Anti-vaccine ads on Delta planes; Magic and Ellen as celebrity champions for HIV/AIDS prevention...and more- What Am I Reading This Week?

New pop culture and public health stories to check out this week:

1. Darrell Hammond of Saturday Night Live fame reveals that child abuse led to alcohol/drug use and cutting. He details the horrific abuse in a new memoir, "God, If You're Not Up There, I'm F*cked".

2. Fellow Boston University School of Public Health alum Elizabeth Cohen reports on the 20th anniversary of Magic Johnson's announcement that he is HIV positive. His announcement had an incredible impact on the public's health- both in terms of reducing stigma of those diagnosed and proving that the diagnosis is not always a death sentence.

3. Delta airlines is seeing backlash from public health organizations and other flu vaccine advocates after airing a 3-minute PSA from the National Vaccine Information Center that describes alternate ways to avoid the flu (besides getting the flu shot).

4. Ellen DeGeneres is named global envoy for AIDS awareness. The hope is that Ellen's enormous platform (from both her TV show and social media channels) will allow her to reach millions of people with the prevention message. Ellen is a partner in other important public health issues, for example- bullying prevention.

5. This week, Evelyn Lauder passed away from Ovarian Cancer. Evelyn was one of the powers behind the creation of the pink ribbon campaign for breast cancer awareness.

How about you? What are you reading this week?

"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?

Miami Dolphin Brandon Marshall's New PSA for Borderline Personality Disorder

In July 2011, Brandon Marshall revealed that he was diagnosed with Borderline Personality Disorder (BPD). According to the National Education Alliance for Borderline Personality Disorder, this serious mental illness centers on the inability to manage emotions effectively. The condition which has strong heritability (68%) and a high suicide rate (10% of adults with BPD die by suicide), produces symptoms such as impulsivity, anger, and chaotic relationships.

When Brandon announced his condition this summer, he vowed to become the face of borderline personality disorder. He seems to be following through on his promise, as he has just released a public service announcement (PSA) in collaboration with the National Education Alliance for Borderline Personality Disorder. The 33-second video is primarily focused on 3 key messages:

1. Prevalence of this condition is high (15 million Americans)
2. There is hope (treatment exists for those who suffer and education exists for families coping with the disorder)
3. There are resources: visit the NEABPD website or follow Brandon on Twitter (@BMarshall19) for more information

I like the PSA for several reasons. It is simple with clear messages (above). The messages are delivered both verbally by Brandon and visually with key words appearing on the screen. The "call to action" is clear. Viewers are directed to the NEABPD website and Brandon's Twitter feed for more information.

I also like that this particular health issue has found a champion or spokesperson. Unlike other mental health conditions like depression with several celebrity spokespeople (e.g., Brooke Shields), less is known about BPD and those who suffer from it. Experts in mental illness stigma like Patrick Corrigan state that there are several strategies for reducing stigma...and one of those strategies is called "Contact". Contact challenges public attitudes about mental illness through direct interactions with persons who have these disorders. The contact does not have to be face to face, but instead can occur through a channel like a PSA.

The strategies that I see for improving this PSA are focused less on its composition, but instead on its distribution/promotion. Although the video has been on YouTube for 6 days, it only has 309 views. Announcements about the PSA are located primarily on football blogs (e.g., Shut Down Corner) or BPD specific websites. It does not seem that the PSA has been picked up by mainstream media or health blogs. This is in sharp contrast to PSAs I've spoken about previously on Pop Health, like in July 2011 when I discussed Kim Kardashian's ovarian cancer research spot which currently has 33,431 views.

Readers- please weigh in: which mental health advocacy organizations would have the best "reach" in promoting this PSA? What other strategies could they use for distribution/promotion?

Pink Fatigue? JCPenney's Sexist Merchandise. Smoking and its Box Office Impact. What Am I Reading This Week?

Here are the top 5 stories I'm following this week:

1. Amid breast cancer month- Is there pink fatigue? A very important public health story. "Awareness" does not equal behavior change (e.g., increased screenings or access to medical care). A related story appeared last week in Upstream: A forum on interdisciplinary health communication.

2. JCPenney CEO responds to petition to stop selling sexist clothing marketed to young girls like "I'm too pretty to do homework". The company is using this incident as a "teachable moment".

3. The use of social media in street protests can be effective for both protesters and police. A story in ScienceDaily.

4. Smoking is a drag at the box office. An analysis of top-grossing movies from the past decade shows that films with smoking make less money.

5. Video game can reduce fatigue in African American women with lupus. A pilot study to explore using Wii Fit to reduce fatigue.

What are you reading this week?

Dr. Pepper Ten: A "Manly" Campaign That Promotes Gender Stereotypes Instead of Health for Men

Yesterday while on the elliptical machine at the gym and watching ESPN (surprise! women watch ESPN), I had the displeasure of seeing the new commercial for Dr. Pepper Ten no less than five times.

Dr. Pepper Ten is a new 10-calorie drink being rolled out by the Dr. Pepper Snapple Group Inc after their client research revealed that men are hesitant to drink diet drinks because they aren't "manly" enough.

The TV commercials that I watched showed men with huge muscles driving through the jungle, shooting guns, and battling snakes. The men say things like, "Hey ladies. Enjoying the film? Of course not. Because this is our movie and this is our soda, you can keep the romantic comedies and lady drinks. We're good."

