Northern California Society of Public Health Educators

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Scholar Corner

Comics to Help Improve Health

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Health workers, artists partner to deliver messages via comics: Tools can influence health behavior

Public health advocates are banking on an old form of communication to get health information to patients in new ways. Health providers are using comics to educate patients on everything from asthma and diabetes to sexually transmitted infections.

Public health and comics have long worked together — World War II posters and pamphlets used illustrations to warn soldiers about venereal disease — but in the modern age, health professionals and artists are working to bring new life to the medium on two fronts: comics as educational tools for public health, and first-person narratives sharing the patient experience. Sometimes, those aspects overlap in a single comic.

“Comics is a rather anarchic medical medium,” said Ian Williams, MD, MA, a Brighton, United Kingdom-based physician and comics artist and writer who founded Graphic Medicine, a website and annual conference celebrating health and art.


A panel from “The Adventures of Iggy and the Inhalers,” an asthma comic from Booster Shot Comics. Public health workers are using comics to educate on a range of health issues.

Image courtesy Booster Shot Comics

“There’s been a huge democratization of health knowledge,” he told The Nation’s Health. “It’s the whole spreading of knowledge among non-experts. That side of it is much more exciting than the traditional side of, ‘I’m a doctor; I’m telling you what to do.’ I see that as a major function of the arts: It distills personal experience.”

Rather than giving patients pages of technical information about their health issues, comics, which can convey information with images and minimal wording, make information both easier to understand and more accessible, especially for people with low literacy levels. That includes people with low socioeconomic status and children — people at high risk for health disparities.

Alex Thomas, MD, a pediatrician and allergist at the University of Wisconsin, and Gary Ashwal, MA, an APHA member and creative strategist for health organizations, are the founders of Booster Shot Comics, a comic company that aims to educate and entertain health audiences. They said that comics have the potential to save lives. They created a comic book, “The Adventures of Iggy and the Inhalers,” to help teach children with asthma the differences between their inhalers, the triggers of asthma and what happens during an asthma attack.

The difference between a controller and a bronchodilator, or rescue inhaler, might seem too complex for an 8-year-old to grasp, but Thomas and Ashwal said that is not true. Kids can handle tough ideas: Adults just need to make ideas something kids will care about. For example, a person who asks a child about Pokémon will probably get a long lecture. So Thomas and Ashwal created anthropomorphized inhaler characters that kids can understand.

Broncho, a cowboy bronchodilator, embodies the rescue inhaler: He is fast and can lasso muscle bands to release them during an asthma attack, but he can only work for a short time. Coltron, a robot controller, is very strong and can keep airways open, but needs a long time to do so.

“Comics, I think, are very good at breaking down complex information, not just for kids but for adults as well,” Ashwal told The Nation’s Health. “It’s fun, relative to other health information that they’re getting, but it doesn’t need to be dumbed down the way we sometimes see it being dumbed down.”

Thomas and Ashwal have seen the results of their comic, which also comes with a short animated video and trading cards. When the Iggy and the Inhalers program was presented to children in June at the University of Wisconsin Hospital, Madison, Asthma Camp, attendees were quizzed about asthma before and after the one-day camp, and their scores improved markedly after reading the comics. Only 18 percent of attendees knew that a controller inhaler was not a rescue medication. After reading the comics, 68 percent got the correct answer.


A CDC motion comic educates young adults on HIV and other sexually transmitted infections. Testing shows the comic reduces stigma and increases protective behaviors, such as condom use.

Image courtesy CDC

Thomas and Ashwal will continue to evaluate their program this year. It will be tested in both inpatient and outpatient settings this fall.

Comics are not just kids’ stuff, however. The Centers for Disease Control and Prevention has created a motion comic that educates young adults on HIV and other sexually transmitted infections. The comics are aimed at people ages 15 to 24 to increase their health literacy and were created by a team of CDC researchers and Terminus Media artists.

In the most recent data — collected in 2011 — nearly half of all new STI diagnoses were among people between 15 and 24 years old. More than a quarter of all new HIV infections occurred among people ages 13 and 24 years old, as well.

“Lack of knowledge, low levels of health literacy, attitudes and incorrect beliefs all contribute to the high rates of STDs and HIV among youth,” the comics’ creators wrote in their description of the project for the Department of Health and Human Services Idea Lab, a contest that encourages innovation in health. “Our testing showed that among viewers, the motion comic decreased HIV stigma and increased intentions to engage in HIV/STD protective behaviors, e.g., condom use, abstinence and HIV/STD knowledge.”

The CDC comics are not limited to a three-panel strip: Motion comics include animation, sound effects, voiceovers and a musical score. They use technology to meet their audience where it is. In a pilot study, viewers who watched the motion comic showed increased knowledge about HIV, STIs and protective behaviors such as abstinence and condom use. The study also indicated a reduction in HIV stigma. The comic, called “There is Something I Need To Tell You,” has not yet made its public debut, but APHA member Leigh Willis, PhD, MPH, a behavioral scientist with CDC’s Epidemiology Branch, Division of HIV/AIDS Prevention, will be presenting on it at APHA’s 142nd Annual Meeting and Exposition, at session 5074 on Wednesday, Nov. 19.


