cancer prevention & control in the changing communication landscape

Cancer Prevention & Control in the Changing Communication Landscape

Bradford W. Hesse, PhDChief, Health Communication and Informatics Research Branch

In 2005, 61.6% (+/- 1.6) of Americans thought of cancer as a death sentence.

Is it?

In 2015, news outlets reported that cancer is “just bad luck.”

Is that right?

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”

Age-Adjusted Mortality

Unpacking Trends: Males

public health control of h-pylori

public health control of tobacco

early detection, better treatment

Unpacking Trends: Females

public health control of h-pylori

public health control of tobacco

early detection, better treatment

224,210

preventable,

371,040

detectable, treatable

604,040


836,710


Just a 1% reduction would save $400 billion

The Role of Public Media

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500

1000

1500

2000

2500

3000

3500

4000

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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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ance

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Female lung cancer death rate

Male lung cancer death rate

Per capita cigarette consumption

Public Health fights back

Advertising

Trend: Marketing to Women

Communication Response

Christy Turlington, Courtesy CDC

Trend: Marketing to Children


Trend: Going Global


But do we need science?Isn’t communication really just common sense?*

*Any resemblance to persons living or dead is purely coincidental

Philip Morris Anti Smoking Campaign*

*Source: PhilipMorrisUSA.com

Anti-Smoking Campaigns: Philip Morris



Counter-normative Communication




Social Modeling for Adult

Smoking


Philip Morris Approach Increased Smoking

Truth Campaign Reduces Smoking Rates

“1200 People”

•Appeal to independence

•High “sensation value” filming

•Data presented as narrative

Deliberate Obfuscation

Source: http://legacy.library.ucsf.edu/tid/rgy93f00/pdf

Oxford Publishers, 2008

Deliberate Obfuscation

Inadvertent Obfuscation

Other Attempts at Obfuscation

Confusion Can Cost Lives

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)”

The New Media Environment

Rise in channels, voices, & conflicting messages

Everything causes?

Can prevent?

Know how?

+7.7%

Confusion

hints.cancer.gov

http://hints.cancer.gov

Everything causes?

Can prevent?

Know how?

+7.7%

-1%

Confusion

hints.cancer.gov


Everything causes?

Can prevent?

Know how?

Confusion

+7.7%

-1%

+3.7%

hints.cancer.gov


Entering an Era of “Data Smog”

Decision Paralysis

Anxiety

Confusion

Impulsivity

Frustration, Anger

Katherine Smith

Jeff Niederdeppe

Kelly Blake

Joseph CappellaResearch in the New

Media Environment

1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation

Fundamental Shifts

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

1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation

Fundamental Shifts


NEW

OPPORTUNITIES

•Rapid response

•Digital press kits

•Quick tracking

•Podcasts

•Sharable widgets


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

http://jama.jamanetwork.com


NEW

OPPORTUNITIES

•Rapid surveillance of digital life: “Infodemiology”

•Development of algorithms to search archived broadcasts

• Just in time, adaptive interventions

Fundamental Shifts1. Speed / Dynamism2. Diversity of perspectives / “narrowcasting”3. Broadened participation Accelerating Analysis of

Cancer Trends through Web-scraping

NEW

OPPORTUNITIES


Media are narrowing to serve interest-based market segments


Disparities Frame

Framing to fit perspective

Matthew Kreuter, Wash U

NEW

OPPORTUNITIES


Impact Frame



NEW

OPPORTUNITIES


Progress Frame



NEW

OPPORTUNITIES


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



NEW

OPPORTUNITIES


NEW

OPPORTUNITIES

Targeting stories to perspectives

Perspective Framed Story Sample Article

NCI Data

Platform for localization


The Trusted Voice Pundits

Newscasters


Time Magazine, 2006


NEW

OPPORTUNITIES

MatthewKreuter


NEW

OPPORTUNITIES

When is genomic information communicated most accurately?

Prestige

Familiarity

Co-construction


NEW

OPPORTUNITIES

When is genomic information communicated most accurately?

Prestige

Familiarity

Co-construction

Prestige

Familiarity

Co-construction

Journalist + Source


NEW

OPPORTUNITIES

BLS USDA CDCCommunity Health Data

Communicating Evidence to the Public

Making Data Talk

Inform Support Decisions

Educate Persuade

Nelson, Hesse, Croyle, 2009

Knowledge in the Head*

Knowledge in The World*

Task Relevant Schemata

General model

Chapter 4: Visual Displays

SOURCE: http://alleydog.com/topics/sensation_and_perception.php

Perceptual Basics

http://alleydog.com/topics/sensation_and_perception.php

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

source: Carpenter PA, Shah P. A model of the perceptual and conceptual processes in graph comprehension. J Educ Psychol. 1999, 91(4): 690-702.






Visualizing Long Term Change






Hans Rosling, BBC

Visualizing Change Dynamically

Overcome “small numbers” bias & emotional response

Exceptional Case

Fallacy of small numbers;Tversky & Kahneman, 1971

Illnesses322,000,000

Hospitalizations21,000,000

Prevented

Deaths732,000

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

Portraying trends to policy makersChoropleth Maps: CDC Obesity Trends, BRFSS 1985

Nonsegmented geographic data

Isopleth “Weather Maps,” HINTS

Juxtaposing geographic distributions

Mortality Maps (SEER): Lung Cancer Mortality

For Example: Knowledge Maps (HINTS): Does Smoking Cause Cancer?

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.

Take Away Points

Communicating Publicly about Cancer is as Important Now as Ever

But the Science of Cancer is Becoming Increasingly more Complex & Precise

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/

But Patients Are Driven to Investigate, Understand, and Act

Dose > Response

Old Public Health Models Are Insufficient

“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

Together, We Can Stand Up to Cancer

Thank You!

cancer prevention & control in the changing communication landscape

Health & Medicine