Spare Change

making a difference with social marketing
by Nedra Kline Weinreich

links for 2006-11-29
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Village is a "multiplayer online real-time strategy game for the PC that

immerses the player into the role of an entrepreneur building companies

to bring prosperity to the villages of the third world." Though they don't have a demo of the game available yet, they are planning on getting an alpha version out in January. The goal of the game is to promote awareness of social enterprise (eradicating poverty through profits) and to get more people involved in third world development.

It seems to be a mash-up of SimCity, Second Life and the Peace Corps:

Fly over a remote village watching people walking about, farmers tending to their crops, people buying and selling goods in the town markets. Browse anybody in the village and see what income, jobs, education they have. View the stores in the town center to find out what is selling well, and what's missing entirely. Set up your own store fronts to offer microcredit, kickstart pumps, solar cell rentals, all the self-sustaining businesses that will have the greatest impact on the villagers. Watch as farms flourish, villagers build new homes, and schools grow larger with more healthy children.

Ultimately, there may be tie-ins to reality, with companies that sell products used by nonprofit aid organizations sponsoring the game, nonprofits soliciting donations, and the possibility of applying what is learned to real villages. I don't know if the business model will take off, given that there's not a lot of extra money floating around in this sector, but it could be a place for Second Lifers to escape the first-world commercialism that's invading their virtual space.

via CharityBlog

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As we sat around the table at Thanksgiving, eating the same food we eat every year (not that I'm complaining!), on the same pilgrim placemats my 10-year old nephew made years ago in preschool, at the same strange time (who eats dinner at 4:00?), with the same wonderful people, I started thinking about the power of tradition. As someone who observes just about every major and minor Jewish holiday with all the requisite flourishes, believe me - I know about tradition.

What is it about tradition that is so important to people? Why do we all have to eat turkey at the same time -- millions of turkeys across the country -- on this one day? (Though my first year in Boston for grad school, I had Thanksgiving with my elderly landlady who could not stand turkey so we had cornish hens -- it just felt wrong!)

I think tradition is especially important to us because when so many things constantly change in our lives, the things that remain the same keep us linked to the past, to our roots, to our family. It's comforting to experience the same tastes, smells, sounds and sights that are connected to positive emotions and feelings of happiness, belonging and love (though sadly this is not true for everyone). Children especially cling to traditions and get upset when they are not followed (what do you mean you didn't put marshmallows on top of the sweet potatoes this year????).

While we generally think of traditions as something that is passed down through the generations, they can also be started anew just by doing the same thing for two years in a row. About 5 years ago, I volunteered to bring a different version of the standard cranberry sauce (a jalapeno-spiked relish - delicious!) that is now a dish I bring every year. Or on a non-holiday note, my husband and I got together a few years ago with some good friends we don't see very often on what happened to be the winter solstice. Since then, we make it a point to at see each other at least twice a year -- on the winter and summer solstices. The tradition ensures that we will maintain our friendship.

Not all traditions come from history, religion or family. Some are manufactured by those with a financial or social interest in the tradition's accoutrements and are adopted widely by a community or culture. Recently I read in the Wall Street Journal (subscriber access only) about Pepero Day, an unofficial holiday in South Korea in which friends and couples exchange the chocolate-coated Pepero cookie sticks (four of which look like the holiday's date -- 11/11). Sales of the snack have skyrocketed since Pepero Day supposedly started in 1994, when girls at a middle school exchanged Pepero sticks, wishing each other to become as tall and slender as a Pepero (though it may be a story dreamed up by the marketing team).

Similarly, Kit Kat bars have become popular in Japan as a way of wishing someone luck on their school exams. This tradition was orchestrated by the marketers in a way that made it seem organic and is based on the similarity between the candy's name and the Japanese phrase kitto katsu, which means roughly "I hope you succeed!" Now Japanese moms wouldn't think of sending their children to take their exams without their lucky Kit Kats.

Is this any different from the Hallmark holidays of Grandparent's Day and Secretary's Day or the obvious commercial tradition of having yearly blowout sales on the day after Thanksgiving (my own private vision of hell is going to the mall that day)? In fact, social marketers do this type of thing all the time, with this Friday being World AIDS Day, next week being National Handwashing Awareness Week and dozens of other national health observances for all days, weeks and months. These observances might be traditions for people working in these fields, but they haven't quite caught on with the general public yet.

How can we create new positive health and social traditions that will be adopted by the people who will most benefit from them?
  • Tie it to a seasonal occurrence - For example, fire prevention programs promote the semi-annual campaign to encourage people to change the battery in their smoke detectors when they change the clocks for daylight savings time.
  • Make it about friends and family - Every October, my stepfamily participates in the Hirshberg Foundation's Walk/Run to raise money for pancreatic cancer research because their father died from the disease. It's a way for them to come together and do something positive in their father's memory.
  • Incorporate the new tradition into already-existing traditions - Perhaps that pumpkin pie can be made in a way that is lower in fat and calories or the family can go on a post-Thanksgiving dinner walk around the neighborhood. One of the best examples of a social marketing program done on a small budget I've seen is a campaign by the state of Georgia to prevent outbreaks of bacterial infection by a couple of small changes to the way mostly older African American women prepare the traditional dish of chitterlings (pork intestines).
  • Incorporate other cultures' traditions into your own - We have a culture that thinks nothing of eating nachos on Cinco de Mayo and drinking green beer on St. Patrick's Day. Perhaps there are other more healthful or socially beneficial traditions from other diverse groups that can be extended to the larger culture. For example, the Mediterranean diet, which centers around olive oil, unrefined grains, fruits and vegetables, and a moderate amount of wine, has been shown to increase longevity and could be touted as part of a Greek festival day. The Chinese New Year could be an occasion for promoting the healthful effects of drinking tea.
  • Institutionalize something as a tradition by doing it annually - Once something has been done two years in a row, it could loosely be considered a tradition. Take advantage of that fact and start referring to your annual event as a community tradition. Boston Medical Center's Halloween Town seems like it could be heading in this direction after just two years. Your community's annual health fair might be the occasion that people look forward to each year to get their blood pressure checked and talk to a health educator about their latest health concern.
Traditions can be big or small. Starbucks is making a little too much of the fact that it rolls out red cups for the holiday by creating an entire website called It's Red Again that is all about holiday traditions. But they are definitely smart to try to tie their product to something that resonates deeply with people -- tradition.

