Public Health Communication
A. SUSANA RAMÍREZ, PhD, MPH
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Health & the Media: Teaching Media Effects to Public Health Students During a Pandemic

12/21/2020

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This is the third in a 4-part series reflecting on teaching during a pandemic semester. In the first part, I described how I prepared for teaching remotely; in the second part, I reflected on how teaching in a pandemic has improved my teaching effectiveness. In this post, I want to describe the content of my class and share how students learned to be more critical consumers of information. 
 
I got to teach my favorite class, Health & the Media, an upper-division elective that generally enrolls mostly public health majors. The overarching aim of the course is to provide students with an understanding of the ways the media influence public health outcomes. We don’t have a communication department on campus so this is likely the only time students will be exposed to communication theory. 
 
In the past, I had relied on three books to achieve the course goals: Merchants of Doubt; Health, Risk and News; and Social Networks and Popular Understanding of Science and Health. In combination with a few chapters from an actual communication textbook, these readings were fun for me to teach and effective for the students. Alas, Health, Risk and News is out of print and hard to find now; while searching for a replacement, I found out that Merchants of Doubt had been made into a documentary! Then it hit me: Students might enjoy (and, ahem, be more likely to complete the assignment) watching a film more than reading a book. So I decided to be more intentional about selecting course “texts”. As much as I enjoyed Social Networks & Popular Understanding of Science, much of the information I wanted students to be able to apply from that book was relevant to understanding the infodemic accompanying the current pandemic – and the World Health Organization, among others, had put together some terrific interactive content. 
 
That left the drier content to cover: Should I just assign the usual textbook chapters? No! It turns out I have super talented friends and one of them just published a book that held considerable promise for entertaining my students while teaching them principles of communication theory. 
 
One last point: I made the decision early in the course design process not to focus this course exclusively on COVID19 or even more broadly, on contagious disease communication. Although I made the decision for my own mental health (remember, I am a human dealing with the pandemic world too), the majority of the students told me the appreciated the course as a respite from the never-ending flow of COVID19 news. 
 
The course was structured around three themes. 
 
Part 1: Making Science News
First, we discussed the processes of making and then translating science for lay audiences. We started by talking about how science happens and the potential for science to biased. We learned about the competing – sometimes clashing – values of scientists and journalists, and the news industry, and how these influence the way scientific information is produced for non-scientists. We also discussed audience features that make it hard for non-scientists to interpret scientific and health information. Some resources that were especially helpful for this section:

  • TED and TEDx Talks
    • Chimananda Ngozi Adichi at TEDGlobal 2009 – The danger of a single story
    • Mona Chalabi at TEDNYC – 3 ways to spot a bad statistic
    • Nina Teicholz at TEDxEast – The Big Fat Surprise
    • Megan Kamerick at TEDxABQ – Women should represent women in media (10:18)
  • Three short animated videos by TEDEd 
    • Can you spot the problem with these headlines? (4:50)
    • This one weird trick will help you spot clickbait (5:25)
    • How to choose your news (4:32)
  • Reading: Anything by Ed Yong but especially: “Why the coronavirus is so confusing: A guide to making sense of a problem that is now too big for any one person to fully comprehend” The Atlantic
  • Documentary films:
    • Merchants of Doubt
    • Picture a Scientist
  • Podcast: Scene on Radio S4 E11 “More Truth”
 
About halfway through this first section I realized students were having a hard time understanding the material. Even the students who reported spending hours engaging with the materials in preparation for our live class sessions were not able to answer what I considered to be basic questions. And without this foundational understanding, we couldn’t have the discussions I wanted to have in class. I built in more scaffolding for note-taking and engaging with the content. I asked them to ask themselves and to write in their notes: What is the author/speaker/film arguing? What is the main claim and what kind of evidence are they using to support this argument? I devoted the first 10 minutes of class (sometimes more) to deconstructing these questions for everything they read. We worked through multiple examples together and I reinforced these lessons through individual “minute papers”, team activities, and quizzes. Doing this transformed the energy in the class: I could tell students were more engaged and interested. They asked better, more specific questions that I could actually answer or help them to figure out how to answer. Although it was definitely challenging, students were able to appreciate the benefit of improving their reading comprehension skills.   
 
