JMIR Publications

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JMIR Public Health and Surveillance

A multidisciplinary journal that focuses on the intersection of public health and technology, public health informatics, mass media campaigns, surveillance, participatory epidemiology, and innovation in public health practice and research.


Journal Description

JMIR Public Health & Surveillance (JPHS, Editor-in-chief: Travis Sanchez, Emory University/Rollins School of Public Health) is a PubMed-indexed, peer-reviewed sister journal of the Journal of Medical Internet Research (JMIR), the top cited journal in health informatics (Impact Factor 2016: 5.175). JPH is a multidisciplinary journal with a unique focus on the intersection of innovation and technology in public health, and includes topics like health communication, public health informatics, surveillance, participatory epidemiology, infodemiology and infoveillance, digital disease detection, digital public health interventions, mass media/social media campaigns, and emerging population health analysis systems and tools. 

We publish regular articles, reviews, protocols/system descriptions and viewpoint papers on all aspects of public health, with a focus on innovation and technology in public health.

Apart from publishing traditional public health research and viewpoint papers as well as reports from traditional surveillance systems, JPH was one of the first (if not the only) peer-reviewed journal which publishes papers with surveillance or pharmacovigilance data from non-traditional, unstructured big data and text sources such as social media and the Internet (infoveillance, digital disease detection), or reports on novel participatory epidemiology projects, where observations are solicited from the public.  

Among other innovations, JPH is also dedicated to support rapid open data sharing and rapid open access to surveillance and outbreak data. As one of the novel features we plan to publish rapid or even real-time surveillance reports and open data. The methods and description of the surveillance system may be peer-reviewed and published only once in detail, in a  "baseline report" (in a JMIR Res Protoc or a JMIR Public Health & Surveill paper), and authors then have the possibility to publish data and reports in frequent intervals rapidly and with only minimal additional peer-review (we call this article type "Rapid Surveillance Reports"). JMIR Publications may even work with authors/researchers and developers of selected surveillance systems on APIs for semi-automated reports (e.g. weekly reports to be automatically published in JPHS and indexed in PubMed, based on data-feeds from surveillance systems and minmal narratives and abstracts).

Furthermore, duing epidemics and public health emergencies, submissions with critical data will be processed with expedited peer-review to enable publication within days or even in real-time.

We also publish descriptions of open data resources and open source software. Where possible, we can and want to publish or even host the actual software or dataset on the journal website.


Recent Articles:

  • The Ending the Epidemic Dashboard homepage (montage). Source: CUNY Institute for Implementation Science in Population Health /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    A Human-Centered Platform for HIV Infection Reduction in New York: Development and Usage Analysis of the Ending the Epidemic (ETE) Dashboard


    Background: Dashboards have been increasingly used in clinic-based interventions, such as clinical performance improvement and monitoring risk of hospital readmissions, and are now gaining traction in population-based interventions, especially in disease assessment. Objective: We describe the design, development, and usage analysis of a geovisualization dashboard, the Ending the Epidemic (ETE) Dashboard. The ETE dashboard is a tool developed to track New York’s progress towards achieving the goal of its ETE Initiative, to reduce new HIV infections from 3000 per year to 750 per year by the end of 2020. Methods: The ETE dashboard was adapted from an existing human-centered geovisualization platform, SanaViz, an Internet-enabled, interactive app incorporating principles of human-centered design and cognitive fit theory to enhance visual exploration of population health data. Usage evaluation of the ETE geovisualization dashboard was conducted using Google Analytics over a 4-week period from March 19 to April 18, 2016. The aim was to monitor user activity and analyze traffic on the ETE dashboard using evidence-based metrics that can provide adequate feedback to enhance its utilization. Usage was characterized based on three metrics: (1) number of unique visits to each page, (2) average time on each page in seconds, and (3) page bounce rate (ie, percentage of visits where user left the site immediately after viewing just a single page). Further analysis was also conducted by cross-tabulating specific usage metrics. Results: Of 860 sessions, 324 sessions were initiated by unique users (37.7%). The most common acquisition channels included direct source (353/860, 41.0%); followed by referral traffic (340/860, 39.5%) and organic search (134/860, 15.5%). Usage statistics indicate that for the 860 sessions initiated by both new and returning users, the average viewing time was 8 minutes, 51 seconds, and the bounce rate was 46%. These statistics reflect positive results given that prior literature estimates an average session duration of 10-20 seconds and a bounce rate of 40-60% for most websites. Key findings from our study showed that the highest bounce rates were seen for the “About” page of the ETE website (65%), which describes the ETE initiative. The lowest bounce rates were seen for the ETE blog page (17%), consistent with prior research on website usage metrics that indicate that blog pages are often the most frequently viewed pages on Web portals. Conclusions: Our findings reveal the potential of Google Analytics as a tool to enhance user traffic and performance of the ETE geovisualization platform by using feedback from regular monitoring of key parameters including page bounce rates and average time on page. It also identifies the need for a follow-up usability assessment of the system.