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One of the things I've figured out as I've gone through life is that the key to happiness is in wanting what you have, not in having what you want. And I am very lucky to have everything I could possibly need. As Thanksgiving comes to America on Thursday, I beg your indulgence as I recount the things for which I am grateful this year:
  • Number one are my wonderful, loving husband and two amazing children (along with my whole extended undysfunctional family)
  • My health and well-being
  • Clients who I love and whose causes I believe in wholeheartedly
  • The opportunity to do meaningful and fulfilling work every day that makes a positive difference in the world
  • Soldiers, police and firefighters who voluntarily put their lives on the line to keep me and my family safe
  • The right to practice my religion in peace, speak my mind, and have a say in what happens in my government
  • The ability to eat a Thanksgiving dinner without worrying where my next meal will come from
  • Living in Southern California, where it's been in the upper 70s and 80s in mid-November!
  • The beauty of this world, from the dew on a spider web to the indescribable purple of dusk
And, what would a blogger be without her readers? Thank you to all of you for caring what I have to say and for spending some of your precious minutes reading my blog. I wish you and your families a very happy Thanksgiving.
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Anyone who has done a Google search on the words "miserable failure" has witnessed the effects of a Google bomb (the first result is a link to George W. Bush's bio, though #2 and 3 are to Jimmy Carter and Michael Moore). This is a way that people attempt to influence the ranking of a page in the Google results -- often for political or humorous reasons. When particular words are frequently linked to a specific website, that site will come up higher in the rankings when a search is done for those words.

These hijinks are not usually something that people outside of SEO or dirty politics need to worry about. But recently it has been noted that the top result on a Google search for "Martin Luther King" is a site called martinlutherking dot org that was created by a white supremacist group (I did not link to it to avoid raising its PageRank). At first glance, it appears to be legitimate, and has probably been used by many unsuspecting people as a source of information about MLK. Apparently, quite a few educators who are trying to teach their students about being critical of what they read on the internet have linked to this page as an example, which has inadvertently raised it to the top spot (not to mention the skinheads or others who uncritically used it as a source who are linking to it as well).

So to try to push this offensive website off the front page, I'm joining in on the campaign to Google bomb it out of there. If you want to join in, you can grab the code from Tuttle SVC's blog for the links below, which provide much better alternatives for those who want real information.

Martin Luther King

Martin Luther King

Martin Luther King

Martin Luther King

Martin Luther King

Martin Luther King

Martin Luther King

Martin Luther King

Martin Luther King

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When you are creating health messages, small changes can make a big difference. A study by researchers at Penn's Annenberg School found that slight differences in how the new vaccine for human papillomavirus (HPV) is described influence whether women decide to get the vaccination.

A representative sample of 635 American adults, of whom 49 percent were women, was randomly assigned to read one of three slightly different paragraphs about the vaccine through the Annenberg National Health Communication Survey.

One paragraph addressed how the vaccine protects against cervical cancer, another how the vaccine protects against cervical cancer and sexually transmitted infection and the third how the vaccine protects against cervical cancer, sexually transmitted infection and how it may or may not lead to increased sexual promiscuity among those vaccinated.

The survey was administered to determine the participant's intentions regarding vaccination.

When women in the survey read that the vaccine protects only against cervical cancer, 63 percent indicated that they were very likely or somewhat likely to get the vaccine compared to 43 percent of women who read that the vaccine protects against cervical cancer and a sexually transmitted infection.

When it's all about preventing cancer, most of the women wanted the vaccine. But when you introduce the factor of it protecting against a sexually transmitted infection -- even while still preventing the Big C -- almost a third of the women opted out. Is this because they don't think it is something that they need (because, after all, THEY would never get an STI), or is it because it stigmatizes the vaccine recipient who wants the cancer protection but does not want people to think she is at risk of an STI?

This has huge implications for how the vaccine is marketed -- especially to parents, who will likely make the decision whether their daughters should get it or not (the vaccine is approved for girls as young as 9 years old).

I wrote about marketing this vaccine a while ago in response to a post that Seth Godin wrote about not wanting that marketing gig. Here's what I suggested should be done (which was endorsed by Seth in the comments!):
We would need to figure out what the key values are of the parents (who would likely make the decision) and appeal to those things that are most important to them -- feeling like a good parent, taking care of their daughters' health, making sure that their daughter will not have reproductive problems in the future. And, God forbid, the worst thing a parent can imagine is their child getting cancer -- what wouldn't they do or pay to prevent that from happening?

Position the vaccine as preventing cervical cancer rather than focusing on anything that might suggest that their daughter would even consider becoming sexually active until she is an adult. Get the CDC to add the vaccine to their recommended immunization schedule so that doctors will provide it as a matter of course with other teen booster shots so that parents won't feel like the recommendation comes from a negative judgment of them or their daughters. Get insurance companies to cover some of the costs of the vaccination since they will have fewer cases of cervical cancer and STDs to pay for later. The fears about long-term effects may be addressed by comparing the risks of the vaccine to other similar products and showing that the benefits far outweigh the possible risks.

In light of these research results, I stand by my recommendations. Looks like Merck is too.