We ended this section with a discussion of the infodemic, including media literacy activities to help empower students to stop the spread of misinformation. Timely and incredibly useful resources:

  • First WHO Global Infodemiology Conference 2020  
    • How to protect yourself in an infodemic (2:08)
    • Conspiracies, rumors, and falsehoods: The truth about why the infodemic is so dangerous and what we can do about it (18:52) Claire Wardle, First Draft News.
    • A New Digital Reality: How Fake News and Misinformation are Derailing the Largest Vaccination Effort in History - A Case Study of Polio Programme (25:04) Rustam Haydarov, UNICEF. 
  • Think ‘Sheep’ before you share to avoid getting tricked by online misinformation. First Draft News
  • Audrey Tang, Digital Minister of Taiwan at TED2020 – How digital innovation can fight pandemics and strengthen democracy (48:55; to 6:05 is a very informative introduction of Taiwan’s digital strategy)
  • Go Viral Online Game
 
Part 2: Advertising and Marketing and Poor Health
In the second part of the class, we moved from thinking about the news information environment to consider the other major source of information and misinformation that affect health: Corporations. We used the public health pandemics of obesity and diabetes as a case study to examine how advertising and marketing of junk foods and sugary beverages contribute to poor population health. My favorite resources for this section were:

  • The documentary film El Susto!
  • Revealed: how junk food and alcohol brands turned Covid-19 into the world’s largest marketing campaignThe Telegraph.
 
Part 3: Comedy and Social Change
The first two-thirds of the course can seem fairly depressing because we focus on how media contribute to poor public health. So to end the semester on a positive note, in the final third of class, we used A Comedian & An Activist Walk Into A Bar to consider how media might be used to effect positive social change and improve population health outcomes. This was so much fun! 
Published by the University of California Press, the ebook was available to students via the University of California library system. This made it affordable (well, free) and also easily accessible to my students. Each chapter was 20-25 pages, which, although the text was sometimes dense, it did not feel like too much to ask students to do given the relatively light reading they’d had throughout the rest of the semester. Each chapter corresponded (roughly) to a specific communication theory that I wanted to cover. Students read each chapter, then we discussed the theory in class and watched some of the comedic clips discussed in the book. This was a highly effective way of teaching. Because they had read both descriptions and analyses of the clips beforehand (and although the book was published this year, almost all of the content was still new to my students!), students were able to bring their developing comprehension and analytic skills to bear on the content themselves. Below I will list a quick summary of the chapters we read in class and the clips that I selected to accompany each chapter.
 
A Comedian & an Activist Walk into a Bar, Chapter 1, “Why comedy, and why now?”  
Although this book focuses on comedy specifically, the theories they use are drawn from and can be applied more broadly to entertainment media of all types. This first chapter does a good job of introducing the idea of media effects, media ecology, and outlining the argument that the many ways people encounter media in their lives make this a good historical moment for thinking about how comedy can cut through the clutter to make positive social change and what that looks like.  
 
Along with reading Chapter 1, students watched a clip of a comedy and social change incubator program run by one of the authors of the book and a funny TED talk about moving from stories to action. 
  • American University’s Yes And Laughter Lab 2019 Trailer
  • Sisonke Msimang at TEDWomen2016 – If a story moves you, act on it
 
A Comedian & an Activist Walk into a Bar, Chapter 2, “How comedy works as a change agent” 
Chapter 2 elaborates relevant theories, charting the paths through which comedy can affect social change. Discussing this chapter allowed me to link back to earlier class materials that had hinted at but not mentioned media effects theories. Because the students are public health majors, it is important to convey the ways systems, policies, and environments affect population health. Thus, in class discussions of this chapter, we focused on the agenda-setting role of media and on cultivation effects. Helpful resources for this chapter: 
  • Media Effects (2:59)
  • Mr. Sinn: “Agenda Setting Theory: Media Theories” (5:15)
  • Podcast: TED Radio Hour “Painfully Funny, Part 1 - Sandi Toksvig: Can Social Change Start with Laughter?”(12:29)
  • Michelle Wolf on The Daily Show: "The All-Male Panel on Women's Health" (3:15)
  • Master of None, The Thanksgiving Episode (2:34)
 
