The following guest post is written by Bob Mook, Editorial Manager at the Colorado Health Foundation. This post comes particularly at a useful time when the Institute of Medicine recently came out with a report on the need for better funding for public health.

If you read Pulse + Signal regularly, you already know about the value of prevention in improving health.

Unfortunately, prevention can be a “hard sell” to those who don’t follow the health sector closely. In Colorado, as in other parts of the country, budget cuts are the norm for businesses and government. Increasingly, money is the “common language” people use and understand in these lean economic times.

As health costs and insurance premiums continue to escalate, there’s been a lot of discussion about cutting costs and reducing demand for health care services. After all, no single entity has unlimited resources to devote to health care.

While many cuts are driven by economic reality, efforts to skimp on prevention funding may prove “pennywise and pound-foolish,” according to “Prevention: Strong Investments in Colorado’s Health”(PDF), a supplement of the 2011 Colorado Health Report Card. The Report Card is published by the Colorado Health Foundation in collaboration with the Colorado Health Institute,  to gauge the state’s progress in health. The Foundation also uses the Report Card to identify priority areas for grantmaking investments.

Though Colorado often gets kudos as a healthy state (no doubt because of its pleasant climate and abundant outdoor recreational activities), the latest Report Card illustrates that our grades are merely “fair to middling.”

For example, though Colorado has the “leanest” adult population of the 50 states, our obesity rate rose from 19 to 22 percent between 2010 and 2011. With the increase, Colorado lost the distinction of being the only state in the nation with an obesity rate lower than 20 percent. One study estimates the economic
impact of obesity for Colorado at $1.7 billion a year. Furthermore, the Report Card shows we lost ground in other important areas, including prenatal care (where we rank No. 31 among states) and dental care (where we fell to No. 38). All of these factors contribute to declining health for Coloradans and adversely
higher health costs for individuals who reside here.

While many of the results from the Report Card don’t bode well for Colorado in the short term, prevention offers a bright ray of hope for improving those grades in the future. The Report Card supplement shows that investing in evidence-based public health programs could substantially reduce health care costs in Colorado over time while improving the health of our residents.

Case in point: One study estimates that an annual investment of $10 per Coloradan in community-based prevention initiatives could save more than $232 million annually in health care costs after five years – a $5.05 return for every $1 invested. Yet, despite this potential cost savings, public health represents a small portion (less than 5 percent) of every dollar spent on health care in the United States.

The supplement highlights the benefits of vaccinations (which saved $5 for every dollar invested and about $11 in additional costs to society), Nurse-Family Partnership programs (which save society $5.70 for every dollar invested) and worksite wellness (one study showed that for every dollar spent on wellness programs, overall medical costs fell by $3.27).

In addition to those encouraging findings about prevention, the Colorado Department of Public Health and Environment has identified 10 “Winnable Battles” in public health – many of which are highlighted in the Report
Card.

Though the Report Card contains some disheartening statistics, the good news is that investing in prevention could greatly improve quality and reduce costs in Colorado and nationwide.

The following is a guest post from Natasha Paleau on the recent National Health Promotion Summit in Washington DC. Natasha is a first-year graduate student at the University of Maryland School of Public Health. She writes regularly for umwellness.wordpress.com , the blog of the University of Maryland Wellness Initiative, and Student Health 101, an online student health magazine. Natasha’s interests are in health disparities and the contextual factors that affect wellbeing for marginalized populations.

The National Health Promotion Summit took place this past Tuesday and Wednesday in Washington, DC. Participants included government officials, policy makers, educators, students, health promotion advocates, and more.

Tuesday’s opening presentation and keynote address was given by Secretary of Health and Human Services Kathleen Sebelius, and focused on the unprecedented focus on prevention efforts in the United States today. Using tobacco control as an example, the secretary highlighted how national efforts and national dialogue are shifting to rethink how we approach health promotion with an increased emphasis on prevention.

The plenary panel of that morning discussed prevention initiatives as they are related to new health care reforms, such as the National Prevention Council, The National Health Service Corps, and the National Public Health Improvement Initiative. The panel mentioned that if the ACA succeeds in expanding health insurance coverage to an estimated 34 million people by 2019, our health care system and safety net will be dramatically altered. As public health professionals, we must be careful about planning interventions and strategies that are flexible to such fast-changing realities.

Drawing on Healthy People 2020, the panel expanded upon Assistant Secretary for Health Howard K. Koh’s assertion that we must have “20/20 vision” for the future of health; indeed, we must be able to view public health issues with “3-D glasses” to address the various levels and determinants of health from a sustainable, combined-thinking, systems approach.

The concurrent sessions of the day touched on various advances in the field of health promotion. Speed Share sessions, which comprised 75 minutes of rotating presentations and group discussions, featured such topics as health promotion-based applications of the HITECH Act and EHRs, social marketing tools and strategies, using web-based approaches for health interventions, and more.