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Nobel Prize-winning economist Milton Friedman died today at age 94. His ideas about a free market economy changed the world. He also applied these concepts to the education system, as an advocate for school choice through the Milton and Rose D. Friedman Foundation.

Through a project I have been a part of, I had the pleasure of seeing him and his wife Rose speak at two different occasions in the past year. The first was at a celebration of the 50th anniversary of his introduction of the idea of school vouchers as a way to minimize inefficient government spending and provide a better education for those stuck in the worst public schools. Milton and Rose -- both about 5 feet tall and walking with assistance -- spoke and answered questions with wit and passion. The years had not diminished their intellect in the least. The keynote speaker that evening was Arnold Schwarzenegger, who towered over the Friedmans when posing for a photo op. Schwarzenegger spoke about how when he was a new immigrant to the US starting his bodybuilding career, he turned on a television in his hotel room, which happened to be showing the groundbreaking series (and book) Free to Choose. He was captivated by the ideas Friedman talked about, which shaped his own political ideology.

Last May, I led a workshop on social marketing at a strategy meeting sponsored by the Friedman and Gleason Foundations, at which Milton and Rose were the dinnertime guest speakers. I was honored to see my name next to theirs on the program, but quite intimidated when I heard that Milton might come sit in on my session. I thought, "How could I teach Milton Friedman anything about marketing?" But it turned out that the traveling had been a little too hard on them to make it to my morning session. I never did go introduce myself to Milton and Rose -- I was just a little too starstruck -- but now I certainly wish I had.

My condolences go to Rose and her family, as well as everyone at the Friedman Foundation. Milton's memory will certainly be remembered for a blessing.

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This is way too much fun not to share. OK Go is a band that has made two of the best music videos I've seen in a long time (okay, well, I haven't really watched many music videos since I was in high school in the heyday of MTV, but that's beside the point). They are original and fun to watch, and done in just one take with one camera (though I'm sure they had to scrap many attempts before nailing it). The band members would seem to be unlikely candidates as dancers, but that just adds to the effect.

I came across the first one a couple of months ago...

and thought it was unbeatable until I just saw OK Go's other dance video on treadmills.

There have been so many people making their own videos of the "Million Ways" dance that OK Go started a contest for the best cover version posted to YouTube, with winners joining them to dance on stage at a show. So far 183 people have submitted entries, including a pair of Canadian bronze medal figure skaters who did a version of the dance in a skating routine. That's the way to get your fans involved!

OK Go has a very distinct brand now in my mind, and I would not have known about the band if they had not posted their videos on YouTube. By "giving away" a sample of their music and personality for free, they've done a great job of building awareness and making me look forward to their next offering. Is there anything you can give away that will pique interest and make people want more of your product?

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links for 2006-11-14
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The New Oxford American Dictionary announced that the Word of the Year is "Carbon Neutral" (actually, that's two words, but who am I to quibble with a dictionary?). It will be added to the next update of the dictionary, due in 2007.

According to the press release, "Being carbon neutral involves calculating your total climate-damaging carbon emissions (your "carbon footprint"), reducing them where possible, and then balancing your remaining emissions, often by purchasing a carbon offset: paying to plant new trees or investing in "green" technologies such as solar and wind power."

Carbon Neutral beat out other potential dictionary inductees with social marketing relevance including (and I'm not making these up):
  • Elbow Bump - a greeting in which two people touch elbows, recommended by the World Health Organization as an alternative to the handshake in order to reduce the spread of germs (Hmmm, wonder why this didn't catch on. I guess it's more hygenic than the Eskimo kiss, which the Alaska Health Organization has been promoting.)
  • Ghostriding - the practice of exiting a moving vehicle and dancing either beside it, or on the hood or roof, while the vehicle is in motion
  • Pregaming - consuming alcoholic beverages before attending a sporting event or party, especially one where alcohol may be limited or banned (or likely, before going ghostriding)
Just for fun, I looked up the Word of the Year for the past few years (though it seems to be a recent annual event for the OAD, so I've had to go to other sources):
2005 - podcast (Oxford American Dictionary)
2004 - blog (Merriam-Webster Dictionary)
2003 - metrosexual (American Dialect Society)

And just to illustrate how the US and UK are two countries separated by a common language, the 2006 word of the year for the Oxford English Dictionary is "bovvered." In case you are not familiar with this word either, here's how the article explained it:

Catherine Tate [a TV comic] catapulted her word into national parlance in November 2005 when at the 77th Royal Variety Performance in Cardiff she asked the Queen: "Is one bothered?" Dictionary compilers say the catchphrase needs little explanation.

A spokesman for the OED said: "Am I bovvered? and it's follow-up Does my face looked bovvered? had already come to be seen as the perfect expression of a generation of teenagers and their speaking style.

"Now in 2006 'bovvered' has taken over from 'whatever' as the signature phrase of teenagers, and to challenge the Little Britain catchphrase 'yeah-but-no-but' as the embodiment of couldn't-care-less adolescence."

Am I bovvered? Gotta go elbow bump my buds before I do some carbon neutral ghostriding. See ya.

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If you were inspired by my last post on working with Hollywood writers to do social marketing "product placement," you're in luck. The Robert Wood Johnson Foundation has just published a report called Your Issue Here: Working with Hollywood to Deliver Your Message to Millions (download pdf or order hard copy).