A Comedian & an Activist Walk into a Bar, Chapter 3,  
Chapter 3 defines different types of comedy and provides examples of each. I almost did not assign this chapter, but I am so glad that I did because it provided a great way to show students how this content might be personally relevant to them. I created a collaborative online assignment on Google Sheets that they completed in teams of 3-5 students. They first had to select a public health problem they care about. Then they identified specific examples of each genre from their own media diets dealing with the issue they selected. Finally, they reflected on the kind of outcome or effect that each genre was best for, and the outcomes, audiences, or effect that might be counterproductive to public health goals. This was a powerful exercise for students because it forced them to reckon with their own media diets; most students had never thought about how they learn from content they choose to consume as entertainment. It was also a great strategy for me to gain insight into the kinds of content that current students are consuming – I was surprised by both the diversity of public health issues they care about and with the sources they found. I would be happy to share the assignment with anyone who emails me to request it.
 
A Comedian & an Activist Walk into a Bar, Chapter 4, “Can laughter help save the planet?”
Chapter 4 specifically focused on the ways comedy could shape public support for policies to reduce the human impact of climate change. This week’s clips were taken straight from the chapter and were big hits with the students. Part of the chapter reported on an experiment testing the relative efficacy of satirical communication compared with straight news about climate change. I showed the videos used in the experiment and asked the students to work in teams to answer reading comprehension questions about the experimental results. 

  • Last Week Tonight with John Oliver “A statistically representative climate change debate”  (4:26)
  • Funny or Die satirical public service announcement “Old people don’t care about climate change”   
  • Funny or Die satirical public service announcement “Climate Change Denial Disorder”
  • News condition: Facts First, "Climate Change is Real"  
  • Control condition: "Overhead in LA with Nina Dobrev"  
 
A Comedian & an Activist Walk into a Bar, Chapter 5, “Beyond poverty porn”
This chapter gave me the chance to talk about framing and priming. In addition to reading this chapter, they watched a TEDx talk about confirmation bias that helped us to link the theories from A Comedian & An Activist back to earlier content about misinformation and communication of science. In class, we watched a few clips referenced in the book. This class was a tough one to teach for me personally and I actually gave a belated trigger warning: I grew up poor and I have witnessed the kind of abject poverty depicted in these clips. And I know that this kind of poverty exists here in California’s Central Valley, and I suspect that at least a few of my students may have experienced it. So the examples in this chapter hit a little too close to home. Nonetheless, they were effective ways to talk about framing and priming. 
  • Alex Edmans at TEDxLondonBusinessSchool – What to trust in a “post-truth” world (17:40)
  • Satirical sketch featuring an impersonation of Sally Struthers, In Living Color (1991): “1-555-FEED-ME”
  • Satirical sketch, Saturday Night Live (2004): “39 Cents”
  • RADI-Aid, a parody of the campaigns satirized by In Living Color & SNL, by Norwegian advocacy organization SAIH: “Let’s Save Africa – Gone Wrong”
 
A Comedian & an Activist Walk into a Bar, Chapter 7, “Creative collaborations: How comedians and social justice advocates work together”
We ended the semester with Chapter 7, which provides specific guidance for how advocates (in my case, public health professionals) can work with comedians to accomplish their goals. Many of my students want to work in health promotion among vulnerable communities, so this was a great primer for things they might consider. 
 
As I reflect on teaching this semester, I realize how interdisciplinary my classroom is. I hope that some of the materials I have provided above will prove helpful to readers. I am also happy to provide the complete syllabus and assignments to anyone who requests it (and promises to use it for good!). Stay tuned for the final installment of this series, where I’ll focus on the substantive content of my course, and what we learned about Health & the Media using the diverse course materials I curated for this semester.
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Teaching University Students Online During A Pandemic: 3 Lessons I’m Taking Forward

12/18/2020

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​Awful as the pandemic has been, teaching during this time has made me a better teacher. In the previous post, I reflected on the process of putting together my online course for Fall 2020. In this post, I will describe three lessons I learned that I will take forward for future classes.
 
