Sunday, July 13, 2014

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

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

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

(1) Substance Abuse



(2) Global Vaccines & Immunization

(3) Infectious Diseases and Various Disasters 


This isn't the first time that I've written about public health agencies aligning with a trending topic in order to engage a new or broader audience. What do you think?
  • Is this an effective way to engage a larger audience?
  • How should public health agencies evaluate such efforts? What metrics are important?
  • Should agencies dedicate staff (on an ongoing basis) to monitoring such popular culture trends in order to develop timely social media content? Why or why not?
  • Please share other examples of Tim Howard/Public Health tweets that I may have missed!

Monday, June 23, 2014

The Value of Social Media for Public Health Professionals- A New Article!

My regular readers know that I am a huge fan of social media. I think it has so much to offer the field of public health. I have regularly posted about how platforms like Twitter, Facebook, Instagram, and Pinterest can be used to support public health activities like emergency response and health advocacy.

In addition to its benefit to the field, I believe social media also benefits the individual public health practitioners who use it. I have recently written an article for the journal Health Promotion Practice which outlines the value of social media for public health career development. I hope you will check it out, share with colleagues, and keep the discussion going!

Monday, June 9, 2014

Apparently the Miss USA Pageant Rewards Victim Blaming

During last night’s Miss USA pageant, the top six contestants were each asked a different question about an important cultural or political issue.

For Miss Nevada, Nia Sanchez, Judge Rumer Willis asked a question about sexual assault on college campuses. She asked why Nia thought such crimes have been "swept under the rug for so long" and what colleges can do to combat that. Here is the response from Sanchez:

"I believe that some colleges may potentially be afraid of having a bad reputation and that would be a reason it could be swept under the rug, because they don't want that to come out into the public. But I think more awareness is very important so women can learn how to protect themselves. Myself, as a fourth-degree black belt, I learned from a young age that you need to be confident and be able to defend yourself. And I think that's something that we should start to really implement for a lot of women."

The reason this response is so cringe worthy is that it completely puts the responsibility on women to prevent rape. In other words: If women are confident, learn self-defense, and fight back- rape will be prevented. On the flip side: If they DON’T fight back, somehow it is their fault that the assault occurred. This is a terrible message and one that goes against everything we know about effective prevention.

Last month I wrote about the White House’s new report “Not Alone” and PSA which focuses on protecting students from sexual assault. They both highlight important strategies for preventing assaults which include:

  • Identifying evidence-based strategies for preventing sexual violence
  • Developing and evaluating new prevention strategies
  • Getting everyone to step in (also known as bystander interventions). Everyone is asked to speak out against rape myths and intervene if someone is at risk of being assaulted.
  • Enlisting men as allies

Effective strategies focus on making change at the system-level. They focus on changing a culture (campus or beyond) that accepts sexual violence. They fight against rape myths that include: “she was assaulted because she didn’t fight back”. Unfortunately, the Miss USA pageant provided a huge stage (literally and figuratively) for that myth to be perpetuated. And Nia Sanchez was greatly rewarded for promoting this victim blaming myth- she was crowned Miss USA.

Monday, June 2, 2014

"Return to Zero"- A Movie Review

Having recently gone through a pregnancy, I debated about watching “Return to Zero”. My little boy was born in January 2014. He was 8 weeks premature and spent a month in the Neonatal Intensive Care Unit. While he is happy and healthy now, there were some scary moments before and after his arrival. I was worried that the movie would be a little too stressful, too soon. But I am incredibly glad that I decided to watch. It premiered on Lifetime TV on May 17, 2014.

The movie begins with Maggie and Aaron Royal in the home stretch of their first pregnancy. Then a few weeks before their due date, they find out that their baby boy is stillborn. A stillbirth is a fetal death occurring after 20 weeks of pregnancy. I assume most viewers were like me- crying along with the Royals as they had to make quick decisions about how the baby would be delivered, if they would like to take pictures, and if the baby would be buried or cremated. The movie then follows the Royals in the months that follow as they grieve, try to hold onto their marriage, re-enter the work force, and (unexpectedly) begin a second pregnancy.