Based on interviews with many of the Entertainment Resource Professionals Association members, writers Karen Brailsford and Andy Goodman have identified 14 principles to guide causes that want to reach out to the entertainment industry. Briefly, they are:
  1. Build your Rolodex and work it relentlessly.
  2. Deliver a strong pitch by keeping the facts hard and the sell soft.
  3. Immerse yourself in the Hollywood community.
  4. Become an indispensable research assistant.
  5. Let the writers do the writing.
  6. Even when they say yes, be careful.
  7. Look beyond the Nielsen Top 20.
  8. Keep it light to shine a light.
  9. Partner with proven experts in entertainment outreach.
  10. Aim high by approaching networks, not just specific shows.
  11. Capitalize on network initiatives already in play.
  12. Make the most of storylines that touch on your issue.
  13. Put a very recognizable face on your cause.
  14. Reward the entertainment community.
Read the report yourself to get the meat behind these tasty bites and benefit from this collected wisdom.

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links for 2006-11-13
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A couple of weeks ago, some of my friends and colleagues from the Entertainment Resource Professionals Association (ERPA), of which I am a member, were interviewed by a reporter at the LA Times.  The article just came out, and is an excellent introduction to how health and social advocates are facilitating their issues' portrayals in the plotlines of daytime and primetime television shows.

Why is this tactic in the social marketing toolbox important?
The CDC analyzed U.S. health survey data in 1999. Researchers concluded that of the 38 million Americans who regularly watch daytime soap operas, almost half said they learned something about diseases and how to prevent them. Even better, about a third of viewers said they took some action based on what they saw on a soap opera, including 7% who visited a doctor and 6% who did something to prevent a health problem.

A year later, the CDC looked at prime-time television. It found that of Americans who tuned in twice a week or more, 52% said they trusted the health information they see to be accurate, and 26% said that prime-time TV was among their top three sources for health information.

Getting your issue on TV is not as simple as sending a fact sheet to the producer of a show.  People who are working in this field have developed relationships over time with writers, researchers, producers and others in the entertainment industry.  They are trusted not to push an agenda or a specific plotline, but to provide accurate facts and ideas that writers can then weave into their storytelling.
Now there is a growing industry in Hollywood made up of advocates who are neither entertainers nor insiders, but who want their disease or issue to get dramatic play before a mass audience. Similar to product placement, it's a kind of ideas placement. A group called the Entertainment Professionals Resource Assn. pulls dozens of these groups together, including the American Cancer Society, Down Syndrome in Arts and Media, the American Heart Assn. and the Mental Health Media Partnership.

"We're trying to shift the norm," says Deborah Glik, director of the UCLA Health and Media Research Group, who is affiliated with the entertainment group. "When you're going to portray a health issue anyway, and you're working with a platform that reaches millions of people, you should do it accurately."

Members make themselves available with scientific facts and a bank of real citizens willing to tell their stories. They carefully push their causes, knowing they walk a delicate line between sparking creativity and triggering annoyance.

David Sampson, director of media relations at the American Cancer Society, has learned that it's better if his organization stays away from pitching specific plots. Policy wonks, it turns out, aren't so good at recognizing the germ of a compelling story line. "Writers come to us," he says, "and almost invariably, they'll pick up on some bit of information that we had no intention of relaying."

But the society doesn't hesitate to advise, when asked. When Alexis on the soap opera "General Hospital" was diagnosed with lung cancer despite being a nonsmoker, Sampson heard that writers wanted to attribute her disease to asbestos exposure. "About 4,000 non-smokers a year come down with lung cancer," he says. "But short of working in a mine, you only get lung cancer from asbestos exposure if you're also a smoker." Exposure to second-hand smoke, the society suggested, was a far better explanation.

The idea is to present entertainment insiders with powerful real stories, inundate them with facts, and then sit back and hope the creative juices take over. "I believe the writer is king or queen," says Lisa Allen, director of the Media Project, which provides entertainment industry professionals with information on reproductive issues. "We don't preach, we don't proselytize."
So the next time you see Jack Bauer get into his Ford Expedition on 24, you'll probably also see him put on his seatbelt, thanks to the work of health advocates and their receptive Hollywood audience.

If you're interested in more on this, here are other posts I've written on this subject:

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I would love help with either or both of these technical questions:

(1) Does anyone know of a way to import html tables into Microsoft Word for Mac keeping the tables intact?

(2) Does anyone have advice regarding whether to switch to Blogger Beta now or wait for the kinks to be ironed out? I have read people raving about it as well as people having problems.

If you have ideas or advice, please leave a comment or email me. Thanks so much!

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Periodically I like to take a look at the search phrases people are using to find my blog. With Google Analytics, I can see the exact words someone used to get to a particular page on my site. Most of the time, the searches are just what you would expect: "social marketing," "what is social marketing," "spare change," various combinations of my name and company, and other phrases that are clearly related to a topic I've written about on the blog. Would you believe that one of the most frequent searches the blog turns up on is for information on Jack in the Box commercials? There must be a lot of JITB fans. And apparently there is a movie out called "Spare Change" because there are quite a few searches for that (as well as a Spare Change hip-hop group).

But then there are other more interesting search terms that somehow led people to a random phrase or unrelated topic I included in a post. In these cases, my peeking at the search engine results feels somewhat voyeuristic, like I'm viewing something that the searcher did not intend for another person to see. But since it's all anonymous, I'm going to share some of the strangest search terms I've seen in the past couple of months with you. Apologies if anyone recognizes your own search in there!