  • HIV blood draw. Source: Associated Press; Copyright: Denis Farrell; License: Creative Commons Attribution (CC-BY).

    HIV Surveillance Among Pregnant Women Attending Antenatal Clinics: Evolution and Current Direction


    Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data.

  • The present manuscript attempted to explore the feasibility of utilizing Google Trends-based data to capture real time Mayaro virus outbreaks. Source: Image created by the authors; Copyright: The Authors; License: Creative Commons Attribution (CC-BY).

    Discrepancies Between Classic and Digital Epidemiology in Searching for the Mayaro Virus: Preliminary Qualitative and Quantitative Analysis of Google Trends


    Background: Mayaro virus (MAYV), first discovered in Trinidad in 1954, is spread by the Haemagogus mosquito. Small outbreaks have been described in the past in the Amazon jungles of Brazil and other parts of South America. Recently, a case was reported in rural Haiti. Objective: Given the emerging importance of MAYV, we aimed to explore the feasibility of exploiting a Web-based tool for monitoring and tracking MAYV cases. Methods: Google Trends is an online tracking system. A Google-based approach is particularly useful to monitor especially infectious diseases epidemics. We searched Google Trends from its inception (from January 2004 through to May 2017) for MAYV-related Web searches worldwide. Results: We noted a burst in search volumes in the period from July 2016 (relative search volume [RSV]=13%) to December 2016 (RSV=18%), with a peak in September 2016 (RSV=100%). Before this burst, the average search activity related to MAYV was very low (median 1%). MAYV-related queries were concentrated in the Caribbean. Scientific interest from the research community and media coverage affected digital seeking behavior. Conclusions: MAYV has always circulated in South America. Its recent appearance in the Caribbean has been a source of concern, which resulted in a burst of Internet queries. While Google Trends cannot be used to perform real-time epidemiological surveillance of MAYV, it can be exploited to capture the public’s reaction to outbreaks. Public health workers should be aware of this, in that information and communication technologies could be used to communicate with users, reassure them about their concerns, and to empower them in making decisions affecting their health.

  • Source: Google Trends /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Syndromic Surveillance Models Using Web Data: The Case of Influenza in Greece and Italy Using Google Trends


    Background: An extended discussion and research has been performed in recent years using data collected through search queries submitted via the Internet. It has been shown that the overall activity on the Internet is related to the number of cases of an infectious disease outbreak. Objective: The aim of the study was to define a similar correlation between data from Google Trends and data collected by the official authorities of Greece and Europe by examining the development and the spread of seasonal influenza in Greece and Italy. Methods: We used multiple regressions of the terms submitted in the Google search engine related to influenza for the period from 2011 to 2012 in Greece and Italy (sample data for 104 weeks for each country). We then used the autoregressive integrated moving average statistical model to determine the correlation between the Google search data and the real influenza cases confirmed by the aforementioned authorities. Two methods were used: (1) a flu score was created for the case of Greece and (2) comparison of data from a neighboring country of Greece, which is Italy. Results: The results showed that there is a significant correlation that can help the prediction of the spread and the peak of the seasonal influenza using data from Google searches. The correlation for Greece for 2011 and 2012 was .909 and .831, respectively, and correlation for Italy for 2011 and 2012 was .979 and .933, respectively. The prediction of the peak was quite precise, providing a forecast before it arrives to population. Conclusions: We can create an Internet surveillance system based on Google searches to track influenza in Greece and Italy.

  • Source: Pixabay; Copyright: seeseehundhund; URL:; License: Public Domain (CC0).

