Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.
In these podcasts, you get to listen in on my conversations about health literacy with some really remarkable people.
Today, I’m talking with Dina Borzekowski, who is the Interim Director of the University of Maryland Center for Health Literacy.
Dina is an international expert on children, media and the health. Her research explores how children and adolescents use media as well as media’s effect on their health and wellbeing.
Dina Borzekowski: It’s nice to talk with you, Helen.
Helen Osborne: This intersection of children and the media, that sounds like an important one. Tell us more. When you’re talking about children, is it just U.S. kids or around the world, and of what ages? Even more, when you’re talking about media, what are you talking about?
Dina Borzekowski: You very well know from walking around your neighborhood or speaking with other families that media and media use is just commonplace for children. It’s not just the television set anymore. Children will come to use a tablet or an iPhone by the time they’re 2 years old.
Helen Osborne: Oh my goodness.
Dina Borzekowski: What’s remarkable about this is it’s not just kids in the United States or in developed countries. It’s global. Children in China, India and Brazil are all looking at their parent’s phones as toddlers and coming to use media and technology as part of their lives.
Helen Osborne: Wow. When you’re talking about this media, I think of my little grandbaby who is a toddler herself. Is it just what they see? Her mom only lets her watch certain shows. Is that what you mean by media, or is it broader than that?
Dina Borzekowski: No, I think media is a presence in kids’ lives. It’s not just the content that they’ll see through a particular application or television show, but it’s the information environment that’s around them. It’s not only the content, but also the use and practices around technology.
Helen Osborne: Can you give an example?
Dina Borzekowski: If a child sees a parent using his or her phone at the dinner table, they come to learn that media use is acceptable at the dinner table, so it’s not just the content that they’re seeing.
Also, in neighborhoods when you walk around, the advertisements that you see on billboards or even on kids’ shirts and backpacks, that logo is part of the media environment.
Helen Osborne: Wow. Everything seems to be branded these days with your sneakers, backpack, notebook and everything else. Is that part of media too?
Dina Borzekowski: Absolutely. A child becomes familiar with, for example, the corporation of Disney from a very young age. They know different characters, but they also see the logos and characters on food items in the supermarket.
Helen Osborne: What about kids who can’t read? You’re talking about little ones here. I’m just thinking of one of our major companies that has a red and white logo that looks like bull’s eye. That doesn’t have any words on it. Would a child even recognize that?
Dina Borzekowski: Absolutely. I can go into telling you a little bit about my research.
Helen Osborne: Yes, please do.
Dina Borzekowski: We looked at kids’ awareness of logos. These are children we did research with that included over 2,400 kids in six countries. We looked at their awareness of logos for everything from cigarettes to fast food to cars and other types of things. We found that kids were extremely familiar with logos.
Helen Osborne: They’re aware of it, so if they see it, are they consciously thinking, “Hey, Mommy, I want to go to that store”?
Dina Borzekowski: It becomes part of their world. If a child becomes familiar with the Coca-Cola or Pepsi logos, they know that that’s something that’s part of their lives and part of their world. If they see those logos, they’re encouraged to reach out and grab that bottle as opposed to a different bottle.
Helen Osborne: It’s giving a subtle message even if it’s not consciously put together as, “I want that one with the blue versus the red coloring on the label.”
Dina Borzekowski: I don’t really know how subtle it is. I think it’s pretty overt. I think kids are getting banged over the head with these messages and logos all the time. Again, it’s not just in the United States, but it’s a global phenomenon.
Helen Osborne: It’s not just in developed nations either?
Dina Borzekowski: No, not at all. I’ve done a huge amount of work in developing countries and you’d be amazed at how regularly you’ll see different types of logos.
Traveling around parts of Tanzania, in peri-urban, urban and rural locations, you’ll see soda logos all over the place. They’re clearly reaching different populations.
Helen Osborne: Wow. That’s fascinating. It’s also appalling.
It’s time to don your health literacy hat. How do these issues relate to health literacy? We’re talking about soda and we’re talking about department stores. How does this affect a kid’s understanding about health?
Dina Borzekowski: I think it’s part of the environment, as I’ve already said. I think in terms of health literacy, what we can do as public health folks is to try to take these lessons learned by the corporations and the marketers and use them for positive health and development for children.
If we can encourage healthy eating practices and physical activity through brands, then that’s a positive step.
I clearly don’t think all media use is bad. As you know, we’ve chatted about my work with Sesame Workshop all over the globe.
Helen Osborne: You and I have met in person. You were talking about your work with puppets and stuff. Tell all our listeners about your work with Sesame Workshop. What do you do there?
Dina Borzekowski: I do a huge amount of work with Sesame Workshop, the producers of “Sesame Street.” We all know “Sesame Street” in the United States. It was developed in 1969. What’s interesting is “Sesame Street” is not just in the United States. It’s global.