Some of them are questions you might never have thought to ask:
  • would Jesus use multimedia [The Sermon on the Mount would have been so much more effective accompanied by PowerPoint.]
  • is it ethical to change name to got milk [What? Someone wants to become "Got Milk" Goldstein?]
  • why the cello squeaks
  • how to make a jack in the box head
  • reasons why you should save your spare change [how about because it's money?]
Some make me wonder why they think I would have the answer for them:
  • best places to get colonoscopy
  • I want to change my religion
  • should I learn cello or piano
  • how do you say goodbye in Chinese
Some of them are just plain creepy:
  • movie about a sex change at a science fair
  • drug use on the set of bionic woman [Not Lindsay! No!!]
  • rubber hands
  • painted overgrown toenail pictures
  • drinking and driving is fun
  • I change the giant puppets
Some combinations of words are puzzling:
  • the number 24 [is this a dyslexic Douglas Adams fan?]
  • king ding a ling
  • juggling lose weight [the new fitness craze that's sweeping the nation!]
  • we agree to change spare
  • panhandlers second life [I guess the SL residents that haven't bought land yet are the new homeless problem]
  • celebrity infant car seats
  • homeless kids fire swallowers [hopefully only in Second Life]
  • yoga fundraising [is that related to Presentation Zen?]
  • change fruit
  • healthy munchies stoners [hey - at least they'll get their essential vitamins and minerals while they get wasted]
And then there are the painful human dramas:
  • games and activities for a 4 year old with asthma
  • can my son change from being gay by using medicine
  • how to create a flyer for a child with cancer
So what's the social marketing lesson here? Perhaps that it can be hard to predict exactly how people will find your website or blog, so you need to make sure that your pages/posts have enough relevant words in them to increase the chances that someone looking for your information will find you. And make sure that if someone arrives at a random page on your website, you have enough navigational information -- or even suggestions of related content -- on each page that they will look around to see what else you have of interest. I'm not a search engine optimization expert, but there are plenty of other blogs and websites that you can look at to get some guidelines. And if any of you with a have some interesting or strange search phrases that you've come across on your own site, please share!

Photo credit: wagg66

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Politicians Sweep Midterm Elections

The Onion

Politicians Sweep Midterm Elections

WASHINGTON, DC—Landslide victories for politicians in all 50 states indicate that voters still tend to elect politicians over non-politicians.

WASHINGTON, DC—After months of aggressive campaigning and with nearly 99 percent of ballots counted, politicians were the big winners in Tuesday's midterm election, taking all 435 seats in the House of Representatives, retaining a majority with 100 out of 100 seats in the Senate, and pushing political candidates to victory in each of the 36 gubernatorial races up for grabs.

While analysts had been predicting a possible sweep for months, and early exit-poll numbers seemed favorable, politicians reportedly exceeded even their own expectations, gaining an impressive 100 percent of the overall national vote.

"It's a good night to be a politician," said Todd Akin, an officeholder from Missouri. "The American people have spoken, and they have unanimously declared: 'We want elected officials to lead this nation.'"

Or, if you prefer something social marketing related:
Americas Cowboys Suffering From Restless Heart Syndrome

The Onion

America's Cowboys Suffering From Restless Heart Syndrome

ATLANTA, GA—Bouts of wanderlust and deep yearning have led a majority of RHS sufferers to head off in the direction of them twinklin' stars.

ATLANTA, GA—Officials from the Centers For Disease Control said Monday that preliminary results from a long-term study showed that the vast majority of America's cowboys suffer from Restless Heart Syndrome, a disorder categorized by deep pangs of yearning, usually following extended, alternating bouts of lethargy and wanderlust.
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Authors of a study just published by the American Journal of Public Health (available online now and in the Dec. issue of AJPH) say that youth anti-smoking television ads funded by tobacco companies are ineffective, and that the spots intended for parents may even have harmful effects. Among 10th and 12th graders, they say, higher exposure to the parent-targeted ads was associated with lower perceived harm of smoking, stronger approval of smoking, stronger intentions to smoke in the future, and a greater likelihood of having smoked in the past 30 days.

"Of course," I can hear you saying to yourself, "we all know that Philip Morris is intentionally sabotaging the ad campaign so that it ends up bringing in more future smokers, or at least is just burnishing its reputation with this campaign as window-dressing." I would have thought so myself. Except that in looking into the campaign, I found out that an old friend and colleague, Cheryl Olson, is on the advisory board for Philip Morris USA's Youth Smoking Prevention initiative.

Cheryl and I met in grad school, and we have since worked on various projects together, including evaluating tobacco prevention programs. She, along with her husband, psychologist Larry Kutner (who is also the chair of the advisory board), founded and co-direct the Center for Mental Health and Media at the Harvard Medical School. I know that Cheryl is no tobacco industry patsy, and that she would not compromise her integrity if she suspected there were any nefarious strategies behind this campaign.

I got in touch with Cheryl and asked her for her take on the research results that were just published. She, not surprisingly, had a lot to say about why this study is flawed and may just be showing what the researchers wanted to find. I invited her to send me her thoughts to post on the blog, which I've reprinted here:
For the past couple of years, I have consulted to Philip Morris USA on smoking cessation and prevention. I had primary responsibility for the content of the QuitAssist cessation guide, and also review and contribute to materials aimed at parents from the Youth Smoking Prevention group.

I work with a group of researchers and clinicians who are affiliated with various universities and hospitals. (We do this work independently from our institutions.) Part of our mandate is to oversee the quality of material content and evaluation, and be vigilant for any unintended negative effects.

Collaborating with a tobacco company can be an awkward and uncomfortable experience for a public health researcher who worked in tobacco control. But since Philip Morris USA is voluntarily committing 100s of millions of dollars to prevention and cessation – going well beyond the requirements of the Master Settlement Agreement - it’s important that a group of independent researchers and clinicians be part of this process to ensure that the resulting materials are honest, research-based, and effective.

My work has included: interviewing parents and former smokers and choosing quotes to use in print and web materials; incorporating research and advice from experts (selected by me) who work with smokers and parents; writing print and web content; and observing focus groups to help formulate and test content (including groups of Spanish speakers with simultaneous translation). I am proud of the brochures and guides I’ve helped develop. Their quality is apparent to anyone who reads them – which may explain why I have received at most a half-dozen phone calls or emails from academics, health workers or reporters asking why I got involved in this.