While the movie focuses on an individual family (based on the true story lived by the director Sean Hanish), there are many public health implications we should be talking about:

  • Public Knowledge and Language: Several times in the film Maggie makes the distinction that a stillbirth is not the same as a miscarriage. Does the public know the difference? From Maggie’s reaction, it is clear that the comparison can be quite offensive to the parents of stillborn children. These deaths happen much later when the babies are often viable. They are (in many cases) full-term. The mothers have felt the babies moving and are visibly “showing” in their pregnancy. They do not have the option of dealing with their loss privately.
    • However, I will note that many who have suffered a miscarriage will relate to the emotions that Maggie and Aaron experience. In revealing her own miscarriage Maggie’s mother tells her, “It’s still a loss Maggie. And it still hurts. It’s not just the loss of a baby, it’s the loss of a possibility of what might have been- and that is exactly the same.” Perhaps there is a way for the stillbirth and miscarriage communities to support each other while still making this important distinction in language and definition?
  • Stigma: Wow! Did I cringe watching some of Maggie’s friends and family members interact with her after the loss of her baby! Some people just walked away to avoid her, others pushed their religious views on her (“this was God’s will, etc). She made people uncomfortable because they did not know what to say or how to help her. This is fascinating considering the prevalence statistics on stillbirth (various sources showing it occurs between 1 in 160 and 1 in 200 pregnancies)- it is not that uncommon! I think that the movie does a great job of pointing this out. This happens to people. We need to learn how to talk about it and support our friends and family.
  • Training for Providers: After learning their son has died, Maggie and Aaron have a conversation with their doctor and a social worker about their plans for their son. They are clearly in shock. As the social worker asks if they have thought about burial or cremation for their son, Aaron asks in frustration and disbelief, “Should we have thought about it?” How do medical, nursing, and social work programs/training prepare providers to have this conversation? Do providers know how to have it in a way that respects the family without further traumatizing them (or the providers themselves)?
  • Support for Providers: In probably the most incredible scene of the movie, we see Maggie deliver her stillborn son. And one thing I kept thinking was- what kind of support is in place to help the medical providers in this situation? Maggie and Aaron had a labor and delivery nurse and doctor with them- how much does this weigh on those providers? They deal with not just stillbirth, but other difficult situations (preterm births, maternal complications, etc.)- I hope that they are given coping skills and the option of speaking with a social worker or other support at the hospital if needed. I would imagine that dealing with this type of case would be incredibly mentally and physically taxing for a provider.

While the subject matter is incredibly difficult, the film is exquisite. Minnie Driver is amazing. And although you are grieving with the characters, you also leave hopeful.

What did others think? Leave me a comment- I would love to hear your thoughts!

Thursday, May 8, 2014

1 is 2 Many: Can a Celebrity PSA Help Men to Stop Sexual Assault?


Last week The White House released, “Not Alone”, the first report of a task force on protecting students from sexual assault. To accompany the report, they also produced a public service announcement featuring several well-known celebrity men: Dule Hill, Benicio Del Toro, Seth Meyers, Daniel Craig, and Steve Carell.  Vice President Biden and President Obama appear in the PSA as well.

There were a lot of good things about the video.  In 60 seconds, it answered these key questions:

  • What is the problem? Sexual assault.
  • Where is it happening? Everywhere- on college campuses, at bars, at parties, even in high schools.
  • Who are the victims/survivors? Our sisters, our daughters, our wives, our friends.
  • Where can I find more information? http://www.whitehouse.gov/1is2many 
  • How can I help? Intervene.

The PSA encouraged viewers to intervene if they find themselves as a bystander. This is important because bystander interventions are promising, evidence-based strategies for preventing sexual assault.
The celebrities outline several key actions that bystanders can take to help the victims/survivors and combat stigma of sexual assault:

  • VP Biden: “If I saw it happening, I was taught you have to do something about it”.
  • Benicio Del Toro: “If I saw it happening, I speak up”.
  • Daniel Craig: “If I saw it happening, I’d never blame her, I’d help her”.

While I liked the PSA for all the reasons above…there were also a few things I found interesting and would have loved to be a fly on the wall during the video development:

  • Celebrity selection: They did a nice job recruiting some diversity in terms of the men’s racial/ethnic backgrounds and their fans/audiences. Meyers and Carell are primarily comedians, Del Toro and Craig have starred in more drama/action movies, and Hill has done both (I’m a huge fan of his from both “West Wing” and “Psych”). The PSA did not list their names to identify them, so I did wonder- “Would every viewer recognize all these actors?- How does that affect the video’s impact?” I also wondered about Del Toro and Craig’s inclusion because they have starred in some incredibly violent movies (e.g., “Traffic” and the James Bond series, respectively). Of course this doesn’t mean they are violent in real life, but how do these movies contribute to violence being accepted in our society?
  • The audience: While we can assume that the intended PSA audience is men (based on language in the “Not Alone” report, their recruiting of all male speakers and their description of victims/survivors- “our sisters, our daughters, etc.”), they never actually say they are speaking to men. They say things like, “we have to stop it”; “we need your help”. Since the intervention strategies can be applicable to anyone regardless of gender, I wonder if they purposely did not use the word “men” to engage a broader audience? 
  • Male victims/survivors: Although the website and report note that men comprise a small number of victims and are no less important, they do not make an appearance in the PSA. This huge national initiative has an opportunity to be inclusive and I worry this exclusion could further stigmatize male victims.

