Let's Give Paris Jackson Some Privacy and Revisit Safe Reporting on Suicide (and Attempts)!

I always cringe when the announcement of a celebrity suicide or suicide attempt comes through my news feed.  First and foremost, because it is incredibly sad to learn that anyone is suffering enough to consider suicide.  Second, because the news coverage that will follow is often invasive and downright dangerous to the rest of us.  The way the media covers suicide can influence behavior negatively by contributing to contagion or positively by encouraging help-seeking.  I have often written on this topic for Pop Health and even as an op-ed for the Philadelphia Inquirer.  However, the message is so important that it bears repeating.

According to multiple news outlets, Paris Jackson (daughter of the late Michael Jackson) was hospitalized this morning after a suicide attempt.  The story was apparently confirmed by her biological mother Debbie Rowe- Paris was hospitalized with cuts on her wrists.  Now I was already concerned that a 15 year old girl was having these personal, medical details released to the media.  Then I saw the coverage on TMZ and just got plain angry.  I won't link to it here because (1) the irresponsible coverage could be dangerous to readers and (2) I refuse to drive traffic to their site.

As a journalist (or public health communication professional) working on this story, your first stop should be Recommendations for Reporting on Suicide.  Although the guide focuses on suicide, the recommendations are highly relevant for attempt stories as well. The recommendations were developed by leading experts in suicide prevention and in collaboration with several international suicide prevention and public health organizations, schools of journalism, media organizations and key journalists as well as Internet safety experts. The recommendations are based on more than 50 international studies on suicide contagion.  Based on their recommendations, here are some of my concerns with the Paris Jackson articles:

• Sensational headlines:  E.g., "Paris Jackson Attempts Suicide, Rushed to Hospital" (US Weekly)
• Oversimplification:  E.g., "A source close to the family tells Entertainment Tonight exclusively that the reason Paris attempted suicide is because she wasn't allowed to go to a Marilyn Manson concert".
• Including photos of the method of death (or in this case attempt):  TMZ has published multiple pictures of Paris (some undated) that zoom in on her wrists to identify possible cutting scars.  This is bad for several reasons:
• 1- Without any confirmation, the writers are suggesting that Paris has a history of suicide attempts.
• 2- The writers are suggesting that anyone who cuts their body is attempting suicide when in fact, some self harm behavior is non-suicidal.  A good resource for definitions of various forms of self-directed violence comes from the Centers for Disease Control and Prevention (CDC).  There can be self harm behavior (like cutting) without the presence (whether implicit or explicit) of suicidal intent.  

A lot can be learned in public health by monitoring this media coverage, highlighting mistakes, and reinforcing safe messaging.  The Paris Jackson articles should:

• Inform without sensationalizing
• Provide valuable education to readers (including suicide warning signs, ways to help a friend/family member, and resources like the National Suicide Prevention Lifeline)
• Seek advice from suicide prevention experts before reporting on data or making assumptions about Paris' intentions or medical history
• Be hopeful! Emphasize that mental illness is treatable and many local and national resources exist

Resources:

1.  Associated Press (New!) Stylebook Entry on Mental Illness
2.  Recommendations for Reporting on Suicide

3.  The National Suicide Prevention Lifeline 1-800-273-TALK (8255)

What Do You Think?

• What was your reaction to the media coverage of Paris Jackson's suicide attempt?
• What other resources would you add to my list to support safe media reporting on suicide and attempts?

"Call Me Crazy": Lifetime's New Movie That Champions Hope and Resilience Around Mental Illness

*Warning: it was difficult to write this post without including a few small spoilers, but I hope you'll watch the whole film anyway.

On Saturday April 20th, Lifetime debuted "Call Me Crazy: A Five Film".  The film (which boasts a star-studded cast and director list) includes five short stories that examine the impact of mental illness from various perspectives.  Each story is named after the main character: "Lucy", "Grace", "Allison", "Eddie", and "Maggie".

