Dr. Cheryl Olson

Dr. Cheryl K. Olson: Consulting, Research and Media Outreach for Public Health

Health

What can we say about teen suicide?

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During the past three years, six students at W.T. Woodson High School in Fairfax County, Virginia died by suicide. Newton, Massachusetts lost three high school students to suicide in recent months. Both communities are heavily populated with high-achieving families, who start plotting their children’s pathways to elite colleges at ever-earlier ages. (My own son, who starts graduate school this fall, is tutoring a ninth-grader taking an AP course in history.)

It’s natural to ask why one school or town would suffer so disproportionately from suicide. Statistically speaking, clusters of rare events are bound to happen now and then. But we still need to check for common threads, just as we would seek to rule out shared exposure to toxins among a cluster of cancer patients.Broken_Car_Windshield

Most of these students gave no obvious warning signs of problems; they appeared successful and popular. One left a note behind, blaming stress from high expectations. This had led to speculation that relentless pressure to compete and achieve contributed to the deaths. A constant push for near-perfect grades certainly can undermine well-being and self-esteem. But evidence suggests that “the vast majority of youth with suicidal behaviors have pre-existing mental disorders.”

In fact, my doctoral dissertation at the Harvard School of Public Health focused on educating teachers to spot signs of depression or suicidal intent (using educational media I’d produced) and refer teens for assessment and help. Unfortunately, since depression and suicidal thoughts are common, and suicide is rare, it’s a tricky balancing act to help troubled students without stigmatizing them or spreading resources too thin.

With suicide, we also have to worry about the effects of “media contagion.” This was on my mind recently as I updated my chapter on “Psychiatry and the Media” for the new edition of the reference book Massachusetts General Hospital Comprehensive Clinical Psychiatry (Mosby, 2014). This is sometimes called the “Werther effect,” after a series of 18th-century deaths apparently inspired by the suicide of the protagonist of Goethe’s classic novel, The Sorrows of Young Werther.

The World Health Organization and other groups have published guidelines for journalists, that may also be of use to people sharing information on social media. Guidelines include:

  • Avoid glamorizing suicide, suggesting that it’s trendy or common, or that it solves problems.
  • Don’t share too much detail about the circumstances of a suicide; it may prompt copycat behavior. (One of the Virginia deaths—from a jump off a parking garage—reportedly followed a well-meant school presentation by someone who survived a leap from a building.) Similarly, don’t publish suicide notes.
  • Be sensitive to nuances of language; for example, “committing” suicide implies a crime.
  • Avoid the temptation of simplistic explanations (e.g., the idea that someone killed himself because he was bullied or he got poor grades).
  • Include information about local sources of help.

Why video games are not like cigarettes…

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A recent series of opinion pieces in the New York Times resurrected the debate on whether media violence causes actual crime or violence. One article dredged up a discredited claim that the link between media violence and actual violent behavior is “on par with the correlation of exposure to secondhand smoke and the risk of lung cancer” (the original claim involved “first hand” smoking).  This confusion arises in part from a misunderstanding of “effect sizes” and how this concept differs in social science research vs. medical research.

Cigarette buttsIs media violence “linked” (a weasel word for maybe-caused-by-but-possibly-not) to real-life violence? Let’s reframe this issue by looking at how scientists prove cause and effect, using the example of cigarettes and lung cancer.

  • Lung cancer was an obscure disease before smoking became common; now it’s the leading cause of cancer deaths. Aggressive behavior was hardly rare before electronic media became popular.
  • Lung cancer rates increase as smoking rates go up, and decrease as they go down. For the overall population as well as for subgroups, the more smoking, the more cancer. We see nothing like this relationship when we look at violent media and measures of real-world violence. According to FBI statistics, violent crime has dropped dramatically since the 1990s, as access to violent video games and other media increased.
  • There is a well-understood physiological mechanism for how cigarette smoke triggers cancer. How media violence might promote or trigger actual violence is still in the realm of speculation.
  • There’s a dose-response relationship between smoking and lung cancer. While genetics and environmental toxins play a role, in general the more one smokes, the higher her risk of lung cancer. We don’t know whether greater exposure to violent media (More hours or years of play? Picking extra-gory games or movies?) is related to greater effects on children.
  • Lung cancer is a clearly defined set of diseases; we know it when we see it, and experts pretty much agree on diagnostic methods and results. But experts don’t even agree on the meaning of harmful “aggression,” let alone how to measure it in lab settings or on playgrounds.
  • Also, the reliability (consistency) of measurement over time is different. Cancerous cells will still be present three hours later, while aggressive thoughts or behavior may have gone away.
  • Finally, smoking causes cancer, not the other way around. But research suggests that children with aggressive personalities may preferentially seek out violent media programs and games.

While linking violent media content with real-world violent behavior is easy for politicians and pundits, the science to support such claims just isn’t there.

New book: Sports Videogames

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If your household includes a preschooler, teenager or young adult, there’s a good chance you already own a potentially powerful weapon against couch-potatodom: sports videogames. I say this because of a surprising finding from my Harvard video game surveys and focus groups.Child with Skateboard White Background

Our survey of middle-school youth found that boys who play realistic sports games (e.g., soccer, basketball, skateboarding) spend more time on real-world sports and exercise. In focus groups, boys spontaneously mentioned trying new sports or playing more sports because of video games. For both boys and girls, competition and excitement are major motivators for video game play; sports games offer both. If you’re a parent who’s less than comfortable with violent game content, consider nudging your child toward video games based on his/her favorite sports. I’ll say more about this in future posts.