According to several online reports (e.g., the MSNBC link above), the campaign also developed a Facebook page which contains an application that allows it to exclude women from viewing content. In addition, the page includes games and videos aimed at being "manly." Several twitter users also report that the campaign encourages viewers to "rat on their friends for not being manly". If true, I have no idea how "unmanly" behavior is being reported.

My analysis:

It is great that advertisers are using focus group and other data to develop products and ad campaigns. They taught many of us in public health the importance of these strategies and we are forever grateful. However...

This campaign promotes strict gender stereotypes: Men act like this and women act like this- no exceptions! This dangerous norm contributes to serious public health problems. For example, the traditional ideology of masculinity has been explored for its relationship to negative outcomes like bullying and high risk sexual behaviors.

This campaign attempts to encourage men to drink a "healthier" soda (less calories, real sweeteners) without making them feel like they are dieting...because after all- dieting is only for women. Too bad the obesity rate is hovering between 32-35% for both men and women.

I have seen weight loss/health for men done much more effectively by other companies without insulting viewers. For example, after they saw their services being utilized by more men, Weight Watchers and NutriSystem rolled out men's programs. Weight Watchers presents strategies for making healthy choices in settings where men may find themselves socially (e.g., at a BBQ or at the bar). To reduce the social stigma around participation, they recruited strong male role models like former NFL quarterback Dan Marino. An ABC story on the companies' programs says "Calorie Counting Can Be Macho".

The strategy used by NutriSystem and Weight Watchers to reduce the stigma around healthy behaviors will be much more effective long-term than simply tricking people into being healthy.

For those readers who think I'm only offended by the campaign because I'm a woman, please see a few tweets from Tuesday night...authored by men. The first by my husband, who wrote multiple posts on Dr. Pepper Ten before I ever voiced my disgust with this campaign:

@jeff_underscore: "Dr. Pepper 10 - I think your ad campaign is insane, insensitive and sexist and unfortunately everywhere".

@sorryeveryone: ".@drpepper i really liked your soda but you know what I like more? treating women like they're human beings and letting men be themselves".

Readers: What do you think of this campaign? Do you think it will be effective in getting men to drink these "healthier" sodas?

#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!

(Dis)Connected: MTV Explores the Impact of Digital Drama on the Health and Safety of Young People

On Sunday October 10, 2011, MTV will premiere "(Dis)Connected". The movie will explore the experiences of four young people. They have never met in-person, but their lives collide online and are forever changed by their digital interactions.

The film supports the network's "A Thin Line" campaign which empowers youth to stand up against digital abuse of all kinds (e.g., bullying, discrimination, etc).

The movie is inspired (in part) by the tragic death of Abraham Biggs in 2008. Biggs, a 19-year old college student, live streamed his suicide on the internet, with some users egging him on and some trying to talk him out of it.

(Dis)Connected supports an ongoing discussion in public health regarding the question: "Does technology help us or hurt us when it comes to issues such as bullying or suicide?" The answer is not clear. There are examples on each side. One year ago today, I wrote the post "Bullying: Is Technology Helping Us or Hurting Us?" The post was inspired by the dialogue of how technology may have contributed to the suicide of Tyler Clementi but also how it was being used in a positive way to prevent bullying in the aftermath (e.g., the "It Gets Better" project).

On her blog "Promoting Hope, Preventing Suicide", Elana Premack Sandler writes about research and advice for preventing teen and adult suicide. Just in the past year, she has extensively explored the issue of technology/social media and its impact on suicide prevention. Some example posts include: Facebook Support Networks (September 21); YouTube Prevents Suicide? (May 4); and Promoting Hope Through Social Media (April 13).

Let's all check out (Dis)Connected on October 10 and let the dialogue continue.

If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK or visit their website here.

Kissing on Southwest Airlines, Over-hyped Reebok Toning Shoes and More- What Am I Reading This Week?

There are many great Pop Health (Pop Culture- Public Health) stories in the news each week, so it can be difficult to narrow down my focus for a weekly post.

Therefore, I'm starting a new feature called- "What Am I Reading This Week?" to link you to my runner-ups:

1. Reebok agrees to settlement over "over-hyped" claims that its EasyTone shoes could tone leg and butt muscles better than regular shoes.

2. Perfect for football Sunday: Cheeseheads take issue with anti-cheese billboard (from groups promoting vegan diets).

3. L-Word actress gets kicked off Southwest flight for lesbian kiss (they say it was based solely on behavior, not gender).

4. Lady Gaga wants to make bullying illegal- wants meeting with the president.

Use the comment box to tell me what you're reading this week!

Celebrities and their Health Causes: What Happens When They Do More Harm Than Good?

Often on this blog I have spoken about the role of celebrities as the spokesperson or "champion" for various public health issues. Many celebrity names are synonymous with particular health causes (Katie Couric- Colon Cancer; Michael J. Fox- Parkinson's Disease; Lance Armstrong- Testicular Cancer; to name a few).

Over the past few weeks, several stories have emerged which beg the question, "what happens if celebrities do more harm than good?" Those in the public eye have such a broad and extensive platform to communicate with the public...what if they disseminate erroneous information or even worse- cause a panic?

The week of September 12 was quite busy! In the Republican Presidential Debate (in the context of discussing mandated HPV vaccines for children), Rep. Michelle Bachmann claimed that the HPV (Human Papillomavirus) vaccine is linked to mental retardation. To support her claims, Bachmann repeatedly told the story of being approached by a woman whose daughter suffered mental retardation after taking the vaccine. As those of us in science well know, one self-reported story does not equal a true incident. Even if true, one incident does not equal a trend or an epidemic. This story has been quickly picked up by scientists who are even offering money if it is proven true.