Lesson #1: Transparent Empathy
First, I will be more transparently empathetic. In the past, students who took the time to get to know me outside of class via office hours or working as my research assistants knew me to be highly empathetic and kind. But some students in my classes struggled with the persona that I (apparently) demonstrate in front of a real-life classroom. 
 
Teaching completely online helped me to break down that barrier. Everything I read in preparation for this semester reminded me that in online teaching, you have to be extra demonstrative so as to keep folks engaged. In addition, the research on metacognition – including teaching students why you are assigning them certain work and what they should gain from it, encouraged me to be more open with my students. 
 
Two other secret ingredients forced this transparency: I have tenure now and thus am not afraid of students’ evaluations potentially forcing me out of the career I have wanted all my life. Now that I have stable employment, I feel free to experiment with ways to be a more effective teacher, evaluations be damned. The other secret ingredient is the fact that I have full-time working spouse and three children at home, and I am as much of a disaster as anyone this year. Students got to hear my real world in the background of our class: A child’s tantrum, a four-year-old’s request for someone to wipe her bottom, piano practice, a parent screaming to a child to stop bothering their sibling. Sometimes our class had surprise cameos by humans or felines. We all just had to roll with it. And so, students got to see that I am a human too. I asked them to give me the grace I was extending to them, and this was effective at helping me to connect with them. 
 
I am grateful for this lesson, and I will take it forward. In the future, I will show my vulnerability and humanity to students.

Lesson #2: Engaged Teaching is Anti-Racist and Inclusive 
Second, I will leverage multiple forms of content to create an inclusive and anti-racist learning environment. Like many people, this year I’ve been inspired by the Black Lives Matter movement to be more intentional and vocal about my approach to anti-racism. I realized as I was curating the materials for my class – deliberately seeking not just traditional written texts, but also audio and video of varying lengths – that these multiple types of materials also opened up more diverse voices than are represented in traditional educational content. Inclusive materials and content (I’ll write more about this in my next post) are one way of enacting anti-racist pedagogy. 
 
Teaching remotely this semester also forced me to reconsider how I engage students in the classroom, and I made some choices that felt more inclusive. Surprise – technology can help with this! For example, I used Google Jamboards to get instant feedback on what students knew about a topic and to assess how much more I need to cover. Jamboards are basically online versions of giving students sticky notes to write down a main idea or theme and posting it on the wall. They are anonymous, so students felt free to share their thoughts with no fear about being wrong because no one knew who had posted what. There are dozens of similar strategies that can encourage participation and active learning; I am just a novice at this. Incorporating these more inclusive, active strategies is a way to practice anti-racism in the classroom.  
 
In the future, I will continue to use active learning and engaged teaching strategies in constructing and facilitating my courses.  

Lesson #3: Educational Technology Can Be Useful
Finally, I will not be afraid to use educational technology – strategically. Once I got over the steep learning curve of our learning management system, I was able to make it helpful to both the students and to me. This was critical in a semester where I had 58 students and no teaching assistant. 
 
All of the course materials were available online, organized by module and by week. This meant that the students did not have to make their own organizational system, and so students who are not naturally inclined toward organization could follow along just as well. I figured out how to set materials to open at certain times, or conditional upon completing other activities, and this provided additional forms of forced organization to meet learning objectives. 
 
I was able to embed the types of frequent, low-stakes assessments that are recommended by engaged pedagogy because they were automatically graded by the system. All of this involved an enormous amount of work to set up, but most of it will be reusable the next time I teach this course. 
 
I am not sure how open I’ll be to allowing devices in the classroom in the future – this semester it was obvious that the students who were using pencil on paper (literal or virtual) were more effective note-takers and performed better on assessments than students who took notes on their computers – but I am at least open to trying it out. 
 
As hard as that climb up the remote teaching curve was, I am thankful to have been forced to learn how to use instructional technologies. In the future, I will choose to use instructional technology strategically to facilitate student learning and to help me spend more time on substantive teaching issues. 
 
