Counting Calories

About a week ago the New York Times had a story about NYC officials working to enforce a rule requiring major fast food chains to prominently display calorie information on their menus.

It's no surprise that the restaurants are fighting back, of course. But I would be curious to see what this really might do to affect people's consumption of fast foods at these restaurants. I would tend to think that most people going to a McDonald's (or wherever) aren't going there because they think it's their healthiest option for a quick lunch. At some level they've already made a decision to trade convenience for health.

But I also wonder if the calorie numbers might truly shock some people into making different decisions. It's interesting to see where calories can "hide" in food. Just from my own experience, I remember how surprised I was after inputting some of my meals into a meal-tracking website (FitDay); there were some things I was eating that I figured were relatively healthy, but then FitDay told the real story. So perhaps someone seeing that their McDonald's deluxe breakfast with a regular biscuit has 1,380 calories (McDonald's nutrition information) will be enough to push them to different meal choices, or even other restaurants.

I can't imagine that McDonald's, or any other affected restaurant, would be all that interested in sharing information about how this sort of requirement would impact sales... That's a shame, because that would be a fantastic set of data for anyone with an interest in health information and how people make decisions regarding their health.

Kellogg's Changes Marketing to Kids

Within several days I received e-mail stories from both RWJ and Advertising Age about Kellogg's new plan for advertising to kids. The short version is that it will be restricting advertising in programs that have more than half of its viewers under the age of 12 to foods that meet particular nutritional criteria. The plan will also impact how Kellogg's markets to children on the Internet, in stores, etc. It's an impressive move that will affect ~$200M in marketing dollars.

Kellogg's is definitely taking the lead in this area, and the move is expected to impact how the rest of "Big Food" (McDonald's, Hershey, General Mills, etc.) will market to kids, too. I think the concept behind these voluntary restrictions is certainly a step in the right direction, but I also don't know how much this will really do to help fight childhood obesity. In the grand scheme of influences on children's diets - parents, other family, friends, what schools have available at lunches, socioeconomic concerns, etc. - I wonder where advertising ranks. Something tells me it's lower than most marketers would like to consider...

Either way, I think it's great that Kellogg's is making these changes. Childhood obesity is obviously a major problem in the U.S., and I think that almost any step taken to address the problem should be taken. I'll be interested to see whether or not the results of these self-restrictions by food companies can be detected by researchers with access to the right sets of data.

Fun with Podcasts

I've found that one of the best ways to avoid thinking about the Texas heat as I walk around the UT campus is to listen to my iPod. Over the course of the last year I've come up with a nice list of health-oriented podcasts that are quite handy for keeping up with current health and health communication news. I find that it's hard to listen to these podcasts without interesting ideas for projects popping up in my head, though I also think most researchers are seldom in short supply of project ideas...

In any case, here are some of my favorite podcasts that anyone reading this blog will probably find interesting and useful:

• National Institutes of Health (NIH) Podcast
  
• National Institutes of Health (NIH) Vodcast (Video)
  
• NPR: Health & Science
  
• NPR: Your Health
  

There are some others that are a little further afield that still have some interesting health/science communication implications:

• Scientific American 60-Second Science
• New York Times: Advertising Spotlight
• New York Times: Science Times

If you go to the iTunes Music Store, you should be able to search for these and find them pretty quickly. They're all free, too, which is definitely a bonus.

(Keep in mind that you don't need to have an iPod to enjoy podcasts. Just download the iTunes software and you'll be up and running in no time.)

FDA Vaccine News

I was initially alerted to this through a RWJ notice (FDA Finalizes Seasonal, Pandemic Flu Vaccine Plans) and then moved on to the actual information on the FDA website. Of course, I think it's great that the FDA posts news like this, because it's obviously important to health professionals and public health officials to know and understand what the FDA is doing. And I suspect that most people who would be looking through the FDA website wouldn't fall into the "general public" category, so some complicated language on that page might not be the worst thing in the world.

But that got me wondering where the average person would end up if they wanted to find out information about the flu vaccine. So I went to Google and searched for flu vaccine, decided that I was feeling lucky, pushed the appropriate button, and ended up on the CDC page for the flu. The page is mostly links, so it made sense to head to the key facts page, the first and most obvious link to follow. What is the first sentence on the page?

