TORONTO - The young denizens of Whyville never saw the dreaded Whyflu coming -- though in retrospect, the flu clinic that mysteriously popped up in their virtual world a few weeks earlier should have been a clue.
Avatars who hadn't received a flu shot started coming down with the Whyflu, sneezing every time they tried to communicate with their online friends. (Avatars are the cartoon-like characters people use to represent themselves in virtual worlds.)
Interest in flu vaccine spiked and over the course of a six-week period in the 2006 flu season, 20,000 Whyvillians were virtually vaccinated. And 20,000 tweens - the age group drawn to the popular Whyville website - learned about influenza and the value of flu shots.
"We really were blown away," says Janice Nall, director of the division of e-health marketing at the U.S. Centers for Disease Control, which mounted the flu shot awareness campaign with the help of Whyville operators.
"It's very cool. Good solid numbers and good questions."
The Whyville flu campaign is just one example of how public health officials are using new tools -- social media, social networking and cellphone texting -- to disseminate health promotion messages.
The popularity of sites like MySpace and YouTube or virtual worlds like Second Life and Whyville has created exciting new communication opportunities that make the old public health standard - a colour brochure - look about as modern as a wax tablet.
"Social media is absolutely a huge element of what we're doing now. Primarily it's because it's where people are," says Nall, who talks about her work with infectious enthusiasm.
"Basically the bottom line is that millions and millions of people are going to these spaces. And ... a lot of learning occurs there, a lot of interaction. And so what we're trying to do is provide our health information in that context."
Others in the public health field are also looking to web-based or mobile media to reach people, whether to pass on information or trace disease contacts or investigate outbreaks.
Last September, for instance, Toronto Public Health used Facebook to locate a woman who had handled a bat that later tested positive for the deadly rabies virus. She desperately needed rabies shots, but all traditional ways of trying to find her had failed.
And last June public health authorities in British Columbia used an online questionnaire to investigate how riders taking part in a mountain bike race in Squamish got infected with a bacteria that causes diarrhea. In record time they figured out that mud contaminated with feces was the likely source of the outbreak.
In a growing number of North American cities, people who learn they have a sexually transmitted disease can use a web tool known as inSPOT to inform their sexual contacts and urge them to be tested. It's like an e-vite to seek treatment. Notifications can be sent anonymously.
Toronto and Ottawa are the two Canadian cities registered with inSPOT. Last Christmas, Toronto Public Health used a new technology -- proximity marketing -- to advertise the service to the gay community.
Using a device called a hypertag in the city's Gay Village, a message was beamed out to all Bluetooth-enabled cellphones within range. Recipients were asked if they would agree to view a message from Toronto Public Health.
Of 1,463 phones that received the message, 317 or 21.7 per cent downloaded the information about inSPOT, says Allie Lehmann, sexual health promotion manager in the directorate of healthy living. The department recently used the technique in six city high schools to raise awareness of chlamydia prevention and testing.
"To get our message to filter through the way we use traditional means is very tough," Lehmann says.
"So this allows us a way to filter through using a communication medium the kids are using. We're very excited about it and we hope that it will take us very far. I do believe it's the wave of the future -- of the now."
The CDC is exploring myriad ways to take advantage of social networking sites and explore the potential of texting.
The Atlanta-based institution has had an outpost in the virtual world Second Life for several years. People who visit the virtual CDC - which looks eerily like the real thing - can work in one of its disease detection laboratories.
There's even virtual swag. Avatars who work in a lab or answer a questionnaire get their own virtual CDC hazmat suits.
CDC also launched a line of e-cards containing health promotion messages. One might be a Mother's Day reminder to book a mammogram or an annual physical. The idea is that this kind of message from a loved one is likely more persuasive than a TV commercial or a print ad.
The options proliferate nearly as fast as the various technologies -- channels, as they are called -- evolve.
"The problem is not: Is there anything to do? It's which ones can we get the most bang for the buck (from) with limited resources and be able to show what makes a difference," Nall says.
One area public health is keenly exploring is text messaging. Earlier this year, CDC sponsored a conference called Texting 4 Health put on by Stanford University's Persuasive Technology Lab.
"Texting isn't that new," says the lab's director, B.J. Fogg, an experimental psychologist whose PhD work focused on how computers can be designed to change human behaviour.
"But what is new and what I tried to do at the event is get all the different stakeholders in the same room and talking. People who had just done interventions and people who wanted to do interventions. People who knew the technology piece and people who knew the health piece."
"It really did lead to people getting inspired and going home and starting this. So we're going to be seeing a lot more examples."
Residents of London, England can already use their mobile phones to check air quality; a program called Air Text sends subscribers air pollution warnings. A U.S. program, diet.com, allows users to submit by text the name of a food and get back a nutritional analysis of it.
In the U.S., the CDC and some partners have launched a campaign called "Knowit" designed to encourage people to be tested for HIV. (People who don't know they are HIV positive may be less likely to practise safer sex; they also don't know they need to start treatment.)
The Knowit campaign urges people to text their zip code to the number 566948 -- the numeric values for the letters in Knowit. The free service shows them testing centres nearby.
Fogg says different channels will work better for different things. For instance, a company approached him with the idea of creating an application for Facebook that would chart a woman's menstrual cycle.
He doesn't see that combination working. "If it's not something you would want to put on your car as a bumper sticker, then it's not really what people are going to Facebook to do," Fogg says.
But forming a club of people who want to lose 10 pounds likely would work in Facebook. Figuring out the potential of each of these channels is the key to using them as effective health promotion tools.
"So what I'm saying is each of those - social networking, social media and mobile -- has their strengths and weaknesses," Fogg says.
"And when it comes to public health it just depends on what you're doing. And often you would have to do more than one channel to get the impact. But you just have to understand what the channels can do and what the best practices are and what's coming next."