This same week, Dr. Mehmet Oz of the Dr. Oz Show (you may remember him from numerous appearances on the Oprah Winfrey Show), claimed that apple juice contains unsafe levels of arsenic. These claims followed research conducted by the Show which had a laboratory examine three dozen samples from five different brands across the United States. The samples were compared to the limits of arsenic set for drinking water by the EPA. Since the claims, many scientists have spoken out regarding concerns about the study's protocols and conclusions (for example, not differentiating between organic and inorganic types of arsenic). Many were concerned about the widespread panic caused by these claims and likened it to shouting "fire" in a crowded theater.

Of course, this is not the first time celebrities have caused a scandal following potentially false and dangerous claims. Jenny McCarthy has dedicated her life to proving the cause between childhood vaccines and autism. Shortly after Brooke Shields released her book, "Down Came The Rain", which chronicled her battle with postpartum depression- actor Tom Cruise (a Scientologist) publicly criticized her for taking antidepressant medication.

So what happens when these celebrities cause more harm than good? What happens when their claims are misguided, misinformed, and/or not based on evidence or science? The answer: they can have huge and far-reaching public health consequences. For example, as we begin to see illnesses like measles reappear- we have to wonder- "Is this the Jenny McCarthy effect?"

"What's Your Weapon?": Billie Jean King, Arthritis Foundation, Ad Council, and USTA Launch Arthritis Campaign

Before Twitter and the U.S. Open was a flutter this afternoon with the news of Venus Williams withdrawing due to the diagnosis of the autoimmune disease- Sjogren's Syndrome, the U.S. Tennis Association was focused on another health related issue. Today the press release went out that tennis legend Billie Jean King was joining the Arthritis Foundation, the Ad Council, and the US Tennis Association (USTA) to launch a public service campaign against arthritis (the leading cause of disability in America).



The ads, launched at the U.S. Open today, feature King (who has osteoarthritis- OA) and highlight the power of movement and exercise as "weapons" in the fight against arthritis. King tells viewers "tennis is my weapon" against arthritis. The ad then asks viewers, "what is your weapon against arthritis?" and directs them to the campaign's website in order to find out: Fight Arthritis Pain. On first view, I was not terribly impressed. The brief ad (33 seconds) does not tell you very much (e.g., King says tennis is her "weapon" but nothing is said about the benefits of movement). The goal of the ad simply appears to be motivating viewers to visit the website for additional information.



The other thing that is not clear in the ad (but clarified in the press release and website) is that this campaign is targeting OA specifically. While OA is the most common type of arthritis, it is not the only type. For example, in contrast to OA which breaks down cartilage, rheumatoid arthritis (RA) (a chronic autoimmune disease) causes inflammation of the lining of the joints. Would the exercise recommendations be the same no matter what type of arthritis? I would say that distinction is unclear for viewers.



However, I did feel better when I read the press release and saw that these ads were tested in focus groups by the Ad Council. Testing your images and messages with your target population is incredibly important. It is reported that participants felt that the concept of "having a weapon" against arthritis was powerful and motivating. That is good news considering formative research by the Ad Council found that only 16% of OA sufferers surveyed felt "very confident" that they could manage their pain. Therefore, if an ad can make viewers feel empowered and confident- that is a good thing.



The press release did not describe the demographics of the focus group participants, but I am assuming they were similar to those originally surveyed (adults age 55+ with OA). If so, it would mean that Billie Jean King was an appropriate "Champion" for the cause and someone that audience admired, having watched her in the 1960s-1970s, her prime competitive years. However, I wonder if she would be the best choice for ads targeting arthritis sufferers in a younger demographic? After all, different types of arthritis can affect people of all ages. Again, this is another reason that I would have wanted to see a clearer definition of the audience for these ads. If we are focused on older adults with OA, then it is a great choice. If we are focused on people of all ages with all types of arthritis, then maybe not.



Overall, I give this campaign a "B". The impetus of the campaign is good in that it is based on research...research that shows that arthritis suffers are too sedentary and do not feel like they have control over their pain management. The campaign aims to address these barriers by empowering viewers with a "champion" who they admire and can model. The campaign also links them to a website with all the information they need about the benefits of exercise for arthritis. However, the execution of this campaign is not as strong as its foundation. It would have benefited from a more clearly defined audience and message.

The East Coast Earthquake, Real Time Twitter Chat, and Facebook Applications for Disasters

Well! Today was an interesting day at the office. Up and down the east coast, many of us felt the tremors resulting from an earthquake in Virginia. While I would like to report that we all stayed calm and participated in orderly, safe, and well rehearsed evacuations...that was not the case. It appeared that the shock of experiencing an earthquake (such a rare event on the east coast) caused a little chaos. On my way into my office to grab my bag before hitting the stairs, I experienced a "George Costanza" type moment as a fellow staff person almost knocked me down in her rush to get out. I heard similar stories from my husband who works 4 blocks away. Upon recognition of the earthquake, his co-workers made a beeline for the safest escape route...the elevator?!