So there you have it. Taking the time to write out these reflections was a good exercise for me, and I hope it has been helpful to those who read through to the end. In the next installments of this series, I’ll focus on the substantive content of my course, and what we learned about Health & the Media using the diverse course materials I curated for this semester.  
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Professional recognition comes with reckoning of where I came from and profound gratitude for all of my mentors along the way

12/31/2017

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Excerpt of my acceptance speech for the 2017 Early Career Award of the American Public Health Association's Public Health Education & Health Promotion Section, delivered November 7, 2017 in Atlanta, GA.

I am humbled when I look at the list of previous winners, leaders that I admire in the field of health promotion. Truly, the Early Career Award is an honor.
 
It is validation that I am doing good work – I especially appreciate this recognition because I have not always felt my work was understood.
 
As writers write what they know, I study what I know. My research aims to understand how to communicate with bicultural Latino audiences to improve the health of this growing and at-risk population.
 
I am myself Mexican-American and my intellectual journey started with my own uncomfortable reckoning with identity. As a young child, I was brought to the United States from Mexico. In that era – the early 80s – and in that place – rural Texas – it was advised that immigrants shed their markers of identification from wherever they came from. So I moved here and was immediately immersed in an English-language world. Within six months my sister and I were fluent in English and Spanish was reserved for summers, when we would get shipped to my abuelita’s house in Mexico. There, my cousins would tease me about my American ways. But at home in Texas and then Arizona, I knew I was not fully American. Despite my parents’ attempts to integrate we would always be outsiders. We looked different and – even if my sister and I managed to escape with no accent, our parents did not. Plus we had funny names.
 
Even though we lived in regions with substantial Latino populations, we always lived where the good schools were. Which is to say, we lived in majority-Caucasian neighborhoods. But of course I was surrounded – in Texas, Arizona, and California – by a broader culture where there were substantial Latino populations. And so when people talked about “diversity,” it was presumed that Latinos were part of that diversity.
 
So when I arrived at the University of Pennsylvania for my doctoral studies, I could not put my finger on why I felt so unmoored. I had heard that Philadelphia was a diverse city, but all I saw was black and white. What I figured out was that people used “diverse” as a code to indicate the presence of African-Americans. What was missing for me – what made me feel unmoored – was the Latino population!
 
At this time I started learning about race in the media and health disparities among African-Americans and the ways in which communication could both contribute to but also help to alleviate health disparities.
 
So based on my own experiences, I got curious. I started asking questions about ethnicity – in media representations, media effects, and health outcomes, and I got blank stares or at best, the response that little was known.
 
And so I started looking into the literature myself, and I found research in health promotion among Latinos. What I found was that almost all of this research was done exclusively with Spanish-speaking populations and was really focused on the challenge of translating appropriately.
 
But this felt incomplete to me, because I knew that Latinos don’t just speak Spanish. And I was learning that population trends support my personal experience: The growth of the Latino population isn’t – and hasn’t been for a while – from new, Spanish-speaking immigrants – it’s from the children of immigrants who will grow up entirely in the United States, and are disproportionately likely to suffer from preventable risk factors and poor health outcomes.
 
And that is how I developed my research agenda.
 
I am gratified that I am no longer the only person talk about the need to move beyond thinking about language as a way to convey health information to Latinos. There is a lot of work to be done, since I still get people telling me about how they translate materials to Spanish as the entirety of their Latino outreach, but I do see more work coming out, not just from me, that is trying to tease out aspects of the Latino experience that affect how we communicate effectively about health with Latinos.
 
So I am grateful for the honor of the Early Career Award in recognition of my contributions to this field.
 
But – the Early Career Award is not just an honor.
 
It is also a challenge. When I look at the list of previous winners, I am humbled by their great accomplishments AFTER their Early Career phase. So, the challenge of the Early Career Award is this: You have done well so far, but you have the potential to do great things.
 
I am thankful for the intellectual home that I have found in the Health Communication Working Group of APHA.
 
To all of you: THANK YOU for having the confidence to grant me this honor and to challenge me to greater achievements.
 
I humbly accept the challenge. 
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    A. SUSANA RAMÍREZ
    ​Associate Profesor
    ​Public Health Communication

    sramirez37 at ucmerced dot edu

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