A panel session on “Preparing the Workforce for New Public Health” focused on innovations for improved training and education of students in various health fields. During this panel, experts discussed basing coursework on Healthy People and other national health targets, to educate students on current realities and future directions in the field of public health. Panelists also discussed some recent trends in improving medical education and training, such as the interdisciplinary program at Nova Southeastern University that combines a Doctor of Osteopathy program with a Master of Public Health Program. Dual graduates are able to ease some of the dichotomies between the different health professions, and address the deficiencies in public health training identified by many students in medical programs.

New and emerging technologies were an important topic throughout the summit. On Tuesday afternoon, before the luncheon keynote address, awards were distributed to the winners of HHS’s Leading Health Indicators Apps Challenge. Three impressive designs were recognized, all of which will be featured at the June 5^th Health Datapalooza in Washington, D.C.

The first place winner, Community Commons, was featured in a second-day panel on “New Innovations in Community Health Assessment.” This website uses geospatial mapping to display various types of public health data. There are over 7,000 data layers in their interactive map room. “Making public data publically accessible,” Community Commons uses an online social networking tool to connect users on the site with each other and with various health initiatives around the country. While it’s still in a testing phase, it’s clear why Community Commons was chosen by HHS as a particularly promising tool for displaying health indicator data, and for future use in community health assessments.

Along with Community Commons, The Community Toolbox and NACCHO’s MAPP program were also featured in the innovative assessment session.

The Surgeon General, Dr. Regina Benjamin, gave the second keynote address on Wednesday morning. In addition to discussing the unprecedented National Prevention Strategy, Dr. Benjamin highlighted the importance of finding joy through health promotion. From zumba to walking events to dance breaks, the Surgeon General showed how she promotes having fun while pursuing optimal health.

Citing a new report on tobacco use, the Surgeon General echoed Secretary Sebelius’ message about the importance of smoking interventions for young people: 99% of first-time smokers are under the age of 25. For every person that dies as a result of smoking, there are 2 new young smokers to replace them- daily. As a result, the Surgeon General’s office has launched a new anti-smoking PSA that is specifically geared towards young people (the Surgeon General herself admitted to the similarities between this PSA and the teen-centric Twilight movies).

A second plenary panel on Wednesday discussed practical applications of the National Prevention Strategy, with a main focus on the co-benefits of a systems approach to creating holistic, integrated, and sustainable communities. The intersection of policy, community development, and public health was a major talking point here, as representatives from Sonoma County Department of Health, the US Department of Defense, and the Kresge Foundation discussed economics, social determinants of health, and various on-the-ground initiatives which were reflective of the National Prevention Strategy already working around the country. A fourth panelist, from Australia’s Gus Nossal Institute, commended the U.S. on the global implications of the US strategy. He mentioned that in addition to universal access to health care, all people are entitled to universal access to prevention.

Finally, Leon Andrews, a senior fellow with the National League of Cities, gave the closing speech late Wednesday morning. He discussed how various cities around the world are considering and re-considering their health initiatives, highlighting the changing culture and dialogue around childhood obesity over the last 10 years. In 1991, obesity was seen largely as an individual issue. Now, in 2012, as peak obesity rates in some states are over 30% of the population, the National League of Cities has designed a policy-centered childhood obesity initiative, in partnership with Michelle Obama’s Let’s Move Towns and Cities initiative to combat the growing epidemic.

As the various speakers and presenters highlighted throughout the summit, the landscape of public health is constantly changing. A central theme to the summit was being able to look forward to the future of health in the United States. There are countless opportunities and challenges ahead, and we would be wise to remain flexible in our approach, keep an eye on emerging innovations, and be willing to constantly evaluate our efforts in promoting health in the U.S.

If you’ve ever smoked, and tried to quit, chances are you know how much fun quitting, and quit attempts, aren’t. The cravings, the mood swings, the weight gain – ugh! What if quitting smoking was fun instead?

Game Mode: Relax

Funded by a Robert Wood Johnson Foundation’s Pioneer Program grant, Lit2Quit is a mobile game that aims to help smokers reduce or quit smoking. This promising technology is being developed and studied by a group of researchers, developers, and health professionals at Teachers College at Columbia University. I caught up recently with Azadeh Jamalian, a Ph.D student at Teachers College, and one of the lead researchers and developers on the Lit2Quit initiative. She graciously agreed to answer my many questions, and share them with Pulse + Signal readers.

BC: Lit2Quit attempts to match the effects of smoking through game play, either relaxation or receiving a “rush” – are there really only two states in which a smoker may find themselves?

AJ: Yes, research shows that smokers perceive smoking as a sedative or stimulating experience depending on their state of mind (Donovan & Marlatt, 2007). However, there may be different motives for smoking. According to Kassel, Paronis, & Stroud (2003), the most commonly reported motive is stress reduction (hence, perceived sedative effects of nicotine); other cited motives include perceived stimulant effect of smoking (specially when drinking), socialization, addiction, habit, and sensorimotor aspects of smoking (see Donovan & Marlatt, 2007).