It is also exciting to be part of a project with such a huge reach. To date, PMUSA has distributed 70 million parent brochures, and hundreds of thousands of QuitAssist guides. The main role of the guide is to encourage smokers to connect with useful government and nonprofit cessation resources; I have heard that the PMUSA web site is the most visited cessation site in the US, and refers more traffic to government web resources than any other source.

I am not involved in developing PMUSA’s TV, radio or magazine ads on smoking cessation or prevention. But I do have some concerns about the article in December’s AJPH. There are some serious flaws in this study’s methodology that make it hard to draw any conclusions about the effects of the ads in question. To describe just two:

1) The “Talk, They’ll Listen” campaign that supposedly harmed children (the one aimed at parents) is based on an estimated exposure to an average of 1.13 thirty-second ads over a four-month period. Let’s take a closer look at this measure of ad exposure.

According to the recent Kaiser Family Foundation national survey, kids between the ages of 8-18 spend an average of 3 hours and 4 minutes per day watching broadcast television. Let’s call it three hours for simplicity’s sake.

There are 122 days in a 4-month period. So kids watch an average of 366 hours or 21,960 minutes of television in a 4-month period. A parent-oriented commercial lasts 30-seconds - or 1/43,920 of their viewing time. If they see 1.13 parent-oriented commercials in 4 months, that means that the commercials comprise 0.000026 (twenty-six one-millionths) of their television viewing content and time. Does it make sense to assume that such an extremely rare event would have the levels of influence on behaviors and attitudes that the authors claim? Based on this exposure issue alone, it’s hard to take the article seriously.

2) The authors should have used a 99% confidence interval (not 95%) with such a big data set
[n=103,172]. That is a standard approach to avoid getting significant results just due to a large sample size. The use of 95% CIs raises questions about the odds ratios.

This is pretty disappointing. It’s hard not to think that the authors were determined to find something negative to say. The dramatic statements in the abstract are hedged a lot in the actual paper text, but the abstract is all that many researchers – and most journalists - will read.

This could have been an opportunity to get some useful lessons that could be applied to future media campaigns, and to model state-of-the-art methods for evaluating media-based behavior change materials – methods that could be used by academics and industry alike.

Among other things, it’s too bad that the authors lumped together ads aimed at youth from two companies that used very different approaches. This doesn’t tell us anything about what aspects might have been particularly helpful or harmful.

Given their well-documented past behavior, tobacco companies (and their anti-smoking media materials) must receive ongoing scrutiny from the public health community. But that shouldn't mean checking our common sense at the door.

Cheryl raises several important points. As much as many of us would like to pillory the tobacco industry, we can't let that cloud our desire for the truth (as best we can find it statistically). When you see (or do) research that confirms your preconceptions, you still need to look at it critically and make sure that you are not letting your assumptions guide your conclusions.

Thanks to Cheryl for taking the time to share her valuable perspective. I would love to see research on whether parents who have seen the ads and read PMUSA's materials have spoken with their children about not smoking and whether their kids are less likely to smoke as a result. But even if that part of the campaign were found to be effective, I have a feeling there are many who would not believe it in any case.

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An anonymous commenter on my recent post on the CDC in Second Life directed me to the Idaho Bioterrorism Awareness and Preparedness Program's Play2Train project.  This space provides a virtual training environment for emergency response professionals.  They have a town set up where they can role play various disaster scenarios complete with victims, as well as a hospital with exercise machines, an isolation ward and a surgery room.  They have also created a machinima video depicting the various stages of smallpox, and a simulation to help teach lung sound auscultation (a fancy way of saying "listening to the lungs with a stethoscope").  What a great way of doing this type of training in a low-cost way but with a big impact.

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Can a blog be beautiful? Absolutely, and especially if it's Ashley Cecil's The Painting Journalist blog.  Ashley got in touch with me to let me know about the blog, which is a combination of art and function.  As she describes it:
Welcome to the marriage of painting and social activism. I’ve been creating art ever since discovering that my mom’s Chanel lipstick made a great oil pastel. Through formal art education and years of professional experience, the adult version of this vocation has evolved into my own job title, “painting journalist.” I’m addressing philanthropic issues utilizing painting as my medium of communication. Much like a photojournalist, I travel to locations/events of cultural interest and capture them, only with my brush.
Ashley sells the artwork that she features on the site, and a portion of the proceeds are donated to nonprofits that are related to the topic of the painting.

Ashley's description and sketches of the aftermath of a murder in her neighborhood is especially compelling to read and view.  She is incredibly talented. If your organization is looking for a piece of art to auction off, or if you would just like to decorate your home or office with artwork that is more than just a pretty picture, take a look at her site.

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links for 2006-11-02
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I don't usually like to talk politics on this blog, but I am making an exception this time. If you live in South Texas (21st Congressional District - Austin/San Antonio), please consider voting for my friend Tommy Calvert for Congress. He is running as an independent and has a strong public service record as well as being a human rights advocate. Tommy and I worked together to raise awareness of human trafficking in Hollywood when he was the director of external relations at the American Anti-Slavery Group. He's a mensch and a smart guy, and I wish I were able to vote for him myself.

My name is Nedra Weinreich and I approve this message. Now back to our regularly scheduled programming.

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Driving in my car this afternoon, flipping the channels, I came across the tail end of a radio ad promoting a career at the CIA.  Given that it was on alternative rock station KROQ (a classic LA station that is not known for attracting a particularly pro-government audience), I kept waiting to find out that it was a parody ad.  But no, it was for real.  It made me wonder whether they had done their research on the station's demographic.

I tried to find the ad online and only found this TV spot, but the words are basically the same.  It was an odd juxtaposition with the Green Day song that came on right after it.

