GirlTrek is what’s next in [digital] public health programs

The New York Times blog, Fixes, featured one of my favorite organizations today. Girl Trek is the best public health program you haven’t heard about [yet]. Look, I’m a scientist, a wonk, a tinkerer. I’m technically inclined, and quantitatively oriented. I’m hyperbolic and excitable, but I’m not easily inspired.

But GirlTrek inspires me [big time].

Here’s a gross simplification — recruit nearly 60k women nationally, women who are mostly sedentary, who lead busy lives and who don’t [yet] take enough time for themselves. Link them with groups, comprised of women, similar and dissimilar, of all ages and backgrounds. Then, motivate them to walk. And walk. And keep walking.

Physical inactivity is one of the most pressing public health crises of our time. And yet, many of our public health efforts haven’t gotten the population moving. This is especially true in high risk groups, like Black women.

GirlTrek is different. They reach, engage, motivate, and inspire with an approach that’s organic, culturally resonant, and technologically sophisticated. My take?

“We’ve spent an enormous amount of money on research-based approaches to obesity prevention and treatment, and almost none of them have worked with black women,” says Gary G. Bennett, a professor at Duke University and a leading researcher on obesity. “One of the key predictors of positive treatment outcomes is really high levels of engagement. I’ve been doing work on obesity as it affects medically vulnerable populations for 15 years, and I don’t know of anything in the scientific community or any public health campaigns that have been able to produce and sustain engagement around physical activity for black women like GirlTrek does. Not even close.”

And, it’s working.

Their secret? Focusing on what matters to women today. Not the health benefits that might accrue in the far future.

“It wasn’t about looking good or weight loss or fitting into a certain type of clothing,” she recalled. “It wasn’t, ‘Hey, you fat person, you need to do this or you’re going to die.’ It was, ‘I love you and I want you to love yourself enough to invest in 30 minutes a day, to walk yourself to freedom like Harriet Tubman did.’ And that spoke deeply for me because my life work is showing up for other people, but I wasn’t showing up for myself.”

We researchers can occasionally have a bit of hubris (!) about what it takes to improve public health. But the data don’t lie. For some of these issues, we need bright, creative, and novel ideas that can work — at scale.

Look no further than GirlTrek.

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[Old] data is the new oil


By now, you’re probably tired of hearing that “data is (sic) the new oil.”

It’s true, but unlike oil, data’s value is on the rise.

Apparently that’s also true for old data. There’s word today that, Viant, the parent company of Myspace (yes, that one) has been acquired by Time, Inc.

Because, data.

In buying MySpace, Viant acquired the data of more than 1 billion registered users. While not all of those people may have kept the same email address from their MySpace days, it still has an enviable database of first-party data….First-party data is considered the holy grail when it comes to advertising online because it means marketers know they are serving ads to the actual consumer they want to be targeting, rather than making probabilistic bets based on browsing behaviour…this gives Time an immediate leg-up … and provides a first-party data set that, in Time’s own words, “rivals industry leaders Facebook and Google.”

Two thoughts here:

  1. Wow

  2. Our data are the gifts that keep on giving. We’re increasingly less likely to churn email addresses and social media credentials, allowing even old data to be linked to what we do today. We have growing comfort with data sharing. Concerns about data privacy are virtually nonexistent — particularly if you grew up in the Facebook age. And there’s revenue to be gained in selling our data (who reads terms of service anyway). Many will be surprised that Myspace still exists, but we shouldn’t be surprised that our data still exists to provide value, long after we’ve moved on.

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Are people with high BMIs unhealthy?

Many American companies have been using BMI as a shortcut to assess their employee’s health status? This approach makes sense, right? Public health agencies often detail the severe health consequences of overweight and obesity. The US Public Health Service Task Force guidelines state that patients with obesity should receive intensive weight loss counseling. Even the American Medical Association calls obesity a “disease.”

Despite this, a sizable number of those with high BMIs have completely normal cardiometabolic functioning. In other words: they’re overweight/obese and otherwise and healthy.

These are the findings of a recent report from colleagues at UCLA. They found that nearly 50% of people with overweight and almost 30% of those with obesity are, in fact, metabolically healthy.

This finding is being interpreted as “the final nail in the coffin” for BMI. There’s no question in my mind that BMIs demise would be welcome to many (in my experience, people love to assail BMI as non-specific, not relevant to specific groups, and a poor measure of fatness — some days, I agree).

But, I suspect the reports of BMIs demise are greatly exaggerated.

The idea of being metabolically healthy while obese is not a new one. Although the size of the metabolically healthy population is a mater of some debate, their existence is well accepted.

But here’s the thing that the recent study didn’t consider: time.

There’s some evidence that people’s likelihood of being obese and healthy drops as they age. Put another way, wait enough time and obesity will start having negative health effects. There’s also emerging data suggesting that the time spent in obesity — literally the number of years that someone spends in an obese state — is independently associated with negative outcomes. This is a particularly potent health risk since very (very) few people with obesity ultimately lose weight (and keep the weight off).