After the shaking took us down 13 flights of stairs, I quickly turned to the only reliable source for real time information- Twitter. Since I was the only one in the area who either grabbed my phone or had twitter, I quickly read off what I knew: "It is a 5.9 earthquake in Virginia"; "My colleagues felt it in- Baltimore, DC, Boston, NYC, North Carolina"; "No damage except one broken window is reported in Philadelphia". After being given the go ahead to return to the building and settling back into our work, we received an official text/email from the University reiterating the information Twitter delivered an hour before. According to Twitter's official profile tonight, within one minute of the #earthquake, there were more than 40,000 earthquake-related tweets. They reached 5,500 tweets per second (TPS).



As I discussed in a related post back in March 2011, the question for public health professionals continues to be- "What is the role of social media in emergency preparedness and recovery?"



I believe we are making some strides in answering that question. Just yesterday, the Office of the Assistant Secretary for Preparedness and Response (ASPR)- located within the US Dept of Health and Human Services (HHS)- launched a contest: The ASPR Lifeline Facebook Application Challenge. The goal of the contest is to create applications that prepare individuals for disasters and build resilient communities. Those who opt into the application will be able to identify "lifelines" or Facebook friends that agree to be an individual's emergency contact and act on their behalf in case of an emergency. They will also be able to create a personal preparedness plan and share that plan and the application with others.



Even without the formal application, we have seen social network sites be used for checking in with friends/family and for getting information out quickly. For example, I follow the Philadelphia Office of Emergency Management on Twitter, so I got the message quickly that our 9-1-1 system was being inundated with calls since the earthquake and we should only use it with a real emergency...for infrastructure damage, call 3-1-1 instead.



While the Facebook application sounds like a great addition to emergency preparedness, it is important to also consider implementation issues which will impact its reach and effectiveness:

• Is the application only available to Facebook members who download it ahead of time? Or will it be available to anyone via the mobile web?
• Do these Facebook members typically update their profile via mobile devices in addition to stationary computers (which may not be available during an emergency)?
• During the emergency, are there cell networks/wifi to support the communication? (e.g., many reported that cell networks were jammed immediately following the earthquake)
• Do these "electronic" preparedness plans need to be rehearsed the same way as "in person" plans in order to increase effectiveness?

The HHS-ASPR contest runs August 22-November 4, 2011. I look forward to seeing the winning applications and hearing about how the dissemination will be conducted and evaluated.



What were your experiences today during the east coast earthquake? What did you hear/see from your colleagues? How did you get/send information to others? Please share in the comments section below.

Should Public Health Professionals "Give A Shit" About MTV's New Campaign?

Has anyone else seen #giveashit on Twitter in the past few days? MTV has launched the "Give a Shit" campaign to increase civic engagement and encourage people to voice their concerns for any issue about which they are passionate. Many are voicing concerns about important public health issues like access to clean water. Great way to engage young people, right? Using a play on words. Using foul language. But the question remains- what are the goals of the campaign? Will the campaign actually improve public health?



The primary strategy for messaging about the campaign is a YouTube video featuring Nikki Reed (of Twilight fame). The tone of the two-minute video is hard to classify. In some ways it appears to be a parody of a real PSA (e.g., it simulates Nikki on the toilet so she can use that time to "give a shit"). But then it seems to have genuine moments when it motivates people to join a movement- any movement. Nikki tells viewers that all they have to do is "give a shit". It doesn't matter if they don't actually DO anything...if they CARE, then the world's problems will cease to exist.



As you can imagine, I take issue with this premise. So much of what we know in public health is based on evaluation data that has shown us that "knowledge" does not equal behavior change. "Increasing awareness" about pregnancy does not eliminate unprotected sex. Having the "intention" to stop smoking does not help when someone is addicted to nicotine. Therefore, it is unclear to me how just caring about an issue like access to clean water will result in positive change.



Next, the video goes on to say that once you care about the issue, you should alert your social networks. It shows images of posts to Twitter like, "I just gave a shit about global warming". So I went into Twitter to see if it is actually happening, and it is. The #giveashit hash tag is alive and well and users are reporting that they care about children with special needs, animal cruelty, etc. But again, I'm still at a loss as to how this "caring" and "twitter posting" actually leads to an increase in positive civic engagement. I tried to look for additional information on their website: www.give-a-shit.org but the site is not currently functioning. That is a problem as well. If the goals of the campaign are already unclear, it does not help that users cannot access information beyond the YouTube video. Several advocacy websites offer a brief overview of the campaign that may be helpful in the absence of a functioning website.



So while the play on words is "cute" and I appreciate a campaign that aims to combat the apathy that can be rampant regarding serious public health issues...I don't understand how this campaign will actually change behavior. And no- I don't agree that just caring about an issue will make all problems go away. If it did, we in public health would be out of a job.

Media Must Cover Suicides Cautiously- In Today's Philadelphia Inquirer

An editorial that I co-authored ran in today's Philadelphia Inquirer. The piece is in response to media coverage of the suicide of a Philadelphia Firefighter. In a previous blog post following a celebrity suicide, I discussed the public health implications of the media coverage that follows. It can either encourage negative behavior in the audience by including unsafe and unnecessary details like detailing suicide methods...or it can encourage positive help-seeking behavior by including resources like the National Suicide Prevention Lifeline. I encourage all bloggers, communication professionals, and journalists to review the expert recommendations on how to safely report on suicides.

I look forward to hearing your comments!

