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?

My First Public Health Book

In 1995, as a high school student, I read the first edition of Joan Ryan's book "Little Girls in Pretty Boxes".  I picked it up because I figure skated for many years (from age 2-14).  Little did I know that I was starting my first exploration into public health.

The book examined public health issues like eating disorders and sports injuries.  It argued for policies that would protect young figure skaters and gymnasts from injury and from exploitation by their coaches, families, and industry.  Ryan conducted intensive interviews for the book, which allowed her to highlight several cases like that of Christy Henrich.  Henrich was a talented and promising U.S. gymnast who died from anorexia at the age of twenty-two.

I thought of this book today when I read a beautiful and honest blog post by Jennifer Kirk called, "An Unrealized Dream".  Jennifer Kirk is a decorated, elite U.S. figure skater who retired from competitive skating in August 2005.  She retired in order to focus on her health and to recover from bulimia, alcoholism, and cutting.  Her post highlights the complexities of these health problems.  They were influenced by her sport, her family, her support system, her early independence, and the pressure that was put on her to have a successful career.

While some safeguards for elite skaters and gymnasts have been put in place since "Little Girls in Pretty Boxes" (e.g., the hotly debated minimum age standards for competition), we still have improvements to make.  Jennifer talks about the strong influence of family and coaches regarding athlete safety and self esteem:

"A few months before I quit skating, my dad and coaches found out about my eating disorder, but nothing was done to get me the help I needed.  This reinforced my belief that skating and my career held paramount importance over other aspects of my life."  

Recently, much of the discussion of elite athlete safety has been focused on the National Football League (NFL), but the same questions are applicable here.  Are athletes putting themselves at risk by playing with injuries (e.g., concussions)?  What is the current organizational culture and does it support an intervention to protect athletes?  Do the coaches and trainers really have the athletes' best interests at heart or are they focused on winning and protecting their investment?

What do you think?  What more can we do to protect athletes at all levels (from recreational to elite)?

Facebook Adds Organ Donation To Timeline: Should We "Like" It?

Typically, I post on Wednesdays.  However, with so much chatter about Facebook's announcement, this felt more timely.
Starting today, you can add your organ donation status to your Facebook timeline using the "share life" tool.  If you are already registered, you can share your story about where and why you decided to become an organ donor.  If you are interested in registering, you can follow links to official donor registries.

ABC has been a primary news source for this announcement, interviewing Facebook CEO Mark Zuckerberg, demonstrating how to use the "share life" tool, and discussing myths and facts about organ donation.

Scanning Facebook and Twitter today (especially among my public health colleagues), the response seems to be overwhelmingly positive.  From my perspective, the Facebook tool has the potential to be effective (i.e., increasing the number of registered donors) because it focuses on action.  The tool is not for education.  The tool actually links to registries so that you can sign up.  The tool aims to increase the visibility of already registered donors, which in turn will influence others to sign up.  The tool aims to decrease the stigma and secrecy of talking about end of life decisions by putting it right up there next to your birth date and relationship status.  This may also influence others to sign up.  In previous posts, I have written about public health campaigns that use social media in order to reduce the stigma around an "undesirable" topic (e.g., STD testing).

Although I am 100% supportive of the mission of increasing organ donors and am familiar with the dire need for donations (e.g., 18 people will die each day waiting for an organ), I have a few reservations about "share life":

In today's New York Times coverage of the Facebook announcement, I read a sentence that concerned me (I added the underlining):

"The company announced a plan on Tuesday morning to encourage everyone on Facebook to start advertising their donor status on their pages, along with their birth dates and schools — a move that it hopes will create peer pressure to nudge more people to add their names to the rolls of registered organ donors".

I consider declaration as an organ donor to be a medical decision.  In public health and medicine, we strive for patients and the public to make such decisions from a position that is informed and lacks pressure from physicians or family or friends.  Therefore, I have reservations about people signing up without educating themselves first and/or because they feel pressure on Facebook.  Just a few weeks ago, I posted about "hashtag activism" and how easy it has become to get involved in causes via social media.  Are we as thoughtful when we participate in causes on Facebook as when we participate in real life?

My other ongoing concern is regarding the proper security and use of personal information that is gathered by Facebook.  Will your organ donation status result in particular advertisements being sent your way?  I remember updating my Facebook status to "engaged" 4 years ago and being overwhelmed by the wedding planning advertisements on my page.  There is increasing public outcry regarding privacy settings and the personal information you enter being used for Facebook to attract advertisers and other business opportunities. 

Again, I am 100% supportive of the organ donation mission.  I think the reach of Facebook offers tremendous public health opportunities (including the possible elimination of long wait time for organs).  While that is an attractive outcome, we must always remember to focus on the ethics of the process as well.

What do you think?

•  Facebook has become directly involved with several public health issues (e.g., suicide, bullying, organ donation).  Are their strategies effective?  Why or why not? 
• Do you foresee any unintended consequences from the organ donation tool?
• Will you include your organ donation status on your Facebook timeline?  Why or why not?

 

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?

"Hashtag Activism"- Is It Working For Public Health?

Last year on Facebook, my timeline was suddenly filled with status updates of just one word.  Red. Black. White.  "What is this?" I thought to myself.  It turned out that it was a breast cancer awareness campaign.  Facebook users were listing their bra colors to help prevent breast cancer.  And there are tons of these public health campaigns all over social networking sites.  "Like" our Facebook page to prevent cancer!  "Re tweet" this message to prevent heart disease!  For those of you familiar with my blog, you'll remember that I think "raising awareness" is the most counter-productive phrase used in our work.  It is not specific enough to measure for change and (on its own) it will not change health behaviors.  

