New York Times.  Instead, most became aware of the story through the national/local news (61.2%) or entertainment news (21.5%).

• Among respondents that correctly reported Angelina's risk of developing Breast Cancer, fewer than 10% had the information necessary to interpret her risk relative to a woman unaffected by the BRCA gene mutation.

• The majority of respondents (80%) did not report any health-related actions (e.g., speaking with a doctor or genetic counselor) in the 3 weeks between the op-ed's publication and survey completion.

The authors' conclusions have important implications for those of us that lead health communication efforts- especially those efforts that intersect with the popular media:

"While celebrities can bring heightened awareness to health issues, there is a need for these messages to be accompanied by more purposeful communication efforts to assist the public in understanding and using the complex diagnostic and treatment information that these stories convey."

What Do You Think?

• Are you surprised that Angelina's op-ed did not result in significant knowledge or behavior change among readers?
• Should we retire "awareness" as a public health goal since it often does not lead to knowledge or behavior change?
• Since most respondents were not able to distinguish Angelina's cancer risk from women who do not carry the BRCA gene mutation, could the op-ed do more harm than good?
• This survey was conducted within 3 weeks of the op-ed publication; are there questions you would like to see asked in a longer-term follow-up survey?

What Public Health Can Learn About Branding From "Parks and Recreation": Fluoride, TDAZZLE, and H2Flow

"All I have on my side is facts and science...and people hate facts and science".

-Leslie Knope

On the November 21, 2013 episode of Parks and Recreation called "Fluoride", the gang once again tackled an important public health issue.  Since the towns of Pawnee and Eagleton have recently been combined, the City Council embarks on a vote regarding the merger of the towns' water reservoirs.  The Eagleton reservoir contains Fluoride and a merger would mean Pawnee residents would drink water with Fluoride for the first time in their history.

The pro-Fluoride contingent (led by Councilwoman Leslie Knope) quickly learns that Fluoride, despite all its public health benefits, faces a serious image problem!  Fellow Council members scare the public by describing Fluoride as everything from a dangerous chemical to a mind-control tool used by Communists.  When Councilman Jeremy Jamm proposes a Pawnee Clean Water Bill that would prohibit adding anything to the water supply (forever), Leslie's Parks and Recreation Administrator Tom Haverford proposes a solution:

"Jamm's already ruined Fluoride.  Everyone's scared of it.  What if we called it something else?  We re-brand."

-Tom Haverford

"What are you saying?  We need to sex-up Fluoride?"

-Leslie Knope

"You got to give people something to get excited about."

-Tom Haverford

The result:  TDAZZLE.  Leslie and Tom describe it as "not a chemical; it is an aquatic-based social media oral experience".  Their presentation on TDAZZLE engages the residents with video, social media, and a free give-away.

When Jamm fights #TDAZZLE with an idea that would actually fill the drinking water with sugar, they re-brand again.

The result: H2Flow.  Tom encourages Pawnee residents to think about H2Flow as an app for your teeth.  The more flow you take in, the more sparkle points you get.  If you get enough sparkle points, then you're on your way to your first Aqua Badge.  If you get enough Aqua Badges, they'll welcome you to the H2Flow Platinum Club.

By the time the episode ends, the re-branding has been successful.  Every Pawnee resident will have H2Flow (a.k.a. Fluoride) in their drinking water.

While this episode and the re-branding campaigns are over the top and ridiculous, they offer some important lessons to public health:

(1)  Science, facts, and reason are not always enough to change public attitudes and behaviors.  
If they were, everyone would stop smoking and get a flu shot.  Leslie and Tom acknowledged this and threw out their dry presentation of chemistry/statistics.

(2)  Language matters
One of the biggest challenges for Fluoride's image in Pawnee was its association with the term "chemical".  Chemicals are considered dangerous and toxic- so why would anyone want them in the drinking water?  Leslie and Tom had to change the way that Fluoride was being described.

(3) Get creative
Integrate advertising principles to get people on board with public health initiatives. Engage audiences by utilizing trends and aligning the "product" with what the public wants/values.  Leslie and Tom used catchy names, social media, and games to connect with residents.

(4) Keep trying
Public health problems/interventions often need to be re-framed in order to make mid-course corrections and keep up with new trends/data/challenges.  When TDAZZLE was defeated by Jamm's "Drink-ems", Leslie and Tom quickly re-branded as H2Flow.

This "image" battle is playing out across the country every day and impacts many public health issues (e.g., vaccinations).  The Fluoride battle even played out this year in Portland, Oregon. In a smart Scientific American article about the Fluoride vote in Portland, the writer Kyle Hill highlights the importance of language, communication, and framing:

"Yesterday’s vote was a failure of science communication, and it falls on public health officials to rectify that, to take back the word “chemical.” Perhaps re-framing the conversation in terms of dental health or water fluoridation as regulation, not just addition, could help. Until political questions are seriously informed by scientific answers, fear and freedom beats facts."

What Do You Think?

• Parks & Recreation Fans:  What other lessons for public health did you find in the episode?
• What examples can you share that highlight a public health issue/intervention that has been successfully re-branded or re-framed in recent years?
• How can we better train public health professionals in health communication/advertising strategies that are so crucial to the success of their work?

