"E-Lane" for Pedestrians: An April Fools' Day Prank With Real Public Health Implications

Earlier this week, Philadelphians were treated to an April Fools' Day prank courtesy of Mayor Michael Nutter and the city's Office of Transportation and Utilities.  Across the street from city hall, an "E-Lane" was designated for pedestrians who use (and are distracted by) their electronic devices while walking.  While the city only expects to keep the joke "E-Lane" around for a week, they also hope that it starts a dialogue about pedestrian safety and people looking out for themselves while walking around the city.  Since this April Fools' week also happens to coincide with National Public Health Week (a time dedicated to recognizing the contributions and challenges of public health), I thought it was a great story for Pop Health.  So I took a stroll down the "E-Lane" on Monday to take these pictures and to get the dialogue started.

While I have written about (and am a huge supporter of) the vast and ever expanding benefits of mobile devices for public health, I also acknowledge the challenges that they have created.  Even though Philadelphia created the "E-Lane" as a joke, drivers and pedestrians distracted by electronic devices have become a serious issue.   

The Centers for Disease Control and Prevention website on distracted driving tells us that each day, more than 15 people are killed and more than 1,200 people are injured in crashes that were reported to involve a distracted driver. Distracted driving occurs while doing another activity that takes your attention away from driving; these activities can increase the chance of a motor vehicle crash.  While distracted driving can include talking on a cell phone, texting, or eating, texting is most dangerous because it takes your eyes off the road (visual), hands off the wheel (manual), and takes your mind off driving (cognitive).

As with any emerging public health problem, we are beginning to see:

• Research:  papers on distracted drivers and pedestrians are being published in the peer reviewed literature.  
• Education: cautionary tales of distracted driving are emerging in the popular media.  Just in the past few months, the Today Show has hosted several sets of parents who lost children due to texting and driving. 
• Celebrity Spokespeople:  Teen sensation Justin Bieber is partnering with the Remember Alex Brown Foundation and Phone Guard's Drive Safe.ly application to promote responsible texting.  The application reads text (SMS) messages and emails aloud in real time and automatically responds without drivers touching the mobile phone.
• Policy Change:  Just a few weeks ago, Pennsylvania became the 35th state to enact an anti-texting law.  The new law allows police to charge anyone caught text messaging while operating a vehicle with a primary offense and a $50 fine. 

As with most public health problems, we will need a combination of these strategies (i.e., individual education, social norm changes, policy/law changes, technological solutions, etc) to see a reduction in injuries and deaths.

What do you think?

• How can we balance the benefits and challenges of mobile technology for public health?
• Do you think the "E-Lane" in Philadelphia is an effective strategy for initiating dialogue around distracted drivers and pedestrians?
• In addition to the strategies listed above, what can public health and the public do to reduce injuries and deaths from distracted drivers and pedestrians?

The Role of Social Media in Emergency Preparedness and Recovery

Last month I attended a presentation about a research study which evaluated the content of State-level emergency preparedness websites. The reviewers were looking for the presence of essential components such as clear contact information and links to federal emergency preparedness resources. I raised my hand and asked, "Are you evaluating these websites/organizations for a social media presence?" I used the example of the most recent Philadelphia "emergency" I encountered, 15 inches of snow. I did not go onto the city's emergency management website for information. I follow NBCPhiladelphia and SEPTA (the city's mass transit system) on Twitter. So I looked at my phone to find out what offices were closed and which buses/trains were running or cancelled. As always the key question remains, how does your target population get their information? What systems will still be working in an emergency (e.g., what if you lose electricity or internet?)

Since last Friday, we have all been watching the sad and heartwrenching images from the earthquake and tsunami in Japan. And you may wonder, with so much of the country affected, how will people make contact with their loved ones and how will the government get critical information out quickly? This morning, Mashable ran an article called, "Social Media Plays Vital Role in Reconnecting Japan Quake Victims with Loved Ones". While the earthquake knocked out electricity, the internet remained largely intact. The US Embassy in Tokyo is trying to take advantage of this fact and is encouraging Americans in Japan to contact their loved ones via text message and social media (i.e., Facebook and Twitter). Facebook and Twitter analytics from the day of earthquake show incredibly high usage.

