Showing posts with label public health. Show all posts
Showing posts with label public health. Show all posts

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In Honor of The World Cup: My Favorite Public Health Themed "Things Tim Howard Could Save"

As the World Cup came to a close this afternoon, I had fun revisiting my favorite #ThingsTimHowardCouldSave. For those of you that missed this fun Twitter hashtag: Back on July 1st, the United States Men's National Soccer Team played Belgium in the World Cup. Although the US lost the match, its goal keeper Tim Howard was amazing with 16 saves. His performance inspired an outpouring of memes that speculated on things that Tim Howard could save around the world. 

Since I am fascinated by strategies for using popular culture to engage people in public health, I was happy to see my colleagues join in and use Tim Howard to draw attention to:

(1) Substance Abuse



(2) Global Vaccines & Immunization

(3) Infectious Diseases and Various Disasters 


This isn't the first time that I've written about public health agencies aligning with a trending topic in order to engage a new or broader audience. What do you think?
  • Is this an effective way to engage a larger audience?
  • How should public health agencies evaluate such efforts? What metrics are important?
  • Should agencies dedicate staff (on an ongoing basis) to monitoring such popular culture trends in order to develop timely social media content? Why or why not?
  • Please share other examples of Tim Howard/Public Health tweets that I may have missed!

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The Value of Social Media for Public Health Professionals- A New Article!

My regular readers know that I am a huge fan of social media. I think it has so much to offer the field of public health. I have regularly posted about how platforms like Twitter, Facebook, Instagram, and Pinterest can be used to support public health activities like emergency response and health advocacy.

In addition to its benefit to the field, I believe social media also benefits the individual public health practitioners who use it. I have recently written an article for the journal Health Promotion Practice which outlines the value of social media for public health career development. I hope you will check it out, share with colleagues, and keep the discussion going!

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Top 3 Pop Health Trends in 2013


Wrapping up 2013 has given me a great opportunity to reflect on what I have been writing about over the past year.  Looking back over 35+ posts, here are the trends that caught my eye:

1.  Social Media & Public Health:  The intersection of these two topics continues to intrigue us in the public health field and the application of social media is being explored in everything from preparedness to health education.

Pop Health Favorites From 2013:


2.  Celebrities & Public Health:  This is not a new topic by any means.  For decades, celebrities have been health advocates and/or the topic of discussion for a number of public health issues.  However, I highlight it as a trend in 2013 for two reasons.  (1) With the help of social media, celebrities are weighing in constantly on health issues and current events in real time. These opinions can come quickly and casually through Twitter or Facebook...they no longer speak exclusively through publicists and press releases.  (2) Public health is putting an emphasis on evaluating the impact of celebrities on health issues.  *I hope we see more of this in 2014!!

Pop Health Favorites From 2013:


3.  Crowdsourcing & Public Health:  While I haven't written about it as much as I would like, I have been fascinated by the creative use of crowdsourcing in 2013 that has helped advance public health dialogue.  [For those not familiar with the term, "crowdsourcing" is the act of obtaining ideas, content, etc. by soliciting contributions from a large group of people- like Twitter users!]  Specifically I'd like to acknowledge Slate for utilizing this strategy in the #NotDeadYet story I link to below and more recently in their analysis of gun death data.  I think we in public health can learn a lot from the crowdsourcing strategies that Slate has used to engage readers.

Pop Health Favorite From 2013:


2014:  I anticipate that each of these three topics will continue to grow and appear in many Pop Health posts in 2014.  I hope that we see more and more evaluation studies of social media/celebrities/crowdsourcing and their impact on public health initiatives.  I hope these studies are widely disseminated and made accessible to many of us- even if we lack comprehensive access to peer reviewed journals.  If you see such studies, pass them along!  I am hoping to expand my "Research Notes" posts in the upcoming year and would love to highlight such studies on the blog.

What Do You Think?

  • What other 2013 trends in health communication/social media/public health did you see in your work?
  • What new/expanding trends do you anticipate in 2014?

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Celebrities Aim To Silence The Sounds of Pertussis


This week I surprised myself when I tweeted:

I happened to catch a portion of last week's episode of Keeping Up With The Kardashians.  While not usually a fan of the content/messages on that show, I was thrilled to see that Pertussis (Whooping Cough) was discussed.  Pertussis is a highly contagious disease that can be fatal when contracted by infants.  Research has shown that the majority of infants who get Pertussis get it from a family member.

Since Kim Kardashian would be staying at the family home with a newborn, her mother Kris brought their family physician in to vaccinate everyone who would come in contact with the baby.  That included the baby's grandparents and aunts/uncles.  What a great preventative health behavior to model on TV!

The show brought me back to a blog post I wrote last year to summarize my reactions to the PBS Frontline special "The Vaccine War".  One question I posed to readers was:

How can public health compete with the media and the internet?

One solution that I proposed:  Let's remember to share the spotlight with celebrities and other spokespeople that have influence over the public.  With anti-vaccine advocates often getting the spotlight (cough...Jenny McCarthy co-hosting The View), we often overlook that there are pro-vaccine celebrities.

This week, a colleague on Twitter shared the link to Jennifer Lopez's PSA for the Sounds of Pertussis campaign.  It was impressive.  First, for the selection of "JLo"- a mother of twins, who is known worldwide for her dancing, singing, and acting.  People are obviously interested in what she has to say- as evidenced by her 25+ million Twitter followers.  Second, her PSA includes the actual sound of a baby with Pertussis.  This is helpful because (1) it educates the public regarding what this cough actually sounds like and (2) without words it portrays the seriousness of the condition.  The baby on the recording is gasping for air.  As Jennifer points out, this sound is hard to hear for 60 seconds on the PSA...let alone coming from your own child.

