Using Twitter to Track Disease: Weighing the Advantages and Challenges

A few weeks ago I participated in a fantastic twitter chat on the use of social media for public health.  During the event, our moderators posed the following question: "Are there any other diseases (besides the flu) that we could track on social media?"

The question generated a very lively discussion that I was inspired to revisit on Storify this morning after reading the Washington Post's article, "Twitter becomes a tool for tracking flu epidemics and other public health issues." 

The WP article highlights several advantages and challenges of monitoring public health diseases and/or conditions on twitter.  My twitter chat colleagues brought up many other important issues for us to consider, so I'm including these expanded lists:

Advantages:

• Offers real time data on health or behavior (Government data can often take weeks or months to be released)
• There is so much available data! 
• It could capture cases that would not otherwise be formally documented at a physician's office or hospital.
• It has proved helpful in tracking time sensitive disease outbreaks (e.g., Novovirus).  *Check out this article about how twitter was used to track Norovirus activity during a journalism conference.

Challenges:

• Accuracy and case definition (i.e., does a twitter user really have the flu or just a bad cold?)
• Tracking specific words like "sick" or "flu" can bring up a lot of content that is unrelated to the twitter user being ill themselves (e.g., "I'm so sick of this terrible weather").  *Check out how Johns Hopkins researchers are working to address this problem by better screening tweets.
• We must differentiate between tracking symptoms vs. tracking cases- they are not the same.
• Our search strategies should include various terms or slang that are used to describe the disease or behavior of interest.
• Caution: media coverage of certain illnesses can cause a spike in key words on twitter without a rise in actual cases.
• What are the privacy concerns?
• Twitter might not thoroughly capture diseases or conditions that carry stigma (e.g., mental illness) because users may be hesitant to discuss them in a public forum.
• Results could be skewed by populations who are over or under represented on twitter.
• Do we need to train "trackers" to intervene? E.g., what if they are monitoring dangerous tweets/behaviors like suicidal ideation and attempts?

While the challenges list is quite long, I hope we are not discouraged!  I think twitter is an enormous resource for public health professionals.  We just need to be thoughtful and thorough regarding how to use twitter effectively.

More Resources:

The Washington Post article and related stories shared great links to more information about research in this area:

• YouTube video on University of Rochester efforts to track influenza on twitter.  It also describes their related app: Germ Tracker (warning: it may have you hopping off your regular morning bus). 
• Johns Hopkins University article: "You Are What You Tweet: Analyzing Twitter for Public Health".
• Brigham Young University article: "'Right Time, Right Place' Health Communication on Twitter: Value and Accuracy of Location Information".
• A great article that highlights what we can learn from Google Flu (since their predictions were off this year)- emphasizes the importance of "re-calibrating" your models or algorithms each year.

What Do You Think?

• What other advantages and/or challenges should we add to the list?
• What other resources can you share?

  

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"This is Public Health" is now an iPhone Application!

In March 2011, the Association of Schools of Public Health (ASPH) launched a new This Is Public Health (TIPH) iPhone application. It is available via the Apple itunes store. “This innovative application will allow users to digitally place an image of the TIPH sticker in photographs on their mobile device, so they no longer need to have physical stickers with them everywhere they go in order to participate in the campaign.”

The "This is Public Health" campaign was first piloted during the 2008 National Public Health Week.

The TIPH campaign was developed to achieve the following objectives:

• Increase awareness about public health and the important role public health plays in our daily lives.

• Position Schools of Public Health as innovative/effective leaders in public health outreach and education.

• Engage new audiences, including policymakers and funders, in a dialogue about the importance of supporting public health.

• Attract and inspire the next generation of public health professionals through non-traditional engagement tools.
  

The campaign uses stickers with the slogan "This is Public Health" placed in locations around the world to help reach its goals.

