Kim Kardashian is a Spokesperson (Again) for a Public Health Issue...Will the Public Buy In This Time?

This afternoon I saw a tweet from Kim Kardashian that read "Recognizing Ovarian Cancer is the 1st step in fighting Ovarian Cancer- please watch and share this video". So my first thought was- "I wonder if this campaign will be more successful than her last?" As you may remember, in December 2010 I blogged about Kim and other celebrities that staged their digital deaths in order to raise money for World AIDS Day. In addition to my concerns about the campaign's design (which included a less than clear cue to action for the audience), its "success" was also questionable because it ended up taking much longer than intended to reach their 1 million dollar goal. So I was quite intrigued to view Kim's newest PSA on YouTube.

The event called "Super Saturday Live" is a collaboration between QVC and the Ovarian Cancer Research Fund (OCRF). On Saturday, July 30, 2011- designer clothes sold on QVC will be 50% off and the net proceeds will be given to OCRF. The PSA informs the audience that this money is necessary because there is currently no good early detection test for ovarian cancer.

I was pleasantly surprised by the PSA. It didn't feel too long (94 seconds). It kept my interest with minimal and appropriate statistics. For example, instead of scaring the audience, the music was upbeat and focused on the positive- a 92% 5-year survival rate when the cancer is detected early. The PSA also had information presented through both audio and visual channels. Finally (and most importantly)- as an audience member, I knew exactly what I was supposed to do. The cue to action was clear. I was to share the video- "like" it, post it, forward it. And finally, I should tweet about #supersaturday. This way the "trend" can get ahead of ovarian cancer.

In addition to the look and feel of the PSA, I think it is important to discuss the strength and popularity of the chosen spokesperson. Just as I mentioned in December, Kim Kardashian is an obvious choice if you are looking for a huge reach. As of tonight, she had 8,380,553 followers on twitter. The PSA already had 5,965 views on YouTube. However, I have my concerns about her genuine interest in this public health issue. Does she have a personal connection or does she just jump on the bandwagon (like in December) for any way to promote her "brand"? I ask because I have concerns due to how she behaves on her E! show- Keeping Up with the Kardashians. For example, just a few weeks ago on the show, Kim had her butt x-rayed to "prove to the media" that it was real (without butt implants). I watched this episode while on the elliptical machine at the gym and felt enraged. First of all, what type of terrible physician allows his time and resources to be taken up with such nonsense? Also, what type of terrible physician agrees to expose Kim, his patient, to needless radiation to help her prove this point? And how much extra time does she (and her sisters) have on their hands to participate in this silly trip to the doctor? If I were the Executive Director of OCRF, even with her extensive popularity, I doubt that I would choose her for a spokesperson.

So let's all check out Twitter on Saturday, July 30th...let's see if #supersaturday is trending and if Kim's "quantity" of followers can help balance out her sometimes lack of "quality" as a spokesperson.

In Honor of World AIDS Day: Can Celebrity "Digital Deaths" Prevent Real Deaths from HIV/AIDS?

Kim Kardashian, Ryan Seacrest, and Lady Gaga are all dead! No, not really...but they are considered "Digitally Dead" for today- World AIDS Day (December 1st). These celebrities and many more joined forces with a charity co-founded by singer Alicia Keys called Keep a Child Alive. The charity provides treatment, love, and support to families affected by HIV/AIDS.

For today's campaign, celebs were pictured in coffins, featured in "last video testaments", and pledging to stay digitally silent on their social media accounts (i.e., on Facebook and Twitter) until their lives were "bought back" by donors reaching a minimum of one million dollars total. Although the images of celebs in coffins were a little creepy, Keep a Child Alive co-founder Leigh Blake says:

"We're trying to sort of make the remark: Why do we care so much about the death of one celebrity as opposed to millions and millions of people dying in the place that we're all from? Its about love and respect and human dignity."

It is an interesting concept for a health communication/advocacy campaign. Usually when campaigns advocate via social media, it is done by bombarding their followers with messages and links to donate or sign up to assist the cause. Here, the campaign is trying to motivate donors by having an ABSENCE of the celebrities' voices. How powerful is that absence? Will the public really miss reading celebs tweets and facebook status updates? Apparently so. As of tonight on Twitter, Kim Kardashian had 5,467,107 followers and Ryan Seacrest had 3,683,658 followers. So whether we like it or not, the voices (and silences) of these celebrities matter in our communities.