Let's Talk Safety Climate and the Airlines: "Welcome Aboard"

I spent the past few weeks out on vacation in the beautiful Pacific Northwest (which explains my brief absence from Pop Health). While the trip was wonderful, it is quite nice to be back on the blog. And in fact, my trip provided me with the inspiration for this post. On my return flight home, I encountered an array of travel nightmares (delays, mechanical problems, cancelled flights, lost luggage). While many people may just consider these as an inconvenience, they also got me thinking about my safety. As we sat at the gate and waited for test after test, my husband assured me that they wouldn't put us on the plane if it wasn't safe. However, I wondered aloud if that was true. With the pressure for the airlines to have better on-time statistics and less angry customers, can we be put on a plane that is unsafe? My experience with USAirways, the similar experiences that I read about on Twitter, and the information I found regarding their dysfunctional relationship with their Pilots Association got me interested in the safety climate of the airline industry.

Everyday we encounter airline advertising that hopes to recruit our business by highlighting a company's high standards for safety, comfort, reasonable prices, and customer service. The ads also try to capitalize on things that we value, for example- freedom. Some memorable slogans include, "You are now free to move about the country" (Southwest); "We love to fly and it shows" (Delta); "Come fly the friendly skies" (United). While these slogans are catchy and convincing, they represent the "espoused values" of the airlines. Espoused values are values and norms stated by the organization. They can often be found in companies' strategic plans, goals, and/or taglines. For example, USAirways has an initiative called "Customers First" which strives to address key service elements that affect their customers.

In addition to espoused values, we also find "enacted values"; these are the norms that are actually exhibited by employees. These values may or may not be in line with the espoused values. That is why even though "Customers First" can be an espoused value, you can still end up bumped off a flight and sleeping in the airport because the rude gate agent told you there was no flight availability. In order to hear about other customers experiences with enacted values, I turned to Twitter and was amazed by what I saw. There were hundreds of comments to or about @usairways that were identical to mine- lots of mechanical failures ending in flight cancellations and luggage that was lost for days. I understand Twitter may be skewed towards the negative because people are less likely to tweet about the on-time departures...however, if you look at another airline (e.g., @southwestair) you see almost nothing about mechanical problems.

A less biased way to learn about employees' values and their level of congruence with the organization executives, is to hear from them directly. Just a few weeks ago, the US Airline Pilot Association- USAPA (the union that represents USAirways pilots), posted on their website to alert customers to the pressure they are receiving from USAirways executives to fly under unsafe conditions. On June 16, 2011, a pilot with 30-years of experience was escorted from the airport after she refused to fly a plane overseas after it failed multiple safety checks. A second group of pilots refused to fly the plane as well. This is not the first time that USAPA has spoken out against the executives. In 2008, they posted a customer alert in USA Today because they were being pressured to fly with less fuel in order to save money.

The examination and measurement of espoused/enacted values and their connection to safety outcomes (e.g., occupational injuries) is the exciting field of safety climate research. The term "safety climate" was coined in 1980 by Dr. Dov Zohar and has been prevalent in the Industrial and Organizational Psychology literature before making its way into the public health literature. For those interested, the journal Accident Analysis & Prevention recently dedicated an issue to safety climate and occupational health.

Safety climate research has been used to assess the climate of a variety of industries (e.g., healthcare). I propose that it is essential for examining the values within individual airlines and their connection to safety outcomes (e.g., worker injuries, passenger injuries, mechanical failures, near-misses, etc). The discrepancy discussed above between employee and company values can become a very dangerous combination.

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

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

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

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

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

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

Where Are the Helmets in the Home Run Derby?

Last night I returned home from a lovely dinner with my injury prevention colleagues to a sight that really caught me by surprise. My husband was watching the Major League Baseball (MLB) Home Run Derby. I tuned in for a moment before turning to him and asking, "Why aren't they wearing helmets?" I think we are all accustomed to seeing players in their batting helmets, so this looked strange to me- especially in contrast to the catcher, who was dressed in full protective gear. My husband informed me that helmets are not necessary because the pitches are much slower. However- I would disagree (and this is not the first time I have critiqued professional sports and their commitment to protecting players from head injuries).

First of all, concussions (which we must remember are a traumatic brain injury!) do not only occur when the ball is traveling 100 MPH. Therefore, a slower pitch does not equal safety. The catcher still wore full protective gear. The pitcher stood behind protective netting. So on some level it is acknowledged that hazards still exist at the Home Run Derby.

In addition, concussions (or more serious injuries) can happen even when you are not the batter. Therefore, helmets protect you when you are on deck, warming up, or coaching from the sidelines. Home Run Derby participants are still at risk for injury when they are not at bat. This is a lesson that many in baseball know far too well. In 2007, a minor league first base coach was killed when he was hit in the head with a line drive. This tragic accident resulted in a change in policy regarding required head protection for first and third base coaches.

Speaking of policy, I find it strange that their batting helmet practices vary based on the speed of the pitch. This is not an acceptable strategy in other areas of injury prevention, so why is that the strategy here? We don't tell people to only wear seatbelts if they are planning to drive faster than 40 MPH. We don't tell people to only avoid texting and driving if they are on the highway. The MLB seems to be accepting a high level of risk for their players in this context. This is especially surprising since MLB and the MLB Players Association have taken steps to prioritize safety regarding head injuries. They recently implemented a universal concussion policy (which went into effect on Opening Day 2011). The new policy dictates both how concussions are initially treated and when player/umpires are allowed to return to play. The most substantial change is the creation of a 7-day disabled list to allow players an appropriate amount of time to heal after a concussion. They are also introducing reinforced helmets that can withstand 100 MPH fastballs.

