Matthew W. Kreuter, PhD, MPH!Washington University in St. Louis!
!!
!!!
CPCRN Investigators Meeting!Denver, CO!
October 3, 2013!!!!
MIYO, health disparities and the!Long Tail of cancer communication!
!
Collaborators!!
• Peter Hovmand, PhD!
• Debbie Pfeiffer, MA!• Chris Casey, MPH!
• Suchitra Rath, MS!• Maggie Fairchild!
• Balaji Golla!!
“At risk” perspective!!!!
“Population” perspective!
“Vulnerable population” perspective!
Why does this happen?!!
• Risk varies by socially-defined groups, not just behavioral risk factors!
!• Core risks – low education, low SES –
increase “risk of risks”, cumulative risk!!• Population interventions not as effective! !!
!
Smoking prevalence by education!U.S. adults, 2008 NHIS (n=21,781)
41!
28! 26!19!
11!6!
0!
10!
20!
30!
40!
50!
60!
GED! < 12 years! H.S.! Associate! Bachelor's! Graduate!
MMWR, 58 (44) 1227-‐1232, 2007
“Vulnerable sub-groups” approaches!!• Intersectoral!!• Participatory!!
!
-‐ Every community is unique
-‐ Customiza?on ma@ers
-‐ Locals know best
-‐ 591 registered users
-‐ 447 organiza?ons
-‐ 47 states, DC, Canada
MIYO users for CRC (through 7-‐11-‐13)
A Long Tail distribution!
PRODUCTS
Blockbusters
Long tail
POPULARITY
Figure 1. The long tail
Long Tail observation #1!!
• More niche products than blockbusters!
!!
Blockbuster vs. Niche!!
• Wide appeal, substantial sales!
! ! ! ! !vs.!• Narrow appeal, nominal sales!
!
!!
12 million!albums!
Long Tail observation #2!!
• Collectively niches make a huge market!
!!
Example 1: Online music!!
• Half of inventory sold ranked below top
5,000 sellers!• Some sold to only a few buyers per week,
worldwide!
!!
!
Example 2: Movie rentals!!
• Blockbuster stocks < 3,000 titles!
• 20% of Netflix rentals outside top 3,000!• Netflix: Bollywood rentals > 100,000/mo.!
!
!!
Example 2: Movie rentals!!
• redbox stocks < 200 titles!
!!
!
Long Tail observation #3!!
• Choice reveals true shape of demand!
!!
24 versions of EBIs
350 messages
400 images
Research questions!!
• Do MIYO products reflect a Long Tail
distribution?!!
• Are MIYO products in the Long Tail more likely to address vulnerable populations?!
!!
!
A Long Tail distribution!
PRODUCTS
Blockbusters
Long tail
POPULARITY
Figure 1. The long tail
Data for analyses!!
• March 2011 – February 2013!
• 4,351 MIYO products for CRC screening!• production details obtained from 905
• Messages chosen
• Images chosen !
!!
Analyses!!
• Plot distribution of all images selected!!
• Infer target population from MIYO images!!
• Compare racial/ethnic mix of images in head, middle and tail of the distribution!
!
!!
Defining high risk/disparity sub-groups!!
• CRC incidence or mortality > U.S. avg.!!
• Screening or 5-year survival < U.S. avg.!
• African American, Asian/Pacific Islander, Hispanic, American Indian/AK Native!
!
!!
Rim SH, et al (2011) MMWR Howlander N, et al. (2012) NCI SEER Cancer Statistics Review Ries LAG, et al. (2007) NIH Pub. No. 07-6215
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
Diversity in the Long Tail Frequency of images selected
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
Head Middle Long Tail
Diversity in the Long Tail Frequency of images selected
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
27 images; 339 docs (12.6) 57 images; 292 docs (5.1) 151 images; 264 docs (1.8)
Diversity in the Long Tail Frequency of images selected
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
TERTILE SPLIT OF DISTRIBUTION
RACE/ETHNICITY OF IMAGES# HEAD MIDDLE TAIL
% White
% African American
% Hispanic
% American Indian/Alaska Native
% Asian/Pacific Islander
% Indian
SMALL MEDIA AND CLIENT REMINDERS
Distinct images used 27 57 151
Total documents created 339 292 274
Mean documents created per image 12.6 5.1 1.8# p < .005 (n=235; �2=25.9, df=10)
235 IMAGES
USED 905 TIMES
35 USES
52 35 25
19 28 32
22 16 6
7 18 24
0 4 11
0 0 1
Figure 3. Diversity in the long tail
Summary!!
• With unconstrained choice, users: !• Address CRC niches in large numbers!
• Niche products addressed:!• More diverse populations!• Populations at higher CRC risk!
!!
Current approaches!!
• Can’t address every niche population!
• May shift the curve, but with disparities!!
!
Long Tail solutions!!
• Feasible with technology!
• More efficient, especially for local efforts!• MIYO as a Long Tail model!
!
