Talking About Health; Why Health Communication Matters

Weighing in — what’s the debate about Dr. Oz and the apple juice story really tell us?

September 21, 2011

All has been quiet on the talking about health front. I am in the midst of teaching the undergraduate class about designing health messages at Penn State, so it is odd that I don’t find my way here more often. But in the fury of the debate over the Dr. Oz show about apple juice. [go here to read and listen to the debate if you want more information: http://www.doctoroz.com/videos/arsenic-apple-juice], I had to make time to add a few thoughts.

First, in favor of Dr. Oz — his show entertains us and informs us at the same time. We do have to remember that someone has to pay the bills for the show, so the entertainment quality has to be there. It is that simple.

The positive things about a show like Dr. Oz is that it can arouse public passions about scientific issues and lead to health advocacy. It may increase healthy behaviors and improve our vocabulary when it comes to talking about health and the science of health.

But on the negative side–it can be confusing and contribute to inaccurate understanding. It may arouse public passions but these can be misdirected.

The apple juice show and related debate illustrates both. The headline for the page above and the text beneath illustrates this reality. What is an “extensive national study”? According to the text, it means “dozens of samples” from “three different cities”. That is neither extensive nor a nationally representative sample.

How was the study conducted? Even with the several dozen samples, there is much room for the approach to vary. Did the tester shake the apple juice before drawing a sample? That might be important in terms of how the contents in the apple juice are distributed through the liquid. Did the tester take a sample from the bottom of the juice container or the top? Did the tester take more than a single sample of juice from each of the containers tested? Inquiring minds want to know…

But instead of focusing on specific and direct questions to guide our understanding, the backlash focused on name-calling. Skimming the contents of various letters from companies represented on the show and the Food & Drug Administration–FDA–“irresponsible” might be the most frequently leveled charge. Dr. Besser calls the Dr. Oz show “fear-mongering”. Watch this exchange:

I give credit to Dr. Oz for remaining calm and answering the charges.

But I wanted to know more about organic and inorganic arsenic levels, and other issues such as I raised above. I wanted to know less about Dr. Besser’s “upset”…

What did I miss in the message about Neti pots and brain-eating amoeba?

August 22, 2011

Perhaps you heard stories last week about a brain-eating amoeba and the use of Neti pots [http://www.wdsu.com/r/28921234/detail.html]. I heard a headline first about a young boy who died after being at a fishing camp and falling into water where he apparently had contact with the amoeba and it got into his body.

I heard about the Neti pot and exposure to the brain-eating amoeba from my husband who asked me to remind him to tell our daughter-in-law about it because she uses a Neti pot. And your sister, I added…

“What can you do about it?” I asked. My daughter-in-law suffers from allergies and sinus problems and the Neti pot provides relief. I didn’t want to just ‘scare’ her. After searching a few stories, I learned that you can use distilled water in the Neti pot to avoid any risk. [http://abclocal.go.com/wpvi/story?section=news/health&id=8314285] Of course, I had to read to the very last line to glean that advice…

How about this: Neti pot users can avoid risk from amoeba by using distilled water. Open the story this way or use this in a headline to state how to respond to the risk. Repeat it near the end to reinforce the response. But avoid telling a tale that arouses fear without a suggestion about how to reduce the risk near at hand…

How does Anderson Cooper’s statement, ‘hope is not a plan’ fit today’s events?

August 8, 2011

I saw an ad for Anderson Cooper’s new talk show coming in September. The ad shows Anderson sitting with Oprah–an excerpt from an interview some years ago. She compliments him on his coverage of Hurricane Katrina. She remarks that he got it right when he said, “Hope is not a plan.”

I thought that it was a bit ironic in the light of the day… after our nation’s credit rating has been downgraded and the U.S. stock market lost 634 points… and the news is covering it round the clock–a reminder that “the audacity of hope” is …hope without a plan…

And what can we do about it? Stop listening? Stop talking about it?

We have talked about in this forum before, news coverage has been found to lead to compassion fatigue. As Susan Moeller wrote in her book about compassion fatigue more than a decade ago in 1999 [http://www.amazon.com/Compassion-Fatigue-Media-Disease-Famine/dp/0415920981], the effects of nonstop alarming news and no messages about concrete actions to represent effective responses: fatigue, exhaustion, and an inability to even feel anything about anything…

Here is the concrete action I seek: no matter how hard it is,

….stop responding by placing the blame on someone else.