The campaign's website clearly shows the reach of the campaign- over 1,000 public health practice organizations, individuals, and other academic institutions in over 45 countries have joined the campaign. But of course (as always), I'm interested in seeing an evaluation of the campaign. It was unclear to me from the website how they define their target audience. I was not sure if they wanted to "increase awareness" of public health among "participants" of the campaign (i.e., those giving out the stickers) or among the general public (i.e., those seeing the stickers in various locations). I was able to track down an evaluation report from September 2009 (which covered the first year of the project). For purposes of this report, data was collected from program participants (defined as those that requested stickers or the campaign video). Both qualitative and quantitative data was collected via phone interviews, feedback from public health groups and individuals, a review of program data and statistics, and an online survey. Here are some key findings:

• The majority of participants [32.7%] learned about the campaign through the ASPH website.

• Educating the general public about public health, increasing awareness about careers in public health and increasing the understanding of the work of a particular institution were the top three goals of those who executed the campaign locally.

• When asked to rate on a scale of 1-10 how effective the “This Is Public Health” materials were in achieving their campaign goals, nearly a quarter [23.8%] gave the materials a 10, citing them as “very helpful” and over three-quarters of the respondents rated the effectiveness a 7 or higher.

• Simplicity and ease of use were what most campaign participants liked best about the “This Is Public Health” campaign.

• Nearly all respondents [92.1%] said that they were likely to recommend the campaign to colleagues in the public health community with almost 70% saying they were “very likely” to do so.

Interestingly, some areas of mixed review were around the program's website, flickr group (pictures), and interactive google maps. There was some concern that keeping all the program materials online because it excluded those without Internet access. In addition, the adoption of flickr and maps depended on the "tech savviness" of the participants. So seeing that their newest addition is an iPhone application, it will be interesting to see which groups of participants are the earliest adopters of the technology. I look forward to seeing the next evaluation report!

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HHS and Data and Technology, Oh My!!

Last week I had the pleasure of attending a talk called, "Unleashing the Power of Open Data to Improve Health" organized by The College of Physicians of Philadelphia-section on Public Health and Preventative Medicine. The speaker was Todd Park, the Chief Technology Officer for the US Department of Health & Human Services (HHS). I have to admit, I was expecting something a little dry (having received my fair share of power point overload at government sponsored presentations). Wow- was I surprised to find Mr. Park on a wireless microphone running up and down the aisles engaging members of the audience!

The presentation focused on how HHS is living up to President Obama's "Open Government Initiative", which promises to have a "system of transparency, public participation, and collaboration". In terms of health data, Mr. Park said let's stop making people find data. Instead, let's "make data find people". In order to develop channels to help data find us, HHS has been engaging leaders from many areas of popular social media and technology (e.g., YouTube and Smart Phone application development). The government team has been sending the message "the data is yours...let's see what you do with it". In order to get the creative juices flowing, HHS has held and continues to hold "Health 2.0 Developer Challenges". The most current being the "Go Viral Collegiate Challenge" which calls on multidisciplinary teams from colleges and universities to develop a web or mobile application to address a significant health problem facing their communities.

Check out some examples of data applications produced through the use of open government health data:

• Community Clash: An online card game that engages you in a discovery of your community's health and well-being status and let's you see how it compares to other communities in a head-to-head clash. (*Warning- apparently this game is incredibly addicting!)
  

• Asthmapolis: A device that uses global positioning satellite technology (GPS) to determine the time and location when an asthma inhaler is used. The data is then stored on a server. The user can use this device to track asthma symptoms, triggers, and medication use- which could lead to an identification of environmental or other factors which improve/worsen their condition.

In addition to these challenges, HHS has also launched multiple websites to assist with the dissemination of this open health data. For example, HealthData.Gov and HealthIndicators.Gov. While this is all fabulous (and I really enjoyed looking at the challenge applications), how is this initiative being evaluated? Is the ultimate goal just about numbers? Does HHS just want to increase the number of people/organizations that are using health data? Do they just want to increase the number/types of data sources they can make available? Or is there some evaluation of the quality and accuracy of what is being produced? The challenge application website is sure to point out that the applications were not produced with federal money and therefore the government does not endorse them. But are they somehow creating an inventory of the applications and evaluating their effectiveness? Do we know which ones are actually increasing knowledge and changing behavior? Are we learning from the ones that do not? I applaud all the excitement around this initiative, but as always- I'm interested in seeing the outcomes. How will this initiative, which "unleashes the power of open data" actually improve health"?

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Text Messages and Public Health: Can They Remove Barriers for "Calling" 9-1-1?