Research Notes: Alcohol Brand References in U.S. Pop Music

Today I'm launching a new feature on Pop Health called "Research Notes".  This feature will highlight new peer-reviewed research that integrates public health and pop culture.

Researchers from the Boston University School of Public Health and the Johns Hopkins Bloomberg School of Public Health have recently released a study that examined alcohol references in popular music.  The study is published early online in the journal Substance Use & Misuse:

Alcohol Brand References in U.S. Popular Music, 2009–2011

Michael Siegel, Renee M. Johnson, Keshav Tyagi, Kathryn Power, Mark C. Lohsen, Amanda J. Ayers and David H. Jernigan

(Posted online on August 23, 2013; doi:10.3109/10826084.2013.793716)

The study highlights several interesting findings:

• Four alcohol brands (Patron tequila, Hennessy cognac, Grey Goose vodka, and Jack Daniel’s whiskey) accounted for more than half of alcohol brand mentions in the songs that mentioned alcohol use in Billboard’s most popular song lists in 2009, 2010 and 2011.

• Alcohol mentions were most common in urban songs (rap, hip-hop and R&B – 37.7% of songs mentioned alcohol), followed by country (21.8%) and pop (14.9%).

• Alcohol use was portrayed as overwhelmingly positive, with negative consequences rarely mentioned.

In the study's press release, researchers highlight several practice implications of these findings:

• “Given the heavy exposure of youth to popular music, these results suggest popular music may serve as a major source of promotion of alcohol use among youth,” said study co-author David Jernigan, PhD. “The findings lay a strong foundation for further research.”

• “A small number of alcohol brands and beverages appear to make frequent appearances in popular music,” said Michael Siegel, MD, MPH, professor of Community Health Sciences at the Boston University School of Public Health. “If these exposures are found to influence youth drinking behavior, then further public health efforts must be focused on youth exposure to alcohol portrayals in popular music.”

A Pop Health Book Review of “In the Kingdom of the Sick: A Social History of Chronic Illness in America”

In 2009 I read "Life Disrupted: Getting Real about Chronic Illness in Your Twenties And Thirties".  Since the book inspired me personally and professionally, I was delighted that Twitter enabled me to connect directly with the author Laurie Edwards.  I was even more delighted when she asked to interview me for her new book, "In the Kingdom of the Sick: A Social History of Chronic Illness in America".  Since Pop Health focuses on health communication and the coverage of public health issues in the media, we had plenty of mutual interests to discuss!

"The very nature of chronic illness- debilitating symptoms, physical side effects of medications, the gradual slowing down as diseases progress- is antithetical to the cult of improvement and enhancement that so permeates pop culture." 
("In the Kingdom of the Sick", page 34)

Early in the book, I found this quote incredibly powerful.  It is true.  Our society values and spotlights those that overcome adversity- those that inspire us- those that beat the odds.  Before his fall from grace, we can all remember the worldwide cheering for Oscar Pistorius- making history last summer for being the first double-amputee to compete in the Olympic games.  Edwards highlights those societal values in her book by drawing on the imagery found in many commercials for breast cancer research and fundraising.  Those commercials show an unforgettable image, a "cancer survivor triumphantly crossing the finish line in her local fund-raising event surrounded by earnest supporters."  That triumphant image is a far cry from what Edwards and colleagues term the "Tired Girls" (i.e., female patients suffering with "invisible illnesses" like fibromyalgia, chronic fatigue syndrome, and migraines).  "The Tired Girl stands for so much that society disdains:  weakness, exhaustion, dependence, unreliability, and the inability to get better" (page 103).

The good news is that many of the "Tired Girls" (and Guys) are getting connected and getting empowered.  Edwards dedicates a significant portion of her book to the discussion of "patients in the digital age."  She describes the emergence of "e-patients" (those that are empowered, engaged, equipped, enabled) and how they are using technology to actively participate in the development of their care plans, connect with patients with similar diagnoses, give voice to their experiences, advocate for policy change, and debate controversial topics like vaccinations.

As a public health professional with significant interest in health communication, I was fascinated by a recurring theme that Edwards highlights from these conversations among empowered patients and writers:

"How does language influence the illness experience?"          

The reader is led through an intriguing discussion of the use and implications of terms such as:

• Illness vs. Disease
• Illness vs. Chronic Condition
• Illness vs. Disability
• Military Metaphors (e.g., "the battle against disease")
• Chronic Pain Patient vs. Patient with Chronic Pain
• Healthy Disabled vs. Unhealthy Disabled
• Patient (does it connote passivity?)

"In the Kingdom of the Sick" is a fascinating read for anyone with a personal and/or professional connection to chronic illness.  It begins by giving you a strong foundation in the history of illness, research, and patient advocacy movements.  It then challenges you to consider the impact of advances in patient rights, science, communication, and technology on the incidence, treatment, and perception of chronic illness.  I highly recommend this book to my Pop Health readers, friends, and colleagues.

