Author: Guest Blogger

Had unprotected sex? Text for help!

This post was written by E. Cameron Hartofelis. Cameron is an MA/MPH candidate in Communication Studies and Maternal Child Health at UNC-Chapel Hill, and will graduate in May 2013. Her work centers on the reduction of barriers to sexual and reproductive healthcare in the United States.

TextForHelpEver had a question about your sexual health that couldn’t wait for a visit to the doctor? What about a question you were too embarrassed to ask a friend? Though the internet can serve as a clearinghouse of information around any subject, sometimes it’s nice to have a person respond to a pressing question.

Planned Parenthood is among a number of sexual and reproductive health providers and organizations in the past year to reach out to their patients with an electronic hand. In September of 2012 they launched their Text and Chat Hotline which includes a web and texting component. The service is specifically geared towards teens who might have less access to information or services, though they happily accommodate requests from all askers. And, this service promises not only a prompt response, but a response from a real, live certified health educator.

This is a fairly new program, but it isn’t entirely novel. Hotlines, such as Exhale, have been providing answers and support around issues of sexual and reproductive health for years. And websites such as Scarleteen offer resources, message boards, and a virtual community to answer teens’ questions about sex. Though the technology and interventions aren’t new, more work needs to be done to better understand the efficacy  and impact of programs such as these in comparison to services offered in person.

So – when you next have an urgent question about sex or sexual health, will you grab your cell phone and text for answers, or are there questions better answered face-to-face?

Image source:

Is TV ‘ad’-ing to underage drinking?


This post was written by Shannon Clancy, a graduate student in the Gillings School of Global Public Health at UNC-Chapel Hill.

This weekend’s Super Bowl will attract millions of viewers. Many will tune in not for the big game but for the greatly anticipated commercials that are bound to incite laughter and dominate water cooler conversations Monday morning. This is one weekend where all eyes are on the pithy pitches of companies like Frito-Lay®, Pepsi Co. ® , and Budweiser®.

While dipping chips and watching football, health is probably a distant afterthought – but do television advertisements have an effect on our health behaviors?

A recent study conducted at the School of Community and Global health at Claremont Graduate University in California found that teens who liked alcohol ads were more likely to be persuaded to try it. Results from this study demonstrated that exposure to ads had a significant correlation with alcohol use, especially among girls. For both boys and girls, the greater their exposure to ads, the more their alcohol use increased from seventh to tenth grade. These results were consistent even when controlling for time spent watching television, involvement in extracurricular activities, and being around friends and well-known adults that drink.

This study coincides with additional research on the growing problem of underage drinking released last week. According to the National Institute on Alcohol Abuse and Alcoholism, in 2010, more than a third of tenth graders drank, and one in four had been drunk in the past month.

Recognizing the power of television, public health has also established a presence on television through public service announcements and story lines on popular TV series that draw attention to the consequence and risks of excessive and underage drinking. Nevertheless, the airways are dominated by the lavish advertising budgets of industry giants like AB InBev and MillerCoors touting six packs (in various forms).

It’s unlikely that advertising regulations will change in the near future, but with social media it is more feasible than ever for public health and other organizations to create and deliver messages about the hazards of drinking that resonate with young people.  Technology and media aside, adults and health professionals don’t need fancy images or creative slogans to have a talk with teens and give them a more truthful understanding of alcohol.

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Finding the eHealth Gems

This post was written by Linden Thayer, a doctoral student in Nutrition Intervention and Policy at UNC-Chapel Hill. Her passions include school- and family-based child obesity prevention, health communication, and gardens.

eHealth: “the use of emerging information and communication technology, especially the Internet, to improve or enable health and health care” (Eng 2001)

eHealth, to this public health specialist, sounds like the Holy Grail. eHealth offers a way to improve efficacy and reach of preventive health programs at a lower cost than traditional approaches, such as in-person counseling or group-based programs. (Think about it: design one app to detect skin cancer, launch, and reach thousands of people for the same price!)