Text messages are a great time saver. You do not have to have a long conversation with someone...instead you can just send a quick message like "I made it home safe!" or "Can you pick up milk on your way home?" These text messages work well to support our busy lives, but can they also be incorporated into effective public health interventions and systems?

This week, the Federal Communications Commission (FCC) announced that it is looking into letting citizens report crimes via text message. An article posted by Wired discusses the possibility and highlights some of the "barriers" that this new strategy could help to address. First and foremost, it could allow citizens to report a crime without being overheard if they were in dangerous situations (e.g., kidnapping, robbery). The FCC specifically pointed to the 2007 shootings at VirginiaTech and reported that texts could have allowed emergency personnel to respond more quickly and with a better understanding of the circumstances inside the campus buildings.

While at first glance, it may seem surprising to use text messaging for 9-1-1 reporting (due to potential logistical considerations and challenges), it would not be the first time that texts were being integrated into public health interventions and emergency response systems. For example:

• Text messages are used to disseminate key health messages to various priority populations. E.g., The Text4Baby campaign allows mothers to self select into their program by texting "Baby" to the program number. The mothers then receive weekly text messages (timed to their due date or baby's birth day) regarding key health issues for their babies (e.g., nutrition, immunizations, etc).

• Many workplaces and college campuses have signed up for emergency response systems that will send out automatic alerts to email and phones (via text message) during a crisis (e.g., shooter on site).

In the case of using text messages for "calling" 9-1-1, I wonder about how texts could influence a well documented social psychology barrier to calling for help. Those of you that took a social psychology course in college may remember the name "Kitty Genovese". She was a woman who was murdered outside her home in Queens, NY in 1964. At least one dozen people heard or observed her attack (lasting approximately 30 minutes), but there was much delay in anyone calling for help. A NY Times article running two weeks after her death was entitled, "Thirty-Eight Who Saw Murder Didn't Call Police". This case is widely discussed as an example of the "Bystander Effect", which is used to explain why many people do not help in emergency situations when others are present. Some hypotheses about the effect are that we just do what others are doing (i.e., nothing to help), we assume someone else is already calling/helping, or we assume that others are more qualified to help. Perhaps it is also too much trouble to call 9-1-1? They require a lot of information, we have to stay on the phone, etc. Perhaps a more "passive" option to report the information (like text messaging) would decrease resistance and the bystander effect?

In addition to the great potential with this strategy, there are also several barriers that must be addressed in the planning:

• Costs (equipment, training, staffing)
• Regulation and Oversight: Will text message support be required or voluntary at emergency centers? Who will conduct a formative and ongoing evaluation of the system?
  
• Interpretation of messages: Operators will need special training to (quickly) interpret and respond to text messages. Texts are often written in short hand, so you would need someone very skilled to decipher them accurately. It may also be time consuming to support the texting back and forth that may be required to receive all relevant information from the "caller" in order to dispatch an appropriate response.

Even with the barriers noted above, it does seem like text messages are a viable option to consider in order to increase timely and safe 9-1-1 reporting. However, the 9-1-1 system will need to think critically to develop the type of infrastructure that can keep up with our ever changing and expanding communication technology.

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Bullying: Is Technology Helping Us or Hurting Us?

Like many of you, my heart broke when I heard about the suicide of Tyler Clementi last week. Unsure of exactly how I wanted to focus my blog on this topic, I took a little time and read the comments coming through on Facebook and Twitter. I talked to colleagues and friends. And something that really struck me was that many people expressed that technology was the problem. All this new technology can only lead to bad things. Right? I agree that new technology has played a large part in our discussions around bullying the past few years. There seems to be an assumption on the part of the bullies that they can be protected by technology- that their identity can be kept "anonymous" in the cyber-world. Perhaps more kids bully online because it is easier to insult or hurt someone at that distance- versus right to their face. Of course, these hurtful comments or videos now have a much broader reach. They can be disseminated through the school, city, state, or even country in just minutes. And you can't take them back. I also think that technology is evolving so quickly that we don't always understand the new boundaries for privacy.