In the meantime, check out Sports Videogames, hot off the presses from Routledge. Edited by Mia Consalvo, Konstantin Mitgutsch and Abe Stein, the book is not just for academics. Since Amazon lacks a chapter list, here’s the rundown:

Sports Videogames: Mapping the Field – Mia Consalvo, Konstantin Mitgutsch, Abraham Stein

1. Games, Sports, and Sport Videogames: Designed Challenges in Racing Games – Jonas Linderoth

2. A Tale of Two Games: Football and FIFA 12 – Miguel Sicart

3. What Are Sports Videogames? – Ian Bogost

4. Joga Bonito: Beautiful Play, Sports and Digital Games – Henry Lowood

5. Women, Sports and Videogames – Mia Consalvo

6. Playing the Game on Television – Abe Stein

7. It’s in the Game? Shifting the Scene with Online Play – Christopher Paul

8. The Slow Grind: Skateboarding Videogames and the Culture and Practice of Skateboarding – John Sharp

10. Likeness Licensing Litigation: Student Athletes and the Future of Sports Videogames – Nina Huntemann

10. Playing Ball: Fan Experiences in Basketball Videogames – Fares Kayali

11. Eventful Masculinities: Negotiations of Hegemonic Sporting Masculinities at LANs – Emma Witkowski

12. Sports Gaming in Everyday Life: A Meaning Oriented Exploration of the Appropriation of the Online Football Manager Game Hattrick – Jeff Wimmer & Jana Nickol

13. Why Sports Videogames Matter to Their Players: Exploring Meaningful Experiences in Playographies – Konstantin Mitgutsch

14. Using Sports Videogames to Promote Real-World Physical Activity Among Young Adolescents – Cheryl Olson

Questioning assumptions

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iStock_boy-ltblue-shirt-300x200When I work with researchers or clinicians on media training and strategy, one thing I warn them about is false or misleading premises. Here is an example.

I just did an interview on CNN’s Headline News, where the focus was a story that’s kicked around for several years: a 2006 video game sold in Japan, called RapeLay, that allows players to grope (with a disembodied hand) and attack cartoon females. (No genitals are shown.) It goes without saying that this is a disgusting concept. The game was never sold in this country…but the idea of it has struck a chord with pundits convinced that video games are debasing our youth. Over the past few years, stories mentioning “rape games” have popped up repeatedly in U.S. news media. Parents may be reassured to know that – in contrast to R-rated movies – there are very few electronic games with nudity or sexual content. All of them can be found on the ESRB website by searching for AO-rated games.

My goal during the Headline News interview was to move away from the “ain’t it awful!” premise, and provide parents with context and specific, useful information.

There’s a link to the interview on GamePolitics.

Also see my article on how the media sometimes bungles research findings: Through the Looking Glass: What Happens When Media Coverage Distorts Science?

Jamie Oliver’s fat chance

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bigstockphoto_Donut_1180941-300x225As a public health booster, you’d expect me to like the new Jamie Oliver reality show on ABC. The young British chef parachutes into a West Virginia town that boasts a frighteningly high obesity rate. There’s a new nutrition sheriff in town who’s gonna clean up this place–er, put healthful food on their school lunch plates.

I do believe he truly wants to help. And it’s clear as plastic wrap that cheap, over-processed food is setting up many of these children for premature death. But although Jamie’s food may be fresh, his “I know best” paternalistic attitude is a counterproductive retread. Here are several of his behavior-change blind spots:

Other people should like what I like.

In part of the program, Jamie provided a family with a week’s worth of healthy meal recipes and ingredients, including an array of unfamiliar herbs. He seemed perturbed that, at the end of the week, most of the exotic ingredients sat wilting in the back of their fridge. Why not instead ask the family about their favorite dishes, and provide recipes that take those preferences into account, but nudge them in a healthier direction?

None of us likes to make drastic changes. And if one meal turns out subpar, it’s easy to reject the new approach wholesale. This is especially true for children, who are not only picky about strange textures and smells, but are often more sensitive to bitter tastes. You may need to offer a new food a dozen times or more before a child will try it.

Other people have the same priorities I do.

Jamie was appalled when, after blending and straining a chicken carcass into beige glop, kids were willing to eat the glop if breaded and fried into patties. When he did this demonstration for kids in the U.K., they always backed away.

I had two thoughts: First, hasn’t he ever watched those gross-out kids’ shows (e.g., Nickelodeon’s famous slime), or seen the deliberately disgusting candy some kids like? He doesn’t seem to know a lot about normal child development.

Second, when he asked the kids why they would eat that fried glop, they simply said, “Because I’m hungry.” A not-insignificant number of these kids probably come from food-insecure homes, where they’d better eat while they can in case the cupboard’s bare tomorrow.

If they’re too dumb to get it, add some cartoons.

In a desperate effort to make vegetables appealing, Jamie parades through the school in a peapod costume. This reminds me of “math-made-easy” books that stuff in cartoons and jokes in lieu of a better instructional approach. Kids are smart. If vegetables are so great, why the hard sell?

Scare ‘em straight.

After failing to get the family to cook healthier meals, Jamie shepherds them to a pediatrician. A physical exam and tests reveal that the son is on a fast track to Type 2 diabetes. Everyone is understandably and appropriately upset.

But what are they supposed to do about it? Research shows that unless a “fear appeal” is strongly linked to specific actions that will reduce risk, people will “cope” through denial. They also need the ability and know-how to take action, and belief in their own power to change.

To his credit, Jamie spends some time cooking with the son, showing him how to whip up a healthy chicken stir-fry. But that’s a small step on a long journey.

 
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