The Sounds of Pertussis campaign is a joint effort between the March of Dimes and Sanofi Pasteur.  They have recruited other celebrities such as actress Sarah Michelle Geller and NASCAR Champ Jeff Gordon.  The campaign website includes both educational materials (e.g., information on transmission) and action oriented materials (e.g., a Grandparents' Guide to Pertussis that includes a pledge to get vaccinated).  The campaign has also expanded its use of social media to include a Facebook component called "Breathing Room".  This component allows new parents to educate their connections about Pertussis and invite them to take the pledge to get vaccinated.          

What Do You Think?

  • Can these pro-vaccine celebrities compete with the anti-vaccine messages we often see in the media/internet?  Why or why not?
  • Do you think that the Sounds of Pertussis campaign addresses some of the key barriers to adult vaccination (e.g., low perceived risk to self or baby?)


 

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What Can “Chronic Resilience” Teach Public Health Practitioners? An Interview With Author Danea Horn


Last month I had the pleasure of receiving an advanced review copy of "Chronic Resilience: 10 Sanity-Saving Strategies for Women Coping with the Stress of Illness".  As I read through the book, I made note of many issues that are relevant to public health practitioners.  Therefore, it is a pleasure to have Danea Horn expand her comments on these topics for Pop Health readers. 

If you would like to connect with Danea, you can visit her website or twitter.

Leah:  In public health, we talk a lot about how our society’s “culture” can promote or harm health.  In several places in your book, you talk about the connection between our societal values and our health.  For example:

Page 33: “Part of the reason we try to be all things to all people is our culture.  Have you ever sat through a business meeting while someone is sniffling and sneezing and exposing everyone else to their cold?  In that moment they are valuing achievement, money, or appearances above their health and the health of everyone else in the room.”

How can we expand your strategies beyond the individual level?  How can we identify and live our health values at the neighborhood, community, and organization levels?

Danea:  It only takes one person to start a conversation that can become the catalyst for big changes. Start talking to people at your work and in your community to get a feel for what is valued currently. The policies (written and unwritten) in our offices and items at our potlucks will say a lot about what we collectively value. If you find inconsistency or confusion in your conversations, open up a dialogue with the leaders in your organization or community to discuss what you would like to collectively choose to value. From here you can brainstorm together ways to influence change. They can be small changes like creating a healthy living block party where people share nourishing dishes and swap good-for-you recipes or larger changes like paid sick leave (which is not mandatory in every state…yet). Never be afraid to speak up. A big theme in Chronic Resilience is controlling what you can control and talking is in your control. 

Leah:  In Chapter #6, you write “It is up to you to decide how public to make your health.”  You and several of the women you interviewed for your book have blogs that document your health journey in a very public way.  Public health researchers Ressler et al (2012) have identified many benefits of patient blogging (e.g., patients report a decrease in feelings of isolation).

What benefits have you experienced as a result of writing about your health?  What challenges have you encountered during the process of sharing your story publicly?

Danea:  Writing helps me process what is going on from a different perspective. I am all about learning from our challenges, so each post I write is a search for a lesson or message that my diagnosis is pointing me toward. I can feel frustrated about the progression of my disease and start out writing a rant, but I find that I naturally end up with a message about letting go of my ideals or acceptance. Reframing my health in this way has been very empowering.

I haven’t encountered many challenges by being public with my health journey. Commenters have been very supportive. That said, I am discerning about what I choose to share and do keep some things private. Challenges I know other people have faced, and someone who blogs publicly about their health should be prepared for, are people sharing remedies, treatment recommendations, cure-all solutions and pleas to have faith in a deity they may or may not believe in. While these all come from a caring place they may feel intrusive. Also, you may want to give a heads-up to your close family and friends before you post anything particularly revealing, emotionally or otherwise, that you haven’t shared with them in private first.

There are a number of ways to benefit from writing about your health. Doing it publicly on a blog can create a sense of support and community, but if that feels too invasive, you can join support forums anonymously, create a private blog or journal pen and paper old school style.

Leah:  In Chapter #7 (“Empower Yourself With Research”), I was thrilled to see your emphasis on helping patients evaluate the validity and safety of medical information found on the Internet.  This is a huge challenge in public health!  Our evidence-based messages and guidelines often compete online with anecdotal evidence and unscientific studies.

Why did you decide to dedicate a portion of your book to this discussion?  Why is it so important for patients to discuss what they find online with their medical team?

Danea:  Before I became discerning about what I read online about my diagnosis, I was completely stressed. I read way too much from too many random sources to properly sort out what I should believe. I also noticed that I was searching for how I was going to become sicker (the side effects, complications, and progression of my illness) instead of searching for how I could support my heath. Fortunately, I realized most of my stress was coming from worry created by endless Internet searching, and I decided to take a different approach.

I found a few sources from trusted physicians and nutritionists to study and implement. I decided to stay focused on my personal symptoms, medications and prognosis instead of what other people I didn't even personally know had experienced. I also started a more open dialogue with my doctors about the diet I wanted to try and some of the studies I had read. When we research and experiment with our health without informing our doctors, we may have conflicting approaches which can create drug interactions or other harmful complications. Doctors are there to support us. If you are uncomfortable talking with yours, it’s time to find one that you trust enough to be completely open and honest with. We should all have a doctor who will work with us to find treatment solutions we feel comfortable with.

Leah:  A big thank-you to Danea for making the time for Pop Health!  "Chronic Resilience" is a great read for those with a personal and/or professional connection to chronic illness.  For public health clinicians, practitioners, and researchers who work in the chronic illness arena:  I think you will get a unique first-hand view into (1) the mental, physical, and emotional challenges that affect this population, (2) the incredible resilience that those with chronic illness show on a day-to-day basis (what can we learn from them??), and (3) specific strategies that can be employed to support patients with chronic illness.  As Danea and I discuss above, these strategies have the potential to be expanded from the individual level to offer support to entire communities.