While I do think the campaign will have large reach, I will say that their coffin posters left room for improvement. I've analyzed health communication campaigns on this blog before, and the key is always- "What is the cue to action? Does the audience know what they are supposed to do after seeing the poster/brochure/PSA?" Well- when I first saw this poster of Kim Kardashian, I had no idea what it was about. I had to Google and read the narrative about the World AIDS Day campaign for Keep A Child Alive. For this blog post, I had to blow the image up over 100% to read the text on the bottom of the poster. It reads,

"Kim sacrificed her digital life to give real life to millions of others affected by HIV/AIDS in Africa and India. That means no more Facebook or Twitter until we buy her life back". Then the charity website and text number were provided to accept donations. In future campaigns, they would want that text to be much bigger. It should not take the audience several minutes, a Google search, and a magnifying glass to figure out what they are supposed to do to help poor Kim get out of that coffin.

Overall, I give this campaign a B+ for creativity in using the "absence" of social media messages and targeting celebrities with a huge following and reach to potential donors.

Anti-vaccine ads on Delta planes; Magic and Ellen as celebrity champions for HIV/AIDS prevention...and more- What Am I Reading This Week?

New pop culture and public health stories to check out this week:

1. Darrell Hammond of Saturday Night Live fame reveals that child abuse led to alcohol/drug use and cutting. He details the horrific abuse in a new memoir, "God, If You're Not Up There, I'm F*cked".

2. Fellow Boston University School of Public Health alum Elizabeth Cohen reports on the 20th anniversary of Magic Johnson's announcement that he is HIV positive. His announcement had an incredible impact on the public's health- both in terms of reducing stigma of those diagnosed and proving that the diagnosis is not always a death sentence.

3. Delta airlines is seeing backlash from public health organizations and other flu vaccine advocates after airing a 3-minute PSA from the National Vaccine Information Center that describes alternate ways to avoid the flu (besides getting the flu shot).

4. Ellen DeGeneres is named global envoy for AIDS awareness. The hope is that Ellen's enormous platform (from both her TV show and social media channels) will allow her to reach millions of people with the prevention message. Ellen is a partner in other important public health issues, for example- bullying prevention.

5. This week, Evelyn Lauder passed away from Ovarian Cancer. Evelyn was one of the powers behind the creation of the pink ribbon campaign for breast cancer awareness.

How about you? What are you reading this week?

A Pop Health Book Review of “Unbearable Lightness”

Welcome back readers! After a holiday, bronchitis, and work travel hiatus- Pop Health is back with a new feature- reviews of books which examine public health and popular culture issues.

Over the weekend I finished reading “Unbearable Lightness- A Story of Loss and Gain”, by Portia De Rossi. I actually mentioned this book back in a November post when it first came out. The story chronicles Portia’s struggle with both Anorexia and Bulimia from approximately age 12 to the present. The strength of the book is in its ability to portray the absolute complexity of an eating disorder. Sometimes these disorders (and other mental or physical health issues) are over simplified. For example, the commonly held belief that someone is Anorexic simply because she/he needs to “have control over something”. However, in Portia’s case, she wove an incredible story that examined causes at multiple levels. And in public health, this multilevel thinking is essential for the development of effective interventions. I have decided to begin with the causes most closely associated with Portia herself and work my way out.

Intrapersonal:

Portia endured a complete lack of healthy coping mechanisms. She dealt with a lot of sorrow and changes in a short amount of time as an adolescent growing up in Australia. Her father passed away and she changed to a more affluent school district. She worked to cope with these challenges by identifying a way to be “special” and “stand out”. She chose modeling because models are special. She also changed her name when she was 15. There was another girl her age with the same name (Amanda Rogers), so she changed it to Portia De Rossi to be more unique.

Portia also felt intense guilt and shame over being gay. Although she realized her sexual orientation early on, she kept this secret until her late 20s. Much of her self hatred focused on feeling as if she was disappointing her family and would ultimately ruin her chances to have a successful career and “normal” life.