In the first story, we are introduced to Lucy (played by Brittany Snow).  Lucy, a law student, has recently been admitted to a psychiatric institution after experiencing a schizophrenic episode.  She is struggling to see how she can live a "normal" life that includes relationships and a career.  Her clinician encourages her to finish law school because she has insight into something very few people understand (mental illness)- so who knows how many people she could help?

In "Grace", we meet a daughter who has been living with a bipolar mother for her entire life.  Grace is played beautifully by Sarah Hyland from "Modern Family"- I loved seeing her in a dramatic role.  We see the "highs" and "lows" of her mother's condition.  We also see the devastating impact that it has on Grace's life when it is not treated.  Grace often plays the role of caretaker- making sure her mother is safe.  We see her struggle to have her own life aside from her mother's illness.

"Allison" offers the viewers a twist.  She plays Lucy's younger sister.  So we step back from Lucy's view and we see how mental illness has affected her entire family.  Allison's childhood, her sense of safety, her relationship with her parents- were all changed as a result of her sister's illness.  She has bottled up a lot of anger and finds it difficult to support her sister through her recovery.

"Eddie" introduces the only male main character.  He is suffering from severe depression.  He has withdrawn from his wife and his friends.  He has stopped receiving help from his therapist.  We watch his wife intervene after discovering that he may be thinking about suicide.

Finally, "Maggie" introduces topics that (unfortunately) are all too common these days- post traumatic stress disorder (PTSD) and military sexual trauma among our returning veterans.  Maggie (played by Jennifer Hudson) was victimized during her time in the Army and its lasting impacts are threatening her ability to have a healthy relationship with her family.  Here we get another update on Lucy- she is now a lawyer and is representing Maggie in court.

While each story stands on its own, Lucy's story is woven throughout "Allison" and "Maggie" as well.  I really liked this strategy.  Not only because I became invested in her character during the first story...but also because seeing her evolve over time helped to demonstrate some key themes from this film- hope and resilience.

As Lucy says to Maggie: "I am living proof". [Of what?] "That there is hope".  In court, Lucy reminds Maggie's judge that having mental illness does not mean that you are a bad person or a bad mother.  She also reminds him about the importance of social support, "it is nearly impossible to get well alone".  Even though we see all of these characters at their lowest point- there is still hope that they can feel better, have strong relationships, and contribute positively to the world.

It seems fitting that Brittany Snow's character delivers these messages about hope and resilience, as she is a strong advocate for them in real life.  Together with the Jed Foundation and MTV, she founded Love is Louder.  Love is Louder is an inclusive movement that amplifies messages of love and support to combat negative messages resulting from bullying, loneliness, and stigma.  She has also publicly shared her own battles with anorexia, depression, and self harm.

As a health educator, I highly recommend this film as a resource for discussing mental illness, suicide, stigma, social support, and help-seeking.  Since each story is approximately 20 minutes, they can be broken down into segments or watched all together.  This film is a great example of Entertainment Education, which is an area of public health that acknowledges the strong impact that television and movies play in educating the public about health issues.

If you or someone you know is struggling with a mental illness, please reach out:
National Suicide Prevention Lifeline (1-800-273-8255)

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder

Seth MacFarlane: An Oscar Host who is Harmful to Comedy and the Public’s Health

This week’s post for Pop Health was co-written by Beth Grampetro, MPH, CHES. Beth has been working in college health promotion for 7 years and her interests include feminism online and in popular culture. You can follow her on twitter @bethg24. 

The role of society is important in public health.  Health is not just influenced by individual decisions and behaviors.  It is also influenced by our interactions with the world around us- our communities, our families, our workplaces, our schools, entertainment, celebrities, and the media.  These interactions can have a very strong influence (good or bad) on the public’s health.

With that in mind, we were horrified to witness host Seth MacFarlane’s monologue and ongoing commentary during Sunday night’s Oscars.  According to Nielsen ratings, approximately 40.3 million viewers tuned in to the Oscar telecast.  This broad audience watched MacFarlane, a widely known celebrity, make jokes about domestic violence, female actresses’ bodies, and various forms of discrimination.