The flu is a contagious respiratory illness caused by influenza viruses.

That registers as a 12th grade reading level, if Word is to be believed. The rest of the opening paragraph (8th grade reading level) and the page as a whole (10th grade reading level) are better. But it still seems that a useful improvement could be the making that opening sentence a little simpler to understand.

I also wanted to see what someone with a little less experience on the Internet might do to find out information about the flu, so I headed to flu.com. That's a website for FluMist, "the nasal flu vaccine that helps provide healthy children and adults, aged 5 to 49, with well tolerated and effective protection against the flu." There isn't any really useful information on the page about the flu, so that's not a great option for less media literate audiences that might not be able to easily search the Internet for relevant information and websites.

In any case, it was interesting to just poke around and see what sort of information would pop up first for people interested in learning more about the flu. It's certainly clear that some of the information might be a little too complicated for some audiences, or even completely lacking in useful medical information. Just a quick, simple example of the challenges that low literate and low health literate people can run into searching for health information online.

Center for Health Promotion & Disease Prevention in Underserved Populations: Summer Research Institute

There is a great research center at The University of Texas at Austin School of Nursing, the Center for Health Promotion & Disease Prevention in Underserved Populations (CHPR). I first heard about CHPR when I came to Austin to interview, and I attended the majority of the monthly colloquia they host during the school year. All of my experiences with CHPR events and faculty have been great to this point.

One of CHPR's best programs is awarding three pilot study grants each year. It's a great system that requires interdisciplinary collaboration, and the pilot projects can help provide preliminary data and evidence to serve as a foundation for future grant applications. Part of the reason I'm a fan of this program is probably that I (along with two colleagues) was awarded one of this year's pilot grants, to fund a project titled "Exploring Cultural and Socioeconomic Factors Influencing Processing of Online Information in Low Health Literate Audiences." I'm excited to get that going and see what we discover.

Another great CHPR program is the Summer Research Institute (SRI), which brings together faculty and doctoral students to spend three days discussing topics central to conducting research on health promotion and disease prevention in underserved populations. I just completed my first SRI experience, and I imagine I'll want to attend again in the future. It was extremely useful both for the topics covered (initiating a program of research, grant writing, etc.) and the chance to meet a lot of other researchers (many of whom were from other institutions) interested in some of the same things that I'm studying. For anyone with an interest in health communication and promotion among underserved populations, I'd definitely recommend checking out the CHPR SRI.

Health Literacy Book List

I'm interested in many aspects of health communication, but I'd have to say the topic that interests me most is health literacy. For those who aren't aware, health literacy is (generally speaking) the ability of individuals to obtain, process, and then act on health information. Health literacy affects everything from patients understanding what a doctor says in the office to reading the directions on a bottle of medicine correctly.

For those who have an interest in health literacy, either as something they're already focused on or as a potential new area of research, I wanted to pass along a few book recommendations.

• Nielsen-Bohlman, L., Panzer, A., & Kindig, D. (Eds.). (2004). Health Literacy: A Prescription to End Confusion. Washington, D.C.: National Academy of Sciences.

• Schwartzberg, J. G., Vangeest, J. B., & Wang, C. (Eds.). (2004). Understanding Health Literacy: Implications For Medicine And Public Health. American Medical Association Press.

• Osborne, H. (2004). Health Literacy from A to Z: Practical Ways to Communicate Your Health. Sudbury, MA: Jones and Bartlett Publishers, Inc.

• Zarcadoolas, C., Pleasant, A., & Greer, D. (2006). Advancing health literacy: A framework for understanding and action. San Francisco, CA: Jossey-Bass.

If you're looking to get a quick overview of health literacy, I think all of these books do an excellent job of reviewing existing work and pointing out directions for future research related to health literacy. Each one offers some different and unique viewpoints, too, so going through more than one of these probably couldn't hurt.

I think this will continue to be a growing area of research in health communication, because the health literacy impacts how people process all kinds of health communication - from interpersonal communication to mass media messages. It's always interesting talking with health professionals as they give examples of things patients have done after not understanding some important health information. Developing new models for improving health literacy, or overcoming low health literacy, also provides researchers with some great opportunities to be creative with new and exciting interventions - that's certainly the reason I have enjoyed focusing on it to this point.

