"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?

Tumblr Contemplates A New Policy Against Self-Harm Blogs: Let's All Weigh In

Tumblr is a popular microblogging platform.  It lets you share anything from text to pictures to video.  According to their website, the average Tumblr user creates 14 original posts each month, and reblogs 3. The "reblog" button on all Tumblr posts allows a meme to spread rapidly across thousands of blogs with just one click.

As with other social media platforms, tumblr has an enormous reach (18,878,347,183 total posts as of the time of this blog).  Therefore, it has great potential to help and hurt the public's health as it facilitates communication among millions of people.

A few weeks ago, Tumblr presented to its users a challenge (and possible solution) regarding blogs that promote self-harm.  Their users are being asked to weigh in on the policy.  I think that is a smart move.

Here is an excerpt from the Tumblr staff blog: 

Our Content Policy has not, until now, prohibited blogs that actively promote self-harm. These typically take the form of blogs that glorify or promote anorexia, bulimia, and other eating disorders; self-mutilation; or suicide. These are messages and points of view that we strongly oppose, and don’t want to be hosting. The question for us has been whether it’s better to (a) prohibit them, as a statement against the very ideas of self-harm that they are advancing, or (b) permit them to stay up, accompanied by a public service warning that directs readers to helplines run by organizations like the National Eating Disorders Association.

We are planning to post a new, revised Content Policy in the very near future, and we’d like to ask for input from the Tumblr community on this issue.

The blog goes on to say that they currently think the right answer is to implement a policy against pro self-harm blogs.  They aim to focus only on blogs that actively glorify or promote these behaviors. They also intend to start showing public service announcements (PSAs) on specific search terms like "anorexic" or "thinsperation".  It is unclear from their post how this policy will actually be implemented.  It would take enormous staff resources to comprehensively review their site and remove concerning materials. 

Other online and social media platforms have struggled with similar issues regarding how to respond to users that may be searching for or posting worrisome content.  Here are a few examples of other challenges and solutions:

• When someone uses Google or Yahoo to search for the term "suicide", the link to the National Suicide Prevention Lifeline is provided as the first result.
• In December 2011, Facebook began a new service that allows "Friends" to report concerning posts.  Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat. Note that Facebook does not troll the site itself, but instead waits for reports to come in.  
• Pop Health has previously posted about the debate regarding Twitter's duty to restrict hate speech vs. its duty to promote free speech among its users.

From these examples, you can see that there have been a variety of approaches to address potentially unhealthy or unsafe posts on social media platforms.  Sites can decide to be inclusive of all posts, they can let users police each other and report concerns, they can post resources in response to keywords, they can actively prohibit certain content...or they can use some combination of these strategies.

• What strategy or combination of strategies is best for the public's health?  
• If users are prohibited from posting, does that make them more isolated and less likely to connect to services?
• Should the overall health of the user group outweigh the health of that individual?

Tumblr is encouraging users to weigh in on their plan...so I ask you to both comment here and contact them at policy@tumblr.com. 

Lady Gaga Launches "Born This Way Foundation" To Promote Safety, Skills, and Opportunity for Young People

Today, in collaboration with Harvard University and other partners, Lady Gaga is officially launching her "Born This Way Foundation".  As discussed on this blog, on news outlets, and in the peer reviewed literature, bullying is a serious problem with potential connection to public health issues such as depression and suicide.  Lady Gaga has been a vocal anti-bullying advocate, and in 2011 channeled that energy into the development of a Foundation.  Lady Gaga and her mother Cynthia Germanotta, founded the Born This Way Foundation to foster a more accepting society, where differences are embraced and individuality is celebrated.

The launch is being held at Harvard University’s Sanders Theatre.  Lady Gaga and her mother will be joined on stage by Oprah Winfrey, author and speaker Deepak Chopra, U.S. Secretary of Health and Human Services Kathleen Sebelius, and esteemed Harvard Law School professor Charles Ogletree to discuss the vision of the organization, and how we can all get involved.

An academic symposium has been planned in conjunction with the launch.  The event invites researchers, policymakers, and foundation representatives to discuss ways to reach youth and promote a culture free from bullying.  I'm proud to see that my former employer, the Education Development Center, has been invited to the symposium and will share insights from their extensive research in this area.

I look forward to hearing more about the vision of the organization, because although Lady Gaga is hugely influential (at the time of this post, she had 19,773,280 followers on twitter), the strategies and tangible goals for the Foundation are not completely clear from their website.  Under their mission statement, they list three pillars of the Foundation:

1. Safety
2. Skills
3. Opportunity

There is some discussion under those pillars of offering support to individuals through online communities, providing training in advocacy and community engagement, and providing opportunities to bring the national BTWF activities to the local level.  However, there are no details regarding how these strategies will actually be executed.  If you click on "Do Your Part" and "Review The Plan", it simply takes you back to the mission statement.

What strategies do you think could help BTWF support the three pillars of safety, skills, and opportunity?
What outcomes should they look at in order to evaluate the effectiveness of their efforts?

Rainn Wilson Apologizes for "Poorly Conceived Date-Rape Joke": What Would RAINN Think?

When I saw a twitter headline today that read, "Rainn Wilson Apologizes for "Poorly Conceived Date-Rape Joke", I first thought, "Is there ever a well conceived date-rape joke?"  Next I thought, "Well- that's certainly a coincidence."