If you are interested in connecting with Laurie Edwards:

Website:  http://www.laurieedwardswriter.com

Blog: http://www.laurieedwardswriter.com/blog

Facebook:  http://www.facebook.com/laurieedwardswriter

Twitter:  https://twitter.com/achronicdose 

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder

Using Twitter to Track Disease: Weighing the Advantages and Challenges

A few weeks ago I participated in a fantastic twitter chat on the use of social media for public health.  During the event, our moderators posed the following question: "Are there any other diseases (besides the flu) that we could track on social media?"

The question generated a very lively discussion that I was inspired to revisit on Storify this morning after reading the Washington Post's article, "Twitter becomes a tool for tracking flu epidemics and other public health issues." 

The WP article highlights several advantages and challenges of monitoring public health diseases and/or conditions on twitter.  My twitter chat colleagues brought up many other important issues for us to consider, so I'm including these expanded lists:

Advantages:

• Offers real time data on health or behavior (Government data can often take weeks or months to be released)
• There is so much available data! 
• It could capture cases that would not otherwise be formally documented at a physician's office or hospital.
• It has proved helpful in tracking time sensitive disease outbreaks (e.g., Novovirus).  *Check out this article about how twitter was used to track Norovirus activity during a journalism conference.

Challenges:

• Accuracy and case definition (i.e., does a twitter user really have the flu or just a bad cold?)
• Tracking specific words like "sick" or "flu" can bring up a lot of content that is unrelated to the twitter user being ill themselves (e.g., "I'm so sick of this terrible weather").  *Check out how Johns Hopkins researchers are working to address this problem by better screening tweets.
• We must differentiate between tracking symptoms vs. tracking cases- they are not the same.
• Our search strategies should include various terms or slang that are used to describe the disease or behavior of interest.
• Caution: media coverage of certain illnesses can cause a spike in key words on twitter without a rise in actual cases.
• What are the privacy concerns?
• Twitter might not thoroughly capture diseases or conditions that carry stigma (e.g., mental illness) because users may be hesitant to discuss them in a public forum.
• Results could be skewed by populations who are over or under represented on twitter.
• Do we need to train "trackers" to intervene? E.g., what if they are monitoring dangerous tweets/behaviors like suicidal ideation and attempts?

While the challenges list is quite long, I hope we are not discouraged!  I think twitter is an enormous resource for public health professionals.  We just need to be thoughtful and thorough regarding how to use twitter effectively.

More Resources:

The Washington Post article and related stories shared great links to more information about research in this area:

• YouTube video on University of Rochester efforts to track influenza on twitter.  It also describes their related app: Germ Tracker (warning: it may have you hopping off your regular morning bus). 
• Johns Hopkins University article: "You Are What You Tweet: Analyzing Twitter for Public Health".
• Brigham Young University article: "'Right Time, Right Place' Health Communication on Twitter: Value and Accuracy of Location Information".
• A great article that highlights what we can learn from Google Flu (since their predictions were off this year)- emphasizes the importance of "re-calibrating" your models or algorithms each year.

What Do You Think?

• What other advantages and/or challenges should we add to the list?
• What other resources can you share?

  

Downton Abbey: A Mountain of Viewer Tears Leads to an Incredible Online Discussion about Maternal Health

Warning: if the January 27, 2013 episode of Downton is still on your DVR- this post contains spoilers!

From the looks of twitter this week, I am not the only person who was devastated by the loss of Lady Sybil on Downton Abbey.  She died of Eclampsia shortly after giving birth to her daughter.  In my house, there was complete silence while we watched Sybil convulsing and struggling to breathe.  After she died, our horror and sadness quickly turned to anger.  There were two doctors in the room (one of whom made the correct diagnosis)- how could this happen?

As I contemplated this question, I was fascinated to see how this story line impacted the public health messaging that started appearing on twitter.  I recognized a few trends:

Making the connection to current women's health issues and debates

There has been much concern about men making decisions about women's healthcare- for example, the comments in 2012 about the definition of rape and the ongoing abortion debate.  Since Sybil's death was largely the result of poor decisions about her health (made by her father and the fancy male doctor consulting on her case), I saw the following post on this topic over and over again:

 

Identifying a Teachable Moment:  Preeclampsia and Eclampsia Specifically

Like many organizations, the American Public Health Association (APHA) followed up on Monday with this message:

Identifying a Teachable Moment:  Maternal Mortality and Maternal Health Broadly  

I saw many links to organizations such as Every Mother Counts, which focuses on global maternal health advocacy:

In addition to the discussion on social media, many news outlets and foundations also took the opportunity to post information on their websites about the condition that killed Sybil.  For example, ABCNews wrote, "Eclampsia Death in 'Downton Abbey' Highlights Pregnancy's No. 1 Killer".

I would love to see some evaluation data to follow this teachable moment.  Some questions that I have:

• How many people searched for Preeclampsia and Eclampsia following the episode?  (As a side note, this episode aired months ago in the UK- was there a similar searching pattern?)
• How many physicians/midwives/clinicians received inquiries from patients following the episode?
• Beyond knowledge- did this episode change any clinician behaviors?  Did they go back and review a suspicious case after seeing a reminder of the severity of this condition?  Did they perform a more comprehensive screening?