In the opening number, MacFarlane sang a song entitled “We Saw Your Boobs”, about the scenes in various movies where actresses in the audience had appeared topless. While it has been reported that the actresses were in on the joke, it is nonetheless disturbing that this number passed muster- especially given that several of the scenes he referenced were from movies where the actresses he named portrayed rape victims.

Other jokes included a reference to Jennifer Aniston’s past as a stripper, a congratulatory statement about how great all the actresses who “gave themselves the flu” to lose weight looked in their dresses, and a comment about how Latino actors (in this case Javier Bardem, Salma Hayek, and Penelope Cruz) have difficult-to-understand accents “but we don’t care because they’re so attractive.”

MacFarlane also tried some jokes that had men as their targets but still managed to get mud on a few women in the process. He joked that Rex Reed was going to review Adele’s performance (a reference to Reed’s recent movie review in which he called Melissa McCarthy a “hippo”) and made a joke about 9-year-old nominee Quvenzhané Wallis dating George Clooney. Some defenders of MacFarlane’s performance argued that these jokes were meant to be about the men in question, but ignored the fact that they were made at the expense of women and girls.

The Oscars are billed as “Hollywood’s Biggest Night”, and it’s incredibly disappointing to see what is the biggest event for the entertainment industry turned into the worst office party in history, complete with a leering coworker who’s creating a hostile environment.  If MacFarlane succeeded at anything, it was reminding women that they’re expected to always be thin, be pretty, and be willing to shut up and take it, lest they spoil the whole evening.

There is evidence to show that (unfortunately) these types of jokes and messages that devalue women are believed and internalized within our communities.  For example, a 2009 study by the Boston Public Health Commission found that over half of teens surveyed blamed the singer Rihanna after she was beaten by her boyfriend Chris Brown.  In addition, research shows that a mere 3-5 minutes of listening to, or engaging in, fat talk can lead some women to feel bad about their appearance and experience heightened levels of body dissatisfaction.

Research also tells us that these internalized messages and social norms are correlated with serious public health outcomes.  For example, the CDC outlines the risk factors for sexual violence perpetration.  Under society level factors we find (among others):

• Societal norms that support sexual violence
• Societal norms that support male superiority and sexual entitlement
• Societal norms that maintain women's inferiority and sexual submissiveness
• Weak laws and policies related to gender equity

So the issue is much bigger than if Seth MacFarlane was funny or made a good Oscar host.  The issue is about the quality of the role models we choose to represent our communities and the messages they send.  These messages can have a broad and long lasting influence on public health.  We hope the Academy will choose wisely next year.

Cameron Diaz: The Next Celebrity Nutritionist?

Cameron Diaz is busy with her next project.  Her rep confirms her interest in writing a nutrition book to help young girls.  She wants to use her celebrity for good- to encourage girls not to fixate on being thin but instead just to make healthy choices.

A few thoughts:

Of all the celebrities that I see pitching these types of projects (I'm looking at you Gwyneth Paltrow), Cameron actually seems to model a healthy lifestyle.  She is not too thin, but instead looks muscular and strong.  We always see her keeping active with surfing and regular gym workouts.

It is reported that (in preparation for the book) Cameron will be visiting high schools to talk to teenagers about their food choices and what is important to them.  She wants to get their input, e.g., how do they decide what to eat? Although this work will not be a formal "Needs Assessment", I like that Cameron will be out in the community and talking to the teenagers who are the focus of her book.  Doing formative work before a project that engages your audience is incredibly important in public health.  Hearing and seeing what the health problem/s look like first hand allow us to craft more effective interventions.  So I applaud Cameron for planning to do this outreach versus just planning to write a book that may or may not address the challenges faced out in communities. For example, Cameron can discuss the importance of choosing fruit over potato chips, but if a teenager does not have access to affordable fresh fruit in their neighborhood, then the recommendation is not helpful.

One challenge to this effort is that even though Cameron appears to model a healthy lifestyle, she is still a member of the Hollywood community that has contributed to setting an unrealistic standard for beauty.  We have seen her on numerous magazine covers looking very thin and of course airbrushed.  In public health, we always have to think- "is this the right spokesperson"?  It is important to know how teenage girls view Cameron.  Do they see her as part of the problem?  Or part of the solution?