What do you think?

  • Do you think the celebrity PSA can help stop sexual assault? Why or why not?
  • Do you think the video producers clearly defined and spoke to their audience? Why or why not?
  • If you read the “Not Alone” report: what do you think about the initial action steps (e.g., launching a sexual assault climate survey for campuses)? Will these steps lead to effective prevention and response?


Sunday, March 23, 2014

#YourMomCares: But Is That Enough To Get You Enrolled For Health Insurance?

This week I saved a tweet that read "Celebrity mothers encourage young people to #getcovered."  I thought "celebrity mothers" would be familiar faces- celebrities that have children (e.g., Jennifer Garner, Reese Witherspoon).  So I was a little surprised when I clicked on the video and didn't recognize the faces.  It turns out that the video features mothers of celebrities- specifically the mothers of Jonah Hill, Adam Levine, Alicia Keys, and Jennifer Lopez.  I started out a bit skeptical, feeling like the "celebrity mothers" terms used to market the video could be misleading.

However after viewing the video several times, I think it has some positive characteristics to support the public health efforts to enroll people in a health insurance plan:

(1) Clear Audience: This video is targeted towards any "kid" over 18 years old.  Alicia Keys' mom says, "There is nothing worse for a mom than feeling that her child is not protected- no matter how old they are."

(2) Clear Focus on Qualities that Audience Members Value: No one wants to worry their parents or make them upset.  And certainly no one wants their parents to nag them over and over about something.  We value making our parents proud and happy.  Jonah Hill's mom says, "Taking care of yourself, so your mothers can sleep and have a nice life after all they've done for you, is not too much to ask in my opinion. [If you enroll] We will be so happy and so grateful and we wouldn't ask you to friend us on social media!"

(3) Humor/Engagement:  As a viewer, I could immediately relate to these moms.  They reminded me of people in my family!  They were funny, they told silly anecdotes about their celebrity kids (e.g., Jonah Hill once flooded the elementary school).  Their concern about the safety of their children made you immediately think of your own parents and how much they worry about you when you are sick, hurt, or unprotected.  These moms did a great job of engaging the audience in a short period of time.

(4) Clear Call to Action:  To me, this is the #1 most important quality in a public health video (and usually my #1 critique).  In this video, it was clear what they wanted the viewer to do: get covered, get enrolled for health insurance, and the resource to do so (Healthcare.gov) was stated both verbally and visually.  First Lady Michelle Obama tells viewers "Go to Healthcare.gov and enroll today."  The final screen includes the website, social media hashtag for more information/discussion (#YourMomCares), and the enrollment deadline (March 31st).  The viewer has all the key information needed to take action.

That said- I had a few other observations regarding the video and possible improvements:

(1) Does disabling the comment section on the YouTube video discourage conversation about the video and/or the #GetCovered initiative?  Of course the comment section is not always productive (e.g., spammers, abusive comments, etc)- but I wonder about the message sent by a disabled comment section?

(2) Is the video too long or does it wait too long to hit the topic?  The video runs 1 minute, 51 seconds but health insurance is not mentioned until 50 seconds into the video.  Jonah Hill's mom transitions into the topic by saying, "One thing we should never have to put up with is our kid not having health care."  Could they lose viewers by not getting to the point sooner?  Or was that first 50 seconds necessary to engage viewers?

(3) Does the solo focus on "Moms" vs. parents or other guardians limit the audience- or worse alienate any audience members?  I ask because the ad made me think of the recent #ThankYouMom campaign from Proctor & Gamble that ran during the Olympics.  Families are changing and it is no longer (or was it ever??) just moms taking care of children, or worrying about their children, or focusing on domestic responsibilities.  There was frustration with #ThankYouMom and I think we should keep that in mind when these types of campaigns are designed.