Stop doing the same thing over again and expecting different results…

Grammie, were you that girl who played ‘boy’ games with the boys?

August 2, 2011

Yes, Grace… I was. We were painting the swingset and ‘chit-chatting’ as my granddaughter likes to call it. Being a baby-boomer has its perks as I have this long view of such matters as ‘what girls and boys do’ and some opinions about how it affects our health…all the way from bone density based on early childhood through developmental years of activity versus inactivity to body image and weight. Or so I thought.

Why is it that the same divisions that seemed like we worked through in the past still remain? The boys always played together at recess…something fun like kickball or chase or even just ‘let’s go expore the other side of the playground.’ The girls always played together at recess…something like ‘let’s catch up on who’s wearing what’ [like we couldn’t all see that and who cares…] and ‘let’s play house’…

Much to my surprise, Grace told me as we were painting all about how she is the girl who crosses over to play with the boys. I knew she played sports at recess because shopping for clothes for Grace means buying something pretty and pink but something–like she is wearing to drive the tractor with Granddad–that she can hang upside down in on any number of jungle gym type toys… skorts–those marvelous crossovers between shorts and skirts are the perfect ticket and have only gotten much cuter over the years. She told me that her best friend is a boy. She was the only girl invited to his birthday party. She told me how there is one boy who sometimes plays with the girls…when they need a ‘daddy’ for their household.

Interesting, I told her. I was the one rolling down hills, climbing trees, and well–being a ‘tomboy’ when I was growing up, too. “A tomboy? What’s that,” Grace asked me.

Well, at least that has changed…

What makes a good public health message–put your sheets in your freezer two hours before going to bed?

July 21, 2011

Yes, it is hot… And the weather affects our health…physically and mentally.

So, what are we to do about it?

I loved the message Dr. Besser gave on ABC News with Diane Sawyer tonight… ‘put your sheets in the freezer a couple of hours before going to bed…’

This is an example of a ‘good’ message. It is specific. It is doable. It is affordable…we mostly have sheets on our beds. We mostly have refrigerators in our homes and these appliances have freezers.

So, I am doing it. I will let your know tomorrow…did it work? That, of course, is one of the most important parts of a good public health message…

…cell phones and cancer…why now?

June 2, 2011

We have been hearing about the World Health organization’s conclusion that cell phones pose a health risk that is similar to lead exposure [http://www.latimes.com/health/la-he-who-cell-phones-20110601-1,0,3926296.story]. A summary of the report will appear in a medical journal in July. But advance news stories indicate that as with lead exposure, more exposure increases risk. Cell phone use rarely–less risk. Cell phone use for hours at a time and/or every day–greater risk.

Why has this report come out now? Last year, the U.S. National Cancer Institute reviewed research relating to cell phone use and cancer and posted a summary of their conclusions at http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones. It is tricky to read through the findings. They sometimes suggest that the issue has been directly studied. The ‘gold standard’ for clinical trials is based on randomly assigning individuals to a condition in which the thing to be studied is ‘given’ to those participants and another condition for which the randomly assigned individuals do not have exposure to the thing being studied. Thus, when the NCI reports about studies that have compared individuals who subscribe to cell phone service with those who do not, it begins to sound like a randomized trial. I subscribe to a cell phone service and seldom use my cell phone. My daughter has a cell phone service, it is the only phone she has [no land line], and she uses the phone–talks on it–a lot. So if we were both included in the study mentioned by NCI based on being subscribers, the results might not be an accurate reflection of a relationship between cancer and cell phone use. Subscribers who seldom use their cell phones, if included in the denominator of an equation designed to inform about risk, may artificially reduce the overall risk.

For example, if there are 2 cases of cancer in people in the population that is not subscribed to cell phone service–let’s say that is 100 people–and there are 2 cases of cancer in people in the population that is subscribed to cell phone service–let’s say that is 200 people–it suddenly appears that there are fewer cases in the latter…. But what if only 50 subscribers use the cell phone everyday….not even counting how long everyday–just everyday. 2 cases among 50 people is twice the risk of the poulation of nonsubscribers… Is that accurate?

