Tumblr Contemplates A New Policy Against Self-Harm Blogs: Let's All Weigh In

Tumblr is a popular microblogging platform.  It lets you share anything from text to pictures to video.  According to their website, the average Tumblr user creates 14 original posts each month, and reblogs 3. The "reblog" button on all Tumblr posts allows a meme to spread rapidly across thousands of blogs with just one click.

As with other social media platforms, tumblr has an enormous reach (18,878,347,183 total posts as of the time of this blog).  Therefore, it has great potential to help and hurt the public's health as it facilitates communication among millions of people.

A few weeks ago, Tumblr presented to its users a challenge (and possible solution) regarding blogs that promote self-harm.  Their users are being asked to weigh in on the policy.  I think that is a smart move.

Here is an excerpt from the Tumblr staff blog: 

Our Content Policy has not, until now, prohibited blogs that actively promote self-harm. These typically take the form of blogs that glorify or promote anorexia, bulimia, and other eating disorders; self-mutilation; or suicide. These are messages and points of view that we strongly oppose, and don’t want to be hosting. The question for us has been whether it’s better to (a) prohibit them, as a statement against the very ideas of self-harm that they are advancing, or (b) permit them to stay up, accompanied by a public service warning that directs readers to helplines run by organizations like the National Eating Disorders Association.

We are planning to post a new, revised Content Policy in the very near future, and we’d like to ask for input from the Tumblr community on this issue.

The blog goes on to say that they currently think the right answer is to implement a policy against pro self-harm blogs.  They aim to focus only on blogs that actively glorify or promote these behaviors. They also intend to start showing public service announcements (PSAs) on specific search terms like "anorexic" or "thinsperation".  It is unclear from their post how this policy will actually be implemented.  It would take enormous staff resources to comprehensively review their site and remove concerning materials. 

Other online and social media platforms have struggled with similar issues regarding how to respond to users that may be searching for or posting worrisome content.  Here are a few examples of other challenges and solutions:

• When someone uses Google or Yahoo to search for the term "suicide", the link to the National Suicide Prevention Lifeline is provided as the first result.
• In December 2011, Facebook began a new service that allows "Friends" to report concerning posts.  Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat. Note that Facebook does not troll the site itself, but instead waits for reports to come in.  
• Pop Health has previously posted about the debate regarding Twitter's duty to restrict hate speech vs. its duty to promote free speech among its users.

From these examples, you can see that there have been a variety of approaches to address potentially unhealthy or unsafe posts on social media platforms.  Sites can decide to be inclusive of all posts, they can let users police each other and report concerns, they can post resources in response to keywords, they can actively prohibit certain content...or they can use some combination of these strategies.

• What strategy or combination of strategies is best for the public's health?  
• If users are prohibited from posting, does that make them more isolated and less likely to connect to services?
• Should the overall health of the user group outweigh the health of that individual?

Tumblr is encouraging users to weigh in on their plan...so I ask you to both comment here and contact them at policy@tumblr.com. 

Anti-vaccine ads on Delta planes; Magic and Ellen as celebrity champions for HIV/AIDS prevention...and more- What Am I Reading This Week?

New pop culture and public health stories to check out this week:

1. Darrell Hammond of Saturday Night Live fame reveals that child abuse led to alcohol/drug use and cutting. He details the horrific abuse in a new memoir, "God, If You're Not Up There, I'm F*cked".

2. Fellow Boston University School of Public Health alum Elizabeth Cohen reports on the 20th anniversary of Magic Johnson's announcement that he is HIV positive. His announcement had an incredible impact on the public's health- both in terms of reducing stigma of those diagnosed and proving that the diagnosis is not always a death sentence.

3. Delta airlines is seeing backlash from public health organizations and other flu vaccine advocates after airing a 3-minute PSA from the National Vaccine Information Center that describes alternate ways to avoid the flu (besides getting the flu shot).

4. Ellen DeGeneres is named global envoy for AIDS awareness. The hope is that Ellen's enormous platform (from both her TV show and social media channels) will allow her to reach millions of people with the prevention message. Ellen is a partner in other important public health issues, for example- bullying prevention.

5. This week, Evelyn Lauder passed away from Ovarian Cancer. Evelyn was one of the powers behind the creation of the pink ribbon campaign for breast cancer awareness.

How about you? What are you reading this week?

Miami Dolphin Brandon Marshall's New PSA for Borderline Personality Disorder

In July 2011, Brandon Marshall revealed that he was diagnosed with Borderline Personality Disorder (BPD). According to the National Education Alliance for Borderline Personality Disorder, this serious mental illness centers on the inability to manage emotions effectively. The condition which has strong heritability (68%) and a high suicide rate (10% of adults with BPD die by suicide), produces symptoms such as impulsivity, anger, and chaotic relationships.