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There's nothing very unusual about two red-headed women chatting in the headquarters of a Federal agency...unless one of the women is actually a man, and the headquarters actually exists on a server somewhere in Linden Lab. That man is John Anderton, who is responsible for bringing the U.S. Centers for Disease Control and Prevention (CDC) into Second Life. I met John's avatar, Hygeia Philo (pictured on left talking to my avatar, Sheva Weeks), when I happened to see an announcement of a CDC Health Fair listed in New World Notes and decided to find out more about what the CDC is up to in Second Life.

John first started exploring Second Life last March, and by July he had convinced the powers-that-be at the CDC to let him establish an agency outpost there, which he built with his own virtual hands. John seems to be the CDC's go-to guy for their health communications "Special Forces" missions, having been detailed to work on public health crises like the CDC's response to the anthrax scares, the flu vaccine shortage and setting up new communications offices in various parts of the agency. He currently (at least until next week) is working in the Office of the CDC Director with the charge of exploring how social media can be used to promote public health, and he plans to continue to serve as the CDC's virtual face in Second Life.

When we met, John graciously agreed to do an interview, which we conducted by e-mail, phone and in Second Life.

Can you tell me about the Center at the CDC where you work, and what your role is there?

I am presently on detail to the Office of the CDC Director, Office of Enterprise Communications. I am the lead for Project Fulcrum; an initiative to advance public health using new media, to recruit new persons into public health careers, and to reinvigorate old public health brands that have fallen by the wayside. Before this assignment, I have served for the last five years as Associate Director for Communications Science in the Center at CDC that deals with HIV, STDs and TB (called NCHSTP, for short). In that role, I was charged with lead responsibility for managing campaigns, media, special projects, contracts, issues management, exhibits, and clearance of communications products and materials for the Center. I have worked at CDC in a variety of communications positions, in several areas. I have a PhD in Health Promotion and Behavior, and a Masters degree in Public Administration.

How widespread within the CDC is knowledge and interest in internet-based applications like Second Life and other social media?

CDC is always looking into better ways to understand its audiences and the public, and to communicate its messages in timely, credible, and relevant ways. An internal blog was started recently, and podcasts began last month for outside audiences. The internal newswebsite is in its second year of daily publication, and it featured a story about CDC in Second Life a few weeks ago, so I think the knowledge of what we are doing internally is growing. I have presented on it a dozen times to various internal constituencies to build inertia around expanding our presence in world. I started looking into Second Life (SL) last March, when only 175,000 persons were in-world, as a way to advance the CDC mission using this new medium, for this specialized audience. We acquired our avatar formally in July, and introduced the space in August. The SL presence has been continuously evolving since that time.

How did you personally become involved as a CDC representative within Second Life? Are there others who are doing work in-world from your Center or other divisions of the CDC?

I began exploring YouTube as a means of disseminating CDC health content, and ran across a machinima presentation on Second Life, in March, 2006. Intrigued, I wrote a white paper to make the case to management for CDC to enter SL, and was authorized to explore and begin involvement. I created an avatar with purpose; Hygeia was the Greek muse of health, and the last name of Philo means 'lover of,' thus a CDC av with the metaphoric moniker of Hygeia Philo (lover of health) seemed perfectly appropriate. I waited until July 13 (CDC's 60th anniversary) for her to formally enter Second Life for the reason that birthdays are rites of passage (drivers license, voting, etc.) and her birthday into the new world, as CDC celebrated maturity in the real world, also seemed appropriate. Everyone I meet has been congenial and both surprised and pleased to see CDC in the SL space. I have been working in SL on a daily basis, part time, for almost 8 months now. As far as others at CDC - the National Center for Environmental Health is exploring how to educate about toxic waste in SL, and the Strategic National Stockpile is exploring training issues in SL. The Injury Center is also thinking about how to get involved, too.

I love the thinking behind Hygeia’s name. If it’s not too personal a question, how does it feel to be a man in real life but use a female avatar?

I think of working with the CDC space and Hygeia Philo like hosting a trade show booth with a colleague. I am there to represent CDC in the best way possible, professionally and personally. The Juwangsan address [the location in Second Life] and the avatar in SL are both parts of that image. The gender discrepancy between myself and my role in SL doesn't bother me, and I don't get much grief at CDC either, as I tend to thoroughly explain why the avatar was chosen before explaining my role. I don't see Hygeia Philo as an alternate John Anderton, rather I see her more as the face of the Agency that I am working with to disseminate health information. More of a partner than a puppet, and I do not hide my true identity when asked, interviewed by the press, or during discussions. When I attended the Second Life Community Conference in San Francisco this past August, the distinction between myself and Hygeia caused a little amusement for a few people, but no apparent consternation.

Please tell me about how the CDC’s presence in Second Life came about. How much resistance did you encounter from others at the CDC to the idea of building a virtual office?

I met with Randy Moss, at the American Cancer Society to learn about how the ACS was raising money with the in world Relay for Life, and then attended the Second Life Community Conference in San Francisco to continue studying how people were playing, interacting, transacting, and studying the possibilities of SL. Both contact experiences were transformative; I came to see this as neither a fad nor a game, but as a social movement and a glimpse into the future of social interaction, learning, and even being. The blended reality aspect of real and virtual worlds is fascinating to me. I wanted to build a space that could both educate and foster/enable dialogue. I routinely change up what is offered, based on interactions with residents who stop by, or whom I meet when I am exploring. The transience of the space is also marvelous; one can change on a dime, if something new presents itself. The day the E. coli scare occurred, I posted a "Real Life Health Alert" in the space for persons to learn about what was going on, and what to do about it. To those who saw it, it was very favorably commented upon; as a bridge builder between real life health threats and virtual education opportunities.