Behavioral and Social Science Research on Understanding and Reducing Health Disparities

My trusty NIH weekly newsletter included one interesting program announcement, titled “Behavioral and Social Science Research on Understanding and Reducing Health Disparities.” There are R01 and R21 versions available for those that are interested.

I think this is an extremely productive area of research, since there are so many communication factors involved in health disparities. I’m about to undertake a project with a couple colleagues looking at the cultural and socioeconomic factors that serve as barriers to parents raising children with health eating and exercise habits. I have at least a few ideas of some of the things that we might uncover, but I have a feeling that the focus groups we’ll be conducting will result in a lot of interesting information that should have a variety of implications - from the design of health messages to interpersonal communication among health professionals and the general public.

What I'm particularly interested in (at least right now) is the role that effective, meaningful customization of health messages might play in communication with these parents. I recently reviewed an article looking at the cultural customization of health messages, and it was disappointing how often the "customization" simply involved changing the pictures of the people in the materials. I think as health researchers and professionals continue to build on the potential of Internet-based applications to appropriately customize health messages, such messages have a chance to become much more effective. It's one thing to suggest to parents that they make sure their kids eat healthy, but it's another to provide meaningful examples of how particular foods and recipes - that might have particular cultural importance - can be changed slightly to be healthier.

One thing I also wonder, when looking at such messages, is what exactly can be done to help educate the designers of some of these health messages about the benefits of real cultural customization. I've run across a few ads recently while working on a project related to direct-to-consumer (DTC) pharmaceutical ads where different versions of the same ad simply replace a person of one ethnicity with another. How much more persuasive could such ads be if they were effectively tailored to reach different audiences? Somehow I think the costs of creating different versions of the ad would be offset by increased sales that would result from better advertisements. The same holds true for more traditional health information messages (brochures in doctor's offices, public service announcements, etc.), as I think a little short term investment in better messages could pay off with much better. I’m going to be spending a couple weeks later this summer at an advertising agency that does a lot of health-oriented work; it will be interesting to talk to the people working there and learn more about some of the decision-making processes that go on during the creation of such advertisements.

Health Communication and Nursing

So this morning my trusty RWJ e-mail subscriptions alerted me to a new Nursing Popular Topic section. While browsing around I found this Virginia program designed to bolster nurse faculty in the state. It seems to be pretty widely acknowledged that there is a serious nursing shortage in the US, and one of the underlying reasons is certainly a shortage of nursing faculty. This program will, hopefully, be a way to start addressing that problem. If it works, I would imagine that plenty of other states would copy the plan, because it clearly has potential.

This got me thinking about other ways of helping build the faculty of Nursing colleges and schools in other ways... For example, do nursing schools have any classes focusing specifically on health communication - which could range from nurse-patient interactions to helping making sure that printed materials are understandable to patients?

The first place I went looking was the Michigan State University College of Nursing. (I worked there for a number of years when I was a student at MSU, so I'm relatively familiar with the quality of the program and what goes on there.) Browsing through their academic programs, there weren't any courses focusing specifically on health communication. And this isn't meant to pick on MSU, because I'd be willing to bet there are plenty of programs all over the country that don't have courses like this; there's also a chance they have a course like what I'm talking about and the name of the class doesn't make it obvious. I also looked at The University of Texas at Austin's School of Nursing, which does have a course called "Communication in Health Care Settings" listed on its undergraduate courses listing.

In any case, I was just wondering if this might be another way of helping address the nursing shortage in the US - bringing in faculty that might not necessarily be experts in nursing, but have a related expertise (like health communication) that could tailor their information for nursing students. It could take some of the load off nursing faculty and let them focus on more nursing-specific courses, and also bring a fresh perspective that might be help strengthen the education of nursing students.

What Is a Blog?

It might not seem like a complicated question to figure out what makes a blog what it is... Yet it would appear, based on plenty of conversations that I had at the 2007 International Communication Association Conference a couple weeks ago that this is actually a tricky question.