But even with all the new challenges and channels to bullying that technology brings, I still do not believe that it is the root cause. As a friend of mine tweeted this week (yes- Beth G you get a shout out here) "Thinking on the Tyler Clementi case. Tired of hearing that technology is to blame. I'm pretty sure Dharun Ravi and Molly Wei are, actually". Let's not forget the role of personal responsibility- I believe that gets lost when the blame falls squarely on technology.

So with all of that as a backdrop for this discussion, I decided that I wanted to focus my blog on how technology can also help us to combat bullying and help those at risk for suicide. Risk for suicide can increase among those who feel isolated and disconnected from resources. They can also suffer when surrounded by social norms that do not support help seeking for the resources that they need.

So I wanted to present these resources that have gone viral in just the past few days. I can't help but think about all the isolated kids/teens they may reach:

1. MTV launched an Iphone application to combat bullying called "Over the Line". Users can post a bullying scenario that they've experienced and other users can vote if it was "over the line". This has the potential to help promote positive norms/limits regarding how we treat each other. The peer support online may also encourage users to ask for help.

2. MTV was also involved in the launch of "Love is Louder". This "movement" has begun primarily in response to anti-gay bullying and suicides among LGBT youth. Viewers (and celebrities) can upload videos of support for these youth. It has been described as a way to channel the sadness and anger we all feel following these events. Again- this has the potential to build peer support among individuals that may be at risk. It also introduces celebrities or role models to support positive social norms.

3. Columnist Dan Savage has organized the "It Gets Better" campaign. The goal is to reach out to lesbian, gay, transgender and bisexual youth who may be the victims of bullying and remind/assure them that things will get better. This campaign has also attracted many celebrity supporters telling their stories (e.g., Tim Gunn from Project Runway was featured on many of my friends' Facebook pages today).

4. Four days ago, Ellen DeGeneres posted "An Important Message" on YouTube regarding the recent suicides of LGBT youth. As of tonight, there had been 235,627 views of that video. She pledged her support and encouraged all of us to have zero tolerance regarding bullying and the loss of these kids/teens.

So that's the complicated story. Technology brings new prevention challenges to bullying. But it can also build peer networks and deliver resources to those in isolation. It can bring the voice of celebrities or other role models into the discussion, which can be a strong influence on kids/teens. I urge us not to write off all technology in light of recent events.

For example, if anyone reading this blog needs help- please call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). Their technology even allows for Veterans to chat with an online counselor. Amazing!

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A Cinematic World? On Jean Baudrillard and Film Studies

Image from Stop-Loss (Kimberly Peirce, 2008). Read Kim Toffoletti and Victoria Grace, 'Terminal Indifference: The Hollywood War Film Post-September 11', which treats this and other contemporary war films.

We are no longer the actors of the real but the double agents of the virtual.

Jean Baudrillard, Fragments: Cool Memories III (New York: Verso, 1997):125

On the occasion of an excellent new issue of online journal Film-Philosophy on "Baudrillard and Film-Philosophy" (Vol 14, No 2, 2010), Film Studies For Free is proud to present a long list of links to openly accessible Baudrillardian film studies. These are set out below the embedded video of the late Baudrillard in action himself. This list incorporates links to the FP articles.

It's so nice to have things in a simulacrum of one tidy place, FSFF thinks. And it hopes you will agree.

Jean Baudrillard thinking and talking about the violence of the image, the violence to the image, aggression, oppression, transgression, regression, effects and causes of violence, violence of the virtual, 3d, virtual reality, transparency, psychological and imaginary. Open Lecture given by Jean Baudrillard after his seminar for the students at the European Graduate School, EGS Media and Communication Program Studies Department, Saas-Fee, Switzerland, Europe, in 2004

By Jean Baudrillard

• Jean Baudrillard, 'Virtuality and Events: The Hell of Power', [Translated by Chris Turner], International Journal of Baudrillard Studies, Volume 3, Number 2 (July 2006)

• Jean Baudrillard, 'Violence of the Virtual and Integral Reality', [Translated by Dr. Marilyn Lambert-Drache], International Journal of Baudrillard Studies, Volume 2, Number 2 (July 2005)

• Jean Baudrillard, 'The Matrix Decoded:  Le Nouvel Observateur Interview With Jean Baudrillard', [Translated by: Dr. Gary Genosko and Adam Bryx], International Journal of Baudrillard Studies, Volume 1, Number 2 (July 2004) 