Everyone at CDC has been saying "Go go go!" there is not internal resistance; rather a chorus of support that is also a little agitated that I cannot go even faster! In world, after an interview with the Metaverse Messenger [a Second Life-focused newspaper downloaded by almost 50,000 people each month], the Editor responded favorably to my request to publish health info in her pub, so I have contributed a weekly column to this news outlet for the last 5 weeks. That has been great too, as a learning tool about virtual media, and the intersection with real world media.

I found out about the CDC in Second Life during a “health fair” you were offering there. How often do you do those, and are there any other virtual activities in which the CDC is involved?

You came on the first day of the first CDC health fair. Events drive interest among SL residents, and I had marveled at how concerts and fashion shows rivaled presentations by the Lindens [the staff of Linden Labs] as both entertainment and information dissemination opportunities. Rather than a big press conference (which we will do later, when we expand), I decided to go the highly localized route of a community health fair. In the real world this is a nice, local platform to display health information, to educate on specific issues while building community and establishing credibility of source. I was delighted at the attendance, and content of discussions. It was surprising to me to be at the top of the list in Rik's Picks, in New World Notes, and kind of exciting to receive coverage from the Second Life News Network on the Fair. I'm not sure if that is due to the novelty of the event, an interest in what CDC is doing, or some other factor, but the interest has been wonderful. CDC is ramping up a variety of offerings, and will require us to expand and complicate the space a bit, but I don't have a timetable for these upcoming developments.

The CDC’s National Center for Health Marketing’s director Jay Bernhardt is one of the first I know of in a Federal health agency to write a blog. While it is not updated very often, I think it is still a significant milestone and an indicator of the CDC’s desire to use the latest tools to communicate with its audience. Are there any other examples of how the CDC is using newer internet/social media or other tools (e.g., mobile phones) to reach its audiences beyond just offering a static website?

I would suggest that you contact Jay with that question - I'm not in a place to be able to answer that effectively.

What has been the response of SL residents to the CDC’s outreach in-world?

Almost without exception, I have been warmly greeted by old and new SL residents. People are kind of amazed that CDC would treat it seriously, and that we are not there for profit. I hope that CDC can continue to grow and evolve in the SL space, as it grows and changes itself. With such rapid development, it forces us to stay on our toes!

Are there specific health issues that you tend to focus on that are more prevalent among Second Life residents because of their demographics and behavioral risk factors?

I would like to gradually introduce the topic of sexual health into the space, as a way to promote discussion about the links between what one says and does in Second Life, and then one's actions in real life. Liaisons in real life, foreshadowed and even pre-enacted though virtual spaces have led to documented disease transmission, and discussion about this seems generally absent from SL. On the demographic side, there are all kinds of opportunities to introduce topics relevant to persons in their 30s about screenings, health and emergency preparedness, childhood milestones, and other topics. On the behavioral side, there is also plenty of room for talk about good eating, active lifestyles, eye strain, and other health topics relevant to persons who spend significant amounts of time sedentary in front of a monitor. The possibilities are hard to count, there are so many.

How do you see Second Life fitting into an organization’s overall social marketing strategy?

Second Life joins the list of audiences, interests, and channels that link the American public with their public health infrastructure. Given that half of residents are international, it also broadens and deepens the CDC communications portfolio into addressing wider audience needs and concerns. I suppose that it is a tactic, and not a strategy in itself, but one that suggests that attention to new media requires constant vigilance, and willingness to experiment. If SL fails, for some reason, the movement of persons into online congregate social settings will probably continue to expand, and understanding how to reach these audiences will continue to be important.

For people at other agencies or organizations who may be considering establishing a presence in Second Life, what advice would you offer?

Do it. Now. In my career at CDC, which spans a short 15 years, four new technologies have emerged and merged with mainstream communications. My first business card had my name, title, address and phone number on it. Then came a fax machine number, then an email address, a website, and most recently, a metaverse designation and avatar. These are all ways that I can receive contact from the world and matriculate therein. They have gone from slow, to fast, to real time. One must be in all of these modes to communicate effectively with the audiences with whom we participate, and to understand the places they inhabit. Galileo reminded us that one sees farther if one stands on the shoulders of giants. There are plenty of giants out there to partner with, in this new medium, and most of them are friendly. Also, and importantly, establish excellent relationships with the IT department; with all of the updates coming from Linden, internal firewalls, network up and downtime, and corporate/governmental IT security issues will cause frequent calls for assistance.

Have you hooked up with any groups of nonprofits that are working on how best to integrate their causes into SL like

No, other than the American Cancer Society and some exchanges with the New Media folks, I have not begun to run with the big dogs. I am still studying how to best interact with persons, groups, and constituencies to best participate in this wondrous landscape. I hope to continue to learn, evolve and adapt to the space in fruitful ways, and if it goes really well, to lead trends.

Is there anything else you’d like to add that we haven’t touched on yet?

Second Life is part of one's first life; not separate from it. Even the immersionists have to sleep, eat, and interact with the Real World. If one can merge good health practices in real life with the fun and play of Second Life, then physical and psychological realms can be enlightened and good habits enacted, to personal benefit. If this happens collectively, then public benefits are achieved, and public health becomes a reality, in virtual and actual ways. Thanks for the chance to talk about these issues.

Thank you to John for providing such an insightful and compelling glimpse into the process he has gone through to keep the CDC in the position of leading trends among Federal agencies. I hope that when other organizations and agencies see that even the CDC, with all its bureaucracy and generally slow uptake of new technology, is taking Second Life and other social media seriously, that they should too. I predict that the CDC's entry into SL will open the floodgates for other people working on health and social issues.

If you are in Second Life and would like to visit the CDC's virtual offices, you can click here to teleport directly. If you are not already in Second Life, you can first download the software and get a free account.

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