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Pop Health Hits 100! Revisiting 5 Favorite Posts.

In honor of Pop Health hitting the milestone of 100 posts, I wanted to take the time to look back, thank my readers (face to face!), and revisit some of my favorite posts.  I selected posts that (1) generated the most readers, (2) solicited the most comments, (3) connected me with colleagues, and/or (4) were just really fun to write and promote!

I am also celebrating this milestone with my first video post!


1.  "Bullying: Is Technology Helping Us Or Hurting Us?"  [October 5, 2010)

2. "Friends Don't Let Friends Drive Drunk:  How Soon Is Too Soon To Find The Teachable Moment In The Death Of Ryan Dunn?" [June 23, 2011]

3.  "Facebook Adds Organ Donation To Timeline: Should We Like It?"  [May 1, 2012]

4.  "Angelina Jolie's "Medical Choice" Dominates The Internet"  [May 14, 2013]

5.  "How And Why Should We "Pin" Public Health?" [June 18, 2013]


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Do Celebrities and the Media Combat or Perpetuate Stigma Around Breastfeeding?

This week's guest post was written by Jennifer Breaux, DrPH, MPH, CHES.  She is an Assistant Teaching Professor & Director, Undergraduate Education at the Drexel University School of Public Health.  Her work is focused on maternal & child health, nutrition, and health as a human right.

Over the past month, Alicia Silverstone has entered the public health conversation once again by launching a vegan mother breast milk sharing program through her website The Kind Life.  The program has been featured by several national media outlets.  Although her idea of milk sharing is not a new one, it has reignited arguments and opinions on both sides.  For example, US Weekly ran a short piece about the proposed milk sharing program where it provided the information but did not give an opinion.  Unfortunately, many uneducated and harsh opinions were given in the comments section of this piece.  They ranged from stating that this was a horrible idea that would give babies diseases to questioning why someone would choose to give breast milk in this situation when there is formula.

I felt compelled to write this blog post because issues relating to breastfeeding and breastfeeding policies are extremely near and dear to me both personally and professionally.  The issue is also quite timely considering that August 1-7 is World Breastfeeding Week and the month of August is Breastfeeding Awareness Month.

Combating Stigma
Alicia’s program was first reported on by Good Morning America (GMA) and I was struck by the uncomfortable nature of the anchors when the health reporter presented breast milk on the table.  Seeing the breast milk out in the open resulted in a visceral reaction of unease for some of the hosts.  I was happy to see the reporter debunk some milk sharing myths like (1) the milk is unsafe, (2) it transmits disease and (3) it is an unnecessary service.  Overall, I thought that GMA did a balanced job of reporting the story.

Perpetuating Stigma
While stories like that on GMA  (in which a medical professional reinforced the safety of breast milk sharing) can help combat stigma, stories like the one in Life & Style can perpetuate it.  The Life & Style magazine ran a story with a quotation by TV host Wendy Williams who basically equated milk sharing with slave nurses and the Civil War.  

The roots of milk sharing date back to wet nursing and this practice actually dates back to before Christ and has been practiced through the centuries.  Yes, wet nursing did exist during times of slavery but it is also something that still exists today – largely invisible to the general population.  However, it did make main stream news outlets a few years ago when Salma Hayek breastfed a malnourished infant during a humanitarian trip to Sierra Leone.    The whole concept of wet nursing and milk sharing is not new and truly a selfless act that has become a life saving option for mothers who can’t or choose not to breastfeed.

The Facts About Safety
The Human Milk Banking Association of North America (HMBANA) was established in 1985 and remains the largest group to acquire breast milk.  It is a lifesaving organization for premature and ill infants and has locations across the country.  One of the main arguments against something like milk sharing is the spread of disease.  Milk that is obtained for the HMBANA meets rigorous standards.  Milk donors are screened and once the milk arrives at the bank it is:

  • Pasteurized to eliminate harmful bacteria,
  • Lab tested to make sure the milk is safe and free of any communicable diseases that are able to be spread in milk, and
  • Once it is ruled free of any cultures, the milk is able to be shipped to recipients

These standards enable parents to give donated milk knowing that it is safe and what is best for their infant.

That being said, there are informal milk sharing programs that are not regulated; the milk does not go through the rigorous testing done by HMBANA, which could pose a public health risk for those receiving the milk.  However, those who choose to participate in these networks are aware of the risks and feel that the benefits provided by breast milk outweigh possible consequences because the amount of external substances absorbed in breast milk is quite small.   An additional reason that families may choose this alternative route is cost.  Babies drink A LOT of milk and to get certified milk from HMBANA for the first year of life is extremely expensive and is only covered by insurance under certain circumstances.

A Call To Action
We, as a society, have opinions on these types of breastfeeding programs, but the debate will continue until we deal with the root cause of the need for increased milk sharing - our poor breastfeeding rates.  According to the World Health Organization and the American Academy of Pediatrics, it is recommended that mothers exclusively breastfeed their infant for the first 6 months of life followed by breastfeeding, in combination with the introduction of complementary foods, until at least 12 months of age and continuation of breastfeeding for as long as mutually desired by mother and baby.  In 2012, the national breastfeeding rate of exclusive breastfeeding at 6 months was only 16.3% with certain subgroups falling far below this percentage.

Stigma surrounding breastfeeding and the lack of support on every level will continue to plague this issue. The irony is that the science is clear – breastfeeding has overwhelming positive benefits for the baby, mother and society.