• Jean Baudrillard video lectures at EGS 

Engaging with Baudrillard's work:

• Stuart C. Aitken and Deborah P. Dixon, 'Imagining Geographies of Film', Erdkunde, Band 60/2006

• Chiara Armentano, '"The Image-Interface": New Forms of Narrative Visualization, Space and Time in Postmodern Cinema', Reconstruction, 8.3 (2008)

• Jon Baldwin, 'Introduction - White Magic: Baudrillard and Cinema', Film-Philosophy, Vol 14, No 2 (2010)

• Melanie Chan, 'Virtually Real and Really Virtual: Baudrillard’s Procession of Simulacrum and The Matrix', International Journal of Baudrillard Studies,Volume 5, Number 2 (July, 2008)

• Alan Cholodenko, The ‘ABCs’ of B, Or: To Be and Not to Be B', Film-Philosophy, Vol 14, No 2 (2010)

• Alan Cholodenko, 'The Nutty Universe of Animation, The “Discipline” of All “Disciplines”, And That’s Not All, Folks!', International Journal of Baudrillard Studies, Volume 3, Number 1 (January 2006)

• Alan Cholodenko, '“OBJECTS IN MIRROR ARE CLOSER THAN THEY APPEAR”: The Virtual Reality of Jurassic Park and Jean Baudrillard', International Journal of Baudrillard Studies, Volume 2, Number 1 (January 2005) 

• Alan Cholodenko, '“The Borders of Our Lives”: Frederick Wiseman, Jean Baudrillard, And The Question of The Documentary', International Journal of Baudrillard Studies, Volume 1, Number 2 (July 2004) 

• Alan Cholodenko, '(The) Death (of) the Animator, or: The Felicity of Felix - Part II: A Difficulty in the Path of Animation Studies', Animation Studies – Vol.2, 2007

• Alan Cholodenko, 'The Spectre in the Screen', Animation Studies – Vol.3, 2008

• David B. Clarke, Dreams Rise in Darkness: The White Magic of Cinema', Film-Philosophy, Vol 14, No 2 (2010)

• Gerry Coulter, 'Jean Baudrillard and Cinema: The Problems of Technology, Realism and History', Film-Philosophy, Vol 14, No 2 (2010)

• Anton Escher, 'The Geography of Cinema - A Cinematic World', Erdkunde, Band 60/2006

• Scott Forsyth, 'Marxist Film Theory: From the Barricades to Postmodernism' , The Socialist Register, 1997

• Anne Friedberg, 'Urban mobility and cinematic visuality: the screens of Los Angeles – endless cinema or private telematics', Journal of Visual Culture, Vol 1(2), 2002: 183-204

• John Frow, 'Australian Cultural Studies: Theory Story, History', Australian Humanities Review, Issue 37, December 2005

• Michael Hemmingson, 'Auto/Ethnography and Tinsel Town: Nathaniel Kohn's Pursuing Hollywood and How it Relates to My Own Experiences Chasing the Dream of Creating Culture Through Cinema', Forum Qualitative Sozialforschung / Forum: Qualitative Social Research,  Vol 9, No 3 (2008)

• Mark Hobart, 'Just Talk? Anthropological Reflections on the Object of Media Studies in Indonesia', A.J.S.S. 34:3 (492–519)

• Mark Hobart, 'The Subject of the Subject: Philosophical background to a critical reconsideration of the problems in studying non-Western media', Position Paper to the Workshop on The Subject of the Subject in Media Studies, Media Research Group SOAS, 2nd. December 1997

• Russell J.A. Kilbourn, 'Re-Writing "Reality": Reading The Matrix', Canadian Journal of Film Studies, 9.2, Fall 2000, pp 43-54

• Marc J. LaFountain, 'Obscene Ethics: A Baudrillardian View of Spurlock’s Super Size Me', International Journal of Baudrillard Studies, Volume 5, Number 2 (July, 2008) 

• Jon Lindblom, 'Toward an Ontology of the Image: Deleuze and the Aura of Simulation', Movement Editions, 2010