The coincidence being that the other RAINN (Rape, Abuse, and Incest National Network) plays an important roll in calling out celebrities (and educating them) regarding the consequences of throwing around the term "rape".  The misuse of the term seems to be hitting epidemic proportions lately:

•   In June 2010, "Twilight" actress Kristen Stewart compared the constant scrutiny that she receives from the paparazzi to a woman being raped.  "What you don't see are the cameras shoved in my face and the bizarre intrusive questions being asked, or the people falling over themselves, screaming and taunting to get a reaction," she said of the constant paparazzi crush. "The photos are so ... I feel like I'm looking at someone being raped. A lot of the time I can't handle it. It's f---ed. I never expected that this would be my life." Stewart later apologized.  

•  In October 2011, actor Johnny Depp compared having his picture taken to being raped.  “You just feel like you’re being raped somehow. Raped. The whole thing,” he told Vanity Fair. “It feels like a kind of weird—just weird, man… Whenever you have a photo shoot or something like that, it’s like – you just feel dumb. It’s just so stupid.”  Depp later apologized.

• In November 2011, "Jersey Shore" cast mate Vinny released a song about raping strippers.  I will not repeat the lyrics here.  Vinny later apologized.

• In January 2012, actress Kim Novak took out an ad in Variety magazine to declare that she felt raped by the makers of the Oscar nominated film "The Artist" because the film used a score from one of her old movies.  The difference here:  Novak's team is not apologizing. 

Whether we like it or not, celebrities influence social norms.  When celebrities use the term "rape" as a joke or to describe their dislike of having their picture taken or their work borrowed, it cheapens what it really means.  It is meant to describe a violent act against women, men, and children...and it is a serious public health issue.  As with any public health issue, it is influenced at multiple levels (individual, interpersonal, community, society). The language we use everyday (whether to friends, family, co-workers, twitter followers, facebook friends) impacts our society on every level.  So think about the words that you choose and do your part to change the conversation.  

National Sexual Assault Hotline:  1-800-656-HOPE (4673)

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)

The NFL Super Bowl Commercial: Has Dedication to Player Safety Really “Evolved”?

In between a fantastic Super Bowl game, gallons of salsa, Madonna’s half-time show, and many disappointing sexist commercials, I patiently waited for the last third quarter commercial break. Almost a week before, the New York Times ran a story about a Super Bowl commercial which would address player safety. The NFL was taking one minute of its own commercial time (valued in the millions) to talk about its commitment to the safety of its players...a commitment which has been questioned over the years.

The one minute spot opens in Canton, OH in 1906 and follows one long kick return 100 yards (and 100+ years). The design of the commercial is well done as it follows famous players through the years. As the years progress (as documented on yardage lines), the viewers see and hear a discussion of key safety innovations. For example, we see no helmets turn into leather helmets turn into plastic helmets. We also see the addition of the facemask and the elimination of dangerous hits on players (e.g., horse collar tackles). The voiceover (telling viewers, “Here’s to making the next century safer and more exciting than ever. Forever forward. Forever football”) is provided by a veteran linebacker for the Baltimore Ravens- Ray Lewis.

In any occupational setting, there is concern that creating a culture of safety can be difficult, especially when veterans want things to stay “how they’ve always been”. Lewis has 16 NFL seasons under his belt and a reputation for playing with intensity. In many cases, he would be the hardest kind of player to get on board. Therefore, it is ideal for the Evolution campaign to have recruited someone like Lewis as a champion for its mission!

I also thought that the choice of words “safer and more exciting” were important. One concern about the increase in equipment and restrictions on hits is that it destroys the essence and entertainment of football. That essence being big men hitting each other, playing through pain, and ultimately being declared “stronger” and “winner”. So for Ray Lewis to promise that game excitement will actually increase (along with safety) is quite important for a possibly skeptical audience.

In addition to the commercial, an accompanying website was launched to provide detailed information about the history of the game and various rule changes. The website provides a very cool interactive timeline which outlines each decade. For example, the 1960’s bring “the world’s first Super Bowl”. It also brings fibershell and plastic pads, universally worn facemasks and the banning of grasping a runner’s facemask (1962).

From a public health perspective, I’m impressed with the quality and persuasiveness of both the commercial and website. A successful campaign was really necessary for the NFL, considering that it has been criticized in the past for its lack of commitment to player safety. Most notably, there has been much concern about the NFL’s protocols for dealing with player concussions (and the short and long-term consequences of those injuries). In recent years, we have seen a variety of public health strategies to address concussions.

They have developed and/or expanded safety committees to compile and analyze head injury data. We have seen numerous policy changes regarding both on the field play and the treatment of injuries. For example, in 2009 the NFL adopted a stricter statement on return-to-play for a player who sustains a concussion. The 2009 statement advises that a player who suffers a concussion should not return to play or practice on the same day if he shows any signs or symptoms of a concussion that are outlined in the return-to-play statement. In addition, the NFL has increased its use of financial penalties for helmet to helmet hits which are especially dangerous.

We have also seen educational materials for coaches and players regarding concussions. In fact, Pop Health critiqued the materials released in summer 2010 (“Concussion: A Must Read for NFL Players”).

While there is still criticism of the NFL’s commitment to player safety and there is always room for improvement, I think the “Evolution” campaign is effective. Reflecting over 100 years of football through the commercial and website, it is clear to the audience that they have come a long way. They have used various public health strategies to reduce injuries (i.e., equipment innovation, policy change, education campaigns, and probably the hardest strategy- culture change). In Ray Lewis, they have effectively retained a respected veteran to champion the cause. Finally, they have reassured the fans that the game will remain (and even increase) in excitement despite additional safety measures.

What do you think? Was the commercial just a PR opportunity for the NFL to defend themselves against recent criticism and lawsuits regarding player concussions? Or did you find it to be an effective reflection of successful safety innovation coupled with a sincere commitment to player safety moving forward?