Some of the proven positive health benefits for breastfed babies are reductions in/of:

  • Hospitalization from lower respiratory infections
  • Ear infections
  • Serious colds, ear and throat infections
  • Necrotizing entercolitis
  • Sudden Infant Death Syndrome (SIDS)- after accounting for confounders
  • Allergic disease
  • Celiac disease
  • Irritable Bowel Syndrome (IBS)
  • Obesity
  • Type I Diabetes
  • Childhood Leukemia and Lymphoma

Some of the proven health benefits for the mother (time dependent) of breastfeeding:

  • Decreased postpartum blood loss
  • More rapid involution of the uterus (post childbirth)
  • Increased child spacing (lactational amenorrhea)
  • Possible decrease in postpartum depression
  • Decreased risk of Type 2 Diabetes
  • Inverse between breastfeeding and rheumatoid arthritis
  • Reduction in hypertension, Cardiovascular Disease (CVD)
  • Reduction in breast and ovarian cancer
  • Reduction in osteoporosis

Additional benefits from breastfeeding annually:

  • $13 million in direct health care savings
  • Prevention of at least 5,000 cases of breast cancer
  • Prevention of at least 54,000 cases of hypertension
  • Prevention of at least 14,000 heart attacks
  • Prevention of the three outcomes above result in about $860 Million in health care savings

Breastfeeding is good public health.  Maybe we should start investing more in making sure babies are able to be breastfed and, if not- afford them the ability to receive affordable and safe breast milk.  We MUST stop considering breastfeeding as a woman’s lifestyle choice and view it for what it really is:  an important health issue, a public health issue and a human right.

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Pinning Public Health: A Spotlight on Hamilton County Public Health

On June 18, 2013 "How and Why Should We Pin Public Health?" became one of Pop Health's most popular blog posts.  So you can imagine my excitement to share a follow-up piece that spotlights the Pinterest work at the Hamilton County, Ohio Public Health Department! 

Today's post is written by Christy Cauley, M.Ed., an Electronic Communications Specialist, who is responsible for the department's social media strategy.  Hamilton County Public Health (HamCoHealth) was established in 1919 to serve more than 460,000 Hamilton County residents living outside the cities of Cincinnati, Norwood, Sharonville and Springdale. With a staff of more than 80, including sanitarians, plumbers, health educators, nurses and epidemiologists, Hamilton County Public Health strives to prevent disease and injury, promote wellness, and protect people from environmental hazards.  

I am very fortunate to work for a local public health department that understands the value of a strong social media presence. Hamilton County Public Health  has a strong presence on Facebook, Twitter and YouTube and now we’re expanding our presence on Google+ and Pinterest. The latter’s image-centered format poses many challenges to public health entities. After all, who wants to look at pictures of syphilis?

That simply means we have to get creative. Rather than pinning a picture of syphilis, I’ll pin a picture of a cute stuffed amoeba that represents syphilis. The photo still links to an article that lets everyone know there is a syphilis epidemic in Cincinnati and what they can do about it, but they are spared the sometimes graphic images that are associated with public health.

We also have to consider our audience. Our Pinterest audience is quite different from other social media outlets. For starters, there is a much stronger female presence on Pinterest. In fact, the vast majority of our followers are women. That affects our pins and our boards – we have a Women’s Health board for example. Our pins have much more to do with family health and safety than our other social media pages. We tend to focus on health, nutrition and fitness, things that matter more to women than men. We have many pins on Pinterest that do not make it to our Facebook or Google+ pages because the audience just isn’t right for it.

Growing our audience has been challenging on Pinterest. Few people outside the profession are really interested in public health until there is a reason to be interested – like an outbreak of West Nile Virus, for example. We take the usual steps – following others’ boards, liking, commenting and repinning when possible. But what we really want is interaction with our stakeholders on our own boards. We want to get our messages out and know that our audience is hearing them.

To help with that goal, we have “public” boards where we allow others to post to our boards (and we have been invited to do the same). This creates boards with people of similar interests who can share pins more easily. We are careful to include a disclaimer on these boards however, and we do monitor outside pins. Our public health and safety boards can only be pinned on by us, but our recipe and fitness boards are open for our followers to share their favorite pins and they do. We pin to a public board called Health Communication & Social Media from Raed Mansour, where social media and communications professionals can share their ideas. Before, our only interaction with these professionals was on Twitter.

Interestingly enough, the place where we receive the most interaction on Pinterest is one of the public boards we were invited to pin to – Cat World, a board by Joyce Egoodman. Yep, you read that right, Cat World. What does that have to do with public health, you ask? Not a lot, although we can connect pets to our emergency preparedness and heat safety topics quite easily. But, people who love cats are our stakeholders. Public health affects everyone, even our pets. And who doesn’t like cute cat pictures?

How it works is we will find the cutest cat picture on our following boards in the morning and repin it to Cat World with a message about public health or safety. That pin then gets repinned by anyone who likes the picture – not necessarily the message. In turn, our message gets disseminated all over Pinterest and it only took a few seconds of our time. Our Cat World pins get commented on, liked and repinned much more often than our other pins because that board has a wider audience (for now).

One of the Social Media for Public Health (#SM4PH) Twitter chat participants (@AmandaMPH) mentioned that there is a LOT of unhealthy dieting information on Pinterest and we have also found that to be the case. That’s one of the reasons it’s so important for health departments to have a presence on Pinterest, so we can put out accurate information that people can trust.

We’ve found that the image is as important as the message. As a result, we keep our messages short and sweet and we keep our pictures creative. For example, did you know Ryan Gosling is the poster boy for public health? There are hundreds, maybe even thousands of Ryan Gosling memes and many of them are public health centered. We try to utilize them on “Fun Friday” as much as possible.