What do you think?

What other evaluation questions should we be asking?

What other trends did you see in the discussion on social media (or in person) following this episode?

Rent The Runway Rocks Real Non-Airbrushed Models: Us!

Like many of you, I have tried ordering clothes online.  And it never goes well.  They are always too tight or too long.  They immediately make you feel bad about yourself.  And of course- it is a huge pain to have to pack it up again and mail it back.  And after all that- you still don't have anything to wear!!  Weird, right?  The clothes looked great in the pictures.

 

The frustration of online shopping is a symptom of a larger problem.  Many fashion lines are not made to fit the average woman.  Rader Programs, a group of  eating disorder treatment facilities, estimates that the average model weighs 117 pounds at 5'll and the average woman weighs 140 pounds at 5'4.  No wonder my purchases are too tight and too long!

 

However, I'm feeling optimistic about change being possible in the fashion world.  As of last week, Rent The Runway, an online service that lets users borrow current season high-fashion, has expanded their  use of real women as models on their site.  Users can upload pictures of themselves in the clothes, and include details about their height, weight, and chest size.  The site will also have the capacity to allow users to search for women of similar body type, so that they can see how the clothes actually fit.  I think this is fantastic.  Not only will it hopefully cut down on the dreaded returns, but women will see models that look like them.  It can reduce the shame and stigma that many women feel for lacking the 117 pounds at 5'll "ideal".

 

This initiative follows what I hope is a pattern of push back on pop culture for upholding women to unrealistic ideals that may lead to unhealthy body image.  For example, we are seeing opposition to magazine airbrushing.  Earlier this year, an ambitious eighth-grader put the pressure on Seventeen Magazine to review its policies on airbrushing and consider the impact it could have on young readers.  Her online petition led the magazine to sign an eight-point "Body Peace Treaty", which outlined a commitment to never change models' body or face shapes. 

 

We are seeing celebrities (especially recently!) disclosing their battles with eating disorders- often discussing the pressure they felt being in the entertainment industry.  Over the past few months, we've heard from Katie Couric, Nicole Scherzinger, and Stacy London.   Last year, Pop Health reviewed Portia De Rossi's book- Unbearable Lightness, which discussed her life-threatening eating disorder in much detail. 

 

I hope that we are continuing to see a shift.  I hope that there is less stigma in disclosing or discussing body image concerns and eating disorders.  I also hope that the public continues to make their voices heard...whether they are fighting the magazine airbrush or the high fashion gown that will look terrible on anyone under 5'10.

 

What do you think:  With the initiatives above and their predecessors (e.g., the Dove Campaign for Real Beauty)- do you see evidence of a shift in pop culture from "thin" to "real women"?  What else needs to change to keep this initiative moving forward?

 

 

 

 

 

 

 

Madonna's "MDNA Show Manifesto" Defends Using Guns on Tour: Do You Agree?

As we speak, Madonna is en route to my city- Philadelphia, to launch the North American leg of her "MDNA World Tour".  In advance of her arrival, she has released a statement to the local Metro defending one of the most controversial parts of her tour...the use of fake firearms in concert.  Here is a portion of that statement:

"It's true there is a lot of violence in the beginning of the show and sometimes the use of fake guns - but they are used as metaphors.  I do not condone violence or the use of guns.  Rather they are symbols of wanting to appear strong and wanting to find a way to stop feelings  that I find hurtful or damaging.   In my case its wanting to stop the lies and hypocrisy of the church,  the intolerance of many narrow minded cultures and societies I have experienced throughout my life and in some cases  the pain I have felt from having my heart broken".

Gun violence is (unfortunately) not a new problem.  However, the topic is quite timely due to increased U.S. media coverage following several mass shootings in the past few weeks- Aurora, CO, Oak Creek, WI, and New York, NY.  The issue of gun violence has reached crisis levels in Philadelphia where Madonna will be performing.  A new open source journalism project called http://guncrisis.org/ "contends that there is an epidemic of homicide by gunfire in Philadelphia and similar cities".  They are seeking solutions.

The solutions being sought by GunCrisis: Philadelphia and others involve taking a public health approach to gun violence.  The recent high profile shootings have produced several well-written pieces about gun violence and what we need to do next:

•  Prompt policy discussions about easy access to ammunition, high-capacity magazines, and assault weapons.
• Use our public health skills to conduct further research into the causes of firearm injuries.
• Examine gun violence as a social disease- one that stems from a society "saturated with guns".

Tell me what you think:

Do you believe that the gun "saturation" goes beyond those in our homes to include those used for entertainment?  E.g., Guns in movies or video games; Madonna's concert props

Is Madonna successful? Does using guns as a metaphorical image help her reach her goals and battle against hypocrisy and intolerance?

In addition to those listed above, what other strategies should we incorporate into a public health approach against gun violence?

Cameron Diaz: The Next Celebrity Nutritionist?