In addition, research shows that nicotine enhances memory and focuses attention (Hahn, Ross, Yang, Kim, Huestis, & Stein, 2007; Lawrence, Ross, & Stein, 2002, Vossel, Warbrick, Mobascher, Winterer, & Fink, 2011). Although you cannot target everything in a single project, and different products may be suitable for different people, we tried to have all these motives in mind when designing Lit2Quit.

Game Mode: Rush

Mirroring the perceived stimulating and sedating effects of nicotine, Lit2Quit is designed in two modes, RUSH and RELAX. These modes use specific breath patterns and game design challenges to excite or relax the player. Depending on his/her state of mind, the player chooses which mode he/she wishes to play. For the future releases of the game, we are planning to integrate social aspects in which players could collaborate and play together, or they can invite their friends to see the world they created. In addition, we believe that since the players control both versions of the game with their breath, the gameplay mimics the behavior of smoking and help smokers to control their urge through engagement of their sensorimotor habits. Further, to enhance player’s attention and memory, the players need to memorize certain patterns to succeed in the higher levels of the game.

BC: The aim of Lit2Quit is smoking reduction through replacement of the stimulus with game play. Can you say more about how this plays out? In other words, are participants switching “cold turkey” to Lit2Quit, or is there a gradual change over time?

AJ: The aim of Lit2Quit is smoking reduction through replacement of the stimulus with game play. Since we haven’t done any field studies yet, we cannot know for sure how smoking behavior changes as the result of the gameplay. However, our hypothesis is that the game will help smokers to gradually reduce their smoking over time, as they become more expert in the gameplay, and hence can perform the advanced breath patterns in the game more successfully. Our initial studies have shown that these advanced breath patterns more closely mimics the perceived and physiological effects of nicotine.

BC: Are there preliminary data you can share with us yet?

AJ: We have compared the physiological and perceived emotional effects of gameplay to smoking through various measurements such as Self-Assessment- Manikin (SAM) survey, Electroencephalography (EEG), electrocardiography (EKG), and skin conductance (SC). Although smoking is perceived as either a stimulant or sedative, physiologically it stimulates the body. Therefore, in order to compare effects of playing the game to smoking, we analyzed both perceived and physiological effects. Overall, results show that on average subjects perceive playing either modes of the game as an enjoyable experience, and that Lit2Quit partially mimics perceived and physiological effects of smoking. We also learned that since breath is a novel game mechanic (as evidenced by the fact that in 100+ subjects, none of them had experience using their breath as a control mechanic for a mobile game), the initial difficulty levels of the game should be set low to allow players to grasp how to play the game using their breath.

At this stage of the project, we don’t have behavior change data to share. Efficacy trials are the next contemplated step for the project pending funding.

BC: After learning about the game, I wondered if the game is able to match the effects of smoking, is there any danger of addiction to the video game?

AJ: Your question reminds me of a recent article, “Saving Education Through Games Addiction.” I personally like the possibility of “saving health through game addiction!”

BC: What else should we know about the Lit2Quit research?

AJ: We have successfully finished the first stage of the project and are publishing our results in tandem with providing peer review opportunities at presentations at notable gaming and health care conferences. Our plan is to enrich the design of the game by adding a layer of social and community aspects to the game as well as explore platform agnosticism and body sensor networking for input monitoring. Most critical to the game’s success and impact are new collaboration and partnership opportunities with developers,
nonprofit foundations, educational institutions and industry. In particular, we are in the process of designing efficacy trials to study short-term and long-term patterns of smoking behavior change as the result of gameplay intervention. You could follow our progress and contact us via our Facebook page or www.Lit2Quit.com.

BC: Do you think Lit2Quit could be played for any other purposes aside from smoking reduction?

AJ: Yes! The game is fun to play and in fact anyone could enjoy playing the game without even knowing that it’s a smoking reduction game. In addition, since there is no direct reference to smoking in the game, the Relax mode in particular could be played for any type of stress reduction. if you gain expertise in the “Relax” version of the game you could train yourself to self-relax through meditative breathing patterns, and therefore self-monitor your stress through breathing slower than your usual rate. The game has other health benefits. It could be used in clinics for treating asthma and chronic inflammatory diseases of the airways.

–

To learn more about Lit2Quit watch this video:

Lit2Quit Video by Advance from Dan Rabinowitz on Vimeo.

Bridgette

Bridgette Collado, MA, RD, is a health communication consultant and registered dietitian, and a contributor to Pulse + Signal. Follow Bridgette on Twitter: www.twitter.com/bcollado.

References:
Donovan, D.M. & Marlatt, G.A. (Eds.). (2007). Assessment of addictive behavior (2nd ed.), The Guilford Press.

Hahn, B., Ross, T.J., Yang, Y., Kim, I., Huestis, M.A, Stein, E.A. (2007). Nicotine enhances visuospatial attention by deactivating areas of the resting brain default network. Journal of  Neuroscience, 27, 3477?3489.

Kassel, J.D., Stroud, L.R., & Paronis, C.A. (2003). Smoking, stress, and negative affect: Correlation, causation, and context across stages of smoking. Psychological Bulletin, 129(2), 270-304.