So that has been the challenge for some years now. No one is going to conduct a randomized trial of cell phone use in which they randomly assign some people to be users and some to be nonusers, and then have some users use briefly everyday, and some users use for two hours, and some more…and track cancer incidence across yearssssss of the lives of the participants. So we have to rely on the research that makes comparisons such as the one described above. The WHO’s group of scientists apparently reached the conclusion that the nearly four dozen published studies reviewed with the thousands of particpants is sufficient evidence to classify cell phones as a possible risk for cancer. In view of how cell phones work, it seems a safe bet. And the ways to reduce risk by using the cell phone with a device that keeps the phone away from my brain is an easy and effective way to reduce that risk…

What’s new under the sun?

April 20, 2011 GUEST BLOG POST by Caroline Gilson

Over the years, the desire to be tan led to use of tanning beds. Somehow, tanned skin is seen to be sexy and attractive. As many people have continuously begun to be “addicted” to tanning beds, their skin has been put in a dangerous environment.

Tanning beds have a different type of UV rays called UV-B rays. UV-B rays are more harmful to the skin than the sun’s UV rays.

The dangers of tanning beds have caused the need for educational programs to educate the public about the health concerns involving tanning beds. Research studies have been done to find out the best way to communicate about the tanning beds. One study in particular looked at the use of narratives, and statistics. (http://www.springerlink.com.ezaccess.libraries.psu.edu/content/

457nhk7324q63501/fulltext.pdf)

This particular study discovered that both statistics and narratives could be effective in educating individuals about the dangers of tanning beds. Specific stories about real life people seem to grab people’s attention. Statistics about tanning beds on top of narratives help with persuasion and education about tanning beds.

The research has been done and now it is time to effectively educate the public about the risks of tanning beds. Hopefully, through health communication, society will make better health decisions…

What do we say to youth about exercise?

April 13, 2011 GUEST BLOG POST by Elliot Searer

In many previous studies, we have found out that a healthy balance of diet and exercise is the most efficient way of staying healthy. I feel more emphasis needs to be put on children and how much physical activity they receive, and if they are even coming close to the recommended 60 minutes per day. I feel that organizations, like YMCAs, should offer more opportunities for our youth to have a place to properly exercise. Questions I have are:

Do our youth have proper access to a clean, safe environment suitable for physical activity and play? Do our youth understand the importance of physical activity from a health perspective? Do our youth have access to information that answers their questions about different exercises or exercise equipment? Do children understand the importance of nutrition in order to gain the most from their physical activity? Are youth who lived in dirty, unsafe conditions permitted to exercise at facilities like YMCAs despite possibly not having the proper financial means?

In a study conducted by Bowman and Neal, particpants between 5 and 17 years of age were scheduled to attend nutrition classes only or nutrition classes and family YMCA membership. The primary outcome measure was change in BMI-for-age percentile. Four participants in the control group and one in the treatment group achieved the target reduction of 2 BMI percentile points. Within the treatment group overall, YMCA attendees had a mean increase of 0.30 BMI points compared with an increase of 0.60 BMI points in nonattendees. Questions I have about the study in particular are:

1) In what type of shape, physically, were the eligible participants in before the experiment? 2) After? 3) What type of guidance was received from YMCA workers or someone of a trainer’s capability?

Through my personal experiences as an athlete, I find it extremely surprising that better results weren’t seen. The study states that some of the participants didn’t even go to the YMCA despite having a paid membership. I would like to know what type of guidance they were getting. For example, if they were doing proper exercises to promote weight loss or if they even knew how to properly operate the equipment and machines.

I feel a lot more can be done by communities to stress getting the 60 minutes of daily physical activity. Organizations should take a stronger stance and venture out in the community, and set up activities in parks or rec sites. It wouldn’t be hard, and would be low cost. Also, the organizations may not even have to use their facilities as host sites for the gatherings. Getting our youth out in the community, learning how to properly take care of themselves through physical activity could possibly lead to more benefits. Better eating habits, spreading nutrition information to other family members, and overall healthier communities may encourage children to pursue sports or other careers based on exercise/play as opposed to sitting at home…

M. A. Bowman and A. V. Neal; Policy and Financing in Family Medicine and the Medical Home. J Am Board Fam Med, May 1, 2010; 23(3): 277 – 279.