But when it comes to using all these fabulous apps and websites, I have to wonder: how do I get individuals to find my programs and use what I think are the best resources?  To illustrate this dilemma, I just entered the second trimester of my first pregnancy and I thought it would be fun to explore pregnancy apps. A quick Google search brought back hundreds of possibilities and, instead of sifting through the clutter, I gave up. Who wants to bother figuring out which apps are evidence-based and which ones are not worth anyone’s time?

If someone had recommended an app to me, I might have tried it. Which reminds me that even in a digital world, we still rely heavily on real people (and their experiences and expertise) to help us navigate and evaluate the options. When it comes to eHealth and the quest to connect real people to effective eHealth technologies, I would love to have one trusted government, not-for-profit or foundation website that aggregates, analyzes and recommends eHealth programs. The National Cancer Institute and the Center for Training and Research Translation are two examples of groups that review health programs, but they do not have a way to identify eHealth programs (websites, apps, video games, etc.) in particular.

If you know of some excellent eHealth-review resources, please share! And if they are not out there yet, we need to find the right people for the job because, as more programs are developed, users are going to need more guidance to sift through the sand and find the eHealth gems.

Image source: Stuart Miles and

Obesity and the Potential Power of Black Media

It is no secret that obesity is a major health crisis in the United States. This epidemic especially plagues Black Americans across the nation. The recent obesity-related, premature deaths of Black celebrities, including rappers Heavy D and Nate Dogg, actor Michael Clarke Duncan, singer Whitney Houston, and comedian Patrice O’Neal, have garnered more attention from Black media outlets about obesity-related health problems.

Recently, Michael Baisden Live, a nationally broadcast daily radio show popular among Black adults, used these deaths as a starting point for having on-air discussions with health experts and its listening audience about the negative health effects of obesity and how to prevent them. The discussions have included segments on obesity-related morbidity and mortality, as well as exercise and diet tips. Another popular Black media outlet, The has special section on its site dedicated to a variety of obesity-related topics (e.g. long-term effects of obesity, obesity and mental health, and policies and programs designed to reduce obesity).

Some Black media outlets provide excellent opportunities for their audiences to receive information about the impact of obesity on the Black community and how to prevent the disease. Additionally, by providing time for listeners to call in or allowing users to comment on news stories, these media outlets provide the opportunity for users to have two-way discussions on their successes and challenges with obesity prevention—which may lead to better uptake of obesity-prevention activities.

One challenge is to determine how best to harness the power of Black media outlets to discuss obesity in such a way that it produces behavior change in members of the audience. Additionally, the majority of the available media outlets are targeted toward adults. Given that obesity is a growing problem among children, another challenge will be to figure out how to facilitate the same level of engagement in obesity prevention among Black children that is being observed among Black adults.

This post is a guest blog written by Andre Brown. Andre is a doctoral student in the Department of Health Behavior, UNC Gillings School of Global Public Health. 

Communicating about genes and health: How do we do it?

How do we talk about how genes contribute to our health status?

In my recent book, Talking about health: Why communication matters [Wiley-Blackwell, 2009], I weave the stories of family members’ health experiences with information about health communication research and practice. Among the topics considered is how we talk about family health history and genetic contributors to health status. My research has been focused in this area for more than a decade. I have been working to identify frameworks to guide health communication, with particular attention on explaining public perspectives that contrast with genetic determinism. I explain that most of us have views about how genes contribute to health that are more relativistic. It depends.

Even for families and diagnosed individuals who have single-gene disorders or chromosomal conditions, beliefs form around why genes affect health. Some of this work is highlighted in a story released March 12th by the Penn State Newswire.

While we do not all hold the same beliefs guiding our understanding of how genes relate to health, outlooks do form several consistent patterns, leading to possibilities to customize communication about genes and health. Integrated relativists, for example, regard personal behavior, and social contributors such as family and friends and stress, and even religious faith and spirituality to play important roles in when and how genes relate to health. Uncertain relativists are not confident that any of these play a role. Personal control relativists regard their personal behavior to be the most important predictor of genes’ role for health. Genetic determinists are confident that none of these impact genes’ role. These frameworks will guide future research relating to how to construct public health genomic messages, as well as genetic counseling approaches. We hope findings in this field will contribute to understanding of decisions related to genetics and health, both inside and outside clinical settings.