Interpersonal:

Portia’s relationship with her mother is examined in quite a bit of detail. Throughout her modeling career as a teenager, her mother was definitely her accomplice in yo-yo dieting. Her mother taught her “dieting tricks” to lose the weight quickly for jobs, but also rewarded her with McDonald's after auditions. However, her mother’s strongest influence seemed to be over the guilt and shame she felt over being gay. After she came out to her mother, the response was “let’s just keep this to ourselves”. Portia was told to keep it from the family and from employers/co-workers.

Besides 1-2 friends and her brother, Portia is very isolated. In addition, her relationships with co-workers on Ally McBeal and other colleagues in the industry seem to have contributed to her eating disorder as well. For example, two of her co-stars (Calista Flockhart and Courtney Thorne-Smith) were famously accused of being Anorexic and underweight throughout the show’s run. So Portia was constantly working with and compared to an unrealistic ideal. In addition, many people who could have and should have recognized the problem and intervened- stayed silent. For example, as Portia dropped from a healthy 130 lbs to sub-100s, her costume designer told her she looked fantastic and asked for her secrets to weight loss. Portia also sought the help of a professional nutritionist. Even though she confided to binging and purging on the first visit, she was still given a food scale and a diet to help her lose weight. The nutritionist did not try to intervene until Portia was almost down to 82 lbs.

Community/Society:

Portia’s existence in several “communities” contributed to her struggle with eating disorders. Her first professional affiliation in the modeling community in Australia is where she developed a strong knowledge of dieting, purging, and excessive exercise. The “older girls” taught her this. It was the norm in that group to be unhealthy in order to get ready for a job.

From Australia, Portia traveled to the United States and the “Hollywood Industry”. Unfortunately, it was a smooth transition from the unrealistic expectations of the modeling to the acting industry. She describes a particularly gut-wrenching fitting that she endured when a photo shoot had to be rescheduled after the client realized that she was in fact a size 8- so no selected clothes would fit her.

In addition to body size, she also felt Hollywood was not accepting of a homosexual lead actress. Several times she spoke of the paralyzing fear she felt after seeing how quickly Ellen DeGeneres’ show was canceled after she came out in the late 1990s.

This is just a brief overview of these complex contributors to Portia’s eating disorder- I could easily go on for many more pages. Overall, I think the book is a fascinating read…for those of us interested in public health, eating disorders, and/or Hollywood. It portrays Portia’s struggle, self hatred, and self destruction with brutal honesty- so be prepared.

A closing word of caution: this book may not be appropriate for someone with a current or recently recovered eating disorder, since it outlines her eating, binging, and exercise rituals in incredible detail.

Courteney and David: A Poorly Designed PSA That Makes Me Want to "Scream"

So Courteney Cox and David Arquette are having a tough week. First they announced their separation and now I have to highlight the poor design of a recent public service announcement (PSA) in which they starred. I must say- they made a much better team on the set of their "Scream" movies.

A recent Newsweek article entitled "Can PSAs End Domestic Violence?" discussed the Cox/Arquette PSA and outlined the challenges of using this particular health communication channel to address the public health problem of domestic violence. The article quotes a wonderful professor of mine (thank you Dr. Emily Rothman for posting this link), so I decided to check the PSA out for myself. Overall, my impression was not good. Let's compare the PSA to some best practices and/or guidelines and see how it holds up. A great resource on this (and all aspects of program planning) comes from the Community Toolbox:

1. PSA Length
A typical PSA runs about 30 seconds. This video runs 1 minute, 50 seconds. And the viewer does not even know what the video is about (cue a random segment about "furry" sex) until the timer hits 1 minute, 25 seconds. They could have very easily lost viewers by that point (either due to boredom, confusion, or because they were offended by the "furry" segment).

2. PSAs Should Have a Clear Message and Call To Action (i.e., what do you want the viewer to do after they see your video?)
So I was a little surprised that the video did not include any specific hotline numbers. In case the audience included victims of DV, you would think that it would be a priority to list those resources. Instead, the only "action" that I could see outlined was how to donate to "OPCC"...and it was unclear what that organization was. So I followed the instructions at the end of the video that gave their Facebook address. Again, there is a huge logo that says "OPCC" (still not sure what that is, so I probably won't give money) and finally (in much smaller writing) some hotline numbers on the left. I went one more step and went to the Ocean Park Community Center (OPCC) website, where it still wasn't immediately clear how this organization supported domestic violence prevention. Apparently, this PSA was to support one of the community programs called Sojourn (a women's shelter)...but geez- how hard was that to figure out!!!???