Cameron Diaz is busy with her next project.  Her rep confirms her interest in writing a nutrition book to help young girls.  She wants to use her celebrity for good- to encourage girls not to fixate on being thin but instead just to make healthy choices.

A few thoughts:

Of all the celebrities that I see pitching these types of projects (I'm looking at you Gwyneth Paltrow), Cameron actually seems to model a healthy lifestyle.  She is not too thin, but instead looks muscular and strong.  We always see her keeping active with surfing and regular gym workouts.

It is reported that (in preparation for the book) Cameron will be visiting high schools to talk to teenagers about their food choices and what is important to them.  She wants to get their input, e.g., how do they decide what to eat? Although this work will not be a formal "Needs Assessment", I like that Cameron will be out in the community and talking to the teenagers who are the focus of her book.  Doing formative work before a project that engages your audience is incredibly important in public health.  Hearing and seeing what the health problem/s look like first hand allow us to craft more effective interventions.  So I applaud Cameron for planning to do this outreach versus just planning to write a book that may or may not address the challenges faced out in communities. For example, Cameron can discuss the importance of choosing fruit over potato chips, but if a teenager does not have access to affordable fresh fruit in their neighborhood, then the recommendation is not helpful.

One challenge to this effort is that even though Cameron appears to model a healthy lifestyle, she is still a member of the Hollywood community that has contributed to setting an unrealistic standard for beauty.  We have seen her on numerous magazine covers looking very thin and of course airbrushed.  In public health, we always have to think- "is this the right spokesperson"?  It is important to know how teenage girls view Cameron.  Do they see her as part of the problem?  Or part of the solution?

Another challenge is that (from my perspective), celebrity "nutritionists" do not have the best track record for safety and accuracy.  Take Cameron's friend Gwyneth Paltrow.  She has regularly promoted nutrition strategies like detox cleanses and gluten-free diets.  Her extreme choices do not send a message of moderation to teenage girls.  In addition, Gwyneth's cover photos also contribute to the unrealistic standard for beauty.

As I've discussed many times on this blog, celebrities can be an incredible resource for public health.  They have a visible platform and extensive reach to many of our audiences.  However, that can work for us or against us based on the accuracy and relevancy of their messages.  It is imperative that they work closely with clinicians (e.g., physicians, nutritionists) and public health practitioners to craft the messages and design outreach programs.

What do you think about Cameron writing a nutrition book?

The Biggest Loser: Who's Really Winning?

This week's guest post for Pop Health was written by Elana Premack Sandler, LCSW, MPH.  Elana writes a popular blog for Psychology Today called, "Promoting Hope, Preventing Suicide".  Written from both personal and professional perspectives, her blog explores suicide prevention, intervention, and postvention.  Often using current events as a starting point, the blog poses questions about what could be done better or differently, what contributions research can make to practice, and challenges and opportunities inherent in new technologies.  Elana earned a Master of Social Work and a Master of Public Health at Boston University and is a licensed social worker in the Commonwealth of Massachusetts. 

There’s a lot of TV I don’t watch, but there’s one show in particular. “The Biggest Loser.”



It’s true - I systematically avoid watching one of the most popular reality TV shows in history. What seems to have drawn in viewers is what bothers me so much about most reality TV. It’s like a car wreck you can’t stop staring at, even though you know it’s a tragedy.



But watching a car wreck is watching an accident, something that wasn’t designed for an audience. With an accident, there’s something very human about wanting to see what’s happened, wanting to know if everyone’s okay.



That’s very different from what I think happens when people watch “The Biggest Loser.”



The few times I watched (I kept trying - people I love and trust told me it was such a good show!), I just wasn’t able to get behind the premise of the show. Yes, I believe that people who have struggled to lose weight can benefit from personal training and major lifestyle changes. Sure, the power of competition can drive some people to work harder than they ever imagined possible.



But, shame? Does shame really help people change their behavior?

When I watched, I witnessed trainers shaming contestants, over and over, in different ways. I heard contestants talk about the shame they experienced as a part of being obese or overweight. The whole show was a shame-fest. Which made me extremely uncomfortable.



Because, when it comes down to it, “The Biggest Loser” is a game show. And I just can’t watch people shamed into losing weight just to win a game show.

  “But it’s not just a game show!” my friends-who-are-fans would say. “People change their lives.”

Oh, wait, you’re right. It’s not just a game show. It’s a franchise.



So, I guess what I really have a hard time with is people being shamed into losing weight to support a game show-Wii-resort-1,200 calorie-a-day diet franchise.



At my professional core, as a public health social worker, I know shame doesn’t work to change behavior. I had thought it was just me who thought that way, until I started reading researcher Brené Brown’s book, “I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power.”



Brown has been researching shame for the past 10 years. But, even before she was a shame expert, she was a social worker, working with people. What did she learn? “You cannot shame or belittle people into changing their behaviors.”



She explains in the introduction to the book:


• Can you use shame or humiliation to change people or behavior? Yes and no. Yes, you can try. In fact, if you really want to zero in on an exposed vulnerability, you could actually see a swift behavior change. 
• Will the change last? No. 
• Will it hurt? Yes, it’s excruciating. [I cringed when I read that part.] 
• Will it do any damage? Yes, and it has the potential to sear both the person using shame and the person being shamed. [More cringing.]
• Is shame used very often as a way to try to change people? Yes, every minute of every day. 


