Talkin' Bout A Revolution...Jamie Oliver is much louder than a whisper!

So I just finished watching the premiere episode of "Jamie Oliver's Food Revolution". It is a new show on ABC that chronicles the journey of English chef Jamie Oliver as he tries to change the eating habits of residents in Huntington, West Virginia. Huntington was recently crowned the most unhealthy city in America.
It is obvious that Jamie has good intentions. He has left his family for several months to work on this project. He is especially concerned about the quality of food being served in the Huntington schools. However, my reaction to the first episode was "No, no, no! Stop what you're doing and talk to these people first!"

The most important part of any public health intervention is getting to know the community you are working with. The worst thing you can do is come in as an "outsider" and start barking orders. Some questions you should ask before getting started are: How does this community operate? Who makes the decisions? What are some of the barriers to serving fresh food in schools? What are the USDA guidelines? (which Jamie knows nothing about) Who are the individuals you want/need to get on board with your idea? How do the parents feel about their children's eating habits? How can you get their buy-in? What would be a realistic timeline for assessment/buy-in before trying to implement change?

Jamie went about this all backwards (which may very well have been to increase drama for a TV show, but it is still a great example of "what not to do"). His first day in town he was told he was viewed as an "outsider" by the trusted radio host...and still proceeded to go into the elementary school and lecture the chefs on how disgusting the food is (after only observing them for one day). And he's surprised he's getting push back on his efforts?! The only small victory he has is creating a partnership with "Pastor Steve" at the local Baptist church. Steve is a trusted leader in the community and knows the families and their challenges very well.

Too bad Jamie did not look to better models of this kind of community effort. Shape Up Somerville (Somerville, MA) began as a community based research study at Tufts University targeting 1^st through 3^rd graders in the Somerville Public Schools. Today there is Coordinator working on active and healthy living programs supported by the Health Department and a Taskforce that is a collaboration of over 11 initiatives and 25 stakeholders involved in working on various interventions across the city. Program components include a focus on the school lunch program, local restaurants, walk ability and safe routes to school, etc. (I'll give a shout out here to one of my public health heroes- Julia Bloom- who helped Tufts bring this model to more rural communities across the country!)

Shape Up Somerville represents a strong program that began with a strong base. The original program engaged key stakeholders and did not try to change the community without first finding out how it worked. The community and parent outreach were an obvious key to success...where that aspect is basically forgotten in the "Food Revolution". Jamie just seems like one man on a mission to change. At the end of the episode Jamie is visibly upset and says "they don't know why I'm here". Yeah- that's because you're an outsider lecturing them on how they should raise their kids!

I'll probably watch the second episode where he actually starts to engage the community...how about you?

Technology: Building Social Connections or Breaking Them Down?

Last week, a friend at work told me that she had given up watching TV for Lent. She said "every time I give up TV, my quality of life goes up". I thought of her immediately today as I read this new article in TIME, "Logged on, checked out...of relationships?" The article discusses a study (published in the March issue of the journal Archives of Pediatrics & Adolescent Medicine) which studied adolescents during two periods of time (1988 and 2004). The adolescents who spent more time watching TV or playing video games were more likely to report lower quality relationships compared with those who logged less screen time.
I find this fascinating because I have followed the debate among colleagues and friends regarding the increase in the use of technology and its impact on social connections. For example, kids that may be "outcasts" at school may find friends online. They may have hundreds of Facebook "friends". They may find lots of kids with similar interests by joining "groups" online. However, one has to ask, are Facebook friends "real"? I personally have 355 friends on Facebook, but would only consider about 10 of those people close friends in my day to day life. Is it worth it to focus your time and attention to online activities (as noted above) to the detriment of your "real life" relationships with friends and family?
In looking at how social connectedness can be a protective factor for things like suicide, the question has also come up: "Is it the quantity or quality of relationships that really count?" In research on college students, studies like Healthy Minds are beginning to indicate that it is the quality that counts. However, unlike my previous posts where it has been easy for me to take one side or the other...I'm torn about this issue. The authors of the above study were as well...they note that there is an obvious correlation between online activities and relationship quality, but the causal link is not clear.
Therefore, I believe it is probably some happy balance that is best. Facebook friends and groups are not all superficial and time wasters. People can connect (or in many cases, "reconnect") with friends and colleagues with shared histories or interests. I've seen Friends post a concerning or unsafe status and 20 people jump in with words of encouragement or offers of help...which is wonderful. On the flip side, it helps to turn the computer or TV off and enjoy the world around us...strengthen those connections with those we live with, eat dinner away from the TV, etc. And of course on that note, I'll log off. LOST starts at 9pm ;)