Children enjoy health comics at a June asthma camp in Madison, Wisconsin, in June. Also pictured is Alex Thomas, a founder of Booster Shot Comics. An evaluation found that awareness of inhalers increased after children read the comic.

Photo courtesy Booster Shot Comics

“We chose this medium because comics are now a very popular and mainstream form of entertainment, particularly for young people,” said Willis, who headed up the team that created the motion comics. “Comics are part of the tradition of using the serial narrative format to deliver health messages — a format that allows for repeated exposure to these messages in (a) way that is also entertaining.”

Willis also told The Nation’s Health that using an entertainment medium to reach and engage young people with health messages makes sense, because young people are already so connected to technology and digital media.

Community health centers and hospitals are catching on to the trend and using comics to reach their patients. Connecticut Children’s Medical Center is using Super Safe Comics to promote public safety, and Graphic Medicine will publish a series through Penn State University Press.

Comics are effective in not only teaching health messages, but making them stick. A study by the Society for Nutrition Education and Behavior, published this year in the Journal of Nutrition Education and Behavior, showed that children who read manga, a Japanese style of comics, about healthy food were more likely to make better snack choices. Educational comics even go beyond the clinical setting.

“There are a lot of comic textbooks for microbiology, calculus,” Ashwal said. “Google put out a comic book explaining the backend workings of the Chrome browser.”

For more information, visit

From maternal health to parasites, comics using illustrations to deliver messages

Health comics cover a range of topics. Among the offerings:

  • “It Takes A Village,” by Zoe Hopkins and Amancay Nahuelpan. The short story covers maternal child health in an aboriginal community.

  • “Parasites!” by Jamie Hall, Edward Ross and Rachel Morris. An eight-page comic, the creators cover both parasitic diseases in developing nations and the economics of researching and treating the diseases.

  • “Blue Pills: A Positive Love Story,” by Frederik Peeters. The graphic novel charts a relationship in which one person is HIV-positive.

  • “Monsters,” by Ken Dahl. Graphic Medicine called the book “the funniest book you’ll read about herpes this year.”

  • “Signature Wound: Rocking TBI,” by Gary Trudeau. The “Doonesbury” creator explores how a young veteran lives with traumatic brain injury after war.

  • “Walking the Dog,” by David Hughes. The protagonist in this graphic novel commits to being healthier as he takes care of a new pet.

Last Updated on Monday, 15 September 2014 04:07

Seniors Vulnerable During Disasters

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Report: Seniors vulnerable in times of disaster

Seniors can sometimes be forced to fend for themselves during disasters. However, they could be safer if they had better forms of communication and access to more resources, according to a new report from the New York Academy of Medicine.

The July report, “Resilient Communities: Empowering Older Adults in Disaster and Daily Life,” was based on focus groups held with New York City seniors who had lived through 2012’s Hurricane Sandy. Almost three-quarters of the participants lived in the area most affected by the hurricane.

While seniors are likely to be influenced by social networks when making decisions in emergency situations, they often are not involved in emergency planning, the report said. Seniors also tend to support their communities before, during and after an emergency, it said.

Because seniors are not often included in community decision-making during emergency planning, they are more at risk during crises, the report found. For example, of the 44 reported New York City deaths during Hurricane Sandy, 31 people, or more than 70 percent, were 55 or older. The majority drowned at home.

People ages 60 and older make up 17 percent of New York City’s population, and those numbers are expected to increase by 50 percent over the next 20 years. Many live independently and function normally from day to day, even with limited mobility or chronic health problems.

“Most older people, despite having chronic health care conditions, operate fine,” said Lindsay Goldman, LMSW, project manager for health policy at the New York Academy of Medicine, in a July teleconference. “They don’t require services; they’re not connected to resources. Once the power is out they become vulnerable.”

Some factors in seniors’ lives can increase their vulnerability. Nearly one in five New York City seniors live in poverty, which means less access to resources, such as cellphones or tablets, that might be helpful during emergencies. The report showed that very few seniors use email or social media to stay connected with their community.

According to the report, more than half of New York City’s senior population is foreign-born. More than a quarter of city seniors speak English “less than very well.” Such barriers can further isolate them from emergency announcements and planning. For example, one focus group participant noted that seniors who could not speak English and could not afford cable television would not be able to watch news channels in their own language, which might alert them to storms or other danger.

The report stressed providing self-empowering resources specifically tailored to seniors, such as training them to identify vulnerable people in their community. Also vital is linking seniors with access to health care, social services and food under both routine conditions and emergency conditions so they can stay healthy and prepared. The report recommended including senior training in disaster preparedness and teaching seniors how to use multiple forms of communication, such as cellphones and tablet devices.

