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?

    Thursday, August 7, 2014

    Olivia Wilde, World Breastfeeding Week, Infant Formula, and A Critique of the Language We Use to Talk About It

    My son taking a bottle of formula in the NICU (February 2014)
    When my baby boy arrived, he weighed 4 pounds, 13 ounces. He entered the world 8 weeks early and spent 29 days in the Neonatal Intensive Care Unit (NICU). When your baby is in the NICU, there is enormous pressure to breastfeed. The nurses rolled a hospital grade pump to my bed side just hours after delivery and minutes after my first visit to my baby’s incubator in the NICU. “Breast milk is like medicine for preemies”, I was told. Every day I pumped around the clock and delivered milk to the NICU in the insulated bags they provided…like I was packing his lunch for school. Every milliliter was carefully inventoried and measured by the NICU nurses. I always knew from the looks on their faces if I had made enough to feed him for the day. Like I said- enormous pressure. Things were going okay until about 10 days after delivery. I developed mastitis on the right breast. For those unfamiliar, mastitis is an infection of the breast tissue. I had pain, high fever, and chills. After two antibiotics it resolved. Then I developed a second mastitis infection on the other side. The pain was excruciating. The infections did a number on my body, my sleep, and my milk production (and yes we worked with lactation consultants and did all sorts of tricks to try and increase production). My husband and I made the decision to switch my son to formula at 3 weeks old. We did it for his health, my health, and my ability to care for him when he was discharged. I can easily say it was the best decision we could have made. My sweet boy absolutely thrived on his special preemie formula. He tolerated it very well, grew, and got stronger. We are incredibly grateful for formula. To us, it is an amazing public health innovation. It feeds our baby when I cannot.

    So it is through the lens of both a (proud) formula feeding mom and public health practitioner, that I examine the current public health campaigns focused on birth and infant feeding. A recurring theme for me is concern about the language being used in these campaigns. Somehow public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

    For example:

    • All birthing hospitals in Philadelphia have officially discontinued the practice of giving free formula to new mothers. While I understand that this strategy is supported by evidence, it is part of a larger international initiative to make hospitals “Baby Friendly”. So using that logic, providing formula is “unfriendly” to babies? This message was reinforced by Nurse McGinn who was interviewed for the story. She reports that she “was given free formula and threw it out”. Quotes like these reinforce the message that feeding with formula is equivalent to giving your kid poison. 
    • A friend sent me a link to a wonderful story about supporting formula feeding moms during World Breastfeeding Week. This article does a great job of examining the language being used in this campaign. The terms connect breastfeeding with “winning” and achieving “goals”. So the flip side is “losing” and “falling short of your goals”? This can be a rough reminder for formula feeding moms. For many women, the switch to formula was made after extreme pain, guilt, and feelings of failure. 

    Recommendation: When thinking about health communication, I’m a big fan of testing out campaign terms, along with their antonyms. This can help you to anticipate unintended consequences of your messages.

    For example, a public health colleague tweeted that we should use the language “breastfeeding is normal” instead of “breast is best”. Although it was not her intention, I read that as meaning that anything other than breastfeeding is abnormal. So formula feeding is abnormal?! Not a great message to send to women.

    However, this kind of message is often communicated. In the Olivia Wilde photo spread for Glamour Magazine which includes a photo of her feeding her son, she says “Breastfeeding is the most natural thing…” I guess it is, unless it did not work for you and your baby. Then it feels pretty unnatural.

    So I ask readers

    (1) While these breastfeeding and baby friendly campaigns have well-intentioned public health goals (which I support):

    • What are the unintended consequences of their language and communication choices? 
    • Do they help reinforce the divide between formula feeding and breastfeeding mothers?
    • What about the women who both formula and breastfeed? Where do they fit in?

    (2) What are your suggestions for more effective language? How can we simultaneously promote breastfeeding without stigmatizing formula feeding?

    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!