The conversation took place during the Q&A session after a presentation I made on a project looking at how people might look at news stories differently if they were credited to an AP writer vs. a blogger¹. I don't want to ruin all the exciting and juicy details of the project (mainly since we want to publish them somewhere at some point), but let's just say that we expected people to rate the AP writer as more trustworthy and credible than the blogger... And we were quite incorrect.

One of the comments from the audience, though, touched on the fact that we showed the same exact article to subjects and simply framed it as either an AP article or something written by a blogger. But the article, no matter what frame it was placed in, was still really written like an AP article. So were subjects rating the article based on the perceived source (AP writer vs. blogger) or the style of the article (which was an AP article in both cases).

The "what makes a blog a blog?" question is something that anyone with an interest in health communication online might want to spend some time thinking about. Do blogs automatically include links to other stories and resources? Do they have to include comments, or at least the ability for users to comment on posts? What about the tone and narrative of the articles themselves... Can a blogger write an AP-style article, or do the conventions of blogs prevent such? What about the presence of ads?

In any case, it's an interesting question, and one that's a great deal more complicated than I'd have originally considered before working on this study. I see more projects on this topic on the horizon...

1. Mackert, M. & Love, B., & McKnight, D. (2007) Comparing Trust and Credibility of Old and New Media in Coverage of Health Issues. Panel at the International Communication Association Annual Convention, San Francisco, CA, May.

RWJ: Disparities and Tobacco

The Robert Wood Johnson (RWJ) Foundation has started two new Popular Topics sections on tobacco and disparities. RWJ is a great resource for news about current research on health topics, and these two new sections should become great cenralized resources for researchers with an interest in these topics.

Also, for those who aren't already making use of RWJ's e-mail services, you might want to check them out. RWJ does a very good job running e-mail newsletters on specific topics, grant news, recent research findings, etc. It's a handy resource for keeping up with the latest research into many areas of health and health communication.

Advertising to Children

A colleague passed along an interesting article¹ discussing the potential role of advertising and media literacy on how children process advertisements. The long and short of it is that the common argument that younger children are more influenced by advertising isn't truly warranted. The authors' primary conclusion is that ads reach these children of different ages (and differing levels of media literacy) through different routes; they rely on the Elaboration Likelihood Model (ELM) to explain this difference, suggesting older children are reached through the more direct central route while younger children are reached through the peripheral route.

(A random side note about Wikipedia, which I linked to for background information on ELM as a resource for those unfamiliar with the model. I find it interesting how anti-Wikipedia some academics are. I admit that it's not a resource I would necessarily encourage my students to cite for a research article, but I also think that it's a relatively good place to start looking for background information on most topics. Articles referenced in the Wikipedia text can typically provide some first good steps toward peer-reviewed work, too. I suppose the credibility of Wikipedia - and online content in general - is a topic for another day, though.)

One interesting issue in the article is the difficulties they describe conducting this literature review, given the frequent lack of details provided in articles about the study stimuli. I experienced that myself when working on a review of the telemedicine literature²; it is surprising how many articles leave out key details that most readers would likely be interested in. I know that I've changed how I write my methods sections after working on that project. That is one positive, I suppose, that came from a rather painful process of reading and coding more articles than I care to recall!

In any case, I found this article to be interesting as it might pertain to how adults of varying levels of literacy might be affected by advertisements. I don't know that I've run across a study looking at how adults with lower literacy might process health campaigns and information via a different processing route than adults with more advanced literacy skills. (That isn't to say it hasn't been done, just that I haven't had it fall onto my desk yet...) But it seems like a particularly valuable direction for research, given the growing recognition of how literacy and health literacy impacts health outcomes.

In any case, I thought this was an interesting article, and it could lead to some interesting directions for future research - both for those working directly on advertising to children and generally anyone with an interest in promoting products/behaviors to adults with lower literacy skills.

1. Livingstone, S. & Helsper, E. (2006) Does Advertising Literacy Mediate the Effects of Advertising on Children? A Critical Examination of Two Linked Research Literatures in Relation to Obesity and Food Choice. Journal of Communication, 56(3), 560-584.

2. Whitten, P., Johannessen, L. K., Soerensen, T., Gammon, D., & Mackert, M. (in press). A Systematic Review of Research Methodology in Telemedicine Studies. Journal of Telemedicine and Telecare.