Another challenge is that (from my perspective), celebrity "nutritionists" do not have the best track record for safety and accuracy.  Take Cameron's friend Gwyneth Paltrow.  She has regularly promoted nutrition strategies like detox cleanses and gluten-free diets.  Her extreme choices do not send a message of moderation to teenage girls.  In addition, Gwyneth's cover photos also contribute to the unrealistic standard for beauty.

As I've discussed many times on this blog, celebrities can be an incredible resource for public health.  They have a visible platform and extensive reach to many of our audiences.  However, that can work for us or against us based on the accuracy and relevancy of their messages.  It is imperative that they work closely with clinicians (e.g., physicians, nutritionists) and public health practitioners to craft the messages and design outreach programs.

What do you think about Cameron writing a nutrition book?

Integrating Public Health Content Into Media Coverage of Celebrity DUIs

Amanda Bynes is just the latest young female celebrity to be arrested for driving under the influence (DUI).  The media coverage has been extensive, with some outlets even raising the question, "Is she the next Lindsay Lohan?"  A fellow former child star, Lindsay Lohan has consistently been in the news the past 5 years with DUI arrests, rehab stints, and poor career decisions.  However, just a few weeks ago we heard the good news that she has been taken off probation from her DUI case...so hopefully things are looking up.

Pop Health has written about related issues in the past:  how soon is too soon to find a teachable moment in a celebrity DUI death?  How does popular media help establish the public health agenda? How does media coverage of public health issues (e.g., suicide) affect the public's health?

So now let's put the pieces together and discuss the work of public health researchers that focuses specifically on media coverage of young female celebrity DUIs.  In 2009, Smith, Twum, and Gielen published "Media Coverage of Celebrity DUIs: Teachable Moments or Problematic Social Modeling?" in the journal of Alcohol & Alcoholism.  They conducted an analysis of US media coverage of four female celebrities (Michelle Rodriguez, Paris Hilton, Nicole Richie and Lindsay Lohan).  The study examined media coverage in the year after their DUI arrests (December 2005 through June 2008).  Among other things, the stories were coded for the presence of public health content (e.g., arrest, death, and injury statistics for DUI).  The authors found that the coverage was primarily focused on the individual celebrities (i.e., their legal and professional repercussions) versus broader social or public health impacts.  They recommended that future research examine both the news coverage and the comprehension and use of that content for policy and behavior change initiatives.

Coverage of a celebrity DUI has the potential to be a teachable moment, but we as public health practitioners need to take advantage of it.  We need to be monitoring pop culture news so that these teachable moments can be identified. We need to partner with journalists in order to make sure that a "public health frame" is incorporated in the development of the articles.  Most importantly, we need to continue to evaluate the media content and use that data to develop effective interventions and policy recommendations.

What do you think?

•   What strategies/information channels do you use to stay on top of public health-pop culture news?
•   How can the public health and journalism fields partner to take advantage of teachable moments and cover public health issues safely and effectively?

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)

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?

#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?"

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.

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.

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.

Marie Claire Blogger vs. Mike & Molly: A "Heavyweight" Fight

Last week a blogger for Marie Claire Magazine named Maura Kelly posted an article called, "Should 'Fatties' Get a Room? (Even on TV)?" The post is focused on a new fall sitcom for CBS called "Mike & Molly". I must disclose that I have not watched this show, but have read that it centers on a couple that meets at an Overeaters Anonymous Group. Ms. Kelly takes a strong position that this show is "promoting obesity" and is grossed out by having to watch two obese people make out (or do anything else, like walk across a room).