Lawrence, N.S., Ross, T.J., Stein, E.A., (2002). Cognitive mechanisms of nicotine on visual attention. Neuron, 36 (3), 24, 539?548.

Vossel, S., Warbrick, T., Mobascher, A. Winterer, G. , & Fink, G.R. (2011). Spatial and sustained attention in relation to smoking status: behavioural performance and brain activation patterns, Journal of Psychopharmacology, 25(11) 1485?1495.

Today marks the beginning of the last month of the year, but it also is a reminder for us about the importance of bringing HIV/AIDS to an end. Today is World AIDS Day. A time for education and action regarding the disease that still is affecting many worldwide.

Phil Wilson, CEO of the Black AIDS Institute, had this to say in a statement on World AIDS Day:

We are at a deciding moment. We have the tools to end the AIDS epidemic in America. We can do more than imagine the end of the epidemic: We can make it happen.  We have new diagnostic tools, new surveillance capabilities, new prevention strategies, new treatment options, and a new understanding of how to interrupt acquisition and transmission. The question is no longer can we end AIDS? The question is: Do we have the moral will and the political leadership to do it. Will we use these newly acquired and in some cases primitive tools efficiently, compassionately and effectively?

I feel that quote can be applied to much in public health and glad Wilson made that part of his statement. He also mentions the national strategy that was developed to combat HIV/AIDS that President Obama put into place. Despite the tremendous amount of politics and commercialization that get attached to these health issues, we must remain focused on the goal of prevention and bringing them to an end.

For those of you active on Twitter, the official hashtag for World AIDS Day is #WAD11

Here are some other highlights for World AIDS Day:

• Phil Wilson’s entire statement
• Crowd Out AIDS initiative (social media/crowdsourcing)
• AIDS.gov resources (@Aidsgov on Twitter)

The following is a guest post from Whitney Zatzkin, Policy and Advocacy Manager at the American Association of Colleges of Pharmacy. A member of the Coalition for Health Funding, she attended a Congressional briefing on the role of public health in disaster recovery on September 12, 2011. More information on this and future events is available through the Coalition for Health Funding.

Disaster Recovery – After the Cameras Leave

The public was captivated when news crews descended upon New York City for the September 11 attacks, the Gulf Coast for Hurricane Katrina, Joplin, Missouri for the tornadoes and, most recently, along the East Coast for Hurricane Irene. But what happens after the cameras leave?

On Monday September 12, 2011 the Coalition for Health Funding hosted its seventh annual Public Health 101 briefing. The event featured Dr. Isaac Weisfuse, Deputy Commissioner for the New York City Department of Health and Mental Hygiene, Clayton Williams, Assistant Secretary for Public Health for the State of Louisiana Department of Health and Hospitals, and public health systems researcher, Dr. Jerry Suls, Professor and Collegiate Fellow at The University of Iowa.

“Gadgets only get you so far, staff is critical.”

So much of disaster response and recovery is fast adaptation and planning for the unanticipated public health response needs. Dr. Weisfuse spoke of the flames, days after 9/11, shooting 20+ feet in the air as workers moved beams for clean-up and of the health cleanliness recertification developed for restaurants and delis to address the places where breakfast was left on the table for weeks. Many anthrax scares followed 9/11 but the first case wasn’t confirmed until October 12^th 2011. This slide from Dr. Weisfuse detailed that confirmed anthrax case – tracing the letter through NBC studios in an investigation that revealed that the NYC subways were, in fact, that dirty. And who knew they used fax machines for cleaning exposed documents for disposal? He closed emphasizing the significance of training, education and multi-layer communication for all stakeholders and highlighted the critical role for public health staff saying, “gadgets only get you so far, staff is critical.”

“We need a solid base in public health. That means people, and that means money.”

Mr. Williams brought the conversation to the recovery tasks following the BP Oil Spill, establishing seafood safety strategies and creating “the MOST certified seafood out there!” through the work of his team in Louisiana. His efforts there focused on “Rescovery,” merging response and recovery programs so disaster recovery programs (exposure screenings) are hosted INSIDE the established local response facilities (community health centers or shelters). Furthering the comments from Dr. Weisfuse, Mr. Williams cited that protocols in New Orleans once detailed that only the Public Health Director was left in the government health offices in its disaster plan. That one person was not enough when response was needed particularly post-Katrina when many colleagues within the Department of Health met the Public Health team for the first time. Emphasizing the important investment needed to build solid relationships with key stakeholders before the disaster happens, not after the incident, he commented, “We need a solid base in public health. That means people, and that means money.”

“We need money for research, staff and for outreach [programs].”