While the safety of the players is paramount, this discussion is also important because MLB players are role models. Therefore, it is important that they model acceptance and proper usage of personal protective equipment. If you looked at the stadium crowd at the Derby (and the lucky few invited to catch balls in the outfield), it was mostly kids. If the MLB and the players do not provide leadership on safety policies and equipment, it could have larger public health effects on the audiences that model their behavior (so don't get me started on the chewing tobacco issue).

Therefore, I strongly encourage MLB to review their policies regarding personal protective equipment and the grey "safe" areas they have identified, like the Home Run Derby. It appears to be a relaxed, fun event during the all-star break but in reality, they are unnecessarily putting the safety of their players at risk.

"Friends Don't Let Friends Drive Drunk": How Soon is too Soon to Find the Teachable Moment in the Death of Ryan Dunn?

"Friends Don't Let Friends Drive Drunk". A memorable tag line from the 1990s, found in many drunk driving prevention public service announcements (PSAs).

Early Monday morning, June 20, 2011, Ryan Dunn and a passenger were killed in a car accident in Pennsylvania. Ryan appeared in all three seasons of "Jackass" on MTV, as well as their movies.

Shortly after the news of Ryan's death broke (along with preliminary reports of speeding and photos of him drinking at the bar hours before the accident), Roger Ebert tweeted "Friends Don't Let Jackasses Drink and Drive". Although Roger did not "intend to be cruel"- he "intended to be true", there was a lot of backlash to his play on the old PSA tagline. Ryan's friends and colleagues from "Jackass" tweeted their anger in response and popular celebrity blogger Perez Hilton posted that Roger responded insensitively to Ryan's death. All felt that it was too soon to hold Ryan up as an example of the dangers of drinking and driving.

So the question I pose is: How soon is too soon to capitalize on a "teachable moment"?

Teachable moments are important in public health. They let us identify a time when our audiences will be more open to prevention education/intervention because they will see its relevance to their lives. Often the identification and sustainability of teachable moments are supported by media reports on the health/lives of celebrities.

As this week has moved along, more information has been released about the accident that killed Ryan Dunn and his passenger. His alcohol level was approximately twice the legal limit in Pennsylvania (0.196%) and he was traveling at a very high rate of speed (estimated at 132-140 mph) at the time of collision. Therefore, there is clearly a lesson to be learned here- about speeding and about drinking and driving. But much of these lessons our audience already knows. If you drink and drive- you could die (and/or kill someone else). If you speed- you could die (and/or kill someone else).

So maybe the lessons have to be broader. Apparently Ryan had a history of speeding and driving under the influence. These factors put him at risk. What could he, his friends, his family, the courts, the bar done to prevent this tragedy? What about the bystanders? His friends at the bar...employees at the bar...his friend who ultimately got into the car...could someone have stopped him from driving? What are the lessons you find in this story and how/when should they be communicated?

Google Continues to Use its Power for Public Health Good

Yesterday, Google announced its new surveillance system for Dengue Fever. Dengue Fever is a disease caused by four related viruses spread by a particular species of mosquito. It can cause high fever, rash, muscle and joint pain, and in severe cases- bleeding, a sudden drop in blood pressure (shock) and death. Millions of cases of Dengue infection occur worldwide each year. Most often, dengue fever occurs in urban areas of tropical and subtropical regions.

The system is similar to that which was previously released as their Google Flu Trends program. These systems use search queries within Google (for example those that enter the disease's name and/or symptoms) to identify trends. The Dengue system also takes advantage of a new feature called Google Correlate, which shows previously unknown correlations between search terms. These correlations allow researchers to model real world behaviors by examining internet search trends. For those who may be skeptical of this model, you should check out a publication (co-authored by Google and the Centers for Disease Control and Prevention-CDC) in the 2009 Nature Journal . The article reports that "because relative frequencies of certain queries were highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day."

This is a pretty exciting addition to public health surveillance (where the goal is systematic, ongoing, data collection that is used to monitor trends, identify priorities, direct resources, identify emerging hazards, and evaluate interventions).

This is not the first time that Google has jumped into the public health field with an impressive contribution. In 2010, Google searches related to suicide started appearing with a message guiding users to the toll-free number for the National Suicide Prevention Lifeline. The number is 1-800-273-8255. Triggered by searches such as "I want to die" or "ways to commit suicide," the number is listed next to an icon of a red telephone, at the top of the search results.

The addition of the Lifeline number came shortly after (at the suggestion of a Google user), the company started displaying the hotline for the American Association of Poison Control Centers after searches for "poison emergency."

These cases of Google's work in public health are great examples of effective health communication and public health principles:

• Identifying the primary channels through which your audience searches for health information (more and more are utilizing the internet) and delivering accurate and effective information and/or interventions via those channels.

• Maximizing data driven surveillance systems- using existing data (e.g., internet searches) to identify public health trends.

• Building strong partnerships (as evidenced by the publication by Google and CDC) CDC has partnered with a company with specific expertise and resources in an area that can be invaluable to their work.
  

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

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

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

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

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

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

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

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

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

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

From The West Wing to the National Health Care Debate

Anyone who knows me well knows that "The American President" is one of my favorite movies. If it is a favorite of yours as well, you may recognize that the actress who plays Press Secretary Robin McCall also plays National Security Advisor Dr. Nancy McNally in "The West Wing". The actress is Anna Deavere Smith.