3. Like any good health communication product, there should be a clear target audience
I have no idea who the audience was for this PSA. This is a direct result of the lack of a clear "call to action". This video had no idea who they expected as an audience or what they wanted those individuals to do. Before the video starts, we are told "this is not for kids" (again- due to the "furry"). So kids are excluded as a possible audience- which is a shame because young adults are also victims of domestic violence. I'm assuming that domestic violence victims themselves are not the audience, since the video did not include any links to DV hotlines/shelters. I doubt the audience was supposed to be DV perpetrators, because I doubt that they would be giving donations. So maybe the intended audience was just potential donors? It is unclear.

4. Evaluation
Ahh! I know I'm a broken record about this issue on my blog. As Dr. Rothman states in the Newsweek article, "there haven't been that many well-designed, rigorous evaluations of the ad's effectiveness". The OPCC spokesperson says that it has been effective because "people are talking about the ad" (how do we know?) and Facebook traffic was up (as of tonight, just 365 people had "liked" the page). But even if "talk" is increased, is that really changing the attitudes or behaviors that were (maybe) targeted by this PSA? If they had clearer goals and a call to action (e.g., The audience for this PSA is women who are victims of DV and the behavior we want to see is an increase in calls to our hotline)- it would be much easier to evaluate. And that evaluation would go well beyond "awareness".

#NoHomos on Twitter, "50/50" looks at Cancer, Johnny Depp's Rape Comments, Chris Christie's Weight, and Steve Jobs: What Am I Reading This Week?

Whew- it has been a busy week for Pop Health! Here are the top 5 stories I've been reading:

1. Twitter is no place for #NoHomo: Should Twitter take a more proactive stance regarding hate speech that can result in trending topics?

2. "50/50"- A Hollywood movie takes on cancer: Cancer has been a theme in many movies (e.g., "Funny People") and TV shows (e.g., "The big C" on showtime)- how does this movie compare?

3. Johnny Depp offers apology for rape remarks: Depp offers an apology for comparing being chased by paparazzi to being raped. Forgivable?

4. Chris Christie's Weight- Big problem or none of our business?: Although Gov Christie has recently announced that he will not run for President in 2012, the conversation continues about his weight and its influence on his ability to be a successful Governor or President. What do you think?

5. Steve Jobs and Pancreatic Cancer: There have been many stories about the death of Steve Jobs and the contribution of pancreatic cancer to his passing. I thought Celebrity Diagnosis did a nice job of guiding readers through his diagnosis.

Please use the comment box to tell me what you think about these stories and about others that you are reading this week!

Celebrities and their Health Causes: What Happens When They Do More Harm Than Good?

Often on this blog I have spoken about the role of celebrities as the spokesperson or "champion" for various public health issues. Many celebrity names are synonymous with particular health causes (Katie Couric- Colon Cancer; Michael J. Fox- Parkinson's Disease; Lance Armstrong- Testicular Cancer; to name a few).

Over the past few weeks, several stories have emerged which beg the question, "what happens if celebrities do more harm than good?" Those in the public eye have such a broad and extensive platform to communicate with the public...what if they disseminate erroneous information or even worse- cause a panic?

The week of September 12 was quite busy! In the Republican Presidential Debate (in the context of discussing mandated HPV vaccines for children), Rep. Michelle Bachmann claimed that the HPV (Human Papillomavirus) vaccine is linked to mental retardation. To support her claims, Bachmann repeatedly told the story of being approached by a woman whose daughter suffered mental retardation after taking the vaccine. As those of us in science well know, one self-reported story does not equal a true incident. Even if true, one incident does not equal a trend or an epidemic. This story has been quickly picked up by scientists who are even offering money if it is proven true.

