James Loy:

This is Reframe, The podcast from the College of Education, Health and Society on the campus of Miami University in Oxford, Ohio.

Even though we have a better understanding of what’s healthy. And what’s not. Improving public health is still tremendously difficult. Because changing attitudes and behaviors is never easy. After all, how do you get people to first pay attention to accurate and relevant information, and then actually get them to do something about it?

So in this episode, we’ll hear about how a local community is making a calculated and creative public health initiative to try and communicate the right message, to the right audience, at the right time.

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In the comic books, superheroes can do incredible things. But in many ways, Rox the Fox is even more heroic. Because Rox can help people too. Except he has the power to make a real difference in the lives of real people, right here and right now.

So, it’s only fitting that Rox the Fox, Oxford, Ohio’s local mascot for health and wellness, would eventually star in a comic book of his own. 

Paul Branscum:

Rox is geared towards these five health messages of eating five servings of fruits and vegetables, drinking at least four cups of water, having three good laughs a day, having no more than two hours of screen time per day, and having at least one hour of physical activity per day. And, really, a lot of these messages are exactly what we promote in terms of obesity prevention, you know, at a larger scale . . . A lot of these were exact behaviors that I did in my dissertation work almost ten years ago.

James Loy:

That’s Paul Branscum, Miami University associate professor of public health, Dr. Branscum is part of a new partnership involving Miami University, the Coalition for a Healthy Community in the Oxford Area, the local Talawanda School District, and, of course, Rox the Fox himself.

Rox is a champion of this “5-4-3-2-1” approach to healthy living. It’s also a message that the mascot will promote through a new series of comic books, which is part of the larger plan to reach kids and adults throughout the entire area. 

Here’s Amy Macechko, Talawanda School District health and wellness coordinator and Oxford Coalition project coordinator. 

Amy Macechko:

So this is a very unique way to engage students. But it's not just students, I see it as a way to engage/rally the whole community around this issue. Our focus is definitely on creating community-level change, and using community change strategies -- one of which is information dissemination. But we know, if we really want to make a difference, we’ve got to dig deeper, right? We've got to change the physical design. We've got to increase access, reduce barriers, policy changes.

That's the kind of work we've been doing in this space, whether it's hosting programs, doing walk audits in the community, to make sure that our sidewalks and streets are accessible to promoting biking and walking, making recommendations to the City where we think things can be improved. So that's kind of the space we've been operating in.

James Loy:

For public health professionals, it’s a lot to consider, and a lot of dots to connect. And not much can get accomplished without first creating some level of awareness, which is why effective communication and information dissemination is so critical.

Most people are not likely to change their behavior, or their environment, or to start building new, healthier habits and lifestyles, unless they first know how to do so, and why they even should.

But this leads directly to another big challenge.

Paul Branscum:

But it's been very much shown that information alone is not enough to drive behavior change. You've got to... there’s a number of, like, different psychological or sociological theories that we use to kind of … that looks at specifically behavior change. What factors... what are the drivers of behavior change. And how can we understand those drivers from behavior to behavior, group to group?

James Loy:

So the goal not only becomes just generating awareness or just capturing attention. That’s just step one. An effective strategy must also then encourage recipients to internalize that information, and in a way that eventually leads to some kind of change.

It can be an involved process, and one that usually requires a multi-level approach. 

And this is a process that Miami students learn through a new public health major now offered as a joint program through the College of Arts and Science and the College of Education, Health and Society, where a focus on health and wellness is a large part of the academic mission. 

Alongside effective communication and information dissemination, students also learn how to investigate the behavioral, biological, environmental, and political determinates of health in any given area. And they also learn how to develop interventions that target specific conditions, as well as additional strategies for treatment and prevention.

This is all part of what it takes for public health professional to be effective today. Here’s Amy Macechko again.

Amy Macechko:

We are trained to look at identifying: What is the problem? And then why is it a problem? What are the risk factors that are contributing to it? And then why is it a problem here? Digging down to that local condition. Because any of the public health issues, why is it a problem “here” is going to look different in the Oxford area than in any other community. Because every community is unique. And so, we can really look at what are the local conditions that are contributing to this issue? And then, how can we choose and implement strategies that will directly get to those local conditions? 

