Friday, January 23, 2015

Should We Trust Similac's "The Mother'Hood"?

If any of you frequent parenting blogs, Facebook groups, or classes, you no doubt saw a link to Similac’s new video “The Mother’Hood”. Trust me- please watch…

I laughed (and cried) watching this video, because it is right on. My favorite line:
“Drug-free pool birth, dolphin assisted”.

In my 51 weeks of parenting so far (yes, my little guy will be 1 year old next week!), I have found the following issues to be HOT and often full of judgment in my circle of parenting groups:

  • Feeding- the early months (breastfeeding vs. formula feeding- or both!)
  • Feeding- the later months (purees vs. baby led weaning; organic food vs. regular food; how and when you introduced solid food)
  • Vaccination 
  • Stay at home vs. parents who work outside the home (and many parents, fall into both camps depending on the day!)
  • Car seats (how long you stay rear-facing; whether you use them on planes)
  • Cloth vs. disposable diapers (and other decisions which impact the environment)
  • Sleep practices (cribs vs. co-sleeping, crib bumpers, sleep training)
  • The type of childcare you select (day care center, in-home daycare, nanny, au pair) 

The list could go on and on….and these are just the hot topics I’ve found in the infant world!

The Mother’Hood Message: Why Does It Help?

The reality is that new parents can often feel very isolated and judged. This has many public health implications, especially for women at risk for postpartum depression. So for that reason, I like the primary message of the campaign which is that we should focus on the things that unite us, not divide us. At the end of the video, we read:

“No matter what our beliefs, we are parents first”.

And although the “cliques” (e.g., the bottle feeding group, the breast feeding group) are meant to show our separations…I also think it can mean that you will find others to spend time with who have a similar approach to parenthood that is compatible with yours. And that is reassuring.

This video is part of a larger campaign from Similac called “The Sisterhood of Motherhood”. The tag line for the campaign is, “Where moms get encouragement, not judgment”.

Can We Trust This Message From a Formula Company?

When I watched the video, I thought to myself- “makes sense this comes from Similac, their customers know a thing or two about being judged”. As I have previously written, it concerns me that public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

So I was a little surprised to see (in social media and news article comments) that many viewers liked the video until they realized it came from Similac. Some expressed feelings that the message was less genuine since Similac stands to benefit financially when there is less public stigma about formula-feeding. One commenter wrote, “I was all for this, until I found out that it was created by Similac”.

Tell Me What You Think:

  • Does the fact that the video comes from a formula company make the message less meaningful or genuine? 
  • Why or why not?

And Can We Trust A Message That Forgot About Dads?

I was really excited to see Dads in the video! They were baby wearing and caring for their kids- it was great. They were even included in the tag line “No matter what our beliefs, we are parents first”…but in the next screenshot, we find out they were excluded from the campaign overall: “The Sisterhood of Motherhood”.

Many online commenters focused on this exclusion. Several asked, “Why not call it “The Parent’Hood”.

In my opinion, this is an unfortunate miss in an otherwise funny, relevant, and moving video. Why include Dads in the video just to exclude them at the end? What about families that have two fathers or a father who serves as the primary caregiver?

Tell Me What You Think:

  • Was the video and overall message ruined for you because fathers were excluded? 
  • Why do you think that the video and campaign developers made that decision? 
  • Do you think they regret it now?

Friday, January 9, 2015

Vaccination is a Work of Art

Vaccination is one of the most important issues we work on and champion in public health. This week we’re talking about nine confirmed cases of measles at Disneyland in California. We just had a measles scare locally in Philadelphia at the beloved Please Touch Museum. News that this year’s flu vaccine is less effective due to a mutated strain has started a public debate about the “worth” of the shot (spoiler alert: you should still get your flu shot!) And internationally, many health workers put their lives at risk every day to deliver vaccines that are so desperately needed.

Over the years, there have been many attempts to creatively and effectively communicate the value and safety of vaccines to key audiences (parents, health care workers, etc.) For example, efforts have included (1) incorporating themes from popular movies/TV shows (check out this Star Wars PSA from the 1970’s!), (2) engaging celebrities as champions, and (3) creating engaging documentaries. The newest effort comes from the Bill & Melinda Gates Foundation. Their campaign, “The Art of Saving a Life” tells the story of the past success and future promise of immunization using the talents of more than 30 world-renowned photographers, painters, sculptors, writers, filmmakers, and musicians. The goal of the campaign is to increase world-wide knowledge about the value of vaccines so that the Foundation (and partners) can build momentum and raise funds in their efforts to reach millions more with these life-saving inoculations.