This week in my "Qualitative Research Methods in Community Health" class, we discussed ethnography. Specifically we discussed Ms. Smith's work as an example of performance ethnography. For over a decade, she has interviewed people across the country and used the "data" to develop a one-woman show. Her newest play is called "Let Me Down Easy" and its goal is to show the human side of the national health care debate. I highly recommend viewing the 10-minute excerpt and interview here.

I'm so sorry that I missed her play when it came to Philadelphia earlier this year because I think it is an amazing example of the richness of data collected using qualitative methods. It is often argued that qualitative methods are too "soft" and limited in view. I've heard them described as "basically just journalism". However, I would argue that qualitative methods are essential to the success of public health.

Instead of surveys and databases, these methods collect data via interview, discussion, and observation. The research is meant to discover the complex relationship between personal and social meaning, individual and cultural practices, and the material environment or context. In contrast to what we have learned since grade school science about the scientific method and generalizability of findings- here the focus is on obtaining a deeper understanding of a population or phenomenon.

Ms. Smith conducted over 300 interviews for "Let Me Down Easy" and ultimately condensed her findings to show the experience of contemporary health care through the eyes of 20 individuals. These kinds of stories are incredibly powerful in public health. They open our eyes to challenges that we never would have found via survey...because we wouldn't have known to ask the right questions. They allow us to share stories with policymakers so they can see the impact of their decisions beyond the sterile statistics often cited. They can allow us to explore experiences or illnesses that occur in too small a population to survey.

Ideally, quantitative and qualitative methods should be used together to create the strongest public health research design possible. It should not be us vs. them...but instead a joint effort. I encourage us all to see the human side of health care reform when Ms. Smith's play airs on PBS "Great Performances" next season.

A Pop Health Book Review of "The Immortal Life of Henrietta Lacks"

This book is not brand new; it has been out for about a year. However, it continues to pick up momentum and be read by book clubs across the country. Therefore, after it was recommended to me by my mother-in-law, I thought it would be perfect for a Pop Health Book Review.

As someone who works in public health, I collaborate with our University's Institutional Review Board (IRB) on a daily basis to ensure the safety of our research (for the good of our research team, funder, and participants). And even though I know and understand the importance of the collaboration, it can still feel like a burden to address and document each question that is asked by our IRB (I know many of you would agree!) I see the students I work with roll their eyes and sigh when they have to take the IRB and HIPAA trainings. HIPAA stands for Health Insurance Portability and Accountability Act of 1996 Privacy and Security Rules. The students say, "Yeah...we already know this stuff".

However, this book takes what you "already know" and puts a face on it. It reminds you that it wasn't long ago that people (especially vulnerable people) were experimented on and/or used for research without their consent. Often with sad and deadly outcomes.

Rebecca Skloot, an award-winning science writer, takes the reader on her personal journey (lasting over a decade) to learn about the woman behind HeLa cells. The woman's name was Henrietta Lacks. The original cells were taken from her cervix shortly after she was diagnosed with cancer and before her death. HeLa cells have been vital for many scientific advances, including the development of the polio vaccine.

Henrietta's story, pieced together through more than a thousand hours of interviews conducted by Rebecca, touches on the most essential and controversial aspects of public health and research:

1. Treatment/Research on Vulnerable Populations:

• Henrietta Lacks was a poor Southern tobacco farmer, seeking medical care from Johns Hopkins "colored" ward in the early 1950s. A sample of her tumor was taken and given to researchers without her consent. She was treated with radiation without a discussion about the side effects. Henrietta had no idea the radiation would cause her to be infertile. The hospital convinced her husband David to agree to an autopsy (after he already refused) by saying that the exam "could help his children one day". The autopsy results were later given to a writer who published all the details in his book.

• It is no wonder that the IRB now requires specific training and attention to address research that focuses on vulnerable populations. These include pregnant women, fetuses, neonates, prisoners, children, and other special classes of individuals such as minorities and those that are mentally ill.

• It is no wonder that it can be incredibly difficult to recruit members of these vulnerable groups to participate in research, even today! Henrietta's family spoke of their fears of being snatched off the streets around Johns Hopkins by doctors wanting to experiment on them. Rebecca found research that tales of "night doctors" had filled black oral history since the 1800s. These doctors would kidnap black people for research.

2. Ethical Issues

• This book examines the ethical issues of sharing human tissue. Consent to share human tissue (e.g., those you have "discarded"after a blood test or biopsy), is not the same as consenting to participate in research. Often consent is not required.

• But do researchers and doctors have an ethical responsibility to disclose to the patient if (1) their cells/tissues are unique and valuable in some way, (2) the researcher or doctor has a financial interest in their tissue, (3) the patient's tissue will be used in any way that is contrary to their beliefs?

3. Informed Consent

• Times have certainly changed since 1951 when Henrietta Lacks was subjected to tests and procedures without giving informed consent. Unfortunately, it took about 50 years to get there. Her husband and children were still left in the dark regarding the purpose of blood tests in the years after her death. Scientists wanted to map their genes. The family thought they were being tested for cancer. They waited years for results that never came.

• Most of Henrietta's family only completed school until their early-mid teenage years. Even when the doctors explained parts of procedures, it was not at a level or in a way that was familiar to them.

• This book emphasizes the importance of being "informed" in the consent process. If the participants don't understand, their verbal or written consent means nothing.

