Social Media and Public Health

Jacqueline R. Dougé, MD, MPH, FAAP

Social media has become an important public health tool. It is inexpensive; it reaches millions, and can positively affect behavioral change. However, for the busy pediatrician it can be hard to stay abreast of all the new and beneficial tools out there. Below are a few that I have found particularly helpful and innovative.

Healthychildren.org is a website developed by the American Academy of Pediatrics to provide health information to parents. Parents can search for pediatric providers, get answers to health questions or look up health topics. It is a great resource to link to your practice’s website and to share with your parents.

Text4Baby recently celebrated its one year anniversary. It is a project of the National Healthy Mothers, Healthy Babies Coalition; the American Academy of Pediatrics is among its many partners. Text4baby provides free health information to pregnant and new mothers via free text messages. The messages coincide with a woman's due date or the baby's date of birth. Moms receive information on topics such as breastfeeding, immunizations, safe sleep, nutrition and smoking cessation. Mothers are also connected to community services. This is a great resource to refer new parents.

The National Association of County and City Health Officials (NACCHO) recently developed a campaign to promote the Vaccine for Children’s Program (VFC). VFC is a federal program that provides free immunizations to millions of children enrolled in Medicaid or who are uninsured. The campaign promotes the program and educates parents as to how they can access vaccinations for their children.

Health and Human Services (HHS) launched a website, InsureKidsNow.gov. This site increases awareness about what programs are available across the country for uninsured children and helps parents enroll their children into affordable health insurance plans.

Lastly, the First Lady’s Let’s Move Campaign uses social media to prevent childhood obesity. The site is bringing together health care providers, parents, children and industry to find ways to promote healthy eating and physical activity.

These social media campaigns not only promote but improve the public’s health. They illustrate how the field of medicine and public health are changing. It is an exciting time to be both a pediatrician and public health professional. Personally, I like to think all pediatricians are also public health professionals and as such it behoves us to familiarize ourselves with the tools and campaigns out there and to share this information with our patients. Social media is a great tool to promote health and improve health behaviors.

To learn more about current social media campaigns and about social media in general, check out the The Centers for Disease Control (CDC) website or the May issue of AAP News.

The Kids Are All Right?

Don Shifrin, M.D. FAAP

Now that Amy Chua has tacked her parenting mantra to the church door, are we surprised the autobiographical view of raising her two daughters has culminated in her becoming more of a controversial cultural lightning rod than Sarah Palin?

I cannot imagine she would be blind to this, as any description of extremism sets its author up as a target. Thus, I feel marginally forthright in adding my modest commentary of the descriptive paradigms of her tome, which some are referring to as the definitive manual on überparenting. T. Berry Brazelton this isn't.

The book reads as a how-to manual for parents who want to help -- no -- make their kids succeed. At the very least, you have to admire Chua's veracity in penning this exposé. Her "Battle Hymn" reveals in graphic terms how she tirelessly compelled her girls to never be losers. The book's descriptive passages struck me as the parenting equivalent of Vince Lombardi's, “Winning isn't everything. It's the only thing."

She has opened up the floodgates of professional and parental scorn, ridicule, and vitriol. I have always acceded to the notion that the word, parent, is more verb than a noun, connoting what we do, not who we are. But, I would be reluctant to highlight Chua as the parent-model others would want or need to emulate.

A simplistic view of parental responsibility would include physical safety, emotional security, fiscal responsibility, as well as social, cultural, community, religious, academic, political, and moral role modeling. Most would agree to throw in more than a little unconditional love as well.

All parents, myself included, have, on more than one occasion, fallen way short of the mark. Granted, our children are subject to the whim and whimsy of quirky parenting styles. (I will confess to being a stickler for politeness and manners.) As a pediatrician, I have seen many parents step right across the egregious over-parenting line, where, it appears that the "Tiger Mother" has firmly planted herself, at least, until she was forced to realign when her youngest 'rebelled'.

The descriptions of her children's subsequent successes as a result of her parenting should not activate or relieve any of our collective parenting angst. Product development takes longer than 18 years. I would caution us to continuously monitor results, while consciously readjusting our outcome parameters. And, inadvertently, that maybe the best lesson from Ms. Chua's book.
Parenting is a challenge; it is not a war. It's a marathon, not a sprint. Children are human hard drives, with back-up programming that fortunately, or unfortunately, will last a lot longer than their parents.

So, I, for one, welcome her commentary, certainly not for her definition of success, but to motivate all of us to reexamine our parenting roles. Getting past all the obvious data points, the take away message is, perhaps, to redirect in a kinder, gentler way the burning passion all parents share: to balance nature and nurture in creating a childhood -- not an apprenticeship.
So, for all you Tiger Mothers (and Tiger Fathers) out there, a final note. Even with the best of intentions, parents that are rarely satisfied with their children, raise children that are rarely satisfied with themselves.