Closing the panel, Dr. Suls reflected on the important research around mental health and the challenges of rebuilding feelings of positivity in a community following a disaster. Not surprisingly, the biggest sources of stress following a disaster are employment, parenting and finances. Research demonstrates that people become more pessimistic following a disaster and they turn to pessimism-boosters, like alcohol and smoking, to find quick stress relief. Dr. Suls further explained that when pockets of optimism exist post-disaster, the feelings are often rooted in the idea that something like that would never happen to the community again and result in an increased number of people that stop being prepared for future events. In some cases, the optimists will even go so far as to not respond to local alerts and warnings to evacuate during the next hurricane or ignore alarms to seek shelter during a tornado. “If you have an immunization for something and no one uses it, you didn’t make an impact,” he said, adding, “We need money for research, staff and outreach [programs]” to make an impact.

Innovation in Public Health and Recovery Response

New York City was overwhelmed by the outpouring of support after 9/11. Volunteers flooded the area and officials sent the volunteers to donate blood when they found themselves over staffed. Quickly, blood donation centers were overwhelmed with donors and volunteers were left standing. The public health community developed new strategies to inform national volunteer deployment strategies and created the Medical Reserve Corps, to verify medical volunteers and deploy them successfully following emergencies.

Evolution in Public Health and Recovery Response

In her Congressional Statement for the Record this past May, Heather Blanchard, co-founder of CrisisCommons, cited the findings of an American Red Cross report and new levels of expected disaster response, “during an emergency… 55% [of respondents believed] help would arrive in less than 30 minutes if they posted a request for help on a social media website.” At the hearing, those in charge of disaster response stated how tweets and other web reports were an unmet need during past responses and that staff training, as well as new communications and new solutions, were needed. The public health and first responder communities are testing tweet-based deployment response and HHS and FEMA worked with Health 2.0 to issue an Application Developer Challenge to create a Facebook application to track a community following a disaster, communicate needs and verify safety. The need is growing for mobile platforms and effective response after an emergency, yet many agencies not only do not have the staff to support new media use but often staff cannot even access the websites.

Despite funding reductions at federal and state levels in recent years, the federal expectations and demands for public health emergency preparedness and response has increased.

In a letter to federal appropriators on August 25^th, 70 member organizations from the Coalition for Health Funding asked Congress to recognize the needed investment in public health funding, detailing the 44,000 state and local professionals already removed from the public health workforce after recent budget reductions while citing the strong ROI of public health programming. Furthering the need, people in need are expecting and demanding more from government agencies and national response units to coordinate relief when disasters happen and turning to new resources and new communications to ask for help, expecting response.

We need to strengthen the capability of public health disaster preparedness and response now, before the next disaster, through staffing, training and research. Only then can we take efficient, effective programs to the places people are already turning to for help and offer recovery support.

October is right around the corner, bringing with it cooler weather, autumn leaves (at least here in New England!) and Health Literacy Month. Fifteen years ago, Health Literacy was a topic still under the radar. Today, we have conferences and courses, a growing body of literature and professional roles dedicated to the subject.

Much of the momentum behind this movement can be traced to Helen Osborne, author of Health Literacy from A to Z, creator of the Health Literacy Out Loud podcast series for healthcare professionals, and founder of Health Literacy Month. Nearing this years Health Literacy Month, I caught up with Helen to learn more about the evolution of this important and fascinating direction in health care.

–

BC: I’ve heard you referred to as the “mother” of the Health Literacy movement. How do you feel about this title?

HO: Well, you’re actually the first to refer to me that way. I honestly don’t consider myself as the one who “gave birth” to health literacy. If anyone deserves that title, it would be Len and Ceci Doak. Instead, I see myself as an early adopter and advocate. My interest began in December 1995 when I read my first-ever article about health literacy (published in JAMA, by Williams et al). At the time, I was working as an occupational therapist on a psychiatric unit in a community hospital in Boston. I read in the article that more than half of the adults in this country struggle to understand written health information. I looked at my patients. I looked at my handouts. And immediately I knew this was so. I’ve since made it my mission to help figure out ways to communicate health information more clearly.

BC: What is the history behind Health Literacy Month?

HO: Soon after I started my own Health Literacy Consulting business, I joined the New England chapter of the National Speakers Association. In one of our programs, a speaker shared how she started her own “holiday.” I thought that might work for health literacy, too. So without really having a clue what I was getting into, I posted a message to a health literacy listserv asking, “Health Literacy Month. How does that sound to you?” And to my surprise, nearly 50 people replied, saying something like, “Great idea. What are YOU going to do?” And so began Health Literacy Month. That was in 1999. Health Literacy Month has been going strong ever since with local and national awareness-raising efforts taking place in the United States, Canada, overseas, and online.

BC: Why October?

HO: I actually gave this a lot of thought. Since I envisioned Health Literacy Month as open to everyone worldwide, I chose October as it tends to have good weather and not many competing holidays. Also, in the U. S. it is just before elections. My figuring was that politicians would be happy to have photos taken with people doing good deeds — such as with those advocating for clear health communication. And one more reason is that October has a lot of health-related “holidays.” You can find an extensive listing in “Chase’s Calendar of Events.”

BC: What are you planning for this year’s Health Literacy Month?

