Kissing on Southwest Airlines, Over-hyped Reebok Toning Shoes and More- What Am I Reading This Week?

There are many great Pop Health (Pop Culture- Public Health) stories in the news each week, so it can be difficult to narrow down my focus for a weekly post.

Therefore, I'm starting a new feature called- "What Am I Reading This Week?" to link you to my runner-ups:

1. Reebok agrees to settlement over "over-hyped" claims that its EasyTone shoes could tone leg and butt muscles better than regular shoes.

2. Perfect for football Sunday: Cheeseheads take issue with anti-cheese billboard (from groups promoting vegan diets).

3. L-Word actress gets kicked off Southwest flight for lesbian kiss (they say it was based solely on behavior, not gender).

4. Lady Gaga wants to make bullying illegal- wants meeting with the president.

Use the comment box to tell me what you're 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?"

"What's Your Weapon?": Billie Jean King, Arthritis Foundation, Ad Council, and USTA Launch Arthritis Campaign

Before Twitter and the U.S. Open was a flutter this afternoon with the news of Venus Williams withdrawing due to the diagnosis of the autoimmune disease- Sjogren's Syndrome, the U.S. Tennis Association was focused on another health related issue. Today the press release went out that tennis legend Billie Jean King was joining the Arthritis Foundation, the Ad Council, and the US Tennis Association (USTA) to launch a public service campaign against arthritis (the leading cause of disability in America).



The ads, launched at the U.S. Open today, feature King (who has osteoarthritis- OA) and highlight the power of movement and exercise as "weapons" in the fight against arthritis. King tells viewers "tennis is my weapon" against arthritis. The ad then asks viewers, "what is your weapon against arthritis?" and directs them to the campaign's website in order to find out: Fight Arthritis Pain. On first view, I was not terribly impressed. The brief ad (33 seconds) does not tell you very much (e.g., King says tennis is her "weapon" but nothing is said about the benefits of movement). The goal of the ad simply appears to be motivating viewers to visit the website for additional information.



The other thing that is not clear in the ad (but clarified in the press release and website) is that this campaign is targeting OA specifically. While OA is the most common type of arthritis, it is not the only type. For example, in contrast to OA which breaks down cartilage, rheumatoid arthritis (RA) (a chronic autoimmune disease) causes inflammation of the lining of the joints. Would the exercise recommendations be the same no matter what type of arthritis? I would say that distinction is unclear for viewers.



However, I did feel better when I read the press release and saw that these ads were tested in focus groups by the Ad Council. Testing your images and messages with your target population is incredibly important. It is reported that participants felt that the concept of "having a weapon" against arthritis was powerful and motivating. That is good news considering formative research by the Ad Council found that only 16% of OA sufferers surveyed felt "very confident" that they could manage their pain. Therefore, if an ad can make viewers feel empowered and confident- that is a good thing.



The press release did not describe the demographics of the focus group participants, but I am assuming they were similar to those originally surveyed (adults age 55+ with OA). If so, it would mean that Billie Jean King was an appropriate "Champion" for the cause and someone that audience admired, having watched her in the 1960s-1970s, her prime competitive years. However, I wonder if she would be the best choice for ads targeting arthritis sufferers in a younger demographic? After all, different types of arthritis can affect people of all ages. Again, this is another reason that I would have wanted to see a clearer definition of the audience for these ads. If we are focused on older adults with OA, then it is a great choice. If we are focused on people of all ages with all types of arthritis, then maybe not.



Overall, I give this campaign a "B". The impetus of the campaign is good in that it is based on research...research that shows that arthritis suffers are too sedentary and do not feel like they have control over their pain management. The campaign aims to address these barriers by empowering viewers with a "champion" who they admire and can model. The campaign also links them to a website with all the information they need about the benefits of exercise for arthritis. However, the execution of this campaign is not as strong as its foundation. It would have benefited from a more clearly defined audience and message.

The East Coast Earthquake, Real Time Twitter Chat, and Facebook Applications for Disasters

Well! Today was an interesting day at the office. Up and down the east coast, many of us felt the tremors resulting from an earthquake in Virginia. While I would like to report that we all stayed calm and participated in orderly, safe, and well rehearsed evacuations...that was not the case. It appeared that the shock of experiencing an earthquake (such a rare event on the east coast) caused a little chaos. On my way into my office to grab my bag before hitting the stairs, I experienced a "George Costanza" type moment as a fellow staff person almost knocked me down in her rush to get out. I heard similar stories from my husband who works 4 blocks away. Upon recognition of the earthquake, his co-workers made a beeline for the safest escape route...the elevator?!



