There is a striking correlation between the decline of pirates and increasing global temperatures. Obviously the solution to combat global warming is not to replenish the population of pirates, but this is a great example illustrating that correlation does not always imply causation. Sometimes a correlation is so ridiculous that no one would even consider equating it with causality (another equally ludicrous example is the correlation between ice cream sales and crime rates). Sometimes it’s a bit more subtle, like the correlation between the use of marijuana and other drugs, and the accompanying theory that marijuana is a gateway drug bound to turn all users into ravenous heroin addicts (while this theory is not supported by science, those responsible for making and enforcing drug policies can’t seem to leave it behind). But either way, it’s always important to try and tease out correlation from causation.

Photo courtesy of: http://bama.ua.edu/

Some studies are intended to look only at correlations, and these studies can certainly provide useful information. Other studies are designed to test causality, and these usually involve control and treatment groups where the variable in question can be manipulated. One recent example of a purely correlative study is the story on the “choking game” that’s been all over the news lately. For those unfamiliar with this game, there is a trend—not new, but one I somehow missed out on in my youth—where kids choke each other with the goal of achieving a temporary high due to lack of oxygen. Obviously when strangulation is involved, there are dangers—there were 82 related deaths reported in the media between 1995 and 2007.

Realizing how dangerous this game can be, some public health researchers decided to look at information from a survey given to 8th graders in Oregon to try and figure out what types of kids were playing the choking game. The survey included questions about whether and how often the students had engaged in various risky behaviors, including the choking game. The researchers wanted to identify other characteristics that could help them predict which children would be more likely to play the choking game, so they could better target public health messages about the dangers of the choking game to the kids most likely to try it.

They found that kids who had tried the choking game were also more likely to have experimented with sex or drugs compared to kids who had never played the choking game. This is useful information to help identify kids likely to try the choking game and inform them of its dangers before they do, but it unfortunately tells us nothing about whether playing the choking game actually puts someone at risk for other risky behaviors in the future. Nevertheless, this is the sensationalistic spin that major news sources thought would attract the most readers. Most likely, a kid who experiments with the choking game is the same kind of kid who is going to experiment with other things like drugs or sex. There is no reason to think that preventing kids from playing the choking game will make them any less likely to use drugs or have sex, and an idea like this is exactly what you cannot prove in a study designed to measure only correlations.

Playing a game involving choking is obviously fraught with risks, and I don’t wish to downplay the dangers inherent in such an activity. Accidental and completely preventable deaths are a tragedy in their own right, but we shouldn’t pretend that eliminating one risky behavior will eliminate them all. Next time you read about a correlation in the news, just think of the pirates.

Recently I reported on the cultural challenges faced by HIV and AIDS prevention educators in the Latino community. A local health center was holding an open house where people could receive free and confidential testing throughout the day.

I filmed carefully in the lobby, avoiding faces. I filmed in the community room where people wandered in and out in search of snacks and information. Ultimately, I told the story of Latino HIV and AIDS communication through the eyes of educators.

But the story I wanted to tell was a different one. I wanted to see what it was like for a person to come into the testing center, be given an anonymous number, sit in the examination room and find out whether he or she was free of disease.

HIPAA laws, which govern the confidentiality of health information, prohibited my exploration of this story, and for good reason. An investigation into personal health is intimate. In the case of sexually transmitted disease, it can also be confusing and fear inducing.

A patient eventually agreed to speak with me, but even then I was wary of intruding on her privacy. I filmed her hands as she opened a safe-sex kit from the testing center and rifled through dental dams and lubricants. I pointed my camera at a beige wall and recorded her voice as she noted that it took only 20 minutes to get the results of her HIV rapid test. I didn’t have the chance to film more intimate and potentially compelling moments—I didn’t film her as she settled into her appointment room and waited for a clinician to return with test results. (Read more…)

Nickelodeon Website

I admit it, I used to be addicted to The Sims.

Maxis won me over with its ability to control an entire world. Suddenly, any 13 year-old barely passing algebra could be dictator of a small city. Feeding your Sim pizza was the equivalent of feeding it a toaster pastry. Two hours later, you were likely to have a whining digital figure on your hands, waving its arms at you while its “Hunger” bar flashed in the red. Art mirroring life! Or perhaps, early-advergame mirroring life?

Advergames are a mix of advertising, videos, and interactive media displayed online to promote products and brands. An analysis done by researchers at UC Davis and published in the Journal of Nutrition Education and Behavior found that, on average, only a single healthy message of nutrition or physical activity appeared for every 45 brand name flashes in these advergames. The analysis looked at products being advertised through the websites of two childhood favorites: Cartoon Network and Nickelodeon. Advergames were the most popular strategy of advertising on both, with a whopping 84% of the 290 total web pages including one.

Researchers hope that this new data will encourage food companies to develop guidelines for sending their delicious but un-nutritous messages to children. Michelle Obama has already begun the campaign with her “Solving the Problem of Childhood Obesity Within a Generation” program. However, the UC Davis researchers recommend that the federal government steps in.

Though childhood obesity is a problem, this seems somewhat extreme. Perhaps a study is first needed on how effective these advergames are in convincing children, and then how easily the advergame is transferred into an actual sale. Until then, the subliminal messages behind the games are just a distraction.

Will we soon see Count Chocula passing on his namesake for organic carob chips? Will Willy Wonka’s factories be forced to fill their advergames with Oompa Loompas doing thirty minutes of physical exercise five times a week?

Children in Haiti (photo courtesy of Bradley Zeve)

Health experts seem to agree that long-term public health effects are one of the most important elements of Haiti’s disaster. The UN recently estimated Haiti’s post-quake health and nutrition needs at $82 million, but Haiti has needed help desperately for years on many fronts – infectious disease, water sanitation, building regulations. And good health care has been in short supply; in many parts of Haiti witch doctors’ superstitions still override scientific advice.

FoxNews.com managing editor Dr. Manny Alvarez said recently that the earthquake has only exasperated the nation’s already endemic problems. Water sanitation has been further endangered, and Alvarez said the catastrophic aftermath will increase Haitians’ risk of developing gastrointestinal diseases and food poisoning, as well as worsening injuries inflicted by the quake. That just touches on one of many, many issues. New and old health hurdles are now a joint part of Haiti’s long-term future. (Read more…)

As the hoopla about swine flu continues to dominate the front pages and airwaves, let me draw your attention for a moment to a tiny story hidden away at the back of today’s New York Times.

It seems the gentleman infected with drug-resistant TB who ignored public health warnings and got on a series of airplanes in 2006 so he could go on his honeymoon is suing the Centers for Disease Control.  The agency released his medical records back then in an effort to find and stop him before he infected anyone else.  Apparently, the stress caused by the damage this did to his professional reputation and marriage (which ended in divorce) are worth some undisclosed amount.

Let’s try not to laugh too hard at this irony, lest we uncover our mouths in public.  And here’s to all who exhibit personal responsibility and restraint to help improve public health!

Now, I must go wash my hands for a full 20 seconds.