When Brandon announced his condition this summer, he vowed to become the face of borderline personality disorder. He seems to be following through on his promise, as he has just released a public service announcement (PSA) in collaboration with the National Education Alliance for Borderline Personality Disorder. The 33-second video is primarily focused on 3 key messages:

1. Prevalence of this condition is high (15 million Americans)
2. There is hope (treatment exists for those who suffer and education exists for families coping with the disorder)
3. There are resources: visit the NEABPD website or follow Brandon on Twitter (@BMarshall19) for more information

I like the PSA for several reasons. It is simple with clear messages (above). The messages are delivered both verbally by Brandon and visually with key words appearing on the screen. The "call to action" is clear. Viewers are directed to the NEABPD website and Brandon's Twitter feed for more information.

I also like that this particular health issue has found a champion or spokesperson. Unlike other mental health conditions like depression with several celebrity spokespeople (e.g., Brooke Shields), less is known about BPD and those who suffer from it. Experts in mental illness stigma like Patrick Corrigan state that there are several strategies for reducing stigma...and one of those strategies is called "Contact". Contact challenges public attitudes about mental illness through direct interactions with persons who have these disorders. The contact does not have to be face to face, but instead can occur through a channel like a PSA.

The strategies that I see for improving this PSA are focused less on its composition, but instead on its distribution/promotion. Although the video has been on YouTube for 6 days, it only has 309 views. Announcements about the PSA are located primarily on football blogs (e.g., Shut Down Corner) or BPD specific websites. It does not seem that the PSA has been picked up by mainstream media or health blogs. This is in sharp contrast to PSAs I've spoken about previously on Pop Health, like in July 2011 when I discussed Kim Kardashian's ovarian cancer research spot which currently has 33,431 views.

Readers- please weigh in: which mental health advocacy organizations would have the best "reach" in promoting this PSA? What other strategies could they use for distribution/promotion?

"What's Your Weapon?": Billie Jean King, Arthritis Foundation, Ad Council, and USTA Launch Arthritis Campaign

Before Twitter and the U.S. Open was a flutter this afternoon with the news of Venus Williams withdrawing due to the diagnosis of the autoimmune disease- Sjogren's Syndrome, the U.S. Tennis Association was focused on another health related issue. Today the press release went out that tennis legend Billie Jean King was joining the Arthritis Foundation, the Ad Council, and the US Tennis Association (USTA) to launch a public service campaign against arthritis (the leading cause of disability in America).



The ads, launched at the U.S. Open today, feature King (who has osteoarthritis- OA) and highlight the power of movement and exercise as "weapons" in the fight against arthritis. King tells viewers "tennis is my weapon" against arthritis. The ad then asks viewers, "what is your weapon against arthritis?" and directs them to the campaign's website in order to find out: Fight Arthritis Pain. On first view, I was not terribly impressed. The brief ad (33 seconds) does not tell you very much (e.g., King says tennis is her "weapon" but nothing is said about the benefits of movement). The goal of the ad simply appears to be motivating viewers to visit the website for additional information.



The other thing that is not clear in the ad (but clarified in the press release and website) is that this campaign is targeting OA specifically. While OA is the most common type of arthritis, it is not the only type. For example, in contrast to OA which breaks down cartilage, rheumatoid arthritis (RA) (a chronic autoimmune disease) causes inflammation of the lining of the joints. Would the exercise recommendations be the same no matter what type of arthritis? I would say that distinction is unclear for viewers.



However, I did feel better when I read the press release and saw that these ads were tested in focus groups by the Ad Council. Testing your images and messages with your target population is incredibly important. It is reported that participants felt that the concept of "having a weapon" against arthritis was powerful and motivating. That is good news considering formative research by the Ad Council found that only 16% of OA sufferers surveyed felt "very confident" that they could manage their pain. Therefore, if an ad can make viewers feel empowered and confident- that is a good thing.



The press release did not describe the demographics of the focus group participants, but I am assuming they were similar to those originally surveyed (adults age 55+ with OA). If so, it would mean that Billie Jean King was an appropriate "Champion" for the cause and someone that audience admired, having watched her in the 1960s-1970s, her prime competitive years. However, I wonder if she would be the best choice for ads targeting arthritis sufferers in a younger demographic? After all, different types of arthritis can affect people of all ages. Again, this is another reason that I would have wanted to see a clearer definition of the audience for these ads. If we are focused on older adults with OA, then it is a great choice. If we are focused on people of all ages with all types of arthritis, then maybe not.



Overall, I give this campaign a "B". The impetus of the campaign is good in that it is based on research...research that shows that arthritis suffers are too sedentary and do not feel like they have control over their pain management. The campaign aims to address these barriers by empowering viewers with a "champion" who they admire and can model. The campaign also links them to a website with all the information they need about the benefits of exercise for arthritis. However, the execution of this campaign is not as strong as its foundation. It would have benefited from a more clearly defined audience and message.