“The Biggest Loser” gets exactly how to use shame to motivate people to make a “swift behavior change.” Body image - for people struggling with overweight and obesity, and for people at healthy or “normal” weights - is a tremendous source of shame. Obesity is even worse. I wouldn’t be the first to say that oppression - hatred, bullying, and discrimination against - overweight and obese people is one of the last acceptable oppressions in our society.



What’s extra-disturbing about how “The Biggest Loser” uses shame is that it doesn’t limit shame to contestants. The show projects shame into the viewing audience, reinforcing biases against people who are overweight or obese. The audience doesn’t root for contestants to work within the challenges inherent in their bodies to figure out a healthy, sustainable way to lose weight and maintain overall health. The audience roots for contestants to not be fat. (Please excuse my lax grammar- I hope it’s worth making the point.)

Finally, the drama of the show revolves around shame. There’s a big reveal every episode, when viewers find out who won’t continue to compete to be The Biggest Loser. If contestants can’t lose weight within the show’s parameters (which include unhealthy weight loss practices, like dehydration), they get kicked off. So, the ideal of working with a supportive trainer goes out the window - and you are shamed, shamed, shamed into returning home, still fat, and, well, not a winner. A loser.



“The Biggest Loser” raises several questions for me:

• Should a game show be allowed to promote unhealthy weight loss practices?
• What kinds of messages does the show send to young people about their worth and value? 
• In what ways are people at a healthy weight influenced by “The Biggest Loser”? 

But, the most important to consider is this one: How much money is being made off of shame?

Integrating Public Health Content Into Media Coverage of Celebrity DUIs

Amanda Bynes is just the latest young female celebrity to be arrested for driving under the influence (DUI).  The media coverage has been extensive, with some outlets even raising the question, "Is she the next Lindsay Lohan?"  A fellow former child star, Lindsay Lohan has consistently been in the news the past 5 years with DUI arrests, rehab stints, and poor career decisions.  However, just a few weeks ago we heard the good news that she has been taken off probation from her DUI case...so hopefully things are looking up.

Pop Health has written about related issues in the past:  how soon is too soon to find a teachable moment in a celebrity DUI death?  How does popular media help establish the public health agenda? How does media coverage of public health issues (e.g., suicide) affect the public's health?

So now let's put the pieces together and discuss the work of public health researchers that focuses specifically on media coverage of young female celebrity DUIs.  In 2009, Smith, Twum, and Gielen published "Media Coverage of Celebrity DUIs: Teachable Moments or Problematic Social Modeling?" in the journal of Alcohol & Alcoholism.  They conducted an analysis of US media coverage of four female celebrities (Michelle Rodriguez, Paris Hilton, Nicole Richie and Lindsay Lohan).  The study examined media coverage in the year after their DUI arrests (December 2005 through June 2008).  Among other things, the stories were coded for the presence of public health content (e.g., arrest, death, and injury statistics for DUI).  The authors found that the coverage was primarily focused on the individual celebrities (i.e., their legal and professional repercussions) versus broader social or public health impacts.  They recommended that future research examine both the news coverage and the comprehension and use of that content for policy and behavior change initiatives.

Coverage of a celebrity DUI has the potential to be a teachable moment, but we as public health practitioners need to take advantage of it.  We need to be monitoring pop culture news so that these teachable moments can be identified. We need to partner with journalists in order to make sure that a "public health frame" is incorporated in the development of the articles.  Most importantly, we need to continue to evaluate the media content and use that data to develop effective interventions and policy recommendations.

What do you think?

•   What strategies/information channels do you use to stay on top of public health-pop culture news?
•   How can the public health and journalism fields partner to take advantage of teachable moments and cover public health issues safely and effectively?

"E-Lane" for Pedestrians: An April Fools' Day Prank With Real Public Health Implications

Earlier this week, Philadelphians were treated to an April Fools' Day prank courtesy of Mayor Michael Nutter and the city's Office of Transportation and Utilities.  Across the street from city hall, an "E-Lane" was designated for pedestrians who use (and are distracted by) their electronic devices while walking.  While the city only expects to keep the joke "E-Lane" around for a week, they also hope that it starts a dialogue about pedestrian safety and people looking out for themselves while walking around the city.  Since this April Fools' week also happens to coincide with National Public Health Week (a time dedicated to recognizing the contributions and challenges of public health), I thought it was a great story for Pop Health.  So I took a stroll down the "E-Lane" on Monday to take these pictures and to get the dialogue started.

While I have written about (and am a huge supporter of) the vast and ever expanding benefits of mobile devices for public health, I also acknowledge the challenges that they have created.  Even though Philadelphia created the "E-Lane" as a joke, drivers and pedestrians distracted by electronic devices have become a serious issue.   