The Injustice of Immunization Interviews

Wendy Sue Swanson, MD, MBE, FAAP
Author, Seattle Mama Doc Blog

When Dr. Wakefield interviewed on "Good Morning America" in January, an injustice occurred. It occurred inadvertently, I suspect, yet this injustice happens frequently in the world of pediatric health messaging. The stories the media covers, clearly change how we think and feel in regards to protecting and parenting our children. Their work to inform and educate, just like that of physicians and nurses, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr. Andrew Wakefield with a 2-minute introduction by Dr. Richard Besser, a pediatrician and medical editor/correspondent. Yet, when the interview was over, we are left remembering the myth.

Dr. Wakefield interviewed with George Stephanopoulos who later labeled the interview "combative." Mr. Stephanopoulos was given a terribly difficult task. He was interviewing Wakefield on one of the most complex, emotional and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefield's purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research refuting his work, Mr. Stephanopoulos had to defend science. Alone. Although Stephanopoulos isn't gaining popularity (read the comments) with the anti-vaccine crowd, the 7-minute interview simply stirs the pot. I trust it had huge viewership. I worry that this is why it was done.

We need to discuss immunizations in the context in which decisions for vaccinating are made. In 2011, interviewing Wakefield alone on national TV doesn’t help. Wakefield’s myth and legacy regain power with each second he's on the news. We need to acknowledge the fear that has arrived on parents' doorsteps because of Wakefield's work. We needed a general pediatrician, a parent of immunized children, and a vaccine expert in the interview too. We need voices of reason. We need to frame issues surrounding immunizations truthfully. Although Wakefield's original study only applied to the MMR he has fueled millions of parents to distrust all vaccines. Dr. Wakefield claims that he doesn’t want others to stop immunizing against pertussis, but this point is easily lost. Stephanopoulos needed to make that point clear. In the office, when parents who are hesitant about immunizations talk about their worry, they point to Wakefield's claim.

Dr. Besser's introduction included micro-interviews (sound-bites) from Dr. Paul Offit and Seth Mnookin (book author of The Panic Virus). Neither was given the time and exposure Wakefield received. What we learned from Offit and Mnookin about immunizations could easily be forgotten by the time the interview with Wakefield was over.

Interviews, such as this one, leave parents increasingly more confused, not more informed. Although some bloggers are declaring vaccine-hesitancy dead with BMJ’s expose on Wakefield's work, we're far from seeing its end. Distrust in our physicians and nurses only increases when stories and interviews occur in this fashion. I suspect I will be helping families concerned about immunizations for the rest of my clinical career.

It can take only seconds to create a myth. It can take decades to rebuild the truth.

The editorials in The BMJ uncomfortably put Wakefield back into the spotlight. His message, although rebuked, regains momentum. Regardless of the scientific findings that vaccines have not been found to cause autism, Wakefield "won" the January interview.

Seven minutes alone in front of millions is power.

Viewership is the economy of television. If you want to get people to watch, putting Dr. Wakefield in the hot seat is a great way to start. And that’s where the injustice occurs.

Physically Isolated, Electronically Connected:

By Elizabeth Murray, MD

My family has recently been dealing with the terminal illness of my father-in-law. Unlike me, he has never been a TV watcher or a strong computer user. Therefore, it was quite an adjustment when he was placed in isolation in the ICU, effectively cutting him off from his friends, and most importantly, his grandchildren. It was then that he was introduced to Skype. Being able to reconnect to his family was the highlight of his day.

My father-in-law's experience is not unique. Work being done at the University of Rochester has shown that teens with cancer suffer not only the side effects of the cancer but significant social isolation due to missing out on the normal activities of teenage life. The effects of this social isolation can linger even after they have beaten the disease. Yet, studies now show that the use of new media and social networking sites are allowing teens to remain connected to their peers and teenage life even when physically separated. Studies like these have the potential to impact how patients are treated in the hospital regarding cell phones and computer usage. These forms of connection to the outside world may be more than merely ways to pass the time, but rather, ways to reduce some of the emotional effects hospitalization has on an individual. As pediatricians, we need to remain open to the fact that, although we often regard increased screen time as something to avoid, allowing a child or teen, in the appropriate setting, to have increased access to computers and cell phones may be beneficial.