All of these important issues are discussed with beautiful storytelling by Henrietta's family and Rebecca's careful research. It is a must read, especially for my fellow science and public health friends out there.

You'll find yourself cheering for Henrietta's daughter Deborah and her siblings, who have all endured more than their share of suffering. And probably most important, you'll find yourself making a pact to never sigh when it is time to complete the annual IRB training.

The Role of Social Media in Emergency Preparedness and Recovery

Last month I attended a presentation about a research study which evaluated the content of State-level emergency preparedness websites. The reviewers were looking for the presence of essential components such as clear contact information and links to federal emergency preparedness resources. I raised my hand and asked, "Are you evaluating these websites/organizations for a social media presence?" I used the example of the most recent Philadelphia "emergency" I encountered, 15 inches of snow. I did not go onto the city's emergency management website for information. I follow NBCPhiladelphia and SEPTA (the city's mass transit system) on Twitter. So I looked at my phone to find out what offices were closed and which buses/trains were running or cancelled. As always the key question remains, how does your target population get their information? What systems will still be working in an emergency (e.g., what if you lose electricity or internet?)

Since last Friday, we have all been watching the sad and heartwrenching images from the earthquake and tsunami in Japan. And you may wonder, with so much of the country affected, how will people make contact with their loved ones and how will the government get critical information out quickly? This morning, Mashable ran an article called, "Social Media Plays Vital Role in Reconnecting Japan Quake Victims with Loved Ones". While the earthquake knocked out electricity, the internet remained largely intact. The US Embassy in Tokyo is trying to take advantage of this fact and is encouraging Americans in Japan to contact their loved ones via text message and social media (i.e., Facebook and Twitter). Facebook and Twitter analytics from the day of earthquake show incredibly high usage.

A recent post on the Federal Emergency Management Agency (FEMA) blog discusses how social media is being considered as a key element in emergency preparedness. FEMA administrator Craig Fugate discusses a January 2011 planning meeting in which he met with the founder of Craigslist and editors from Wired, Twitter, Apple, and Facebook. He reports that they discussed:

• "The need to provide information to the public as data feeds, because they are a key member of our emergency management team"
• "The importance of referring to people impacted by a disaster as survivors and utilizing them as a resource"
• "The importance of providing good customer service"
• "How [emergency managers], need to stop trying to have the public fit into our way of doing things and receiving information, but that we should fit the way the public gets, receives and seeks out information"

It is great to hear that emergency managers are identifying social media as a powerful tool and planning how best to take advantage of it during an emergency.

Other online resources for making connections after a tragedy include:

Google Person Finder : This google service is used in the aftermath of such tragedies and allows users to click, "I am looking for someone" or "I have information about someone".

Red Cross Family Links: The purpose of this website is to help people get connected after being separated by disaster or conflict. Currently, there are links for Japan, Bosnia, Kosovo, Nepal, Iraq, and Somalia.

HHS and Data and Technology, Oh My!!

Last week I had the pleasure of attending a talk called, "Unleashing the Power of Open Data to Improve Health" organized by The College of Physicians of Philadelphia-section on Public Health and Preventative Medicine. The speaker was Todd Park, the Chief Technology Officer for the US Department of Health & Human Services (HHS). I have to admit, I was expecting something a little dry (having received my fair share of power point overload at government sponsored presentations). Wow- was I surprised to find Mr. Park on a wireless microphone running up and down the aisles engaging members of the audience!

The presentation focused on how HHS is living up to President Obama's "Open Government Initiative", which promises to have a "system of transparency, public participation, and collaboration". In terms of health data, Mr. Park said let's stop making people find data. Instead, let's "make data find people". In order to develop channels to help data find us, HHS has been engaging leaders from many areas of popular social media and technology (e.g., YouTube and Smart Phone application development). The government team has been sending the message "the data is yours...let's see what you do with it". In order to get the creative juices flowing, HHS has held and continues to hold "Health 2.0 Developer Challenges". The most current being the "Go Viral Collegiate Challenge" which calls on multidisciplinary teams from colleges and universities to develop a web or mobile application to address a significant health problem facing their communities.

Check out some examples of data applications produced through the use of open government health data:

• Community Clash: An online card game that engages you in a discovery of your community's health and well-being status and let's you see how it compares to other communities in a head-to-head clash. (*Warning- apparently this game is incredibly addicting!)
  

• Asthmapolis: A device that uses global positioning satellite technology (GPS) to determine the time and location when an asthma inhaler is used. The data is then stored on a server. The user can use this device to track asthma symptoms, triggers, and medication use- which could lead to an identification of environmental or other factors which improve/worsen their condition.

In addition to these challenges, HHS has also launched multiple websites to assist with the dissemination of this open health data. For example, HealthData.Gov and HealthIndicators.Gov. While this is all fabulous (and I really enjoyed looking at the challenge applications), how is this initiative being evaluated? Is the ultimate goal just about numbers? Does HHS just want to increase the number of people/organizations that are using health data? Do they just want to increase the number/types of data sources they can make available? Or is there some evaluation of the quality and accuracy of what is being produced? The challenge application website is sure to point out that the applications were not produced with federal money and therefore the government does not endorse them. But are they somehow creating an inventory of the applications and evaluating their effectiveness? Do we know which ones are actually increasing knowledge and changing behavior? Are we learning from the ones that do not? I applaud all the excitement around this initiative, but as always- I'm interested in seeing the outcomes. How will this initiative, which "unleashes the power of open data" actually improve health"?