The Centers for Disease Control and Prevention website on distracted driving tells us that each day, more than 15 people are killed and more than 1,200 people are injured in crashes that were reported to involve a distracted driver. Distracted driving occurs while doing another activity that takes your attention away from driving; these activities can increase the chance of a motor vehicle crash.  While distracted driving can include talking on a cell phone, texting, or eating, texting is most dangerous because it takes your eyes off the road (visual), hands off the wheel (manual), and takes your mind off driving (cognitive).

As with any emerging public health problem, we are beginning to see:

• Research:  papers on distracted drivers and pedestrians are being published in the peer reviewed literature.  
• Education: cautionary tales of distracted driving are emerging in the popular media.  Just in the past few months, the Today Show has hosted several sets of parents who lost children due to texting and driving. 
• Celebrity Spokespeople:  Teen sensation Justin Bieber is partnering with the Remember Alex Brown Foundation and Phone Guard's Drive Safe.ly application to promote responsible texting.  The application reads text (SMS) messages and emails aloud in real time and automatically responds without drivers touching the mobile phone.
• Policy Change:  Just a few weeks ago, Pennsylvania became the 35th state to enact an anti-texting law.  The new law allows police to charge anyone caught text messaging while operating a vehicle with a primary offense and a $50 fine. 

As with most public health problems, we will need a combination of these strategies (i.e., individual education, social norm changes, policy/law changes, technological solutions, etc) to see a reduction in injuries and deaths.

What do you think?

• How can we balance the benefits and challenges of mobile technology for public health?
• Do you think the "E-Lane" in Philadelphia is an effective strategy for initiating dialogue around distracted drivers and pedestrians?
• In addition to the strategies listed above, what can public health and the public do to reduce injuries and deaths from distracted drivers and pedestrians?

Lady Gaga Launches "Born This Way Foundation" To Promote Safety, Skills, and Opportunity for Young People

Today, in collaboration with Harvard University and other partners, Lady Gaga is officially launching her "Born This Way Foundation".  As discussed on this blog, on news outlets, and in the peer reviewed literature, bullying is a serious problem with potential connection to public health issues such as depression and suicide.  Lady Gaga has been a vocal anti-bullying advocate, and in 2011 channeled that energy into the development of a Foundation.  Lady Gaga and her mother Cynthia Germanotta, founded the Born This Way Foundation to foster a more accepting society, where differences are embraced and individuality is celebrated.

The launch is being held at Harvard University’s Sanders Theatre.  Lady Gaga and her mother will be joined on stage by Oprah Winfrey, author and speaker Deepak Chopra, U.S. Secretary of Health and Human Services Kathleen Sebelius, and esteemed Harvard Law School professor Charles Ogletree to discuss the vision of the organization, and how we can all get involved.

An academic symposium has been planned in conjunction with the launch.  The event invites researchers, policymakers, and foundation representatives to discuss ways to reach youth and promote a culture free from bullying.  I'm proud to see that my former employer, the Education Development Center, has been invited to the symposium and will share insights from their extensive research in this area.

I look forward to hearing more about the vision of the organization, because although Lady Gaga is hugely influential (at the time of this post, she had 19,773,280 followers on twitter), the strategies and tangible goals for the Foundation are not completely clear from their website.  Under their mission statement, they list three pillars of the Foundation:

1. Safety
2. Skills
3. Opportunity

There is some discussion under those pillars of offering support to individuals through online communities, providing training in advocacy and community engagement, and providing opportunities to bring the national BTWF activities to the local level.  However, there are no details regarding how these strategies will actually be executed.  If you click on "Do Your Part" and "Review The Plan", it simply takes you back to the mission statement.

What strategies do you think could help BTWF support the three pillars of safety, skills, and opportunity?
What outcomes should they look at in order to evaluate the effectiveness of their efforts?

Rainn Wilson Apologizes for "Poorly Conceived Date-Rape Joke": What Would RAINN Think?

When I saw a twitter headline today that read, "Rainn Wilson Apologizes for "Poorly Conceived Date-Rape Joke", I first thought, "Is there ever a well conceived date-rape joke?"  Next I thought, "Well- that's certainly a coincidence."

The coincidence being that the other RAINN (Rape, Abuse, and Incest National Network) plays an important roll in calling out celebrities (and educating them) regarding the consequences of throwing around the term "rape".  The misuse of the term seems to be hitting epidemic proportions lately:

•   In June 2010, "Twilight" actress Kristen Stewart compared the constant scrutiny that she receives from the paparazzi to a woman being raped.  "What you don't see are the cameras shoved in my face and the bizarre intrusive questions being asked, or the people falling over themselves, screaming and taunting to get a reaction," she said of the constant paparazzi crush. "The photos are so ... I feel like I'm looking at someone being raped. A lot of the time I can't handle it. It's f---ed. I never expected that this would be my life." Stewart later apologized.  

•  In October 2011, actor Johnny Depp compared having his picture taken to being raped.  “You just feel like you’re being raped somehow. Raped. The whole thing,” he told Vanity Fair. “It feels like a kind of weird—just weird, man… Whenever you have a photo shoot or something like that, it’s like – you just feel dumb. It’s just so stupid.”  Depp later apologized.