Helen Osborne: Oh, I didn’t know that.
Dina Borzekowski: Yes, Sesame Workshop goes to countries and works with other countries to develop in-country production of “Sesame Street.” For example, in Indonesia, you have “Jalan Sesama.” In India, you have “Galli Galli Sim Sim.” You have “Sesame Square” in Nigeria. You have “Takalani Sesame” in South Africa.
Helen Osborne: Oh, this is so neat.
Dina Borzekowski: These are “Sesame Streets” that for the most part teach literacy and numeracy, but also in certain countries they take on additional curriculum topics.
For example, we just finished doing work in India, Bangladesh and Nigeria where, as part of the “Sesame Street” curriculum, we incorporated lessons about health and hygiene, meaning sandal wearing, hand-washing and using latrines.
We developed messages that could be conveyed through the TV production about how to improve children’s lives.
Helen Osborne: That is so neat.
Dina Borzekowski: This is an example of health literacy. Children who may not be able to read are able to receive messages about health through a Muppet.
Helen Osborne: That’s neat. That’s an example of ways to use the branding and the logos that the child is already accepting of and turn that into a positive health message.
I recall seeing recently the Surgeon General of the United States actually had a little bit of a conversation with one of the “Sesame Street” characters about getting a vaccine. I think it was Elmo. Is that the same way to use that?
Dina Borzekowski: Possibly, if the Surgeon General was involved, the audience might have been the parents of the children, but absolutely Muppets can be used to deliver healthy messages.
When we did our project in India where we were trying to covey information about health and hygiene, we created a new Muppet. Her name is Raya. She is a very strong advocate for wearing her sandals whenever she’s outside of her house and she always makes sure to wash her hands after using the latrine.
Helen Osborne: That is so neat. I just can’t get the smile off my face as you are telling me about this.
You and I started this podcast conversation talking about stores, fast food, Pepsi, Coke and all that kind of stuff. Is there an example you can give us about using that branding or the logo for positive messages about nutrition for kids?
Dina Borzekowski: Absolutely. There has been some work that has been done by other researchers that looks at putting stickers of famous characters on bananas and oranges, and they’ve seen very positive results.
When you put a sticker of a familiar character on a banana, kids are more likely to eat that banana than a banana with no sticker.
Helen Osborne: That is so neat. We’ve got amazing people like you researching this, so it’s not that it just seems like a good idea or a whim. It really works.
Dina Borzekowski: It absolutely works. We’ve seen both positive and negative effects of the media and how it can reach very young children, not to mention throughout the entire childhood. We see a continued use of media use reaching children through their preteen and adolescent years as well.
Ask to be involved with the kid’s media use and look at it. Then you as a parent can make decisions about if you happy with the messages your child is receiving as well as putting out.
Helen Osborne: What happens if we’re not happy? There are probably plenty of ads for all kinds of cereal I wouldn’t want anyone I know and love to be eating. What can we do about that when our little ones are bombarded with those messages?
Dina Borzekowski: When they’re very little, you can turn off the media. You really can.
Helen Osborne: There is an off button.
Dina Borzekowski: There is an off button and you can monitor it.
Once they get to first or second grade though, conversations can be had. You can discuss with your child why you like a particular cereal or don’t like a particular cereal. You can talk about sugar-sweetened beverages. You can talk about obesity issues with very young children.
Again, it’s part of health literacy. It’s part of having a conversation about messaging and the positive and negative impacts of those.
Helen Osborne: It sounds like it’s being aware of the world around us, being aware of the tremendous amount of media messaging that is out there and taking control when we can take control by using that off button if needed.
Beyond that, it’s putting it in context of the child’s life by really talking about this. That sounds like those inherent great principles of health literacy in action.
Dina Borzekowski: They are. I think it’s a fun process to walk around your neighborhood or community with your child or grandchild and look at all of the messages that are out there together.
Helen Osborne: Look at messages together. That is really neat. I know you’ve raised my awareness about that messaging a lot.
In a few years in an ideal world, what would you like to see? Would you like to see more messaging or less?
Dina Borzekowski: I think allowing the democratic process to take hold is good because I don’t want us censoring messages. I’d like people to be able to see the messages, understand them and, if they don’t like the messages that are out there, create their own.
Helen Osborne: Also to know the studies behind it for those of us in a position of influence, be it as parents or as professionals.
Dina, I am so glad you’re doing all that you’re doing and sharing it with all of us on Health Literacy Out Loud. Thanks so much.
Dina Borzekowski: It’s been my pleasure.
Helen Osborne: As we just heard from Dina Borzekowski, it is important to consider even the context within which we receive health information–even those logos and branding that our little kids are finding every day.