A few of my favorite images in the campaign:

Campaign developers are hoping that the images will be widely shared and viewed, and inspire dialogue and donations. Since the campaign is targeted towards an international audience, I think primarily using images (vs. writing) will bridge countries, cultures, and literacy levels effectively. You can follow #vaccineswork on social media to participate in the discussion.

In terms of evaluating this campaign, I am assuming (and hoping) they will track:

  • Activity on social media that uses the campaign hashtag #vaccineswork. *One thing to note is that this hashtag is not unique to this campaign. So their staff may need to sort through what is directly sharing/discussing the campaign vs. general vaccine promoting communication to get a more accurate view of the hashtag’s usage.
  • How many people go on from their campaign website to visit the sites of partnering organizations listed on the bottom of each page (CDC, PATH, UNICEF, etc.) And how many of those people go on to take action on a partner site (i.e., make a donation, sign a petition, register to volunteer, etc.) 
  • Some type of qualitative feedback on the art pieces themselves. Overall, are these images more effective for communicating with an international audience? Were certain pieces more effective than others? If so, why were they more effective and with what audiences?

Tell me what you think:

  • What images/stories in the campaign do you find most interesting or inspiring?
  • What other outcomes besides those above should be evaluated?
  • What other campaigns have effectively used art work to communicate about a public health topic?

Friday, January 2, 2015

Searching for Mental Illness on Twitter: Data Jackpot or Ethical Minefield?

Just after Christmas, the New York Times published an article about the “Risks in using social media to spot signs of mental distress”. The piece detailed the failed launch of the application Samaritans Radar developed by the Samaritans, a well-known suicide prevention organization in Britain. The free app alerted users when someone they follow on Twitter wrote a worrisome post. For example, the app would detect phrases such as “tired of being alone” or “hate myself”. Soon after the launch, concerns were raised about the app identifying and targeting people who were already vulnerable. Several experts in the NY Times article also expressed concern about the app contributing to stigma, discrimination, and inaccurate diagnosis/labeling of people who may or may not actually have a mental illness. The app is currently disabled and the developers are working with partners to evaluate user concerns and test potential adaptations to the app.

While I agree with pulling the app to address privacy concerns, I was very surprised by the following quote which accompanied the NY Times article:

“If someone tweets ‘I’m going to kill myself,’ you can’t just jump in,” said Christophe Giraud-Carrier, a computer scientist at Brigham Young University who studies the role of social media in health surveillance. “There are all these psychological factors that come into play that may push someone over the edge.”

While I acknowledge that there are complex factors in suicide intervention, I worry that this statement discourages intervening online (or developing applications that could facilitate this intervention). A lot of suicide prevention work has focused on training community members (I would argue this includes your online community) to be active bystanders who intervene when they see someone at risk. For example, gatekeeper trainings are popular strategies which help participants to develop the knowledge, attitudes, and skills necessary to identify those at-risk for suicide, determine levels of risk, and make referrals when necessary. The National Suicide Prevention Lifeline provides guidance for helping online when someone might be suicidal. They also link to safety teams at each social media site, including Twitter.

From my review of the research and relevant articles, there seems to be an emerging line between using Twitter to gather anonymous, aggregate mental illness data and identifying and intervening with individual users. For example, researchers at Johns Hopkins University have had a very positive response to their research using Twitter to collect new data on post-traumatic stress disorder, depression, bipolar disorder, and seasonal affective disorder. The scholars emphasize that their findings do not disclose the names of people who publicly tweeted about their disorders. Their goal is to share timely prevalence data with treatment providers and public health officials.

Tell Me What You Think:

  • Do these two stories represent the boundaries of using Twitter to search for warning signs or symptoms of mental illness? In other words, is using Twitter to gather anonymous data sets the only way to use it ethically and safely? 
  • Or is there a way to overcome the privacy concerns to empower/enable/encourage users to intervene with their fellow users if necessary?

Monday, November 3, 2014

Research Notes: Spotlight on Social Media and Angelina Jolie (Again)

Here are the top public health and popular culture stories I'm reading this week:

Authors: Robin H. Juthe MPH, Amber Zaharchuk MBA & Catharine Wang PhD, MSc

Genetics in Medicine (2014) doi:10.1038/gim.2014.141
Published online October 23, 2014

The study found huge spikes in Internet traffic on selected National Cancer Institute (NCI) sites in the immediate aftermath of Angelina’s May 14, 2013 disclosure in the New York Times that she has a BRCA1 mutation and underwent a mastectomy. 

