Health in the Hearing?

This week Bristol Palin is coming to Louisville to speak at a fundraiser for a Christian pregnancy support center. She has been invited to speak, not because of any great wisdom or insight she might have about life as an unwed mother, but because her name will sell tickets to the fundraising diner. This posting is not really about Bristol or any other Palin, but it is about the concept of using her as a speaker, and how that is related to health promotion concepts.

Shortly after Bristol’s son was born, she became active as a national speaker on postponing sex until marriage. The basic formula goes something like this: 1) I thought I knew what I was doing and that it was going to be so great; 2) Before I knew it, things got out of hand; 3) Then something happened that I never would have believed could happen to me; 4) Now life is so much more difficult because of bad decisions I’ve made; 5) with the help of family, friends, church, and community services, I am slowly getting my life back; 6) I strongly urge you not to do what I did.

This sounds very harsh and uncharitable, but it is not meant to be. There are people who specialize in these types of presentations about pregnancy, drug abuse, gangs, self-mutilation, and other destructive behavior. Many are very sincere while some are just good at stage craft. Some are paid and others are zealous volunteers. The outline in the previous paragraph can be made to fit all of these issues, just by changing the examples. Usually, local communities will invite these speakers to talk to middle and high school kids at school events, sometimes at churches, but such speakers also make appearances on college campuses as well.

Unfortunately, motivational health speakers are not supported by any evidence of effectiveness, except the effectiveness of getting speaking invitations. There are two problems. The first is one I’ve written about before: relying on information alone to change behavior is almost never effective. The health speakers may be very entertaining and engaging, but they are still just offering information. Facts usually do not have the motivational staying power to influence decisions about behavior that occurs on a frequent, long term basis. Facts about influenza might influence a person to get a flu shot, but once the needle is out, no other thought about the flu is required. On the other hand, teen sex or drug use or cigarette smoking or shop lifting or diet behavior all require a continuous decision making. A more comprehensive set of factors must be managed to have any chance to influence those types of decisions.

The second problem has to do with adolescent cognitive development. The reason parents and other adults with programming budgets like the motivational health speakers is because they have messages that we desperately want kids to hear. However, what we hear is not what kids hear. When we hear a speaker give a heart-felt presentation on how pregnancy ruined her life, it resonates with our understanding and our values. But, our relational field of vision is much greater than that of kids, and we have enough life experience to understand ways in which life can be profoundly challenging. On the other hand, kids see a, usually, youthful speaker. He or she speaks in youth speak, wears hip clothes, knows how to engage the audience, and makes a lot of money. Kids tend to gloss over the ruined life part and focus on the now. How bad could it have been? She got pregnant, and now schools and churches pay her money to speak.

Sincere but trivial and simple-minded thinking is not a winning strategy for designing good health promotion or public policy. Make a note to yourself whether you are in public health or politics.