• Scott A. Lukas, 'Fragments of The World Thinking Me, Or How The Digital Facilitates Human Separation', International Journal of Baudrillard Studies, Volume 3, Number 2 (July 2006)

• Chris Lukinbeal, 'The map that precedes the territory: An introduction to essays in cinematic geography', GeoJournal 59: 247–251, 2004

• Christopher Macallister, 'The Changing British Sensibility Towards War and the Reimagining of World War Two in the Cinema', War, Virtual War and the Challenges to Communities Oxford 16th – 18th July 2002

• Russell Manning, 'Taking Baudrillard to the Movies (To Talk About Death)', International Journal of Baudrillard Studies, Volume 7, Number 1 (January, 2010)

• Erik Marshall, 'Fatal Strategies and Film Studies', Film-Philosophy, Vol. 6 No. 44, November 2002

• William Merrin, 'Speculating to the Death: Machinic Integration and Transformation Within A Virtualized Reality', International Journal of Baudrillard Studies, Volume 4, Number 2 (July, 2007)

• William Merrin, 'Total Screen: 9/11 and the Gulf War Reloaded',International Journal of Baudrillard Studies,  Volume 2, Number 2 (July 2005)

• Paula Murphy, 'The Simulacra of Global Conflict', International Journal of Baudrillard Studies, Volume 5, Number 2 (July, 2008)

• Pamela Nilan, 'Applying Semiotic Analysis to Social Data in Media Studies', Jurnal Komunikasi Massa Vol. 1, No. 1, Juli 2007, 60-74

• Benjamin Noys, 'Crimes of the Near Future: Baudrillard / Ballard', International Journal of Baudrillard Studies, Volume 5, Number 1 (January, 2008) 

• William Pawlett and Meena Dhanda, 'The Shared Destiny of the Radically Other: A Reading of  The Wizard of Oz', Film-Philosophy, Vol 14, No 2 (2010)

• Richard Pope, 'Baudrillard’s Simulacrum:  Of War, Terror, and Obituaries', International Journal of Baudrillard Studies, Volume 4, Number 3 (October, 2007)

• James Rovira, 'Subverting the Mechanisms of Control: Baudrillard, The Matrix Trilogy, and the Future of Religion', International Journal of Baudrillard Studies, Volume 2, Number 2 (July 2005)

• Kenneth Rufo, 'Obscenity with a View: Baudrillard's  Revenge of the Crystal and Film Studies', Film-Philosophy, Vol. 6 No. 43, November 2002

• Marita Ryan, 'Answering the Question: “What is Intermission?” – An Exploration of Intermission as a Postmodern Film', International Journal of Baudrillard Studies, Volume 5, Number 1 (January, 2008) 

• Alan N. Shapiro, 'Baudrillard and Trek-nology (Or Everything I Know I Learned From Watching Star Trek and Reading Jean Baudrillard)', International Journal of Baudrillard Studies, Volume 2, Number 2 (July 2005) 

• Mark Shiel, 'Cinema and the City in History and Theory', Cinema and the City (Oxford: Blackwell, 2001)

• Jonathan Smith, Jean Baudrillard’s Philosophy of Magic', International Journal of Baudrillard Studies, Volume 4, Number 2 (July, 2007)

• Richard G. Smith, 'Lights, Camera, Action: Baudrillard and the Performance of Representations', International Journal of Baudrillard Studies, Volume 2, Number 1 (January 2005)

• Paul Taylor, 'Baudrillard's Resistance To the Ob-Scene As the Mis-en-scene (Or, Refusing to Think Like a Lap-Dancer’s Client)', International Journal of Baudrillard Studies, Volume 5, Number 2 (July, 2008)

• Paul A. Taylor, 'The Pornographic Barbarism of the Self-Reflecting Sign', International Journal of Baudrillard Studies, Volume 4, Number 1 (January 2007)

• Kim Toffoletti and Victoria Grace, 'Terminal Indifference: The Hollywood War Film Post-September 11', Film-Philosophy, Vol 14, No 2 (2010)

• Hunter Vaughan, 'The Paradox of Film: An Industry of Sex, a Form of Seduction (Notes on JeanBaudrillard’s  Seduction  and the Cinema)', Film-Philosophy, Vol 14, No 2 (2010)

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iPads and other wireless technology: Forget the fun...will they be the next great public health invention?

iPad mania is sweeping the nation! It even made a cameo in my new favorite show, "Modern Family". In a recent episode, all Phil Dunphy wants for his birthday is an iPad. He is excited to use it for web browsing, eBook reading, and video watching. But what if it could also improve his health?
A great article in The Economist this week called, "When your carpet calls your doctor", examines how the convergence of wireless communications, social networking, and medicine will transform health care.