Another small thing we do is change our board covers often. When new stakeholders visit our page, we want them to see a captivating image that makes them want to view the board, but we also want to make sure that the pin in question is toward the top of the board. I can’t tell you how many pages I’ve visited where I wanted to repin the board cover image, but once I clicked the board, it went on forever and the cover photo was nowhere to be found. We want our stakeholders to find things easily. It’s a small thing, but don’t underestimate its importance to the aesthetics of your page. And don’t neglect the description and category areas either.

We have also taken advantage of @PinGraphy, which allows us to schedule pins for certain times and days. When interaction matters so much and we do not have someone on social media on the weekends, this tool is invaluable. (We use HootSuite for scheduling our other social media sites.)

Getting our feet wet in Pinterest has been challenging. We have made a lot of changes to our boards since we started in response to feedback from users. We’re still learning, but we hope that Pinterest will be a valuable tool in spreading our messages about public health and safety issues in Hamilton County, Ohio and throughout the world.

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A Pop Health Book Review of “My Foreign Cities: A Memoir”

I cannot remember the last time I was so engrossed in a book that I looked up with shock to see the clock read 2:00am.  Well, that happened to me on both Friday night (when I started) and Saturday night (when I finished) the book “My Foreign Cities”.  The memoir chronicles the love story between author Elizabeth Scarboro and Stephen Evans.  In late high school/early college, their friendship grew into love and Elizabeth chose to be with Stephen, even though she knew his cystic fibrosis (CF) would limit his life expectancy (30 years old on average), impact her choices, and reduce their time together:

"In comparison to Stephen, most things would be there.  If I wanted him, I had to hurry up" (page 36).

While there were numerous public health topics of interest in this book, I was most struck by the strength, resilience, and creativity that Elizabeth brought to her role as a caregiver.  While the focus was on Stephen's health, we also learned how and when she needed to take care of herself.  Many of her words have stayed with me, so I'm weaving her eloquent quotes into this review.

Throughout the book, I was surprised by how she could both focus on the present and think about her future.  Even though she knew that future would not include Stephen at some point:

"Back then, this was my plan to get through Stephen's death: I'd have a life, a self, I wanted to continue after he was gone.  But I couldn't invent that on the spot- it would have to already be there, which meant I'd need to live it while he was here too" (page 79).

Because of this mindset, the reader gets to hear about the risks and adventures they took- both big and small.  The big being the trips to Mexico, Hawaii, Scotland, and Ireland- the moves to San Francisco, Boston, and back to San Francisco again- going to graduate school- and getting married.  The small being the clandestine escapes to the hospital roof for privacy during a long stay and their wonderful hikes around their homes in Denver and San Francisco.  Elizabeth's writing is so vivid that you can see the scenery, feel the air on your face, and sometimes hear Stephen's labored breathing.

When Stephen struggles with a dangerous addiction to his pain medication, we are reminded that caregivers deal with all the side effects and dangers that surround an illness- not just the disease itself.  Stephen managed to hide the addiction from Elizabeth for almost a year.  Their relationship and communication were challenged as she tried various solutions to the problem- locking up the medications, alerting his physicians. Elizabeth talks about how his withdrawal symptoms and subtle disclosures were often lost on her because she always viewed things within the larger context of CF:

"But that was the great thing, and the dangerous thing, about life-threatening illness- every other problem appeared like a sideshow when cast in its light" (page 108).

When Elizabeth battles depression during Stephen's recovery from a double lung transplant, we are reminded that caregivers have their limits and that self-care is incredibly important:

"And then I crashed.  Not in the way that Stephen might have, with none of the magnitude or danger, but in the way of a healthy person, slipping slowly, with the strong sense that it couldn't be happening, I could fix it if I just tried hard enough.  Maybe I crashed because I finally could, because Stephen was okay" (page 188).

During her recovery from depression and later- as Stephen's condition worsens, the reader is introduced to Elizabeth's amazing support network.  I can only hope that every caregiver has a group of friends/family like hers:

"Back home, my friends converged to take care of me, like incredibly skilled dancers, hiding the work of it, moving so seamlessly that I barely noticed the details, I just felt, underneath me, a solid floor" (page 273).

I would highly recommend this book to public health professionals, clinicians, patients, and caregivers.  While some parts are heartbreaking, the theme of resilience dominates.  We also get an inside view to patients and caregivers that should help us think about access to health care, quality of life, and the empowerment of patients.

I would also recommend this book because Stephen was one of us.  After college, he enrolled at the Harvard School of Public Health to pursue his interest in health care policy:

"Stephen was most concerned about how people without insurance would be managed, or worse, not taken into account at all.  He felt indebted to the California state system that covered CF, and he wanted to give back" (page 103).

I hope this book helps continue this legacy for Stephen.  I hope the book ignites conversation about access to care, coverage for the uninsured, and support for chronic illness patients, transplant patients, and their families.

Supplemental Information:

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Instagram It! Using Instagram for Public Health

This week's guest post for Pop Health was written by Alyssa Anderson.  She is a Community Health Education graduate student focusing on health promotion and work site wellness. Originally, she thought employee wellness was her niche but soon discovered that social media took 1st place in her heart. Finding ways to weave health promotion, marketing, and communication with social media is her main focus these days. She currently lives on Pensacola Beach, FL, enjoying her slice of paradise on the Gulf Coast. 

Follow Alyssa on Twitter, Instagram, and pin with her here!

There is certainly a wide range of social media channels discussed on Pop Health. However, as I was browsing and chatting with Leah about this guest post, we discovered that Instagram had not yet been covered. I jumped at the opportunity to highlight some public health organizations using this channel. And with the revealing of Instagram Video, the timing just seemed perfect.

