cancer prevention & control in the changing communication landscape
TRANSCRIPT
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Cancer Prevention & Control in the Changing Communication Landscape
Bradford W. Hesse, PhDChief, Health Communication and Informatics Research Branch
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In 2005, 61.6% (+/- 1.6) of Americans thought of cancer as a death sentence.
Is it?
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In 2015, news outlets reported that cancer is “just bad luck.”
Is that right?
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What do the Data Say? What researchers found:
Correlation between • Type of cell & life time risk• Cells that divided frequently had
greater probability of mutation• Unless prevented …
“It’s like ... traffic patterns. There is a tight correlation between the number
of cars on the roads and the number of accidents, but that doesn’t mean that it’s pure bad luck if you have an accident.
Bad luck is not scientific: Many cases can be prevented”
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Age-Adjusted Mortality
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Unpacking Trends: Males
public health control of h-pylori
public health control of tobacco
early detection, better treatment
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Unpacking Trends: Females
public health control of h-pylori
public health control of tobacco
early detection, better treatment
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224,210
preventable,
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371,040
detectable, treatable
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604,040
detectable, treatable
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836,710
detectable, treatable
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Just a 1% reduction would save $400 billion
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The Role of Public Media
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0
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*Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Public Use Tapes, 1960-2000, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. Cigarette consumption: US Department of Agriculture, 1900-2000.
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Female lung cancer death rate
Male lung cancer death rate
Per capita cigarette consumption
Public Health fights back
Advertising
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Trend: Marketing to Women
Communication Response
Christy Turlington, Courtesy CDC
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Trend: Marketing to Children
Communication Response
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Trend: Going Global
Communication Response
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But do we need science?Isn’t communication really just common sense?*
*Any resemblance to persons living or dead is purely coincidental
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Philip Morris Anti Smoking Campaign*
*Source: PhilipMorrisUSA.com
Anti-Smoking Campaigns: Philip Morris
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Philip Morris Anti Smoking Campaign*
*Source: PhilipMorrisUSA.com
Counter-normative Communication
Anti-Smoking Campaigns: Philip Morris
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Philip Morris Anti Smoking Campaign*
*Source: PhilipMorrisUSA.com
Social Modeling for Adult
Smoking
Anti-Smoking Campaigns: Philip Morris
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Philip Morris Approach Increased Smoking
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Philip Morris Approach Increased Smoking
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Truth Campaign Reduces Smoking Rates
“1200 People”
•Appeal to independence
•High “sensation value” filming
•Data presented as narrative
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Deliberate Obfuscation
Source: http://legacy.library.ucsf.edu/tid/rgy93f00/pdf
Oxford Publishers, 2008
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Deliberate Obfuscation
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Inadvertent Obfuscation
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Other Attempts at Obfuscation
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Confusion Can Cost Lives
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Confusion Can Cost Lives“One in four people in
the United States—nearly 80 million—are infected with at least one type of
human papillomavirus (HPV)”
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The New Media Environment
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Rise in channels, voices, & conflicting messages
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Rise in channels, voices, & conflicting messages
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Rise in channels, voices, & conflicting messages
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Rise in channels, voices, & conflicting messages
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Everything causes?
Can prevent?
Know how?
+7.7%
-1%
Confusion
hints.cancer.gov
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Everything causes?
Can prevent?
Know how?
Confusion
+7.7%
-1%
+3.7%
hints.cancer.gov
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Entering an Era of “Data Smog”
Decision Paralysis
Anxiety
Confusion
Impulsivity
Frustration, Anger
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Katherine Smith
Jeff Niederdeppe
Kelly Blake
Joseph CappellaResearch in the New
Media Environment
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1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Fundamental Shifts
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
TuesdayJuly 9, 2002
Online First article published
WednesdayJuly 10, 2002
ThursdayJuly 11, 2002
FridayJuly 12, 2002
SaturdayJuly 13, 2002
Doctors Receive Journal Issue
Issue Published
Radio, TV news
*See: Hesse BW. The Patient, the Physician, and Dr. Google. JAMA Virtual Mentor. 2012;14(5):398-402.