As I watch my 15-month-old daughter figure out how to play movies on my iPhone all by herself, I am struck at how intertwined our lives have become with new media and technology. I realize how different my daughter's and father-in-law's lives will be because of the flood of technological advances and new media that has entered our lives. But as she smiles at videos of herself with her great-grandfather, I am thankful for video conferencing and cell phones that can record memories at the push of a button. New technology and increased screen time are here to stay. Yet, if used appropriately, they may actually have positive impacts on our patients and their families.

Mirror, Mirror on the Wall, Which Friday is Blackest of Them All?

By Vandana Bhide MD, FAAP

I’m in a panic because it is November and I have already missed the “first” Black Friday and now am about to miss the “second” Black Friday of the holiday season. I am fascinated by the marketing phenomenon of this year’s “early” Black Friday. “Traditional” Black Friday (I am waiting for the greeting card industry to get in on this one so I have yet another card I have to send during the year) is, of course, as every smart American shopper knows, the day after Thanksgiving. (Another requirement for a greeting card, I rest my case.)

Last year, a few “genius” manufacturers decided to advertise an “early” Black Friday and they scored a home run in sales. In response, this year, many retailers, desperate for business in difficult economic times, started “early” Black Friday advertising (AKA “sales” and “deep discounts”) as early as July.

No wonder parents feel like a pawn in the endless sea of toy and electronic gadget advertising, aimlessly trying to determine which toys will be “the IT toy” of the holiday season. (Hint: Cabbage patch dolls ARE NOT hot this year!). Not necessarily the most fun toy, but the item that one “must have.” Kids are still determining which toys they “must have” from Santa this year while manufacturers jockey for position to be the “ultimate number one” toy to have in 2010. (Ta Da!)

I am embarrassed to say that as a pediatrician and a parent, I too have succumbed to the pressure of finding the “IT” toy before the item “runs out” and I have to buy it online for ten times the suggested retail price. Of course, suggested retail price is a relative term, determined primarily by the phenomenon of the “sale” price. I’d rather spend $30 on a toy that is “slashed” from the suggested retail price of $60 than actually buy an item that costs the suggested retail price of $30. And if I can find a coupon for $5 off, well, I am in parents’ retail heaven.

Whew, I am sweating at the mere thought of not being able to get the “right toy” so that my child is not an outcast at school for getting that “educational” holiday present (AKA books or “reading material”). Parents (AKA “consumers”) are now used to the annual ritual of fighting for a small supply of the most popular toys (which will surely be determined by a multitude of manufacturing experts writing online articles now that the first two “early” Black Fridays are over so that one may prepare for the “original” Black Friday, followed by the “late” Black Fridays of the holiday season.) Parents are forced by manufacturers to believe that a toy can’t be valuable unless it is in short supply. The aura of a holiday present is not quite the same unless your Santa gets it when other kids’ Santas were unable to find it in time for the holidays! (Of course finding a coupon and a “drastic reduction” in price helps. None of us wants to admit going overboard on holiday presents!).

Of course the unknown deciding factors this year are the holiday movies geared toward children and teenagers. Can one really accurately determine the “best toys of 2010” until after the movies have come out? (Surely they will be released on what will be known as the third and fourth “early” Black Fridays of this year.) That’s a lot for parents to think about (along with internet safety, bullying and underage drinking)!

How is a parent to deal with all of this? Well go on the Internet of course! Right after each Black Friday, there will be plenty of retail “experts” writing Internet articles telling us which items are the “official” “must have” items for 2010. I have already read ten “Top Ten Toys of 2010” lists online in the time it took me to write this blog post!

For a second there, I toyed with the idea of dawdling enough to get presents at the “the last and final early Black Friday” of 2010, also known as the “day after Christmas sale,” which I now believe will be called “the first earliest Black Friday of 2011.” Nah…

Hats off to the Professor

By Don Shifrin, MD FAAP

It wasn’t so long ago that Robert Preston played the legendary flim-flam man, Professor Harold Hill in the 1962 movie, The Music Man. In it he envisions a way to profit from the paranoia he creates by sensationalizing the threat to River City’s youth from the local pool hall. In the movie’s seminal scene he sings to the parents of the ‘troubles’ hanging around the pool hall will cause:

“Well, either you're closing your eyes
to a situation you do not wish to acknowledge
or you are not aware of the caliber of disaster indicated
by the presence of a pool table in your community.
Ya got trouble, my friend, right here,
I say, trouble right here in River City.

Now, I know all you folks are the right kinda parents.
I'm gonna be perfectly frank."

Flash forward 48 years to the concept that the newest “threat” to our youth might be media overexposure. Could it be real, or as exaggerated as the Professor’s theory regarding pool halls?

The list of negative outcomes from media overexposure grows longer each day: from early sexuality, smoking, poor nutritional choices, sleep problems, attention issues, cyber-bullying, violence, decreased family time, and potential academic underachievement.