So I thought of my frustration with these campaigns as I read a great article in the New York Times this week called, "Hashtag Activism, and Its Limits".  David Carr writes eloquently about the ease of supporting a variety of causes:

"If you “like” something, does that mean you care about it?  It’s an important distinction in an age when you can accumulate social currency on Facebook or Twitter just by hitting the “like” or “favorite” button.

The ongoing referendum on the Web often seems more like a kind of collective digital graffiti than a measure of engagement: I saw this thing, it spoke to me for at least one second, and here is my mark to prove it".

I like that David brings up the question of engagement here.  Many of these public health campaigns on social media just strive for "likes" on Facebook or "hits" on a website or "re tweets" on Twitter.  And not that they mean nothing, but those measures are just the tip of the iceberg in measuring audience engagement.  And audience engagement (beyond "raising awareness") is what could actually lead to public health activism, knowledge change, and ultimately behavior change. Leslie Lewis gives a great overview of Return on Engagement (ROE) on her blog "digital.good".  According to Leslie, ROE measures tend to be more qualitative and measure message reach and spread.  In addition to "likes", ROE also measures things like brand/campaign awareness, comments, shares, and returning visitors. 

I certainly do not think that all public health campaigns delivered via social media are ineffective.  On the contrary, I think that social media is an incredibly powerful tool for public health.  David Carr makes similar comments later in his article.  Challenging his initial skepticism of web activism, he lists several recent "campaigns" that have been quite effective (e.g., the reversal of Susan G. Komen de-funding Planned Parenthood).

However, to use social media effectively in public health, we must be strategic and we must evaluate.  

Some sample questions that I ask program planners:

• What is the goal of the campaign?  (e.g., to drive traffic to your website; increase hotline calls; increase specific behaviors like breast self examination?).
• How will the campaign activities (logically) lead to the desired goal/outcome?
• Are your goals/outcomes measurable?
• Have you thought about evaluation before launching the campaign?
• Besides the ideas listed above, how are you measuring "audience engagement"?

 
 What other questions should we be asking?

The Vaccine War: Public Health vs. The Media

A few weeks ago, I had the pleasure of speaking with Laurie Edwards, a writer and blogger who examines chronic illness, healthcare, life balance, public health history, and everything in between.  Among other topics, we talked about the role of social media and mainstream media in the vaccine debate.

So I thought of that conversation as I watched last night's re-run of PBS Frontline's special "The Vaccine War" (originally aired April 27, 2010).  I highly encourage advocates on both sides of the issue to check it out.

The piece was quite balanced with interviews on all sides.  For example, we heard from vaccine advocate Dr. Paul Offit, bioethicist Dr. Arthur Caplan, anti-vaccine advocate parents in Ashland, OR (with one of the lowest vaccine rates in the country),  Jenny McCarthy and her colleagues at Generation Rescue who continue to argue for evidence of the link between vaccines and autism, and from parents of a girl who almost died at 6 weeks from whooping cough.

It explored possible contributors to the fear of vaccines and/or the lowering vaccination rates:

• 1998 Lancet article by Dr. Andrew Wakefield that linked autism to childhood vaccines (*This article has since been retracted and MANY U.S. and International epidemiological studies have found no scientific evidence of a causal link)

• A new generation of parents that are too young to know the devastating effects of vaccine-preventable diseases like polio.  One interviewee used a term that I really like- "Community Recollection".  As Community Recollection of these diseases disappears, we can become complacent.

• A false sense of security because many of these diseases are not seen frequently in the United States.  However, we forget that with the ease of air travel, borders are almost non-existent.  For example, the piece followed an outbreak of measles in San Diego that started when a non-vaccinated 7 year old from the US contracted it while vacationing in Switzerland and brought it home to classmates.

• The Internet.  While it also offers many positive benefits regarding healthcare (e.g., access to information/publications; online support groups and connections with a "community" of individuals with similar diagnoses)- it also has its potential downfalls.
• It can keep controversy alive- even after it has been disproven (e.g., the Wakefield article)
• False or unproven information can go viral and it is hard to retract!  They use the example of the youtube video of Desiree Jennings (a 25 year-old Washington Redskins cheerleader) that claimed that a flu shot caused her debilitating muscle disorder.  

So how can Public Health compete with the Media and the Internet?

• Let's not compete.  Let's collaborate.  Let's learn (either through our own capacity or collaboration) to effectively communicate public health information online.  Our biggest audience (the public) is not usually reading our peer reviewed journals or attending our annual conferences.  This is already starting to happen.  Public health organizations have active Facebook and twitter accounts, blogs, videos.  Let's keep going.  And let's train our public health colleagues/students in health communication.

• Let's remember to share the spotlight with celebrities and other spokespeople that have influence over the public.  Like it or not, the way people get their health information and make decisions is changing.  They do not just agree with doctors or scientists.  I almost always see these debates featuring Public Health (scientist speaking in jargon) vs. Celebrity/Parent with moving emotional story about their child being injured by a vaccine.  That is hard to compete with!  Believe it or not (because we seem to only hear from Jenny McCarthy), there are also pro-vaccine celebrities.  Jennifer Garner and Kristi Yamaguchi have been flu vaccine advocates.  Jennifer Lopez and Keri Russell have been pertussis vaccine advocates.  Let's make sure the public knows that. 

• Let's think about the framing and marketing of vaccination messages.  When the HPV vaccine is framed as a Cancer Vaccine for both boys and girls...versus an STD Vaccine for just girls/young women it is perceived very differently by the public.

Tell me what you think:

• What can we do to change the current "Community Recollection" about vaccinations?
• Other suggestions regarding how public health can collaborate with the media/internet sites to communicate more effectively with the public?

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)

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?

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?

#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?"

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.