As you can imagine, this post has been met with quite a reaction, including 3,195 reader comments (as of tonight) that prompted Ms. Kelly to post an update (aka apology). The update apologizes to those readers that were offended (many of which state that they have since canceled their Marie Claire subscription) and offers that perhaps her strong reaction to these overweight actors comes from her own history as an anorexic. The gist I get from the comments, is that most readers do not feel the apology is sincere and expected a better response from Marie Claire (that would include firing Ms. Kelly and/or making it clear that they will not support this type of discrimination). There has also been a strong response from the celebrity community, including Sharon Osborne on "The Talk" who said that she was appalled and wondered about what Ms. Kelly would think of her. Sharon admitted that she's 30 pounds overweight...should she not be allowed to kiss her husband or walk across the room?

According to the Centers for Disease Control and Prevention (CDC), 34% of adults are overweight and about the same percentage are obese. If approximately 70% of our adult population is overweight or obese, why don't we have more characters that accurately reflect what people actually look like and the challenges that they face? Hasn't there been some effort to portray more diverse characters in other ways (e.g., race and ethnicity)? Why would being overweight be so offensive to the viewing population? And is Mike & Molly really the first show to do this? Growing up, I was a fan of the sitcom "Roseanne" (1988-1997). The primary couple on the show (Rosanne Barr and John Goodman) were very overweight and struggled quite openly with weight, diet, and exercise on the show. Perhaps my memory is fuzzy, but I never remember hearing that viewers were horrified by these characters showing affection on the show.

Ironically, as I was getting ready to put this post together today, I caught the Oprah show. She had on Portia Di Rossi who discusses her battle with Anorexia and Bulimia in her new book "Unbearable Lightness".

Portia spoke about her breakout role in Ally McBeal in the 1990s. Many of you may remember the media headlines at that time calling the three female leads "Scary Skinny" (which they were- Portia was down to 82 pounds at one point). Ironically, she specifically discussed her fear about a scene where she seduces her boss in her lingerie in the law office. Although she was skeletal and sick looking, did we hear from viewers or writers that they were "grossed out" to watch her make out with her boss on the show?

So what is best for viewers? What messages regarding "normal" should we be sending to viewers? If actors are too skinny, the concern is that the image is not realistic and it is causing young girls to have eating disorders trying to achieve this ideal. However, when a show like Mike & Molly is showing characters that accurately represent 70% of the population, there is also controversy. From a public health perspective, I would say that characters should accurately reflect the viewing population- people tend to respond to people that they can relate to. If you are creating a health communication product (e.g., poster or brochure), you test it with the target audience to make sure that they connect to the images. If you are concerned about "promoting obesity", then have the characters modeling healthy behaviors. For example, Mike & Molly are attending an Overeaters Anonymous Group, which means they are taking steps to improve their lifestyle.

I for one, would be very happy to see more realistic characters on television. I would also like to see research on how those characters can be used as a health communication tool to promote positive body image and health behaviors among the viewing population.

Hollywood's "Dilemma": Should "Gay" Jokes Be Censored?

Recently I went to see "The Social Network". We watched several movie trailer previews, including the Ron Howard directed film "The Dilemma". The preview included a scene with Vince Vaughn exclaiming to a conference room full of colleagues, "Ladies and gentlemen...electric cars are gay". He goes on to clarify that he does not say "gay" to mean happy, instead he compares its level of "coolness" to your parents chaperoning a school dance. I leaned over to my husband and whispered, "I thought they were taking this scene out of the trailer?". I guess it had not yet been pulled (and was instead being seen by millions, as The Social Network was #1 at the box office that week).

The controversy regarding this quote began several weeks ago. CNN's Anderson Cooper was one of the first to draw attention to the preview when he appeared on the Ellen DeGeneres Show. His argument (especially in light of the recently publicized suicides involving gay children/teenagers) was that we must "make those words unacceptable cause those words are hurting kids". In addition, the Gay & Lesbian Alliance Against Defamation (GLAAD) put out a statement on the situation:

"When 'gay' is used as a pejorative, it frequently sends a message- particularly to youth and their bullies- that being gay is wrong and something to laugh at. We invite Vince Vaughn to work with us and help insure that gay youth and those perceived to be gay aren't put in harm's way by such jokes".