HO: My biggest news is the publication of the Second Edition of my book, “Health Literacy from A to Z.” You can learn more at http://www.jblearning.com/catalog/9781449600532/. Ever since Health Literacy Month began, the fall has been a very busy time for me and others in health literacy. This year, I have lots and lots of speaking engagements scheduled from mid-September through mid-November. That’s very good, indeed.

BC: Where do you see the field of Health Literacy heading?

HO: The field of health literacy has changed so much in the last 10-15 years. While years ago few people ever heard the term or knew why it mattered, today health literacy is central to many national and international health policies, innovations, and programs. While I’m delighted that the field is finally getting the attention it deserves, I hope that sometime soon there will be consensus as to its scope and definition. To me, that is key in sustaining the health literacy momentum.

–

Many thanks to Helen for squeezing this Q&A into her busy schedule!

My news feeds have been much abuzz with talk of the newly announced journal, Games for Health: Research Development, and Clinical Applications. Gaming for health is a topic we’ve been covering here at Pulse + Signal, so when we heard the news, we caught up with the journal’s Editor-in-Chief, Bill Ferguson, for a Q & A.

Mary Ann Liebert, Inc., the publishers of the anticipated journal, hope to bring greater cohesion to the field of health games with its launch in early 2012. In addition to peer-reviewed articles, the journal will feature product news and reviews, as well as reports from the field. Read on for more detail…

BC: Why launch an academic journal for games for health?

BF: Health games are perhaps the most powerful new tools for the prevention and treatment of health issues.  I was asked by Mary Ann Liebert, the founder of our company, to attend the most recent games for health conference in Boston this past May to see if the field of health related games had matured to the point where the researchers, game developers, therapists, end users and so on would benefit from a dedicated journal.  I was very impressed by the depth and breadth of research going on in universities as well as the many very practical uses of games to improve the well-being of people with many different challenges.  Many of the key people I met including Debra Lieberman of the University of California at Santa Barbara, Paul Tarini of the Robert Wood Johnson Foundation and Ben Sawyer, the organizer of the conference, enthusiastically supported the idea of a journal dedicated to games for health.

BF: Robert Wood Johnson Foundation has been a powerful force in health games research. At present, they have no official role in the journal although many of their grantees are on our editorial board.

BC: Who’s brain child is the new journal?

BF: If you take a moment to look at the history of Mary Ann Liebert, Inc. you will see that she and our colleagues have been the pioneer publishers in some seventy health and human wellness fields including Diabetes Technology and Therapeutics in which we have worked closely with Sanofi.  Our peer reviewed journals often precede public awareness of emerging health sciences as is the case with Games for Health:  Research, Development, and Clinical Applications.

BC: Published articles will be peer reviewed, is that correct? With the diverse mix of developers, clinicians and researchers working in the field, how will reviewers be chosen? 

BF: Yes, in addition to field reports, product reviews and news from the field, our content will feature peer reviewed research papers.  Two of our key editorial board members, Dr. Lieberman, whom I mentioned, and Tom Baranowski, PhD of Baylor University will help me to determine and enlist appropriate reviewers for each submitted paper.  We are currently putting together our website and I will be issuing a call for papers very soon.

BC: Are there plans to make the journal open source? If not, how can we gain access?

BF: The journal will be available by subscription in print and online.  The Games for Health:  Research, Development, and Clinical Applications website www.liebertpub.com/g4h will feature complimentary sample issues and articles and clear instructions on how to submit articles and information of interest.

BC: How often will the journal be published?

BF: Initially, we will print bi-monthly with the hope that the volume of papers, news, activities and demand will drive us to monthly publication.

BC: Is there anything else you’d like our readers to know about the journal?

BF: I’d like your readers to know that they now have a forum to share their advancements, developments and interests in the field of games for health as well as a single source for leading edge news.  It is our goal to be a powerful vehicle for sharing and shaping this important new field.  Your contributions are welcome in Games for Health:  Research, Development, and Clinical Applications.

–
Bridgette Collado for Pulse + Signal

Follow Bridgette at twitter.com/bcollado

The following is a guest post from Elizabeth Brotherton of PreventObesity.net reviewing the final day of the recent Childhood Obesity Conference held in San Diego, CA. More photos from the event can be found on their Facebook page. You can see Part 1 of the conference review here.

Get ready to sweat.

If there was one message out of last month’s 6^th Biennial Childhood Obesity Conference, it was that solving obesity won’t be solved with one big fix. It’s going to require significant policy change on the federal, state and local level, doing everything from promoting healthier food and beverages to increasing physical activity and the monumental task of getting people to spend less time in their cars. And it’s going to be an effort that will take a decade or more.

But as mentioned in the last post, the topic du joir was food marketing, as panelists and participants alike brainstormed ways to curb the influence that food and beverage companies have on children.  The problem, the experts seemed to agree, is that marketing has become so powerful and prevalent that even the most active and involved parents have a difficult time combating it.

