"Health Fashion" Police

It is the day after the Emmy Awards, so most of us have fashion on the brain and are eagerly awaiting E! Fashion Police. As a result, I thought it was very timely to discuss "Health Fashion". The idea came to me this weekend in two ways. First, as I saw new fashion merchandise (modeled by celebs like Jordin Sparks and The Jonas Brothers) in the form of "TXTING KILLS" thumb bands to reduce texting while driving. Next, I read a fabulous new article in the September 2010 issue of Health Promotion Practice called, "Undressing Health Fashion: An Examination of Health-Cause Clothing and Accessories".

The article provides a great overview of the history of health fashion, including its beginnings in 1953 with the first Medic Alert bracelet. It then proceeds to discuss the use of colorful ribbons to support causes (e.g., AIDS, deployed troops, etc) over the past 30 years. However, the authors really highlight the Lance Armstrong/Nike release of the yellow Livestrong wristband in 2004 as the event that created an explosion of Health Fashion and Cause Marketing.
Health Fashion is sorted into one of three categories:
1. Wearables: Worn by the consumer (e.g., Nike Livestrong wristband)
2. Usables: Items that are directly consumed or that utilize health fashion symbols in manufacturing/packaging/marketing (e.g., United States Postal Service breast cancer stamps)
3. Displayables: Items that are displayed in homes/offices/cars which use health fashion symbols (e.g., Swarovki pink ribbon holiday ornaments)

The article also does a nice job giving an overview of how this merchandise becomes a hot trend. It introduces the reader to Everett Rogers' Diffusion of Innovations theory and how innovators and early adopters (often well known/respected in the community) can disseminate messages or material throughout their community/society, etc. Many of you may be familiar with this theory after reading Malcolm Gladwell's "The Tipping Point".

However, the key question on this blog (and happily in the article as well) is: "Are these initiatives effective?" In order to make that call we have to define what we mean by "effective". The article points out that many campaigns (e.g., Go Red for Women) define their goals as raising awareness. Therefore, if they survey women pre and post campaign and they report an increase in knowledge of facts such as "heart disease is the number one killer of women"...then they can say that the campaign was effective. However, if they had defined their goals in terms of behavior change (e.g., more women will visit their doctor for yearly blood pressure checks), it would be unclear if their goals were achieved.

Another way "success" or "effectiveness" has been defined for health fashion has been focused on the revenue generated by the sale of these items. If the Livestrong wrist bands or Avon's "Kiss Goodbye to Breast Cancer" lipstick line raise significant funds for their charities, then we can consider them successful....right?

Here are some questions regarding effectiveness raised by the article...with my own two cents (okay- more like five cents) thrown in:
1. Are we achieving saturation point with the marketing of health fashion? Does anyone even know what color wrist band supports what cause?
2. How will increasingly knowledgeable consumers affect the sale of these items? It is much easier to find out what percentage of your donation/purchase is actually going to the charity vs. to the corporation.
3. How have social networking sites like twitter/facebook affected the adoption/dissemination of health fashion and cause marketing? Support for a cause can be almost instant and celebrities can quickly call on their twitter followers, which in some cases number over one million. Are consumers being as thoughtful/careful when it is so easy just to click their support?

What are your questions?

Teen Moms and Teachable Moments

For one terrible minute on Monday night, my remote control found itself on ABC Family's "The Secret Life of the American Teenager". The show is completely unrealistic in showing 15 year olds pregnant and parenting with the maturity and vocabulary of people in their 30's. However, my remote control has recently become stuck on a reality show of the same topic on MTV called "Teen Mom". Now this is quite a leap of faith for me, as I pretty much gave up on MTV after its early quality reality shows (Season 3 of Real World with Pedro, anyone?) turned nasty and staged and scandalous. But according to a recent NPR story, I am not the only one thinking that this new show has some value and "reality". The Kaiser Foundation has funded reproduction of the series so that it can be distributed to schools, non-profits, and social service organizations that are working to reduce teen pregnancy.

The educators mentioned above believe that "Teen Mom" helps create and capitalize on a teachable moment. This is defined as "a moment of educational opportunity...a time at which a person, especially a child, is likely to be particularly disposed to learn something or particularly responsive to being taught or made aware of something". One reason to buy into this theory is based on the idea that modeling is important. People learn from watching each other. What high school students see other high school students doing is very important. Therefore, seeing the realistic struggles of the four girls on the show could help them think about potential consequences of teen pregnancy. We see the relationships with their family or the baby's father crumble. We see them working and paying bills in addition to waking up at all hours to a screaming baby. We hear about how one girl lost the father of her baby in a car accident before the child was born...now she is a single mom.

Of course anyone who reads this blog on a regular basis knows that I need to mention that this show is being used in schools as an educational piece. And of course an educational piece is not a silver bullet because it cannot address all the complex risk factors for teen pregnancy which include things like economic disadvantage and growing up with teen parents yourself. However, I think it is a step in the right direction. It is definitely an improvement in the quality of MTV reality shows. It also shows these girls in a pretty "real" light without being preachy or fear-based. Check it out and let me know what you think.

The NFL is making pretty posters- but what are they doing to change the CULTURE of playing with head injuries?

Hot off the presses! Check out the new poster produced by the NFL which now hangs in every locker room in the National Football League. This poster represents a new effort within the sport to educate and protect its players from head injuries. However, I would argue that these strategies (and the others that I will outline) will not do anything to help the problem until a culture shift begins on the player level.
I was inspired to write this blog post after reading an editorial by Michael Wilbon in the Washington Post (thanks to my husband for making me a PTI fan). Mr. Wilbon compares these posters to the Surgeon General's warning that appears on each cigarette package. I completely agree- and they will be just as ineffective. Straight education and "fear-based" messages are not capable of changing behavior.

My first concern is regarding the layout and content of the poster itself. In any good health communication piece, you want the target audience to quickly and easily understand what you are trying to say and what you hope they will do after viewing the piece (i.e., what is the "call to action?"). The NFL poster fails in multiple areas:

1. It is not quick: It took me almost 5 minutes to read it thoroughly.
2. There are too many goals/calls to action (at least three by my count): 1- Education about the facts and symptoms of concussions; 2- How/why to refer yourself; 3- How/why to refer a teammate.
3. It uses some "fear-based" messages (e.g., head injuries can cause early onset dementia).

I highly doubt that this poster was tested with the target population (NFL players)- which is always the best way to produce effective health communication materials. Perhaps the players would have pointed out the obvious oversight that the photographs on the poster are not NFL players (but instead children and those playing other sports).

The posters are being rolled out in conjunction with other prevention strategies. For example, there have been policy changes (either under consideration or already active) regarding how quickly a player can come back after a concussion, how much contact/hitting can take place in practice, etc. They are also reviewing new data regarding the safety of different types of helmets and supporting a coaches committee dedicated to the discussion of player safety.

But what about the players themselves? Are they ready to sit out games? Will they support their teammates sitting out games? From many stories heard from the fields and locker rooms- players have not yet bought into this "new system". For example:

Last November (2009), Ben Roethlisberger of the Pittsburgh Steelers sustained yet another concussion. It was ultimately decided (by his physicians) that he could not play in a key game versus the Baltimore Ravens. The result- he did not receive support from his teammates. Hines Ward told the media that support in the locker room was "50-50" regarding if Ben should play. He talks about how other players have played (and would have played) through a concussion. He also discussed how they would lie to physicians in order to be cleared for play.

So while it is great to have committees and make posters, until the players are on board and feel supported by their teammates to put their health first (without consequence or retribution), these other measures will not truly be effective. A culture change must come first- and it must start with the players.