James Loy:

In Oxford, the 5-4-3-2-1 campaign is part of a larger strategic initiative designed by the Coalition for a Healthy Community, which is primarily focused on three specific issues. Here, the goals are to prevent substance abuse, increase mental health, and reduce obesity. 

And these three areas were not arbitrarily chosen. The Coalition worked closely with the local hospital, McCullough-Hyde TriHealth, which is required every three years to complete a community health needs assessment to maintain their nonprofit status. And it was this needs assessment that determined that these areas -- substance abuse, mental health, and obesity -- are the three areas that this community is most concerned about.    

Which brings us back to Rox the Fox.     

Amy Macechko:

When we specifically were getting into the space of active living, one of the things that we had seen working in a community out in Missouri was the idea of having a mascot to kind of brand your work, and be a focal point that everybody could kind of rally around. When they see this mascot, they know that healthy activities are taking place. And so, we actually held a contest in our Talawanda middle school and asked middle school students to submit ideas and thus was born Rox the Fox. An eighth grade student submitted an image of this fox she named Rox. And now we have an actual Rox figure walking around town, and promoting these messages that we want to share through the coalition.

James Loy:

Rox the Fox can often be seen around town and across campus supporting events and participating in various activities that address these same issues, and the forthcoming comic books will be another extension of this mission. 

Currently, there are five issues being planned, one for each of the 5-4-3-2-1 behaviors, which again are all about eating five servings of fruits and vegetables every day, drinking at least four cups of water, having three good laughs, having no more than two hours of screen time, and having at least one hour of physical activity per day.

And comics books, as a medium, as a way to distribute this information, were also specially chosen for a reason.

First of all, Comic books have a long history of being used to increase literacy. They can expose children to words they might not be familiar with. And that combination of pictures and words helps build vocabulary and create a context for young readers. Plus, Dr. Branscum has already had previous experience using comic books for other public health projects.

Then, of course, there is no denying the strong influence that comic book content and culture has had on entertainment in general, especially considering the extreme popularity of Marvel comics-based toys, TV shows, and movies that are now found all throughout popular culture.

Finally, each issue is also being developed using a program called Comic Life, which combines real photos with classic comic book elements. And in this case, it’s become another way to create a deeper, more personal connection with local students themselves.

Amy Macechko:

So, what I’m so excited about and the kids jumped at the opportunity, is that it’s actually Talawanda students photographed in these comics. So they were the actors and actresses that were so excited to be a part of this. We took their pictures. And I think, when the comics come out, and they see themselves and see their friends and their peer group, it's going to be a different way of sharing the message that is going to really get them excited about it.

James Loy:

This initiative is just now in the beginning stages. But because of this new partnership between Miami University, the Coalition, and the Talawanda School District, there is already the potential for this project to make an impact.

Paul Branscum:

This is actually the first time I've worked with an organization who had a mascot, who wanted to develop comics around that mascot, that had healthy messages already. So if this launch is successful, and then there's more interest, it just kinds of gets bigger and bigger.

Right now to be successful, we would just want to expose the children to the comics and see what their feedback is. And see if the kids respond favorably to them, if they read them, if they want to reread them. That’s kind of the first step.

But we know, very intentionally, what we're doing is when you kind of have this big initiative of childhood obesity prevention, you kind of have to backtrack and think about, okay, first we really need to design a good intervention. Something that's gonna get the kids’ interest. That is going to lead to changes and things like attitudes, or self-confidence, or building social norms about, you know, eating healthy is an acceptable thing. And you slowly predisposed kids to these messages to build things like that. So that their behaviors kind of start following suit.

And so, theoretically what should happen is that designing these interventions promotes these positive messages, changes their attitudes, which then leads to behavior changes, which then leads to things like obesity and chronic diseases that we hope to kind of see decrease throughout time.

James Loy:

So, precisely the kinds of changes that all public health professions hope to see.

The new series of comic books staring Rox the Fox are being finalized now, and they should be in the hands of students this fall.

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