This same week, Dr. Mehmet Oz of the Dr. Oz Show (you may remember him from numerous appearances on the Oprah Winfrey Show), claimed that apple juice contains unsafe levels of arsenic. These claims followed research conducted by the Show which had a laboratory examine three dozen samples from five different brands across the United States. The samples were compared to the limits of arsenic set for drinking water by the EPA. Since the claims, many scientists have spoken out regarding concerns about the study's protocols and conclusions (for example, not differentiating between organic and inorganic types of arsenic). Many were concerned about the widespread panic caused by these claims and likened it to shouting "fire" in a crowded theater.

Of course, this is not the first time celebrities have caused a scandal following potentially false and dangerous claims. Jenny McCarthy has dedicated her life to proving the cause between childhood vaccines and autism. Shortly after Brooke Shields released her book, "Down Came The Rain", which chronicled her battle with postpartum depression- actor Tom Cruise (a Scientologist) publicly criticized her for taking antidepressant medication.

So what happens when these celebrities cause more harm than good? What happens when their claims are misguided, misinformed, and/or not based on evidence or science? The answer: they can have huge and far-reaching public health consequences. For example, as we begin to see illnesses like measles reappear- we have to wonder- "Is this the Jenny McCarthy effect?"

Giuliana and Bill: A Reality Show Addressing the Real Stigma of Infertility

Talking about infertility makes people uncomfortable. Those struggling are uncomfortable because it is extremely personal. Perhaps they feel like they've failed at something that should come naturally...something that seems easy for everyone else. Perhaps it is difficult to explain why they cannot bring themselves to go to a friend's baby shower. Perhaps people at work ask them "when are you going to have a baby?"...not realizing that it is an incredibly painful question because they have been trying for years.

With this as the current state of affairs, you can imagine my surprise to see Giuliana and Bill Rancic come on The View two weeks ago and tell their story about trying In Vitro fertilization (IVF) and suffering a miscarriage. Their ordeal is also documented on their reality show: Giuliana & Bill. I just finished watching my DVR copy of their season premiere which follows them on their IVF cycle. What I really appreciated was the honest display of how difficult the cycle was. Were they both on board with this next step? How scary were the bags and bags of medication!? How would they coordinate their work schedules to make it happen? How could they keep it a secret from their work colleagues and their families? Who would stay home with Giuliana for her 48 hour bed rest? And of course it was difficult to watch them get the happy news of "you're pregnant!" at the end of the episode, since we already knew what was to come nine weeks later.

But what I really want to talk about are the huge strides they've made in reducing the stigma of IVF and miscarriage in just a few short weeks since they've come forward. I've spoken in previous posts about the importance of celebrity role models in reducing stigma of various conditions. Besides their appearance on The View and their very honest portrayal on their show, they have also partnered with key professional organizations like Fertility Lifelines and Resolve- The National Infertility Association. They have created a PSA for Fertility Lifelines encouraging couples to visit a fertility specialist. They offer statistics to help normalize the struggle to conceive and to build a community by letting viewers now that they are not alone.

Just three days ago, Access Hollywood reported that actor Kelsey Grammer came forward to say that the pregnancy he and his girlfriend had just announced in August had ended in a miscarriage. It is hard to imagine that the culture is changing this quickly...in all my entertainment news watching, I can count on one hand how many celebrities have shared this type of story.

I also think that having a "spokescouple" increases the effectiveness of their message. The stigma of infertility so often falls to the woman. "What is wrong with her?" The woman also has to endure the physically and emotionally difficult treatments. Having a couple remind us via this PSA that it can be 50/50 as to which person (or both!) is leading to the infertility helps take the stigma off the woman alone.

This situation also makes me think about the systems (or lack there of) that exist to support couples once they make the choice to see a specialist. Are these types of specialists/procedures even covered by their health insurance? Is it difficult for couples to take time off of work to deal with the physical/emotional demands that come along with this process (which is so often completely inflexible in its scheduling)? Are human resource departments/managers supportive of making accommodations and/or keeping this information confidential for their employees? Are there enough mental health professionals that specialize in infertility to help couples/individuals with the emotional challenges that go along with the physical?

As more couples wait longer to have babies and science moves forward to offer more treatments for infertility, we're going to have to grapple with these questions on a broad system level. However, that conversation is easier to have when stigma is reduced and more couples come forward to ask for what they need and offer to help each other.