A quick search of Instagram revealed that a number of public health organizations are actively using this photo-sharing application.

  • Chicago Department of Public Health (By the way, congratulations to the Blackhawks!)
  • American Public Health Association
  • Austin, TX Department of Health and Human Services (what they did is really great, more to come!)
  • The Red Pump Project (Hey, National HIV Testing Day is June 27!)
  • American Cancer Society
  • The list continues…

While there are quite a few public health organizations on Instagram, their usage differs. For example, Chicago Department of Public Health is sharing mostly promotional messages, such as


It may seem simple and a no-brainer, but these posts have received little engagement. A "like" here, a comment there, but no real involvement from other followers.  In fact, Chicago Department of Public Health only has 195 followers. In a city of 2.7 million, their Instagram is having very little reach.

On the other hand, the Red Pump Project has 905 followers. They promote awareness and education for women and girls about HIV/AIDS using the red shoe as their symbol. Users can tag their pictures with #RockTheRedPump to show their support. Typical posts are from events, putting faces to their movement, and event promotion. Here are a few snapshots:






The images are more colorful and vibrant than those posted by the Chicago Department of Public Health. And some image descriptions have a call to action…asking followers to like and share, comment below, etc. The second picture has 47 likes and most have over 20 likes with comments.

On social media, using calls to action or cues inspires people to do just that. Regardless of the message or reason for using social media, engaging with your target audience is key and helps to expand your reach.

Now, the city of Austin tried something this past April during National Public Health Week. They tasked their audience, the citizens in the city to help them answer a question: What is public health? Instagram users were to snap a picture of what public health means to them in Austin with the unique tag #austinpublichealth.

Such a great idea! Think about it, a photo journey from your target audience about what public health means to them. You could almost use these as unfocused focus groups and see what your audience does with the resources you have provided.

Unfortunately, only 17 pictures were tagged with #austinpublichealth. Bummer.
Here’s what I think could have gone better:

  • Promote, promote, promote! If these pictures were to be part of a larger campaign, creative marketing strategies to get the word out could have been used.
  • Incentives. As much as we want to believe everyone cares about public health, you sometimes have to lead people with a carrot. There could possibly be red tape with giving away prizes to the best picture, but perhaps an award or certificate could have been used.
  • Engage. No other users engaged with the 17 pictures, no one championed the program from the department.

So we’ve seen the good (The Red Pump Project), the bad (Stanley Cup winning Chicago…I’ve got to throw my hometown a bone!), and the different (#austinPublicHealth). The biggest take-away from this would be inviting engagement.

  • Tell people what you want them to do, kindly. Share this post! Double-tap if you think #vaccines rock! 
  • Take interesting pictures. We see your event posters all over town and we’re just as blind to them online as we are in real life. Snap a shot of a child wearing a bike helmet and elbow pads instead of a flyer with Bike Safety Tips listed. 
  • Be a real person. People want to engage with other people, not ambiguous brands or images.
  • Test NEW things. Don’t be afraid to try things out and don’t feel bad if they fall flat! 

And since we are discussing trying new things, have you tried Instagram Video? How do you like it compared to Vine? I think the length is going to be great for public health professionals, much better than a 6 second loop. What sorts of videos would you like to see for #publichealth?

(P.S. Comment below and share this with your friends!)

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How and Why Should We "Pin" Public Health?


I regularly participate in the social media for public health (#sm4ph) twitterchat.  The chat (sponsored by the Public Health Management Corporation and hosted by Jim Garrow) explores various forms of social media use and how they impact (or could impact!) public health.  Back in March, the following question was posed to twitterchat participants:


At the time, I took note that several participants (including me) thought that Pinterest could be "the next big thing" (FYI: Pinterest is an online pinboard that allows users to create and share image collections):


Then this week, Nicole Ghanie-Opondo posed an important question to the field:  "Is Public Health Pinnable?"  She does a great job of breaking down all the "stuff" public health people want to pin (i.e., campaign posters, event information, staff photos) and analyzing why or why not it is a good fit for this particular communication channel.  She also emphasizes the key principle we need to remember and revisit in health communication:  

Think About Your Audience!  

When exploring any new communication channel, we need to review available data regarding the demographics and online behaviors of those users (whether it be Pinterest or Facebook or Twitter) and then tailor our content/strategies to those users.  The Pew Research Center's Internet & American Life Project is a great resource for social media user data.

In preparation for this post, I followed up with Nicole to see if she had received any feedback from public health colleagues on her post.  She shared the major theme from her (informal) feedback so far:  

Public health is not creating content to optimize pins.

I thought that was really interesting and it changes the conversation for me.  The question is not: "Should we use Pinterest- yes or no?"  There seems to be enough evidence that Pinterest is a promising communication strategy.  For instance we have: (1) strong interest in Pinterest from the field (as seen above), (2) available data on its users, (3) key audiences represented among users (e.g., women), and (4) colleagues that are successfully integrating this channel into their social media plans (e.g., CDC and Hamilton County Public Health).

Therefore, the question should become:  "How can we use Pinterest strategically in public health?"  This approach would require a discussion of the following questions:

  • What audience/s should we be engaging on Pinterest?
  • What kinds of content/images are most likely to be re-pinned or shared?
  • How can we optimize our content for pinning?
  • How are we evaluating our Pinterest efforts? (*Note that CDC's National Prevention Information Network (NPIN) recently had a wonderful webcast on social media evaluation. While Pinterest was not one of the featured channels, many of the concepts and resources would still be applicable.  The slides are available here).

Tell Me What You Think:
  • Why (or why not) should we "pin" public health?
  • How should we "pin" public health?
  • What other planning questions should be considered?
  • Please share examples of Pinterest being used successfully (or unsuccessfully) in public health!

