The importance of specific health communication

Often people speak in general terms about the negative effects of smoking. Here's a highly specific risk: smoking at the time of breast surgery can cause nipples to fall off. When the doctor warned his patient in general terms, she didn't really listen. When he told her specifically that her nipples might fall off if she kept smoking, she said she had the motivation to stop right away. That's a very important lesson for health communication in general, but also hard to implement because when public health campaigns do show very specific things that can go wrong, there can be accusations of scare tactics, whether it's showing very specific problems from STIs or very specific problems from smoking.

What's the line between a scare tactic and effective communication?

MSM sugar daddies in India

This article covers Indian male college students who are part-time sex workers with upper class clients. The narrative is like that in the more educated classes Africa (female university students in Zimbabwe) or the US (a recent Huffington post article.)

To me, the remarkable part is how frankly these students call themselves sex workers. While normally pejorative, that sex worker label may serve an important role for males who consider themselves heterosexual and want to distance themselves from their "work." Unfortunately, engaging in more likely than not unprotected receptive sex that they're being paid for doesn't mitigate the disease risks to their female partners who will likely never know about their part-time jobs.

Do people report embarrassing facts?

I've done some work in whether people report facts about themselves that are sensitive or embarrassing, and it seems that generally people report a surprising amount of sensitive information. Something that I've found fascinating is how people will reveal sensitive information when it's not called for on the humor blog "Damn you autocorrect". Usually, the cases are innocuous or not-so-innocuous, but occasionally the autocorrect will falsely "reveal" information (by correcting text to something not meant) that will induce the correspondent to reveal information that they would not have otherwise said.

Here are the examples:

• Person reveals herpes infection.
  
• Girlfriend reveals interest in breaking up.
  
• Mother reveals that parents suspect son is gay.
  
• Person reveals that she's heard her friend is well-endowed.
  

Only 4 examples and presumably it doesn't always "work" (that is, reveal information that would otherwise be hidden and not revealed on a survey), but I wonder if this could be harnessed somehow as a survey device.

You may already have an STD

The Medical Institute for Sexual Health (a conservative abstinence advocating health group) has created an STD Wizard to help people realize which STDs they are at risk for. I applaud the idea. People way underestimate their risk for chlamydia and HPV, and the latter is extremely extremely common. The only reason why many people who have had sex test negative is because they had the virus and then cleared it.

So I was looking forward to hearing them say that. I went through their quiz, filling in age, region of country, gender, race, drug use and STD history, and some yes/no sexual activity and drug questions. Not as fun as the purity test "Have you done it in a box? Have you done it with a fox?" They don't ask lifetime number of sex partners, only whether you have recently been raped or gotten a new sex partner.

And my results were. . .

I should take an HIV test, based on the fact that I haven't had a test in the past 12 months.

A healthy woman having unprotected vaginal sex with an HIV+ person has less than a 0.1% chance of contracting HIV. On the other hand, she is more than 2 orders of magnitude more likely to contract chlamydia or HPV if she's having sex with a person with those.

They follow this by, "Note: Even though many sexually active people have herpes, testing is rarely recommended."

And then, "Fact sheets for STDs you may have:" with links to HIV/AIDS fact sheets.

Way to go with the inaccurate fear-mongering. There is plenty of risk you could talk about.

Righteous adolescents

The current generation of adolescents has a strong tie with religion: the vast majority attend church, believe in God, and many are religiously engaged. Christian popular culture is a non-cynical mirror-image of mainstream popular culture: the well-known ascendancy of Christian rock bands into the mainstream, and the skater, surfer, hipster, and bling-heavy Republican hip-hop ministries. Lauren Sandler explores the Christian subcultures in Righteous: Dispatches from the Evangelical Youth Movement. Adolescents and young adults join these movements in search of "authenticity," a word which recurs in each of the ministries' self-descriptions.