After the shaking took us down 13 flights of stairs, I quickly turned to the only reliable source for real time information- Twitter. Since I was the only one in the area who either grabbed my phone or had twitter, I quickly read off what I knew: "It is a 5.9 earthquake in Virginia"; "My colleagues felt it in- Baltimore, DC, Boston, NYC, North Carolina"; "No damage except one broken window is reported in Philadelphia". After being given the go ahead to return to the building and settling back into our work, we received an official text/email from the University reiterating the information Twitter delivered an hour before. According to Twitter's official profile tonight, within one minute of the #earthquake, there were more than 40,000 earthquake-related tweets. They reached 5,500 tweets per second (TPS).



As I discussed in a related post back in March 2011, the question for public health professionals continues to be- "What is the role of social media in emergency preparedness and recovery?"



I believe we are making some strides in answering that question. Just yesterday, the Office of the Assistant Secretary for Preparedness and Response (ASPR)- located within the US Dept of Health and Human Services (HHS)- launched a contest: The ASPR Lifeline Facebook Application Challenge. The goal of the contest is to create applications that prepare individuals for disasters and build resilient communities. Those who opt into the application will be able to identify "lifelines" or Facebook friends that agree to be an individual's emergency contact and act on their behalf in case of an emergency. They will also be able to create a personal preparedness plan and share that plan and the application with others.



Even without the formal application, we have seen social network sites be used for checking in with friends/family and for getting information out quickly. For example, I follow the Philadelphia Office of Emergency Management on Twitter, so I got the message quickly that our 9-1-1 system was being inundated with calls since the earthquake and we should only use it with a real emergency...for infrastructure damage, call 3-1-1 instead.



While the Facebook application sounds like a great addition to emergency preparedness, it is important to also consider implementation issues which will impact its reach and effectiveness:

• Is the application only available to Facebook members who download it ahead of time? Or will it be available to anyone via the mobile web?
• Do these Facebook members typically update their profile via mobile devices in addition to stationary computers (which may not be available during an emergency)?
• During the emergency, are there cell networks/wifi to support the communication? (e.g., many reported that cell networks were jammed immediately following the earthquake)
• Do these "electronic" preparedness plans need to be rehearsed the same way as "in person" plans in order to increase effectiveness?

The HHS-ASPR contest runs August 22-November 4, 2011. I look forward to seeing the winning applications and hearing about how the dissemination will be conducted and evaluated.



What were your experiences today during the east coast earthquake? What did you hear/see from your colleagues? How did you get/send information to others? Please share in the comments section below.

Where Are the Helmets in the Home Run Derby?

Last night I returned home from a lovely dinner with my injury prevention colleagues to a sight that really caught me by surprise. My husband was watching the Major League Baseball (MLB) Home Run Derby. I tuned in for a moment before turning to him and asking, "Why aren't they wearing helmets?" I think we are all accustomed to seeing players in their batting helmets, so this looked strange to me- especially in contrast to the catcher, who was dressed in full protective gear. My husband informed me that helmets are not necessary because the pitches are much slower. However- I would disagree (and this is not the first time I have critiqued professional sports and their commitment to protecting players from head injuries).

First of all, concussions (which we must remember are a traumatic brain injury!) do not only occur when the ball is traveling 100 MPH. Therefore, a slower pitch does not equal safety. The catcher still wore full protective gear. The pitcher stood behind protective netting. So on some level it is acknowledged that hazards still exist at the Home Run Derby.

In addition, concussions (or more serious injuries) can happen even when you are not the batter. Therefore, helmets protect you when you are on deck, warming up, or coaching from the sidelines. Home Run Derby participants are still at risk for injury when they are not at bat. This is a lesson that many in baseball know far too well. In 2007, a minor league first base coach was killed when he was hit in the head with a line drive. This tragic accident resulted in a change in policy regarding required head protection for first and third base coaches.

Speaking of policy, I find it strange that their batting helmet practices vary based on the speed of the pitch. This is not an acceptable strategy in other areas of injury prevention, so why is that the strategy here? We don't tell people to only wear seatbelts if they are planning to drive faster than 40 MPH. We don't tell people to only avoid texting and driving if they are on the highway. The MLB seems to be accepting a high level of risk for their players in this context. This is especially surprising since MLB and the MLB Players Association have taken steps to prioritize safety regarding head injuries. They recently implemented a universal concussion policy (which went into effect on Opening Day 2011). The new policy dictates both how concussions are initially treated and when player/umpires are allowed to return to play. The most substantial change is the creation of a 7-day disabled list to allow players an appropriate amount of time to heal after a concussion. They are also introducing reinforced helmets that can withstand 100 MPH fastballs.