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The Moore Tornado Reminds Us That "Sheltering" Is A Community-Level Concern

As the news of the Moore, Oklahoma tornado flooded in on Monday, the images were terrifying.  Over and over, Meteorologists kept saying- "it would be very hard to survive this storm above ground".  And then we heard that basements and safe rooms are not common in Moore.  Safe rooms being structures that are reinforced to withstand 200+ MPH winds.

So how can that be?  How can a town situated in an area of the country ripe with tornado activity be without basements and safe rooms?

Well- as with most public health challenges, the answers are complex:

Environmental:  The soil in the state is comprised mostly of clay.  The bedrock is mostly limestone.  Both absorb water and become unreliable foundations for a basement.

Urban Sprawl:  As The Atlantic points out, "One reason tornadoes prove so deadly now is that, given the spread of the suburbs, their funnels simply stand a better chance of touching down where people are".  Therefore, instead of striking farmland, these tornadoes are striking homes and schools and shopping centers- many without sufficient sheltering options.

Cost: Various estimates have been given over the past two days, but NBC News reports that individual home safe rooms can cost $8,000-$10,000 to construct.  There is a lottery to receive state assistance for these costs.  The most recent lottery selected 500 homeowners...out of 16,000 applications.  The city of Moore recently applied for $2 Million in federal aid to help build safe rooms in an additional 800 homes.  City officials report that the program was delayed because FEMA standards were a "constantly changing target".

There are additional cost challenges at the community-level.  NBC News reported that it would cost $1.4 Million to construct safe rooms in each school.

Access:  The City of Moore has no community (or "public") tornado shelters.  On their website, they attribute this to two reasons:  (1) People take less risk by sheltering in place and (2) There is no public building in Moore that is suitable for a shelter.

With hindsight being 20/20, it is heartbreaking  to read the following statement on their site:

"Statistically, there is only about a 1-2% chance of a tornado - of any size - striking Moore on any particular day during the spring. But of all tornadoes that do strike us (again, not very many historically), there's only a less than 1% chance of it being as strong and violent as what we experienced on May 3rd [1999]".  

Interestingly, "May 3rd" (as it is often abbreviated), shined a light on the need to shift from individual (family) shelters only to community-level ones.  Shortly after that storm, FEMA released design and construction guidance for community safe rooms.  Many communities, such as nearby Tushka, OK, have constructed such rooms very successfully.

In public health, we assess health needs and change the conversation from individual-level to community-level solutions.  We need that frame of mind to improve emergency preparedness planning for tornadoes.  As Megan Garber writes for The Atlantic:

"The old, Wizard of Oz-style model of sheltering -- every farm with its cellar -- is slowly giving way, in the age of suburban sprawl, to large shelters meant to house large groups of people".    

"Sheltering, in other words, is moving from an individual concern to a collective one". 


Tell Me What You Think:

  • What are some solutions to the challenges (environmental, cost, access) listed above?
  • What is your reaction to the shift from individual to community-level shelters?

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Angelina Jolie's "Medical Choice" Dominates the Internet

I woke up this morning to the quintessential Pop Health story.  Angelina Jolie published an op-ed called "My Medical Choice" in the New York Times.  She talks about undergoing a preventative double mastectomy in February 2013 after genetic testing revealed that she carried the BRCA1 gene.

As I inventoried her column and the online chatter today, I worried that I missed the boat!  Dozens of bloggers and news outlets wrote about her op-ed within hours of its posting...what else could I add to the conversation?

With so many posts for readers to sift through- many of which focus on very specific issues (e.g., the efficacy of preventative mastectomies)- I decided to add to the conversation by cataloging the public health implications being discussed:

Angelina as a "champion" for breast cancer prevention: will her celebrity status help or hurt the cause?:  Most of the articles and comments that I read in response to her op-ed were overwhelmingly positive.  This is exemplified by an open letter on KevinMD.com written by Dr. James Salwitz.  He praises Angelina for her bravery and leadership in the battle against breast cancer.  He goes on to state, "Your action will save more lives than all the patients I could help, even if I were to practice oncology for hundreds of years".  On the flip side, a few writers/commenters raised the concern that Angelina's influential status in conjunction with her decision to have surgery could cause women to panic about their own breast cancer risks.  For example, David Kroll writes for Forbes, "For all the bravery of Ms. Jolie and the positive groundswell that her op-ed generates, I also want to be sure that women with breast cancer - women who are already scared - do not feel the extra burden that they’re not doing enough if they don’t consider a double mastectomy".

I thought that Linda Holmes (of NPR's pop culture blog) did a really nice job of reconciling Angelina's role as both "celebrity" and "champion" in her post called "Why Angelina Jolie's Op-Ed Matters".

Legal and Policy Issues:  BRCA Genetic Testing:  On April 15, 2013, the Supreme Court heard oral arguments challenging Myriad Genetics' patents on "the breast cancer genes".  As a side note: I do not remember hearing about this story last month- perhaps because the Boston Marathon bombings also took place on April 15th?  The concern is that such patents inhibit scientific advancements, keep testing costs high- and therefore limit access to the testing.  Angelina alludes to this in her op-ed when she reveals that the BRCA1 and BRCA2 testing costs approximately $3,000 in the U.S.  Sarah Kliff from The Washington Post notes that this testing "is about to get significantly less expensive: The Affordable Care Act included the genetic test among the preventive services that insurers are required to cover without any cost sharing".