I first wrote about Angelina Jolie in May 2013 when she penned the op-ed. At the time I posed the following question to my readers, "What (other) public health implications could result from Angelina Jolie's disclosure in today's New York Times?" As you can imagine I'm thrilled to see that formal research was conducted to examine various outcomes that followed her writing. In a December 2013 Research Notes post, I highlighted another research study that surveyed the public to document their understanding, reactions, perceptions, and subsequent health-related actions following the media coverage of Angelina's story.

Authors: Jenine K Harris, PhD;  Sarah Moreland-Russell, PhD;  Bechara Choucair, MD;  Raed Mansour, MS;  Mackenzie Staub; Kendall Simmons

Journal of Medical Internet Research (JMIR) (2014)
DOI: 10.2196/jmir.3622
Published in Vol 16, No 10, online on October 16, 2014

Researchers analyzed a "Twitter Bomb"- more than 600 tweets in one week against the Chicago proposal regarding local regulation of electronic cigarettes. Most against the regulation were from outside the Chicago area, while Twitter users from Chicago were significantly more likely to tweet in support of the policy. About 14 percent of the tweets used an account or included elements consistent with “astroturfing,” a strategy used to promote a false sense of consensus. 

I highly recommend reading this innovative study, as its methods and findings can help public health organizations to anticipate, recognize, and respond to coordinated social media campaigns.

What are you reading this week?
  • Wednesday, September 10, 2014

    Media Reporting about Domestic Violence: What’s Missing?

    Please welcome Elaine J. Alpert, MD, MPH as today's guest writer. Dr. Alpert is an internationally-respected family violence, sexual assault, and human trafficking education, advocacy, and policy expert. She is an independent curriculum design and policy consultant in all forms of violence prevention, teaches at the University of British Columbia School of Medicine, and provides expertise in Human Trafficking as Senior Global Health Fellow at Massachusetts General Hospital’s Division of Global Health and Human Rights. She also serves as a Trustee of the all-volunteer Steve Glidden Foundation, which provides summer camp scholarships for children who are homeless, refugees, abused, or affected by family or community violence. She can be reached at 

    I’ve been watching news coverage about Ray Rice’s domestic violence (DV) assault for the past two days now and I have to say that, on balance, I am disappointed.

    As a veteran physician, educator and scholar in the fields of domestic violence, sexual assault and, more recently, human trafficking, I’ve been paying attention over the years both to events (often tragic) as they happen, and to trends in both media expertise and public perception. Here are some observations along with a few words on how I think the media can do better:

    Media attention ideally should:

    • Tell the viewing, listening, reading, or clicking audience what happened (report the news);
    • Raise questions that people might not otherwise have considered;
    • Educate, inform and raise awareness among the general public; and
    • Motivate people to action (for example, by providing ready resources for those at risk, and by showing those who want to help how to do so).

    How good a job do our media really do (in general) when reporting about DV? Typically, for a few days after a high profile DV assault or murder, we see coverage about whatever “event” transpired, along with passionate and generally well-meaning attention paid to DV as a whole. Overall, (and not specific to the Rice case), we tend to see variations of:

    • Shock or disbelief that such a nice guy could have done such a terrible, unanticipated thing, often supported by “evidence” of niceness – he was a pillar of the community, he walked his dog every morning, he brought the paper to the elderly neighbor’s door, he belonged to the neighborhood watch, etc.  Often these “nice guy” testimonials come from neighbors or passers-by;
    • Proclamations that this was either a one-off act of insanity or passion, or at least could not have been predicted  – he must suddenly have lost control, perhaps something happened (provoked him) to make him “lose it,” no one saw this coming, etc. These “no-one-saw-this-coming” testimonials are usually from acquaintances, co-workers, or local officials, often accompanied by assurances that the neighborhood itself is “nice,” “quiet,” or “tranquil,”  or at least full of hard-working, honest and earnest people. Accompanying footage often shows tree-lined streets and picket fences whenever possible;
    • A general wringing of hands about difficulty the “victims” (or their children) may encounter moving forward (sometimes accompanied by additional angst about extended family members, pets, or traumatized neighbors). A few even engage in hand-wringing about the future well-being of the perpetrators (think Steubenville). All commentators can participate freely in the wringing-of-hands exercise, including reporters themselves; and
    • Assurances that whatever tragic event just transpired was the tipping point and things will be better (this will not happen again, police responses will be improved, weapons will be better regulated, social service referrals will be handled more promptly, etc.). Such assurances usually come from local or statewide officials.