Goldman said that it is important to understand the culture of housing complexes where seniors often reside. Whether they live in high-rise apartments, senior living complexes or town homes, seniors can be left out during decisions to evacuate, such as one focus group member who woke to find his neighbors were gone without notice.

Stress and chaos in a disaster situation are especially difficult for seniors with mental health conditions such as dementia and those who lived through traumatic experiences such as civil war and the Holocaust, the report said. Such seniors said they felt safest at home and therefore decided not to leave.

But many of the seniors who lived in the area affected by Hurricane Sandy said they stayed because they thought they could help others who decided not to evacuate. One resident spoke about cooking for the young children in her building, while others made sure fellow seniors were safe. The report found that seniors with skills and experience took leadership roles after the hurricane by training volunteers, taking donations and identifying isolated neighbors.

In fact, seniors with close ties to their community can make excellent volunteers, the report found. They were especially adept at identifying isolated seniors who might need extra help. But others might be cut off from their peers and younger generations, the report found. Because of the isolation some seniors may feel even in their own neighborhoods or buildings, community outreach groups said they feel the need to extend their services to seniors who may not participate in community organizations.

Social networks within neighborhood communities proved to be influential. Many seniors counseled each other to decide if they would leave or stay. Seniors were often skeptical about evacuating during Hurricane Sandy, and refused to go to shelters, the report found. For example, when one focus group participant was asked why he did not evacuate despite not having water for 10 days, he said it was because all his friends were still there.

“This report reinforces the need to assess our neighborhood’s identity and plan with the community rather than for the community,” said Susan Fox, executive director of Shorefront YM-YWHA, a community group in Brooklyn, New York.

The academy also recommended that landlords of buildings with high concentrations of seniors be supported in making plans to care for the populations, and making seniors more generally aware of services available to them, like churches and libraries during routine conditions so they know where to turn during emergency conditions.

Goldman will be presenting about the report during a session at APHA’s 142nd Annual Meeting and Exposition this fall. The session, 3211, will be held on Monday, Nov. 17.

For more information on the report, visit

Last Updated on Monday, 15 September 2014 04:08

Vitamin D Deficiency Linked to Alzheimer's and Dementia

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Vitamin D Deficiency Linked to Increased Risk of Alzheimer’s and Dementia

Fish-rotatedSeniors with a severe vitamin D deficiency had more than twice the risk of developing Alzheimer’s disease and dementia than those with normal vitamin D intake, according to a new study. Among those with low – but not deficient – levels of vitamin D, the risk for Alzheimer’s increased 69 percent. The observational study looked at the health data of over 1,600 U.S. adults over the age of 65 for a period of about 6 years. It confirms earlier studies showing an association between low levels of vitamin D and an increased risk for Alzheimer’s disease and other dementias.


National Preparedness Month

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September is National Preparedness Month!

National Preparedness Month 2014September is National Preparedness Monthand the Centers for Disease Control and Prevention (CDC), along with over 3,000 organizations across the country, are teaming up to encourage Americans to be prepared in case of an emergency. During the month, each week will have a different focus, and older adults will be featured during the week of September 14. The CDC will release senior-specific messaging, informational graphics, blog posts, and a mobile application aimed at the specific needs and limitations of older adults and the importance of keeping specialized items ready in case they are needed during an emergency or natural disaster.

Those with Alzheimer’s disease and other dementias are particularly vulnerable during emergencies and need special consideration to keep them safe. National Preparedness Month gives the public health community a prime opportunity to include those living with Alzheimer’s into their state and local emergency preparedness plans (Road Map Action Item P-02).


Healthy People 2020 Senior's Health Improvement

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Healthy People 2020 Reports Improvements in Seniors’ Health

Healthy People 2020 LogoJune 2014 Healthy People 2020 progress review reported improvement in nearly half the objectives targeting older adults, including areas important to brain health. Healthy People 2020 set 10-year national goals designed to improve the nation’s health and for the first time, the initiative includes older adults and dementia as separate topic areas. Among the highlights of the progress review were an increase in physical activity among seniors – increased physical activity has been shown to reduce the risk of cognitive decline – and a decline in the number of adults aged 65 and older with moderate to severe functional limitations.

Although not yet posted to the Healthy People 2020 website, new national baseline data for the two objectives in the “Dementias, including Alzheimer’s Disease” topic area were also announced during the progress review. For the first objective on diagnosis, the baseline measure shows only 34.8 percent of seniors with a dementia diagnosis, or their caregiver, were aware of the diagnosis. For the second objective on preventable hospitalizations, the data show 25.3 percent of older adults with a dementia diagnosis had a preventable hospitalization. The target for both objectives is a 10 percent improvement by 2020.

You can view the PowerPoint slides from, and read a transcript of, the June 2014 older adults progress review webinar here.

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