NHLBI detects rise in breast cancer for
PremPro
Patients access article online
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1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Fundamental Shifts
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
•Rapid response
•Digital press kits
•Quick tracking
•Podcasts
•Sharable widgets
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
•Better integration of online and print content
•Multimedia content for public and the press
•Data repositories for “open science”
•Digital Object Identifiers for journalistic content
jama.jamanetwork.com
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
•Rapid surveillance of digital life: “Infodemiology”
•Development of algorithms to search archived broadcasts
• Just in time, adaptive interventions
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation Accelerating Analysis of
Cancer Trends through Web-scraping
NEW
OPPORTUNITIES
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Media are narrowing to serve interest-based market segments
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Disparities Frame
Framing to fit perspective
Matthew Kreuter, Wash U
NEW
OPPORTUNITIES
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Impact Frame
Framing to fit perspective
Matthew Kreuter, Wash U
NEW
OPPORTUNITIES
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Progress Frame
Framing to fit perspective
Matthew Kreuter, Wash U
NEW
OPPORTUNITIES
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
3.25
3.5
3.75
4
4.25
4.5
4.75
5
Progress Impact Disparity
Low MistrustHigh Mistrust
3.25
3.5
3.75
4
4.25
4.5
4.75
5
Progress Impact Disparity
Low MistrustHigh Mistrust
I want to be screened for colon cancer? Framing X Medical Mistrust
Results
Framing to fit perspective
Matthew Kreuter, Wash U
NEW
OPPORTUNITIES
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
Targeting stories to perspectives
Perspective Framed Story Sample Article
NCI Data
Platform for localization
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
The Trusted Voice Pundits
Newscasters
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
Time Magazine, 2006
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
MatthewKreuter
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
When is genomic information communicated most accurately?
Prestige
Familiarity
Co-construction
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
When is genomic information communicated most accurately?
Prestige
Familiarity
Co-construction
Prestige
Familiarity
Co-construction
Journalist + Source
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Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation
NEW
OPPORTUNITIES
BLS USDA CDCCommunity Health Data
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Communicating Evidence to the Public
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Making Data Talk
Inform Support Decisions
Educate Persuade
Nelson, Hesse, Croyle, 2009
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Knowledge in the Head*
Knowledge in The World*
Task Relevant Schemata
General model
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Chapter 4: Visual Displays
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SOURCE: http://alleydog.com/topics/sensation_and_perception.php
Perceptual Basics
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source: Carpenter PA, Shah P. A model of the perceptual and conceptual processes in graph comprehension. J Educ Psychol. 1999, 91(4): 690-702.
• Constructive process
• Gaze goes to center for pattern
• Contiguous labels for meaning
• Left to right tendency in western culture
• Perceptual rules guide meaning
Cognitive / Perceptual Research
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source: Carpenter PA, Shah P. A model of the perceptual and conceptual processes in graph comprehension. J Educ Psychol. 1999, 91(4): 690-702.
• Constructive process
• Gaze goes to center for pattern
• Contiguous labels for meaning
• Left to right tendency in western culture
• Perceptual rules guide meaning
Visualizing Long Term Change
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• Constructive process
• Gaze goes to center for pattern
• Contiguous labels for meaning
• Left to right tendency in western culture
• Perceptual rules guide meaning
Hans Rosling, BBC
Visualizing Change Dynamically
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Overcome “small numbers” bias & emotional response
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Exceptional Case
Fallacy of small numbers;Tversky & Kahneman, 1971
Illnesses322,000,000
Hospitalizations21,000,000
Prevented
Deaths732,000
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See: Fagerlin, A., Ubel, P. A., Smith, D. M., & Zikmund-Fisher, B. J. (2007). Making numbers matter: present and future research in risk communication. Am J Health Behav, 31 Suppl 1, S47-56.
Icon arrays designed to convey natural frequencies
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Portraying trends to policy makersChoropleth Maps: CDC Obesity Trends, BRFSS 1985
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Nonsegmented geographic data
Isopleth “Weather Maps,” HINTS
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Juxtaposing geographic distributions
Mortality Maps (SEER): Lung Cancer Mortality
For Example: Knowledge Maps (HINTS): Does Smoking Cause Cancer?
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Added User Controls 14 datasets spanning 6 years
NSF, NIH Collaboration
Dissolving Barriers Between Clinical and Community Health
source: Hesse, Bradford W. (2007). Public Health Informatics. In M. C. Gibbons (Ed.), eHealth Solutions for Healthcare Disparities (pp. 109-129). New York, NY: Springer.
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Take Away Points
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Communicating Publicly about Cancer is as Important Now as Ever
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But the Science of Cancer is Becoming Increasingly more Complex & Precise
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The Public’s Reaction to Cancer Will Be Driven by Emotion
“Communication can never reshape everyone’s deep passions about what feels safe. Risk management … must account for the mistakes we sometimes make.”
-David Ropeik
http://undark.org/article/know-this-first-risk-perception-is-always-irrational/
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But Patients Are Driven to Investigate, Understand, and Act
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Dose > Response
Old Public Health Models Are Insufficient
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“Meaningful Use”
Safety, Quality Improvement
Patient Engagement
Continuity of Care
Population Health
Privacy, Security TRUST
New Models, Taking Advantage of New Information Environment, Are Needed
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Together, We Can Stand Up to Cancer
Thank You!
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Together, We Can Stand Up to Cancer
Thank You!