Health Communication- Risk Perception:  Nancy Shute wrote an interesting piece for NPR entitled, "Angelina Jolie and the Rise of Preventative Mastectomies".  She interviews Dr. Todd Tuttle, who raises concerns about women overestimating their risk of breast cancer (in the other breast after being diagnosed on one side) and choosing more invasive treatment like mastectomy when not medically necessary.  Shute also discusses some potential contributors to the increases in risk perception and preventative mastectomy. For example, she mentions advancements in breast surgeries/reconstructions and the "hyper-awareness" of breast cancer resulting from ubiquitous pink ribbon campaigns.  Many of these contributors were discussed two weeks ago in the must-read The New York Times Magazine article "Our Feel Good War on Breast Cancer" by Peggy Orenstein.

Reviewing the Evidence Base for Recommending BRCA Testing or Preventative Mastectomies:  Many articles focused on reviewing what we know about the effectiveness of (1) BRCA testing for predicting cancer and (2) mastectomies for preventing cancer death.  Several articles linked to the CDC feature, "When is BRCA Genetic Testing for Breast and Ovarian Cancer Appropriate"?  Sarah Kliff discusses why "Most Women Probably Shouldn't Get the Cancer Screening Angelina Jolie Did".  NPR linked to a 2010 Journal of the American Medical Association (JAMA) article that provided the "clearest evidence yet that women carrying the BRCA1 and BRCA2 genes should consider preventive surgery because they are at a very high risk for breast and ovarian cancers."

With so many articles and blogs to sift through, I could probably keep going.  But I'd like to stop and hear from you:

  • What other public health implications could result from Angelina Jolie's disclosure in today's New York Times?
  • How do you think her disclosure could impact the issues I've raised above- risk perception, policy decisions, etc?
  • I've linked to some of the articles that I read today- are there others that you would recommend to me and Pop Health readers?

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"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

  • Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.
Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.
  • Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.
Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.
  • Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".
Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:
  • What have been your favorite episodes of "Call the Midwife"?
  • What other public health issues are portrayed in the 1950s that still challenge us today?

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Kudos to The New York Times Magazine for Examining the "Feel-Good War" on Breast Cancer!

In last week's The New York Times Magazine, Peggy Orenstein wrote an article called "Our Feel-Good War on Breast Cancer".  The piece is lengthy but well researched, insightful, and well worth the reading time.

Peggy, a breast cancer survivor herself, hits every key public health issue- cancer screenings, treatment options, "awareness" raising, message framing, funding, and research.  As someone who has been critical of "awareness" raising, I was happy to see the issue discussed front and center.  For me, her interview with Dr. Gayle Sulik (Sociologist and Founder of the Breast Cancer Consortium) was the most striking.  A key quote from Dr. Sulik (I added the bolding):

“You have to look at the agenda for each program involved.  If the goal is eradication of breast cancer, how close are we to that? Not very close at all. If the agenda is awareness, what is it making us aware of? That breast cancer exists? That it’s important? ‘Awareness’ has become narrowed until it just means ‘visibility.’ And that’s where the movement has failed. That’s where it’s lost its momentum to move further.”

Peggy also tackles the issue that is an ongoing challenge in public health and medicine:  screening.  Screenings are tests that look for diseases before you have symptoms.  Ideally, screening will identify diseases early when they are easier to treat and have better outcomes.  For breast cancer, the key screening test is a mammogram (x-ray of the breasts).  However (as Peggy points out), we seldom hear about the research that demonstrates limited effectiveness of mammograms for reducing cancer death.  This is not the research cited in the communication materials from advocacy organizations.  We also tend not to hear about the negative side effects of screening large segments of the population.  There can be false positive tests: which subject the patient to unnecessary medical intervention and emotional distress.  There can also be over-treatment for the detected cancer, even if it turns out to be a non-aggressive tumor.

When I was working in suicide prevention, one of the best articles I read was "Screening as an Approach for Adolescent Suicide Prevention" by Dr. Juan Pena and Dr. Eric Caine.  The authors dedicate a section of the paper to key decisions and tasks to resolve before implementing a screening program.  While the public health issue and screening tests are different, I believe many of their decision points are generalizable to almost any health issue.  The table presenting these decisions and tasks is a great reminder to public health professionals and clinicians that recommending and undertaking a screening program should be strategic and the decision should be re-visited regularly.  For example, the authors highlight:
  • Key Decision:  Population and Setting- Is the screening program consistent with the target population's community or cultural values?
  • Key Decision:  Screening Instrument- What will be the false positives and false negatives rates in the population to be screened?  Are these rates acceptable?
  • Key Decision:  Staffing and Referral Network- Are there effective treatments available for the types of conditions being screened for?
  • Key Decision:  Quality Assurance- How will the screening program be monitored to ensure that protocols are followed?
  • Key Decision:  Legal and Ethical Issues- Has sufficient informed consent been given to parents and youth about risks, benefits, and limits of screening?

Going back to the "Feel-Good War" article:  I like that Peggy did not just point out all the flaws in our current breast cancer screening and treatment systems.  Instead, she invited her interviewees to recommend potential improvements.  Some ideas were noted in two key areas:
  • Message Re-Framing:  Rather than offering blanket assurances that “mammograms save lives,” advocacy groups might try a more realistic campaign tag line. The researcher Gilbert Welch has suggested this message, “Mammography has both benefits and harms — that’s why it’s a personal decision.”
  • Funding Re-Distribution:  Peggy asked scientists and advocates how some of that "awareness" money could be spent differently. She highlights the February recommendations of a Congressional panel (made up of advocates, scientists and government officials) that called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities. 

Tell Me What You Think:
  • What do you think about the "pink culture" or awareness raising around breast cancer?  Will it effectively lead us to our goal of prevention?
  • In addition to message re-framing and funding re-distribution, what else would you recommend to help improve the approach to breast cancer prevention, screening, and treatment?


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"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)

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