So, it’s true: companies that want to quickly assess employee health probably shouldn’t use BMI. But, if they want to make predictions about future health risks, BMI might be a helpful tool.

h/t @qz

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Stop counting blueberries

I was excited to hear that Sandro Galea took the mantle at the Boston University School of Public Health. I’m more excited that he’s using that perch to shape discussions about how we can improve the public’s health.

Far too much university research and funding, Dr. Galea said, is dedicated to making increasingly precise tallies for relatively minor issues. Instead of paying researchers to count how many blueberries per day may cut the risk of heart attacks, Dr. Galea said, universities and their funders could more systematically identify and tackle the root causes of social problems — such as tolerance of violent attitudes, indifference to environmental concerns, and large and persistent gaps in wealth, education, and economic opportunity.


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This is why it’s so hard to launch a health app

(Or any other app for that matter)

Nielsen just announced its list of 2015s top 10 smartphone apps. [Not] surprisingly, all 10 of the apps hail from just 3 companies: Facebook, Google and Apple.

I’ve been a bit of a broken record about this lately, but it’s becoming hard to ignore the obvious: it’s hard out here for an app.

There are no health apps, no apps from startups, and none that rely on connected devices. Given the challenge of getting and retaining users, most of us who create digital health approaches need to identify new routes into consumer’s hands. Looking for some ideas? Start here.

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Chatting about digital health and food at James Beard

I had a great time at this year’s James Beard Foundation Food conference — what an amazing group of food thinkers and makers. My panel, Health or Hype: Dealing with Information Overload, was particularly fun (and stocked full of Dukies — 3 of us). Check out the video.

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Am I taking a student in 2016?

It’s that time of year again. I’m a faculty member in the clinical psychology program at Duke. Clinical psychology programs are kind of competitive.  During application season, I get lots of questions about whether I’m taking a graduate student, as well as what I’m looking for.

Back when I applied to graduate programs in clinical psychology, I had an entire kitchen table full of brochures, letters, and file folders for each university. We didn’t apply electronically, so I had an assembly line with stacks of printed personal statements, letters of recommendation in sealed envelopes, and special sections for schools — like Duke at the time — that required extra stuff.

Some things change, some things stay the same. Then, as now, I remember wondering whether individual faculty would be taking students in my application year. I really appreciated those faculty who were transparent about their plans, so I aim to do the same. Therefore:

tl;dr: Yes, we are [probably] taking a student next year. {#tl;dr:-yes,-we-are-[probably]-taking-a-student-next-year.}

Now, a few pieces of totally presumptuous advice:

As most of you know, clinical psychology programs that adopt the scientist-practitioner model operate along a continuum from clinical-heavy to research-heavy emphasis. Duke’s clinical program resides at the research-heavy end of the continuum. Duke offers absolutely splendid clinical training. We have outstanding clinical supervisors and a diverse set of training settings. Our alums become very strong clinicians. But we remain a research-heavy graduate program. If you are primarily interested in becoming a clinician or are not sure about your research interests, then I would strongly consider whether a research-heavy program is right for you. My opinion: they’re probably not.

Next, when it comes to evaluating potential research mentors, fit should be your primary consideration. I cannot emphasize this enough. For better or worse, many graduate programs still use an apprentice training model. This means that you will spend at least the next four years working very closely with a research mentor to develop the skills necessary to pursue an independent research career.

Here is a universal truth about graduate study:

If the fit with your mentor stinks, your graduate experience will too. -Me

Look, we know that there are lots of good reasons to pursue graduate studies at Duke. We are one of the best research institutions in the country. We have the country’s most beautiful campus. We have the best men’s and women’s basketball teams in the nation. Our faculty actually play basketball. We have will soon have the best football team in the country. We have the best food and food trucks in the country. We have the best dance festival in the country. We have the prettiest gardens and forests in the country. We have the best weather in the country. We have the best college chapel in the country (I was married there). We have the most spirited undergrads in the country. Did I mention that I am an alumnus? Duke is an amazing place, but if the fit with your research mentor stinks, very little of this will matter.

In that spirit, here’s what I’m looking for. First, know that my team designs, tests, and disseminates interventions for obesity treatment in medically vulnerable populations. This means a few things:

  • We’re looking for those who want to learn how to develop interventions.
  • We work in real-world settings with medically vulnerable populations; for obesity this means socioeconomically disadvantaged, rural, older aged, and racial/ethnic minority groups. We’re less in determining what works for obesity treatment in highly motivated populations. We work in busy primary care settings, often far from campus.
  • We use digital health approaches. We don’t use paper, pencils, workbooks, food models, or in-person individual or group treatments.
  • Although psychology is an individual discipline, our research program is heavily invested in population health.
  • We work on the public health challenge of adult obesity. We don’t work in eating disorders (although Duke has great faculty in this space). We’re getting more interested in work with kids, and will probably start with families.
  • Finally, when evaluating a graduate application, I’m looking for those who have demonstrated an ability to think big, articulate focused research questions, work independently, execute in the field, meet deadlines, work well with colleagues, and communicate effectively – all while knowing how to have fun.

Good luck and Go Duke!

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