Last week, Vince Vaughn addressed the above concerns with his own statement that highlighted his feelings that the "gay joke" should be kept in the trailer and in the movie:

"Let me add my voice of support to the people outraged by the bullying and persecution of people for their differences, whatever those differences may be. Comedy and joking about our differences breaks tension and brings us together. Drawing dividing lines over what we can and cannot joke about does exactly that; it divides us. Most importantly- where does it stop?"

ABC's The View also discussed this during its "Hot Topics" show yesterday. I was actually pretty surprised that there seemed to be consensus and support for Vince Vaughn's statement. How can you censor a "character"? This was not about Vince making homophobic statements...but it was the statements of his character. What if the character is a jerk? Then he/she will sound like a jerk. Whoopi Goldberg spoke about recently watching "Roots" on TV and how much of the message was lost due to the censoring of the racist language.

I can see both sides of the argument on this one. Of course, people of all ages look to celebrities and movies to be role models and to confirm (or break) social norms. Therefore, statements using "gay" as a pejorative can absolutely influence the beliefs of an audience. However, I also understand the slippery slope of censorship and the concern that stories can no longer be told with the same honesty and depth of characters. It is also unclear how this censorship would be overseen and enforced. Can we always tell the difference between a statement of someone's beliefs and their attempt at a joke? And just because something is intended as a joke, does that really mean there are no consequences? If your boss "jokes" about how your clothes fit...it is still sexual harassment.

With tomorrow being "Spirit Day" to combat anti-LGBT bullying, it seemed very timely to toss this "dilemma" out to my readers for comment. I look forward to your thoughts.

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".

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.

Evaluating 90210 & Public Health Interventions: My Perfect Fantasy Job

Cases in Public Health Communication & Marketing is an online, open-access journal (coming out of the George Washington (GW) University School of Public Health and Health Services) which focuses exclusively on case studies from the fields of public health communication and social marketing. The journal's mission is to promote the analysis of real-world experiences and practice-oriented learning. They have recently published Volume 4 (Summer 2010) which includes several case studies focused on Entertainment Education and the work of Hollywood, Health, & Society.

Hollywood, Health & Society (HH&S), is a program of the USC Annenberg Norman Lear Center, and provides entertainment industry professionals with accurate and timely information for health story lines. Funded by the Centers for Disease Control and Prevention (CDC), The Bill & Melinda Gates Foundation, The California Endowment, and the Health Resources and Services Administration's Division of Transplantation and Poison Control Program, the program recognizes the profound impact that entertainment media have on individual knowledge and behavior. These professionals (who totally have my perfect job!) focus on Entertainment Education (EE), which is a communication strategy that involves embedding health or social messages into entertainment programming that can influence knowledge and attitudes, and promote healthy behavior among television drama audiences. The two cases highlighted for the GW publication included a The Bold and the Beautiful (daytime soap opera) storyline which promoted bone marrow donation and a (new) 90210 (nighttime young adult soap opera) storyline which highlighted a main character with bipolar disorder.

What is really fantastic about the case descriptions (beyond the collaboration and prep work that went into creating these accurate and engaging story lines) was their discussion of how to evaluate their efforts. Evaluation is (unfortunately) sometimes an afterthought for public health interventions. Or evaluation is poorly defined as simply measuring satisfaction- "Did the viewers "like" the episode?" Despite the complexity of evaluating health communication efforts, these case studies were quite thorough. For example, with the 90210 episode, they looked not only at exposure (i.e., how many watched the episode or saw the accompanying PSA on bipolar disorder) but also at help-seeking behavior following the episode. They documented calls/contacts to their partners (e.g., SAMHSA Health Information Network and the Child and Adolescent Bipolar Foundation (CABF). The evaluators also collected qualitative feedback from volunteers and teens who visited the CABF online chat rooms after the episode aired. "As expected, visits to the chat rooms increased shortly after the episode aired. Remarkably, traffic and participation in the chat rooms continued for months after the episode and PSAs aired".

It is always validating to see that watching TV can be more than a mind numbing couch potato activity...it can be educational and essential for shaping and measuring social norms around important health issues.