    And then, almost like clockwork, once the arraignment (or funeral) has passed, and the world turns its attention to the next short-cycle news event, coverage moves to the next ratings-boosting headline.

    Although still early, this pattern is already being replicated in the Ray Rice assault. The current pundits – at least on the news clips I am watching – are predominantly:

    1. NFL or other sports experts/journalists talking about how it's important to figure out who in the league knew what, and when they knew it, while proclaiming how shocked they were when these allegations first arose last winter because Rice was – guess what – a pillar in his community;

    2. Journalists and authors who are either psychologists or other counselors, or who have had personal experiences with DV and have written (and are, at times, quite obviously plugging) books about what "battered women" are “like” or what they “go through,” earnestly trying to explain Janay Rice’s various (and some would argue, stage-managed) "stand by your man" statements;

    3. Legislators who proclaim (sometimes with passion) that DV is bad and VAWA is good; or

    4. Lawyers who wonder why Rice was allowed to enter a "diversionary" program and was not jailed for aggravated assault.

    Some of this commentary can add value to the societal discussion that needs to take place. Clearly, it is necessary, but it is not sufficient.

    What I do NOT see - and what I think really needs to be featured prominently – is reporting that provides:

    1. Commentary from DV experts, including community-based or national experts from DV advocacy organizations, recognized scholars, and those whose expertise is in primary prevention – changing conditions to prevent DV from occurring in the first place. Baltimore (and the DC Metro area) has all of that to offer - and then some.

    2. Resource information for the viewer (or reader) on how to get help or how to get involved to help. This can easily be offered as a “crawler” with the vital information scrolling past at the bottom of the screen on TV or as a sidebar in print or on the internet.

    At least as far as I have seen, very few "pundits" have talked about how to reach out to, and empower, survivors.  No one (at least on broadcasts I’ve seen) has told viewers who may be in danger that there are vital community-based services in most localities and how to contact them to get help. Not one has talked about the restorative power of support groups (though lots of pundits have talked about how important it is for the Rices to get one or another kind of therapy for things that may or may not have happened in their own childhoods). Not one has talked about how to engage men and other bystanders as active allies to challenge and change entrenched social norms that tolerate and promote violence. And not one has displayed the National DV hotline phone number (1-800-799-7233) or website (

    Many years ago, when print media reigned supreme, the Boston Globe included an inset box with every article about DV. The box included a stylized image of a telephone, words identical or similar to “To Get Help,” and a DV hotline number. This boxed information was normally inserted in the final layout process. During a layout makeover several years ago, this vital information got dropped and, to my knowledge, has not been restored.

    Including “To Get Help” info about DV in print, on TV news, and on web-based news sources is such a no-brainer. Why not include it automatically in news reporting?

    None of this is rocket science – whenever you read about a disaster of any other kind – from Katrina to Sandy to tornadoes – there is ALMOST ALWAYS commentary from experts in the field, accompanied by a box or informational inset that provides information for people who need help or who want to volunteer, contribute or help in some other way.  Why is there a different set of rules for DV?

    So we have come a long way I guess, but the media has still not got it quite right – at least not yet.

    Janay – if you read this, your local DV organization is ready to reach out to you without judgment, and with compassion, patience, information, empowerment, and support.  If only the TV would tell you the phone number…

    Saturday, September 6, 2014

    Can Free Product Giveaways Actually Improve Health? A Guest Post for HealthComU

    This week I had the pleasure of contributing a post to the blog HealthComU. The site was founded by five health communicators who met during their master's program in health communication at Boston University. The blog explores lots of interesting communication issues from effective advertising to the integration of social media in health communication efforts. This week I pose the question, "Can free product giveaways actually improve health?" I would love for my readers to share their perspectives on the piece!

    Wednesday, August 13, 2014

    Can The #IceBucketChallenge Really Help Cure ALS?

    Picture via

    *Thank you to Erica Banz, Tim Reinhardt, Christina Reinhardt, Dorothy Sutton, Lauren Sierotowicz, & Kellie Anderson for sharing your insights as Ice Bucket Challenge participants and supporters.

    Public health professionals are naturally skeptical. We see tons of health programs and initiatives launched every day. If they lack a logic model, a strategic plan, and strong evidence to show that their activities lead to specific, measurable outcomes, we hesitate to support them. Acknowledging my skepticism, I felt it was important to integrate the perspective of ice bucket challenge participants into this post.