What do you think about these frameworks for understanding the relationship between genetics and health?

Roxanne L Parrott, PhD

Distinguished Professor

Pennsylvania State University



Blinded by the light

An intriguing new skin cancer prevention campaign from the UK-based non-profit Skcin had 14,000 sun worshippers logging onto their site to receive messages about skin cancer.   How did they do it?  By telling them there is a way to make the effects of the sun even stronger.

Starting with a teaser campaign in magazines and social media, potential “customers” are directed to a website claiming to sell a new product that makes the sun work three times as hard while tanning.  The visitor is asked to input their contact information to receive a free sample of this miracle cream.  Instead of receiving a confirmation that their order is on the way, a pop-up message reveals that there is no such product and, in fact, sun exposure is linked to skin cancer, which is a leading cause of death in the UK.  These statements are followed by jarring close-up images of skin cancer lesions and an invitation to visit a website that promotes self-protection from the sun and skin cancer.

An interesting approach for sure, but how many of these tanners will spend their next beach trip under an umbrella, slathered in SPF 50+?  Behavioral science would suggest that it won’t be very many.

There are a few reasons for this.

First, the campaign targets those who are unlikely to be ready to change their current behavior, and does so in a way that is deceptive.  By focusing on an audience that’s not apt to be interested in engaging in preventative behaviors (i.e. people who are actually looking to make the sun’s effects STRONGER, not trying to protect themselves from it), they probably won’t consider the message to be relevant or applicable to them, and therefore, won’t absorb it.  Also, the credibility of the source of information is undermined by using a bait-and-switch tactic that tricks people coming to the website.  These two factors combined make it almost certain that the message will be dismissed.  As anyone who has been a teenager knows, having an unrespected voice of authority telling you not to do something is the surest way to get you to do just that thing.

Second, the campaign employs a fear appeal approach.  This method of persuasion has been used in many campaigns, often intending to scare teenagers away from drugs and sex.  But the track record for this tactic is spotty.  Fear appeals don’t tend to work when the targeted audience is already entrenched in that behavior and doesn’t consider themselves at risk, like this group of extreme tanners.

Finally, the messages focus primarily on providing information about the dangers of overexposure to UV rays.  The problem with this approach is that, as with most health issues, a lack of knowledge is probably not the barrier to taking action.   In order to enact true behavior change, it is imperative to go deeper than providing information and actually speak to the motivations of the target audience.  I’d venture to guess that the average heavy sunbather has likely heard all of the warnings about skin cancer but feels that “it won’t happen to me.”  That same person may also be very concerned about their appearance.  Focusing on the more immediate and tangible adverse effects of tanning, such as leathery skin or pre-mature wrinkles, may resonate more with this audience and inspire them to take steps to adopt healthier behaviors.

That said, it is clear that with so much competition for the attention of your target audience, innovation is the key to breaking through.  The challenge now is to develop ground-breaking campaigns while using behavioral science to light the path.  Non-UV light of course.

Diane Freeman is a Behaviorist at MicroMass Communications, Inc., located in Cary, NC.   Diane is a recent graduate of UNC’s MPH program in Health Behavior and Health Education with a certificate in Global Public Health.  She also holds a B.A. in International Business from Notre Dame University of Maryland.  Diane spent several years in Cambodia designing and implementing marketing and behavior change communications campaigns for malaria patients and providers.   Diane’s current work at MicroMass focuses on using behavioral science to uncover insights and translate them into actionable strategies to achieve improved patient outcomes. 

The importance of “talk” in mass media campaigns

Why should mundane, everyday conversations between people matter when considering mass media campaign design and evaluation?  Colleagues and I have spent the last few years considering exactly that question and what we’ve found suggests we probably should spend more time monitoring social networks than we currently do.  My colleague, Marco Yzer, and I outlined at least three theoretical roles for talk — media campaign outcome, moderator, and mediator — in a 2007 review piece we wrote for Communication Yearbook.