Some adolescents seem to join these communities in search of love. The book opens with an anecdote of a high school student who seeks the love of Jesus while attending a Christian rock concert to compensate for a love she lost in a break-up. I find it interesting that religious love articulated by religious music replaced her failed romantic love. Since popular culture idealizes romantic love and sex so much, it can remind the unpaired of break-ups, loves lost and unrequited. Christian rock doesn't talk about romantic love, but has similar aesthetic qualities, so it must be refreshing to adolescents to experience music which does not reinforce their loneliness and romantic insecurities.

Young adults seem to join Christian communities not only because of the community that they offer, but because the communities allow them to maintain superficial contact with their Goth, rocker, tattooed subcultures after swearing allegiance to the church's social conservatism. The particular church that she profiles, Mars Hill in Seattle, is attached to a nightclub which uses its hosting of secular acts to attract new members. Once in, church members don't just signal their commitment to their church's vision of traditional families, they actually have to attest that they agree with it; in this church, women quit jobs to become home-schooling mothers and yield decision-making authority to their husbands. The high admission price of membership brings benefits, consonant with Eli Berman's theory (and perhaps the theory goes back before him) that the amount of mutual aid available within communities is directly proportional to their admission price. She tells of a mega-church member whose friends built him a backyard fence because he couldn't afford to hire workers.

Other ministries are entirely away from churches, such as in skating parks. Skateboarders in a van purchased on ebay for $700 travel to small, economically depressed towns and put on a combination skating/music show, which starts out secular and gradually increases the Christian content. The explicitly Christian portion of the show starts with an apology for the "jackasses" that attempt to spread the word of God, and ends with a group prayer which brings some audience members to tears. A more slick, professionally-produced show does the stereotypical altar call, passing out commitment cards, and counting the number of cards they receive, not unlike virginity pledge cards.

Sandler calls for secular culture to offer meaning, but she never presents an alternative paradigm other than rationalism. Rationalism is great for science, but it is not going to cause tearful conversions. As steeped in rationalism and atheism as she describes herself, Sandler says explicitly that she was touched by the sincerity and emotion: while narrating her experiences with the $700 van skaters, she describes her unwillingness to convert as "not yet," and at an ecstatic two hour worship service breaks out in tears and briefly considers conversion. Nor will rationalism exact a sufficiently high admission price to inspire mutual aid; people only give aid to people who signal sufficient belonging in a community, so they can avoid free-riding.

Perhaps a more realistic alternative to secularism for adolescents are liberal evangelical Christian organizations such as Jay Bakker's church called "Revolution" and Relevant Magazine", which Sandler profiles briefly. Bakker's church not only has the badass façade of the hip socially conservative churches, such as meeting in bars and calling itself "a church for people who have given up on church," but also has liberal politics. The church embraces actively-identified gay members, and its motto is, "As Christians, we're sorry for being self-righteous judgmental bastards." Sandler quotes a lesbian health educator speaking in Bakker's church as saying that abstinence-only education does not work, and quotes Bakker as saying, "You should know that Christian kids are sleeping together.... People do drugs. People have sex. And I'm afraid if we don't live in the reality of the world, we're just losing the battle."

Sandler's sparkling language is sometimes marred by unfairly snarky comments, but many of her critiques seem fair.

The evangelical youth movement continues to grow without secular counter-pressure, and liberal churches such as Bakker's are rare. Social policy is often formulated by those without direct experience with religious subcultures. Any intervention for adolescents needs to account for the fact that a large proportion of them are evangelical Christians. While adolescents evangelical Christianity is aesthetically similar to mainstream popular culture, the message needs to account for their Christianity. Public health can fill the gap between the religious abstinence message and the reality that most religious adolescents have sex and many others engage in other risk behaviors.

Interventions can explicitly address the conflict between adolescents' hormones and their morals: the religious message says that they should choose their morals over their hormones, but judging from the proportion of religious Christians who have sex, this message is not efficacious. Teaching adolescents to think realistically about their sexual decisions, and to create a contingency plan to ensure that any sex is as safe as possible, is important for both their physical and emotional health. While the idea of such a contingency plan is seen by religious leaders as an unacceptable concession to secularism, many religious leaders also know that continual feelings of guilt and cognitive dissonance risk driving people away from religion altogether.