I accede to the positive aspects of media for children and teens to connect, form peer-related communities, heighten political awareness, and hyper-accelerate learning.

I am not looking for profit, like Professor Hill, but note that in respect to learning. Michael Kirst, an emeritus education professor at Stanford, estimates that 60 percent of incoming community college students and 30 percent of incoming freshman at 4 year schools need remedial reading and math courses. ( Newsweek 9/13/2010)

While elementary schools are making progress academically, high schools have stagnated. Is it the teachers, courses, rigor, or failure to engage academic curiosity? Or is it media time, content and depth, or constant multitasking that is one of the biggest factors in disincentivizing students to “not like school”?

The US high school drop out rate is now 1 student every 26 seconds (7000/day). There are nearly 2000 high schools in the US where 60% of the students entering do not graduate. I can guarantee you, however, that those who drop out are all very media aware across a multitude of electronic devices.

Is there a carry-forward? I suspect strongly that tweens and teens are “tuning in, turning on”, and possibly then ‘dropping out” of the traditional educational process. (Apologies to Timothy Leary circa 1965 urging people to embrace change by using LSD to remove their cultural and conventional norms.)

Can we not say that media is now the primary peer of our digital generation and cajoles them in similar ways: incessantly glamorizing, sensationalizing, and normalizing behaviors for them to emulate?
I want to bring us back to the reality of digital immersion: it is not going to vanish, unlike an obsession with billiards. Sixty-four percent of adults in 2004 thought that owning a TV was ‘necessary’. In 2010, that number dropped to 42% indicating that other devices are supplanting TV as a primary media source.

So the digital footprint moves quickly. This Professor thinks that the greatest risk for our children would be NOT to grant them access. And the second greatest risk would be to grant them unlimited access without guidance.

In my view their social, cultural, academic and economic future will be digitally integrated. Tools are being developed to change the school paradigm from classical appointment education in a classroom, to anytime, anywhere digital learning.
Soon tablets, interactive textbooks, super fast anywhere download speeds, educational games, voice processing, and Avatar model learning systems will come online.

Who will mentor children in this brave new world? Through multiple media outlets children are repeatedly exposed to questionable ethical behavior and morals. If left to sift through the world of reality TV, talk shows, political pundits, etc. without supervision, can we expect them to emulate the values we intend them to have?

Therefore, like Professor Harold Hill I now urge parents to “Heed the warning before it's too late!
Watch for the tell-tale sign of corruption!”
That may be a little too bombastic for this topic, but parent’s need to “turn on” and tune in” to the fact that the daily media exposures of 7+ hours (Kaiser Family Foundation Jan.2010) has essentially “dropped them out” of their role as the family’s primary value filter and educator.

Without sensationalizing the topic any further please encourage your parents to answer two questions:

1) Does your child have unsupervised and unlimited electronic access on his/her various devices, especially in the bedroom?
2) Has your child’s use of media changed his or her behavior(s), academic or social, or sleep habits, or his/her connection with your family?

If their answers are inconclusive, perhaps a song from the Professor might be appropriate.

Turnoff Week - September 19th-25th

By Corinn Cross, MD FAAP

Next week, September 19-25th, is National Turnoff Week. Parents are encouraged to use this upcoming week as a seven-day hiatus from televisions, video games, web surfing etc. Instead, families are encouraged to spend a screen-free week together.

Turnoff Week is supported by the American Academy of Pediatrics and the Council on Communications and Media. The most recent statistics show that the average American child spends over 1000 hours a year watching TV and playing video games. To put that in perspective, they only spend 900 hours a year in school. Television, video games, computers and now cell phones are becoming an increasing part of everyday life for the American child. Although there may be many advantages of living in such a technological era, there are well-documented detriments as well.

America is quickly becoming a nation of overweight individuals, and obesity is highly correlated with increased screen-time. Studies have shown that children who spend 4-6 hours a day in front of screens have a higher risk of being obese. All this screen-time is at the expense of less time spent playing sports, doing outdoor activities, reading and having family time.

Pediatricians can help parents by encouraging families to take part in Turnoff Week. As pediatricians, we can discuss the challenges of implementing a screen-free week and provide families with tools to help make the week successful.

1. Have a plan for each day in order to help keep children occupied.
2. Encourage outdoor play.
3. Schedule a family game night.
4. Involve children in dinner. Allow them to create a menu and help with the cooking.
5. Go on a family outing. Fall is a great time to go apple picking or to a pumpkin patch.
6. Plan a trip to the library.

These are just a few ideas of ways to pass seven days without a television. As the Turnoff slogan goes, "Turn off TV. Turn on life."