Recently, several of us had the opportunity to empirically test the possibility of indirect mediation using data from 1,079 tobacco smokers in the Netherlands who were targeted by a smoking cessation media campaign (van den Putte et al., 2011).  While one might suspect the main role of media campaign exposure would be a direct cessation prompt, data suggested that campaign exposure also led to conversations about cessation and those conversations about cessation were subsequently linked to actual cessation attempts.  In other words, some of those people not directly exposed to the campaign nonetheless appear to have been affected indirectly through conversations that were generated in part by the campaign.

All of that suggests that actively leveraging social networks to indirectly spread campaign messages might be a useful strategy.  At the same time, such an approach is not without pitfalls, though.  In a 2010 Social Science & Medicine piece with some other colleagues (Southwell et al., 2010), for example, we reported that peer referral of health information depended in part on the availability of social networks in one’s zip code.  In that light, we might worry about disparities between people — whether in the neighborhood or in Facebook — in the extent to which some people diffuse campaign messages and others do not.

At this moment when social media are ubiquitous in popular culture, it appears that campaign evaluators and health communication scholars have plenty of work to do in assessing exactly how the myriad and sometimes complicated connections between people amplify, shape, facilitate and mitigate our carefully planned campaigns.


Southwell, B. G., Slater, J. S., Rothman, A. J., Friedenberg, L. M., Allison, T. R., & Nelson, C. L. (2010). The availability of community ties predicts likelihood of peer referral for mammography: Geographic constraints on viral marketing. Social Science & Medicine, 71(9), 1627-1635.

Southwell, B. G., & Yzer, M. C. (2007). The roles of interpersonal communication in mass media campaigns. In C. Beck (Ed.), Communication Yearbook 31 (pp. 420-462). New York: Lawrence Erlbaum Associates.

van den Putte, B., Yzer, M., Southwell, B., de Bruijn, G.-J., & Willemsen, M. (2011). Interpersonal communication as an indirect pathway for the impact of antismoking media content on smoking cessation. Journal of Health Communication, 16(5), 470-485.

This post is a guest blog written by Brian Southwell, Ph.D.
Research Professor, School of Journalism and Mass Communication, UNC-Chapel Hill
Senior Research Scientist, RTI International
He has studied a variety of topics relevant to health communication, including campaign measurement and evaluation, with special emphases on the intersection of interpersonal communication, social networks, and mass communication and on the role of aging.


Catapulting NFL concussions into the public consciousness through media advocacy

Sports-related head injuries have drawn big headlines for the past several years, with increasing attention paid to the potential health risks to young athletes.

I examined the issue of sports-related head injuries and the National Football League’s reaction from a public relations perspective in a case study, available from the Arthur W. Page Society. While the case focuses on the issue from a corporate communications standpoint, it is also illustrates how public health groups can use public relations techniques and media-based advocacy to draw attention to health issues and push for change.

Chris Nowinski and the Sports Legacy Institute used the mainstream media to catapult the issue of sports-related head injury into the public eye. Without Nowinski bringing the Waters case to the attention of Alan Schwarz and the New York Times, it is possible that the issue would not have gained recognition beyond the medical research community. In this instance, the Sports Legacy Institute acted as an issue champion, bridging the gap between the researchers and the media.

By effectively highlighting the research and the stories of the afflicted players and their families in the media, advocacy groups were able to gain leverage—in this case, though the involvement of government regulators—on the NFL and effectively pressure for policy change.

There are limits to media-based advocacy as a strategy for addressing sports-related head injury as a public health issue however. While public and governmental pressure forced the NFL to reconsider its policies, the larger project of protecting individuals from sports-related head injury will take more than just public awareness, it’s going to require a cultural shift on how we play sports.

This post is a guest blog written by Andrea Goetschius.

M.A. School of Journalism and Mass Communications, UNC Chapel Hill
Her interests in health communication include message development, social marketing and women’s health. She earned a Bachelor’s of Fine Arts in graphic design from Alfred University and worked as a graphic designer for education and health-related organizations, including LEARN NC, Ipas, and the University of North Carolina at Chapel Hill. Her work at Ipas, an international public health organization, sparked her interest in health communications.