While the safety of the players is paramount, this discussion is also important because MLB players are role models. Therefore, it is important that they model acceptance and proper usage of personal protective equipment. If you looked at the stadium crowd at the Derby (and the lucky few invited to catch balls in the outfield), it was mostly kids. If the MLB and the players do not provide leadership on safety policies and equipment, it could have larger public health effects on the audiences that model their behavior (so don't get me started on the chewing tobacco issue).

Therefore, I strongly encourage MLB to review their policies regarding personal protective equipment and the grey "safe" areas they have identified, like the Home Run Derby. It appears to be a relaxed, fun event during the all-star break but in reality, they are unnecessarily putting the safety of their players at risk.

Google Continues to Use its Power for Public Health Good

Yesterday, Google announced its new surveillance system for Dengue Fever. Dengue Fever is a disease caused by four related viruses spread by a particular species of mosquito. It can cause high fever, rash, muscle and joint pain, and in severe cases- bleeding, a sudden drop in blood pressure (shock) and death. Millions of cases of Dengue infection occur worldwide each year. Most often, dengue fever occurs in urban areas of tropical and subtropical regions.

The system is similar to that which was previously released as their Google Flu Trends program. These systems use search queries within Google (for example those that enter the disease's name and/or symptoms) to identify trends. The Dengue system also takes advantage of a new feature called Google Correlate, which shows previously unknown correlations between search terms. These correlations allow researchers to model real world behaviors by examining internet search trends. For those who may be skeptical of this model, you should check out a publication (co-authored by Google and the Centers for Disease Control and Prevention-CDC) in the 2009 Nature Journal . The article reports that "because relative frequencies of certain queries were highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day."

This is a pretty exciting addition to public health surveillance (where the goal is systematic, ongoing, data collection that is used to monitor trends, identify priorities, direct resources, identify emerging hazards, and evaluate interventions).

This is not the first time that Google has jumped into the public health field with an impressive contribution. In 2010, Google searches related to suicide started appearing with a message guiding users to the toll-free number for the National Suicide Prevention Lifeline. The number is 1-800-273-8255. Triggered by searches such as "I want to die" or "ways to commit suicide," the number is listed next to an icon of a red telephone, at the top of the search results.

The addition of the Lifeline number came shortly after (at the suggestion of a Google user), the company started displaying the hotline for the American Association of Poison Control Centers after searches for "poison emergency."

These cases of Google's work in public health are great examples of effective health communication and public health principles:

• Identifying the primary channels through which your audience searches for health information (more and more are utilizing the internet) and delivering accurate and effective information and/or interventions via those channels.

• Maximizing data driven surveillance systems- using existing data (e.g., internet searches) to identify public health trends.

• Building strong partnerships (as evidenced by the publication by Google and CDC) CDC has partnered with a company with specific expertise and resources in an area that can be invaluable to their work.
  

From The West Wing to the National Health Care Debate

Anyone who knows me well knows that "The American President" is one of my favorite movies. If it is a favorite of yours as well, you may recognize that the actress who plays Press Secretary Robin McCall also plays National Security Advisor Dr. Nancy McNally in "The West Wing". The actress is Anna Deavere Smith.

This week in my "Qualitative Research Methods in Community Health" class, we discussed ethnography. Specifically we discussed Ms. Smith's work as an example of performance ethnography. For over a decade, she has interviewed people across the country and used the "data" to develop a one-woman show. Her newest play is called "Let Me Down Easy" and its goal is to show the human side of the national health care debate. I highly recommend viewing the 10-minute excerpt and interview here.

I'm so sorry that I missed her play when it came to Philadelphia earlier this year because I think it is an amazing example of the richness of data collected using qualitative methods. It is often argued that qualitative methods are too "soft" and limited in view. I've heard them described as "basically just journalism". However, I would argue that qualitative methods are essential to the success of public health.

Instead of surveys and databases, these methods collect data via interview, discussion, and observation. The research is meant to discover the complex relationship between personal and social meaning, individual and cultural practices, and the material environment or context. In contrast to what we have learned since grade school science about the scientific method and generalizability of findings- here the focus is on obtaining a deeper understanding of a population or phenomenon.

Ms. Smith conducted over 300 interviews for "Let Me Down Easy" and ultimately condensed her findings to show the experience of contemporary health care through the eyes of 20 individuals. These kinds of stories are incredibly powerful in public health. They open our eyes to challenges that we never would have found via survey...because we wouldn't have known to ask the right questions. They allow us to share stories with policymakers so they can see the impact of their decisions beyond the sterile statistics often cited. They can allow us to explore experiences or illnesses that occur in too small a population to survey.

Ideally, quantitative and qualitative methods should be used together to create the strongest public health research design possible. It should not be us vs. them...but instead a joint effort. I encourage us all to see the human side of health care reform when Ms. Smith's play airs on PBS "Great Performances" next season.