How should we talk about tanning?

April 12, 2011 GUEST BLOG POST by Danielle Torrisi

Take a look around any college campus, and you’ll notice at least a handful of tanning salons. Pick up their college’s newspaper and you’ll find ads for tanning salons with gorgeous, tanned women pictured with the slogan “Beautiful Tan Today. Young looking skin tomorrow” and promotional discounts that is sure to catch the eye of any student. The tanning industry portrays tanning as harmless and risk-free. However, research has shown that the incidence of melanoma has continued to rapidly increase since the 1970’s.

A recent study at a southern university surveyed 492 students and results showed that a majority of the participants knew sun exposure increases the risk for skin cancer, but only 29% correctly identified behaviors that reduce this risk.

Less than 46% of the participants were able to identify signs of melanoma, and less than 10% were able to identify the primary area of the body for melanoma. Approximately half of the participants strongly believed that a tan improves one’s appearance, and only half thought that sun safe behaviors are necessary. It is very troubling to learn that they think their appearance outweighs their health.

College students need to be informed about the dangers of using tanning beds in hopes of changing attitudes and behaviors. It all starts with the media and advertisements need to show a more natural appearing skin. “As long as marketers portray being tan as healthy, attractive and sexy, young women will continue to believe that a tan is desirable, regardless of the risks” (Spradlin et al).

It needs to be understood that there is no such thing as a healthy tan. “In fact, UVA rays which are used in tanning beds can go all the way through the skin’s protective epidermis to the dermis, where blood vessels and nerves are found. Because of this, UVA rays may damage a person’s immune system, making it harder to fight off diseases and leading to illnesses like melanoma, the most serious (and deadly) type of skin cancer” (Tanning). This needs to be reinforced in student’s minds in order to see a behavior and attitude change.

To view this article go to: Citation: Spradlin, Kimberly, Martha Bass, William Hyman, and Rosanne Keathley. (2010). Skin Cancer: Knowledge, Behaviors, and Attitudes of College Students. Southern Medical Journal. 103, 999-1003.

Does peer sexual health education change the trainers’ behaviors?

April 3, 2011 GUEST BLOG POST by Kaitlyn Krauss

I get it–sex is a taboo topic. It’s something that shouldn’t be discussed in public let alone in front of people you don’t know. Yet I do this all the time. I know my dad would never tell his friends his daughter hosts “Safer Sex Parties” up at Penn State and I know my mom isn’t too happy that I demonstrate how to properly put on a condom, but it’s something I do and it’s something I love.

As a peer educator through University Health Services, I chose to become involved with the sexual health group. During my first year as a volunteer, I was elected the group leader. I believe that unsafe sex is one of the biggest problems that all college campuses face. It is important for everyone to be aware of the risks of sexual activities because STIs such as HPV, Chlamydia, Gonorrhea and Genital Herpes are common on college campuses.

The CDC reports that 1 in 4 college students have been diagnosed with an STI in their lifetime. I don’t know about you but that statistic shocks me every time I hear it. It was my love of communication, volunteering and always wanting to help others that led me to become a peer educator. Regardless that not everyone agrees with what I do, I’d like to think it’s worth it, even if I help one person or change one persons mind.

Because of my experiences as a peer educator, I review research about the benefits of peer educators in talking to people about sex. One of these articles conducted in 2007 (http://www.informaworld.com/smpp/content~db=all~content=a903650971) considered the question, “Does Peer Sexual Health Education training shift trainee’s own behavior towards health promotion and safer sex behavior?” Through a series of surveys and training programs, the study found that participants improved their STD knowledge and health-promotion counseling self-efficacy. This is something that I believe all peer educators should grasp before preaching safer-sex to hard-headed college students. Whenever I give a safer sex party, it’s new facts that often motivate people to change. By learning the facts and improving one’s training skills, peer educators become more valuable.

College students believe they are invincible and many won’t stop and think twice about something until they are hit with the consequences. STIs are serious and that is why I try to convince people to prevent them instead of deal with the problem when it arises. The study found that peer educators were a successful tool in training college students. A lot of the educators also changed their ways after going through the training. All of the health promotion competencies they learned in the study are necessary components of a peer education program that enhances the health of its clients. And that’s why I do this, to enhance the health of my clients, my peers, and my friends…