• In November 2011, "Jersey Shore" cast mate Vinny released a song about raping strippers.  I will not repeat the lyrics here.  Vinny later apologized.

• In January 2012, actress Kim Novak took out an ad in Variety magazine to declare that she felt raped by the makers of the Oscar nominated film "The Artist" because the film used a score from one of her old movies.  The difference here:  Novak's team is not apologizing. 

Whether we like it or not, celebrities influence social norms.  When celebrities use the term "rape" as a joke or to describe their dislike of having their picture taken or their work borrowed, it cheapens what it really means.  It is meant to describe a violent act against women, men, and children...and it is a serious public health issue.  As with any public health issue, it is influenced at multiple levels (individual, interpersonal, community, society). The language we use everyday (whether to friends, family, co-workers, twitter followers, facebook friends) impacts our society on every level.  So think about the words that you choose and do your part to change the conversation.  

National Sexual Assault Hotline:  1-800-656-HOPE (4673)

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)

Why Everyone is so Angry at Paula Deen- A Guest Post for "The Public's Health"

Last week I had the pleasure of being invited to guest blog on "The Public's Health". The blog is a collaboration between Drexel University School of Public Health and The Philadelphia Inquirer. In multiple posts each week, the authors highlight contemporary, historical, and ethical matters that challenge public health professionals.

For my post, I was able to contribute a "Pop Health" story which examined Paula Deen's disclosure of her type 2 diabetes and the media and societal backlash which followed.

What do you think? Do celebrities have the right to talk about their health information whenever and however they feel comfortable? Or do they have a social responsibility to disclose as early as possible- and to discuss it in a way that is most likely to improve the public's health?

"Starving Secrets": Does Lifetime's New Reality Show on Eating Disorders Offer a Path to Recovery or a How-To Guide to Disordered Eating?

Last night, a public health colleague (@bethg24) tweeted about the new Lifetime reality show called "Starving Secrets". The show will be hosted by Tracey Gold (who had her own very public battle with an eating disorder) and feature real individuals struggling from anorexia, bulimia and other eating disorders.

According to the National Eating Disorders Association (NEDA), as many as 10 million females and 1 million males suffer from an eating disorder in the United States. Therefore, it is a serious and relevant public health problem that (not surprisingly) gets media attention. "Starving Secrets" is not the first movie or television show to take a documentary-style approach to portraying those that suffer from these disorders:

1. MTV's series "True Life" (which I have long admired for their portrayal and stigma reduction efforts regarding various medical conditions...I have been less impressed by episodes like "I'm a Jersey Shore girl"). True Life aired "I have an eating disorder" on April 3, 2003.
   


2. HBO documentary "Thin": This special followed four women during their in patient stays at the Renfrew Center in Coconut Creek, Florida. It premiered on November 14, 2006. I remember this being both incredibly powerful and difficult to watch.



3. E! "What's Eating You?": Admittedly, I only watched one episode of this show. True to E! form (Ahem- Kim's Fairytale Wedding), they are more about sensationalism versus journalism and stigma reduction as compared to other networks.

As with the portrayal of other mental health disorders in the media, I hope that these shows will do something positive. Specifically- reduce the stigma around these disorders and normalize help seeking behaviors.

However, I am also greatly concerned that shows like "Starving Secrets" will actually endanger vulnerable audience members by offering a "how-to guide" to having an eating disorder. The concern stems from research on pro-eating disorder websites. They can offer "thinsperation" to stay skinny by the images portrayed. They can also give tips and strategies for hiding/refusing food or getting rid of it. Sometimes people don't realize that by telling their story in vivid detail, they are actually sharing their "creative tips" for sustaining an eating disorder.

That said, I will definitely be setting the DVR on December 20 to see the show and assess it more accurately. What do others think? Do reality shows like these have the potential to endanger the public's health? Or do their "pros" (e.g., stigma reduction) outweigh the risks?

#NoHomos on Twitter, "50/50" looks at Cancer, Johnny Depp's Rape Comments, Chris Christie's Weight, and Steve Jobs: What Am I Reading This Week?

Whew- it has been a busy week for Pop Health! Here are the top 5 stories I've been reading:

1. Twitter is no place for #NoHomo: Should Twitter take a more proactive stance regarding hate speech that can result in trending topics?

2. "50/50"- A Hollywood movie takes on cancer: Cancer has been a theme in many movies (e.g., "Funny People") and TV shows (e.g., "The big C" on showtime)- how does this movie compare?

3. Johnny Depp offers apology for rape remarks: Depp offers an apology for comparing being chased by paparazzi to being raped. Forgivable?

4. Chris Christie's Weight- Big problem or none of our business?: Although Gov Christie has recently announced that he will not run for President in 2012, the conversation continues about his weight and its influence on his ability to be a successful Governor or President. What do you think?

5. Steve Jobs and Pancreatic Cancer: There have been many stories about the death of Steve Jobs and the contribution of pancreatic cancer to his passing. I thought Celebrity Diagnosis did a nice job of guiding readers through his diagnosis.

Please use the comment box to tell me what you think about these stories and about others that you are reading this week!