Sesame Street's "Talk, Listen, Connect": A Strong Public Health Program for Military Families

Both academic and popular news sources have been reporting on the health problems experienced by active duty military and veterans (e.g., Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). Recently we have also begun to see research looking at the health problems experienced by spouses and children within military families. This January USA Today story highlights two such research studies:

(1) The first study (published in the New England Journal of Medicine) concluded that wives of soldiers sent to war suffered significantly higher rates of mental health issues than those whose husbands stayed home.

For example, wives of soldiers deployed to Iraq or Afghanistan between one and 11 months had an 18% higher rate of depression than those whose husbands did not go to war. When soldiers were deployed 11 months or longer, their wives had a 24% higher rate of depression.

(2) The second study (by the RAND Organization) found that children of deployed parents suffer more emotional issues, particularly if separations are long or the parent at home is troubled.

Based on this data, public health experts can see a clear need to develop interventions not just focused on active duty military and veterans, but also for their families. Therefore, I was happy to see that Sesame Workshop (the non-profit organization behind Sesame Street) has created a program called "Talk, Listen, Connect", which addresses priority issues for this population. I reviewed three brief videos and accompanying literature on this project and was very impressed:

• The "channel" being chosen to reach parents and children is an existing one. Families are already familiar with (and trusting of) Sesame Street, so they are not asking families to bring an unfamiliar resource into their homes. E.g., Elmo is the character used most frequently in these videos, and he is beloved by children. They are used to learning from Elmo.
  
• The videos used various methods for providing information, so it can be appropriate for learners of multiple levels/backgrounds. E.g., Pictures, songs, modeling of conversations between Elmo and his Dad, celebrity cameos (Queen Latifah stars in the third video).
• The creators obviously did research into relevant issues for military families (e.g., the videos address preparing for deployment, adjusting to homecoming, and coping with changes). The third video even shows a child coping with a Dad who came back with TBI- an injury unfortunately too common with these wars.
• The Sesame Workshop is even going beyond education to address real barriers to families staying connected. I was thrilled to see them examining challenges in the environment! They have created Sesame Street Family Connections. It is a little like having a Facebook Family Page. It is a a child-centered online space where both children and adults can interact and stay connected over long distances when everyday communication can otherwise be difficult. Family and friends can post pictures and videos, share messages and artwork, etc. This strategy is attempting to increase connections and family support (and decrease isolation)...which can help reduce associated negative health effects (e.g., depression).
• A plan for outcome evaluation exists! So often, this is left out of public health education planning. Although research about the effects of Talk, Listen, Connect on families experiencing multiple deployments and injuries is forthcoming (as the projects moves through several phases of roll-out). A summary study for the first phase of the project, which dealt with a parent’s first deployment, revealed that the materials helped military parents and children feel better during deployment, and helped them to be prepared emotionally for the deployment process. It also showed that Talk, Listen, Connect is helping parents by giving them the language and tools they need to engage in a dialogue with their children.

Although the details of a formal evaluation still need to be reviewed, I feel optimistic about this program for military families. They have incorporated the latest research (e.g., populations to target, risk/protective factors for adverse health effects, effective communication channels) into the program design. Go Elmo!