I was particularly struck by the words of Dr. Margo Wootan, the director of nutrition policy at the Center for Science in the Public Interest, who appeared on a panel about advertising to children, alongside other policy pros like Dale Kunkel of the University of Arizona and Kelly Brownell of the Yale Rudd Center for Food Policy and Obesity at Yale University.

Wootan was able to spout out plenty of interesting statistics about food marketing to kids — mainly that advertisers hawk all the unhealthy stuff and don’t bother pushing nutritious items — but I was moved by her own experiences as a mom. Being a nutrition expert, Wootan worked to ensure her daughter wasn’t exposed to fast food… but it was in vain.

“Even before my little girl was watching television, she was talking about… that hamburger place with the clown has,” Wootan said, referring McDonald’s. “And then her cousins taught her that they also have French fries.”

Wootan noted that studies show that kids need to push their nine times for something before exhausted moms or dads finally give in. Advertisers know that, which is why they push so hard for kids to know about their products.

The beverage industry also was the focus of the last day of the conference, as experts presented evidence showing the growing influence of the soft drink industry during the past decade. During one soda-focused session, Harold Goldstein of the California Center for Public Health Advocacy screened this classic Pepsi ad featuring Michael Jackson (and a young Alfonzo Ribeiro from “The Fresh Prince of Bel Air”). The infamous ad features Jackson singing his song “Billie Jean” with the rewritten lyrics “You’re the Pepsi Generation/guzzle down and taste the thrill of the day/and feel the Pepsi way.”

The ad, Goldstein noted, is a clear marker of a “whole new generation” addicted to soda — and significantly more obese.

Brownell also spoke on the soda-themed panel (seriously, that guy was everywhere) and said that while targeting soda might not be the only solution to reversing obesity, “it’s a good place to start.”

“I think we are going to win this, but it’s not going to be easy,” Brownell added.

The conference wrapped up with a keynote panel on social media, which included a few words from my boss, PreventObesity.net co-founder Marty Kearns. Marty and the other participants pushed the 300 or so folks who stayed until the last moments of the conference to really embrace social media as a way to get their message to others, and present relevant data in new and interesting ways.

It’s more than just tweets, they agreed; it’s about using technology to present material to people in ways that effects them and spurs them to act.

—————————

Elizabeth Brotherton is a senior writer and editor for PreventObesity.net. She is tasked with creating original content for the project, including on its blog and weekly newsletter, The Inside Track. Brotherton previously wrote the “Heard on the Hill” column for Roll Call and has written for a number of publications, including the Orange County Register, Press-Enterprise and the Almanac of the Unelected.

The 7th annual Games for Health conference began today in Boston. This conference is one of several going on now as part of Games Beyond Entertainment Week, organized by Digitalmill, Inc. and is supported by the Pioneer Portfolio of the Robert Wood Johnson Foundation. Today’s pre-conference line-up did not disappoint – I’m only sorry that I couldn’t attend every presentation! From accessibility to sensors, prevention to rehabilitation, medical education to research, the day was packed with awesome speakers, great design and a whole lot of inspiration. Here are just a few of today’s take-aways…

1. Gaming has the potential for application in a long list of healthcare topics.

Continua Health Alliance talked about the many health gaming opportunities, including integrative health activities, simple secondary input, chronic disease care and diagnostic gaming.

2. Incentives work.

Incentivizing gaming was a practice and recommendation across the board. Continua Health Alliance provided that competitions are the greatest motivators (the speaker referenced Partners Healthcare data not available in the public domain). Group competitions were also a hot topic – they are not only highly motivating but add a social dynamic different from head-to-head rivalry. Creativity and supplying options were also mentioned as important factors in considering incentives, for example, allowing one to apply credit to a cause, or trade it in for mobile minutes, may be more motivating than cash for some.

3. Users who share their success do better.

Bill Sabram of MeYou Health talked to this point, touting the power of connection. In Monumental, MeYou Health’s free iPhone app that “takes you to the top of virtual monuments as you climb real stairs,” users can share results with other users through social plug-ins, and these users are more successful.

Tomorrow looks just as promising! So, look for more conference coverage tomorrow on Pulse + Signal and follow the hashtag #G4H11 for live news.

–

Bridgette (a.k.a. @bcollado)

This is a post that my friend/colleague Fran Melmed of [context communication] wrote recently, dissecting Georgia’s media campaign around childhood obesity. I really enjoyed how it was broken down and wanted to share with you all – with permission from Fran, of course (who by the way, enjoys lowercase writing).

the georgia children’s health alliance has taken a lot of grief for this campaign. the links here are a smattering of the hue and cry. the campaign originally consisted of billboard ads and a website with four personal narratives. the billboards have been pulled and so has one of the videos.

i’ll be honest; i don’t like the campaign. i’m going to break down why in this post, because dissecting this campaign offers valuable lessons for employers working this health puzzle.  i’ve included the billboard ads and one of the four videos. i wanted to include the one from bobby, but that was pulled. rightfully so. i review why in “message” below.

your face here?