    The #IceBucketChallenge (IBC) that has gone viral on social media in recent weeks is focused on Amyotrophic lateral sclerosis (ALS). This disease affects the nervous system, causes muscle weakness and impacts physical function. It is a devastating disease.

    What Makes Something Go Viral (or not)? 
    We public health folks are always trying to figure out what communication strategies will capture attention, be clear/understandable/sustainable, and easy to share on social media. So what I find fascinating is that this same challenge strategy was making the rounds on social media long before it became linked with ALS...but few of us had heard of it. For example, in June college basketball programs started the #chillin4charity cold water challenge to benefit the Kay Yow Fund. The change came (according to Elle Magazine), when Pete Frates took the IBC on July 31st. From then on, the challenge was forever linked with ALS and it caught on like wildfire. Why was the same challenge, same strategy so much more popular for the ALS initiative? Timing? Visible champions for the cause? Marketing?

    I asked my friends about their motivations for participating and their thoughts on what made the challenge so popular. Several had a personal connection to the cause of ALS, so were already engaged. However, almost everyone mentioned that the challenge was funny, driven by the nomination/“nudge”/peer pressure factor, and encouraged community building. Tim compared it to a 5K race. “Inherently, running 3.1 miles has nothing to do with solving a problem or curing a disease, but it is a fun activity to do with other people and it results in money being raised and awareness being raised.”

    Is The Ice Bucket Challenge Effective? 
    Along with the glowing articles of support and famous participants, there have been several articles that have strongly criticized the challenge. The concerns are primarily that the challenge’s origins/rules are vague, participants do not always know what they are supporting, and accepting the challenge does not necessarily translate into donations or increased resources for ALS.

    For me, there are a few key questions to be answered before we can talk effectiveness:

    #1 What are the goals of the ice bucket challenge?
    Clear goals are the only way to evaluate the success of the program. I’ve heard the goal is to “raise awareness” and if you are a regular Pop Health reader, you know this makes me cringe a little. In my opinion, “raising awareness” is one of the most poorly defined concepts in public health. If you talk to 10 people, you get 10 different answers about what it means. Usually people say it means one or more of the following:

    • Knowing that a disease exists (symptoms, causes, treatments, etc.)
    • Getting people to talk about the disease with others
    • Getting people screened for the disease
    • Getting people to donate money for the disease (for treatment, research, etc.)

    As you can imagine, with a wide variety of definitions, “raising awareness” can be very hard to measure. Each of the goals above would be measured and evaluated in a completely different way.

    #2 Are participants sticking to the rules of the challenge?
    From my research, the rules of the IBC are:

    • You receive the challenge from someone else and have 24 hours to accept
    • Accepting includes filling a bucket with ice and cold water, dumping it over your head, calling out the cause you're supporting and challenging friends to continue the message, and of course, posting video proof to social media
    • Declining includes donating $100 to an ALS association of your choice (or whatever charity has been named)

    In preparation for this post, I watched a bunch of friends’ videos. While all very funny, I can certainly say I have some concerns about program fidelity (i.e., how closely a program was implemented as intended). Kellie voiced the same concerns, “I think the donation piece of it has gotten lost through the various iterations.” If the challenge morphs over time (like a game of “telephone”), it can be very difficult to evaluate. In other words, if goals are not achieved, is that because the challenge is just a bad idea? Or is it because half the required elements were missing from participants’ videos?

    #3 What outcomes are being measured?
    While there have been some negative reactions to the challenge, there is no denying that donations are up. It may be hard to evaluate the true scope of donation increases because people are donating to many different ALS charities. Hopefully these charities are communicating and finding a way to aggregate and report on their donations post-IBC as a whole. My colleague Christine Keeves points out that only time will tell if participants evolve from one-time donors to long-term engaged donors/activists.

    In the Elle article, Pete’s wife Julie says that the goal for the challenge is to help people understand what ALS is. “...even if they just see the ice bucket challenge and Google, 'What is ALS?' that’s a success, because that’s really all we can ask for." I certainly hope someone is evaluating this because it is easily measurable! Other studies of similar activities (e.g., autism awareness month) have shown a boost in Google searches.

    It is unclear what is next for the challenge. Christina wonders “how and when it will fade out, and whether people will continue to donate down the line.”

    I want to hear from Pop Health readers (both IBC accepters and decliners):

    • Why did you accept or decline the challenge?
    • What do you think made the challenge go viral for ALS specifically?
    • Will the challenge be successful? Why or why not?
    • If you were the program evaluator, what other kinds of outcomes would you want to measure?