This concept appears quite realistic for several reasons:

• Doctors are already using and comfortable with the technology. The article quotes a forthcoming report by the California Health Care Foundation that found that two-thirds of doctors are already using "smart phones" (a mobile phone with advanced capabilities such as Internet connectivity). Doctors are also used to turning to their computers and/or wireless devices for programs like Epocrates to review treatment information and decision making tools.

• Wireless technology reduces treatment barriers such as the distance and/or availability of the health care provider. One example of the technology being developed is a device which will be able to contact a doctor when his/her elderly patient is about to take a fall in their residence. The article also quotes successful work being done in developing countries such as Rwanda and Peru. This work has expanded to public health programs in the United States, such as Text4baby. This is an educational program of the National Healthy Mothers, Healthy Babies Coalition (HMHB). Women who sign up for the service will receive free text messages each week, timed to their due date or baby's date of birth.

• This technology is aiming to address barriers and facilitators of Behavior Change, not just an increase in knowledge! The focus soley on education to increase knowledge is the downfall of many public health programs. Knowledge alone will not change behavior. However, check out the programs from the company Virgin HealthMiles. They have begun using online social networks, through which co-workers or family members can cheer on or nag patients electronically, in order to encourage exercise or weight loss. The company is beginning to explore how to increase the level of social support and social/family acceptance that patients receive regarding their recommended treatment. Lack of support in these areas can often be a barrier to treatment success.
  

Of course there are still a few things that remain to be seen about the success of these eHealth programs. What are the privacy implications? Are smart phones (or similar wireless technology) widely available to the populations that most need these interventions (e.g., low socioeconomic status, the elderly, rural residents, etc)? What do my readers think?

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Technology: Building Social Connections or Breaking Them Down?

Last week, a friend at work told me that she had given up watching TV for Lent. She said "every time I give up TV, my quality of life goes up". I thought of her immediately today as I read this new article in TIME, "Logged on, checked out...of relationships?" The article discusses a study (published in the March issue of the journal Archives of Pediatrics & Adolescent Medicine) which studied adolescents during two periods of time (1988 and 2004). The adolescents who spent more time watching TV or playing video games were more likely to report lower quality relationships compared with those who logged less screen time.
I find this fascinating because I have followed the debate among colleagues and friends regarding the increase in the use of technology and its impact on social connections. For example, kids that may be "outcasts" at school may find friends online. They may have hundreds of Facebook "friends". They may find lots of kids with similar interests by joining "groups" online. However, one has to ask, are Facebook friends "real"? I personally have 355 friends on Facebook, but would only consider about 10 of those people close friends in my day to day life. Is it worth it to focus your time and attention to online activities (as noted above) to the detriment of your "real life" relationships with friends and family?
In looking at how social connectedness can be a protective factor for things like suicide, the question has also come up: "Is it the quantity or quality of relationships that really count?" In research on college students, studies like Healthy Minds are beginning to indicate that it is the quality that counts. However, unlike my previous posts where it has been easy for me to take one side or the other...I'm torn about this issue. The authors of the above study were as well...they note that there is an obvious correlation between online activities and relationship quality, but the causal link is not clear.
Therefore, I believe it is probably some happy balance that is best. Facebook friends and groups are not all superficial and time wasters. People can connect (or in many cases, "reconnect") with friends and colleagues with shared histories or interests. I've seen Friends post a concerning or unsafe status and 20 people jump in with words of encouragement or offers of help...which is wonderful. On the flip side, it helps to turn the computer or TV off and enjoy the world around us...strengthen those connections with those we live with, eat dinner away from the TV, etc. And of course on that note, I'll log off. LOST starts at 9pm ;)

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