health awareness is not promotion

one of my issues with this campaign is that it’s a health awareness campaign, not a health promotion campaign, the difference being that one makes you conscious of something and the other helps you do something about it. stealing from the world health organization, health promotion is “the process of enabling people to increase control over, and to improve, their health.”  awareness campaigns have knowledge as the end result; promotion campaigns: action taken.

what works

even though i don’t think this campaign works as a whole, i don’t want to shortchange the fact that (most of) the videos do. the kids are emotionally naked. they bring you into their world, and it’s painful to be there. most grown-ups watching this video—parent or not—would want to do what they can to alleviate their pain.

what doesn’t work

now for what doesn’t work and what i think would’ve fixed it. i’m breaking down my reasons into three buckets: tone, message, and location (or channel).

tone. there’s a vast difference between the tone of the billboard ads and that of the videos. the kids break your heart. they speak about their pain, about being ostracized, about their illnesses in stark terms. the billboard ads use punchy lines and common jokes, like having “big bones,” to make a point.

how it could’ve been fixed: stay true to one tone—the tone that’ll appeal most to the audience you’re trying to reach. the alliance has been a little wishy-washy on who that audience is, but most of us would agree it’s parents. the genuine tone of the kids is the one to stick with and carry through to the billboards. it has the emotional pull and resonance the billboard text currently lacks.

message. with any communication, your aim is to leave your target audience with one clear message about what they should think, feel or do. consider the “it gets better” project. it’s name is its message, and the message is carried through every video as well. here, it’s unclear what the main message is. parents could feel shame, sorrow, inadequacy. as to what they should think or do? that’s left to their own invention.

(note: bobby’s video was pulled and replaced with this awkward one. here are my planned comments on that video which features bobby talking about his love of donuts, his hiding of chips so he can eat them later, and his vegetable disgust. “a separate issue is bobby’s video. i parenthetically added ‘most of’ when talking about what works about the videos because bobby’s stands out as being different. he talks of his love of food. of donuts and chips. i’ve no doubt he loves these things. most of us do. but in a campaign about childhood obesity, his testimony seems open to ridicule. its message validates the person who already believes solving obesity is as simple as telling someone to put down the donut. this video may be meant to show parents their food choices matter, but it’s a poor, misplaced choice and makes bobby vulnerable.” obviously, others turned up the heat on the alliance and they pulled the video, which would’ve been my suggestion as well.)

how it could’ve been fixed: kill the glib, dire billboard text. replace it with a combination of the kids’ real words and a new tag line. i’d play around with something we parents hear regularly from our kids:  “mommy…daddy…help me.” one billboard could read something like: “mama, help me: i want to play outside. stopchildhoodobesity.com.” not only would this approach play to our role as supporter, nurturer and steward, but it makes it clear that parents need to step up and learn how to prevent and reduce obesity and its many related problems. the idea needs work, but a clear call to parents to help their kids live a full, happy, healthy life might be a more persuasive technique.

location/channel. bj fogg explains effective behavior change as putting hot triggers in the path of motivated people. what he means is that we need to seize opportunities when someone shows a readiness to make a change. we need to allow them to act right then before the moment’s gone. you could argue that the billboard is a hot trigger, but we have no reason to believe that someone driving down the road is specifically motivated to tackle his or her child’s obesity problem. nor does driving down a road constitute a very good opportunity to take action.

the second breakdown here is that anyone who’s triggered to visit the stopchildhoodobesity site won’t find much. it features the videos of the four kids, a brief video on georgia’s childhood obesity statistics and an invite to join the conversation on facebook. there’s no support here. no guidance. no resources. no links. that’s coming in a previously unmentioned phase two and three, according to a recent interview given by ron frieson of the alliance. if you do visit their facebook page, you’ll find a stunning lack of involvement from the alliance. it’s been taken over by haters and others, including a representative from the CBS show the talk, who’s hunting them down for comment, i assume.

how it could’ve been fixed: don’t rely solely on one channel. billboards may be right for georgia’s culture, but there are significant shortfalls with their use, including fighting for attention in a cluttered air space. add channels that are relevant to and can springboard your audience to guided action. for example, ancillary materials shared with doctors, health clinics, community centers and schools bring the subject closer to the desired audience at a time when the information can be combined with personal discussion.

create a social strategy and follow through on it. the campaign’s use of facebook, twitter and youtube is ill-thought-out and poorly executed. they had an opportunity to reach out to the community, to rally discussion, to pull in people who’ve been there and can advise, nudge and empathize. instead, they’ve ceded the facebook page to the individuals commenting on it instead of engaging them in conversation, and they’ve let their youtube and twitter page languish. the obvious fix is: don’t take the easy step of using the tools and miss the hard, first step of planning.

these are my opinions, and these things can be subjective. a young woman who was part of the campaign eloquently spoke out about how her confidence grew because of being part of this campaign. what are your thoughts?

——————–

Fran regularly blogs on wellness/health in the workplace and health communication initiatives. She is the co-founder of the #co_health Twitter chat, a monthly chat on corporate wellness topics. You can follow her on Twitter at @femelmed.