What Do You Think?  
I would love to hear feedback on these questions from my readers!:

Monday, March 3, 2014

Medals and Mental Illness: Olympic Athlete Sparks A Dialogue

Today's guest post comes from Julie Maier. Julie has a master’s degree in social work and is currently a PhD student in the Kinesiology Department at the University of Maryland (Physical Cultural Studies focus).  Her research interests focus on the intersection of mental health, gender, sexuality, and the body. If you'd like to get in touch, she can be reached at jmaier@umd.edu

Olympic season brings with it a plethora of news stories focused on some of the best athletes in the world.  In addition to factual accounts of Olympians’ performances, human-interest stories and sensationalized gossip pervade the print and online media.  Indeed, one would have to bury his or her head in the snow to avoid hearing about athletes during this time of year.  While many Olympic-centered articles are seemingly trivial, some stand out as having the potential to create a more socially just world.  For example, an Olympian came out describing his struggles with something that remains relegated to doctors’ offices or psychology classrooms: mental illness.  Though athletes’ discussion of mental health can be seen as a way to de-stigmatize this issue, the overall impact is dependent upon informed reporting that does not perpetuate misconceptions about various forms of distress.

  Upon winning the gold medal in the 1,000 meter men’s speed skating event in Sochi, the news reports that followed not only detailed the Dutch athlete Stefan Groothuis’ Olympic win, but his disclosure of his battle with depression.  According to Reuters, Groothuis had struggled with depression for years, which hindered not only his training, but his overall ability to enjoy life.  Casert, in an article by the Associated Press, noted that Groothius’ depression brought him to the point of contemplating suicide.  By opening up about mental illness, Groothius joins a handful of professional athletes who, through the years, have come out as living with particular forms of distress such as depression, borderline personality disorder, bipolar disorder, and obsessive compulsive disorder.

The significance of such attention to mental health issues cannot be overstated.  Though progress undoubtedly is being made to reduce the stigmatization of those who live with mental illness, there is still a long way to go.  For instance, in a 2014 article published in Psychiatry Services, Dr. Jennifer Stuber and colleagues found that negative attitudes towards people with mental illness were prevalent amongst the lay public, as well as some mental health providers.  Participants indicated being particularly afraid of individuals with schizophrenia due to the misperception that such people are inherently dangerous.  Additionally, over two-thirds of the general public and almost one half of mental health practitioners in the study reported not wanting somebody with schizophrenia to marry into their family.  Such stereotypes contribute to an environment in which those suffering from mental health conditions are subject to discrimination, marginalization, and various forms of abuse.  Greater openness about mental health may help to educate the general public about a topic that frequently arises only in light of sensationalized tragedies such as mass shootings, and then quickly disappears, sending the message that those with mental illness are a threat to public safety, and mental health is only appropriate to discuss when lives have been taken.

The fact that professional athletes are stepping out and talking about their experiences with distress is of particular importance.  In the realm of sport, a traditionally (and still!) masculine domain, mental illness is too often equated with weakness.  In fact, historian Dr. Roberta Park (2012) noted that sport was used as a way to toughen up men returning from war who were suffering from what we might now consider a form of post-traumatic stress disorder (PTSD). The idea that mental illness is a form of weakness or an excuse can be seen in many of the responses to NBA player Royce White’s coming out as having obsessive compulsive disorder and generalized anxiety disorder (GAD) in 2012, which included death threats.  Such negative reactions, however, only reaffirm the importance of celebrated athletes speaking up about mental health.

Although self-disclosure is of course not enough in and of itself to drastically change the lives of those living with depression, schizophrenia, or the like, it can have a positive impact on the discourse surrounding mental health.  This is dependent upon the way journalists and others craft and frame the athletes’, and other public figures’, stories.  For example, one headline pertaining to Groothius announced that “Groothuis gold ends years of misery, depression,” while another boasted that “Stefan Groothuis overcomes depression and wins Olympic gold.”  Such framing may perpetuate the misconception that most mental illnesses can be overcome, never to return, as opposed to an ongoing condition whose severity may ebb and flow throughout one’s life--something that can be managed, though never fully cured.  This is not to discount Groothuis’ experience; perhaps he has indeed ‘overcome’ depression. However, for many suffering from depression—particularly, major depressive disorder—they may never be fortunate enough to be totally free from depression (see psychiatrist Peter Kramer’s widely cited book, Against Depression, for more on this).  With that said, the aforementioned headlines may make people with depression who have struggled for years to recover feel further marginalized, while perhaps sending the message that mental illness is temporary.

Additional conversation surrounding mental health is desperately needed, and stories such as Groothius’ help to chip away at the deep-seated misunderstanding and stereotyping pertaining to mental illness.  Hopefully one day athletes coming out with their stories of depression will be a non-issue, but until then, such disclosures are vital for the health of all.