A recent post on the Federal Emergency Management Agency (FEMA) blog discusses how social media is being considered as a key element in emergency preparedness. FEMA administrator Craig Fugate discusses a January 2011 planning meeting in which he met with the founder of Craigslist and editors from Wired, Twitter, Apple, and Facebook. He reports that they discussed:

• "The need to provide information to the public as data feeds, because they are a key member of our emergency management team"
• "The importance of referring to people impacted by a disaster as survivors and utilizing them as a resource"
• "The importance of providing good customer service"
• "How [emergency managers], need to stop trying to have the public fit into our way of doing things and receiving information, but that we should fit the way the public gets, receives and seeks out information"

It is great to hear that emergency managers are identifying social media as a powerful tool and planning how best to take advantage of it during an emergency.

Other online resources for making connections after a tragedy include:

Google Person Finder : This google service is used in the aftermath of such tragedies and allows users to click, "I am looking for someone" or "I have information about someone".

Red Cross Family Links: The purpose of this website is to help people get connected after being separated by disaster or conflict. Currently, there are links for Japan, Bosnia, Kosovo, Nepal, Iraq, and Somalia.

Text Messages and Public Health: Can They Remove Barriers for "Calling" 9-1-1?

Text messages are a great time saver. You do not have to have a long conversation with someone...instead you can just send a quick message like "I made it home safe!" or "Can you pick up milk on your way home?" These text messages work well to support our busy lives, but can they also be incorporated into effective public health interventions and systems?

This week, the Federal Communications Commission (FCC) announced that it is looking into letting citizens report crimes via text message. An article posted by Wired discusses the possibility and highlights some of the "barriers" that this new strategy could help to address. First and foremost, it could allow citizens to report a crime without being overheard if they were in dangerous situations (e.g., kidnapping, robbery). The FCC specifically pointed to the 2007 shootings at VirginiaTech and reported that texts could have allowed emergency personnel to respond more quickly and with a better understanding of the circumstances inside the campus buildings.

While at first glance, it may seem surprising to use text messaging for 9-1-1 reporting (due to potential logistical considerations and challenges), it would not be the first time that texts were being integrated into public health interventions and emergency response systems. For example:

• Text messages are used to disseminate key health messages to various priority populations. E.g., The Text4Baby campaign allows mothers to self select into their program by texting "Baby" to the program number. The mothers then receive weekly text messages (timed to their due date or baby's birth day) regarding key health issues for their babies (e.g., nutrition, immunizations, etc).

• Many workplaces and college campuses have signed up for emergency response systems that will send out automatic alerts to email and phones (via text message) during a crisis (e.g., shooter on site).

In the case of using text messages for "calling" 9-1-1, I wonder about how texts could influence a well documented social psychology barrier to calling for help. Those of you that took a social psychology course in college may remember the name "Kitty Genovese". She was a woman who was murdered outside her home in Queens, NY in 1964. At least one dozen people heard or observed her attack (lasting approximately 30 minutes), but there was much delay in anyone calling for help. A NY Times article running two weeks after her death was entitled, "Thirty-Eight Who Saw Murder Didn't Call Police". This case is widely discussed as an example of the "Bystander Effect", which is used to explain why many people do not help in emergency situations when others are present. Some hypotheses about the effect are that we just do what others are doing (i.e., nothing to help), we assume someone else is already calling/helping, or we assume that others are more qualified to help. Perhaps it is also too much trouble to call 9-1-1? They require a lot of information, we have to stay on the phone, etc. Perhaps a more "passive" option to report the information (like text messaging) would decrease resistance and the bystander effect?

In addition to the great potential with this strategy, there are also several barriers that must be addressed in the planning:

• Costs (equipment, training, staffing)
• Regulation and Oversight: Will text message support be required or voluntary at emergency centers? Who will conduct a formative and ongoing evaluation of the system?
  
• Interpretation of messages: Operators will need special training to (quickly) interpret and respond to text messages. Texts are often written in short hand, so you would need someone very skilled to decipher them accurately. It may also be time consuming to support the texting back and forth that may be required to receive all relevant information from the "caller" in order to dispatch an appropriate response.

Even with the barriers noted above, it does seem like text messages are a viable option to consider in order to increase timely and safe 9-1-1 reporting. However, the 9-1-1 system will need to think critically to develop the type of infrastructure that can keep up with our ever changing and expanding communication technology.