    Online Perceptions of Mothers About Breastfeeding and Introducing Formula: Qualitative Study


    Background: Although the benefits of breastfeeding are well established for babies and their mothers, many women give formula to their infants. Whether to breastfeed or to give infant formula is a complex decision to make. Many parents use the Internet to find information and support that relate to infant feeding decisions. Objective: The aim of this study was to analyze the perceptions of mothers, who are discussing the topic on Web forums, about introducing infant formula. Methods: This is a qualitative, descriptive, and cross-sectional study on online data from parenting Web forums. The text was analyzed using qualitative content analysis. Results: The analysis resulted in 1 main theme, “balancing between social expectations and confidence in your parental ability,” which is further divided into 3 themes: “striving to be a good mother,” “striving for your own well-being,” and “striving to discover your own path.” Conclusions: Breastfeeding is complex, and health care personnel can, with a more open approach toward formula, create better support for mothers by helping them to be more confident in their parental ability.

  • CARE Hotline SMS text reminder (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Check and Report Ebola (CARE) Hotline: The User Perspective of an Innovative Tool for Postarrival Monitoring of Ebola in the United States


    Background: The response to the 2014-2016 Ebola epidemic included an unprecedented effort from federal, state, and local public health authorities to monitor the health of travelers entering the United States from countries with Ebola outbreaks. The Check and Report Ebola (CARE) Hotline, a novel approach to monitoring, was designed to enable travelers to report their health status daily to an interactive voice recognition (IVR) system. The system was tested with 70 Centers for Disease Control and Prevention (CDC) federal employees returning from deployments in outbreak countries. Objective: The objective of this study was to describe the development of the CARE Hotline as a tool for postarrival monitoring and examine the usage characteristics and user experience of the tool during a public health emergency. Methods: Data were obtained from two sources. First, the CARE Hotline system produced a call log which summarized the usage characteristics of all 70 users’ daily health reports. Second, we surveyed federal employees (n=70) who used the CARE Hotline to engage in monitoring. A total of 21 (21/70, 30%) respondents were included in the survey analytic sample. Results: While the CARE Hotline was used for monitoring, 70 users completed a total of 1313 calls. We found that 94.06% (1235/1313) of calls were successful, and the average call time significantly decreased from the beginning of the monitoring period to the end by 32 seconds (Z score=−6.52, P<.001). CARE Hotline call log data were confirmed by user feedback; survey results indicated that users became more familiar with the system and found the system easier to use, from the beginning to the end of their monitoring period. The majority of the users were highly satisfied (90%, 19/21) with the system, indicating ease of use and convenience as primary reasons, and would recommend it for future monitoring efforts (90%, 19/21). Conclusions: The CARE Hotline garnered high user satisfaction, required minimal reporting time from users, and was an easily learned tool for monitoring. This phone-based technology can be modified for future public health emergencies.

  • Study personnel practicing the use of the bimodal symptoms reporting system before home visits began in San Marcos, Guatemala, on August 1st, 2016. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Will Participatory Syndromic Surveillance Work in Latin America? Piloting a Mobile Approach to Crowdsource Influenza-Like Illness Data in Guatemala


    Background: In many Latin American countries, official influenza reports are neither timely nor complete, and surveillance of influenza-like illness (ILI) remains thin in consistency and precision. Public participation with mobile technology may offer new ways of identifying nonmedically attended cases and reduce reporting delays, but no published studies to date have assessed the viability of ILI surveillance with mobile tools in Latin America. We implemented and assessed an ILI-tailored mobile health (mHealth) participatory reporting system. Objective: The objectives of this study were to evaluate the quality and characteristics of electronically collected data, the user acceptability of the symptom reporting platform, and the costs of running the system and of identifying ILI cases, and to use the collected data to characterize cases of reported ILI. Methods: We recruited the heads of 189 households comprising 584 persons during randomly selected home visits in Guatemala. From August 2016 to March 2017, participants used text messages or an app to report symptoms of ILI at home, the ages of the ILI cases, if medical attention was sought, and if medicines were bought in pharmacies. We sent weekly reminders to participants and compensated those who sent reports with phone credit. We assessed the simplicity, flexibility, acceptability, stability, timeliness, and data quality of the system. Results: Nearly half of the participants (47.1%, 89/189) sent one or more reports. We received 468 reports, 83.5% (391/468) via text message and 16.4% (77/468) via app. Nine-tenths of the reports (93.6%, 438/468) were received within 48 hours of the transmission of reminders. Over a quarter of the reports (26.5%, 124/468) indicated that at least someone at home had ILI symptoms. We identified 202 ILI cases and collected age information from almost three-fifths (58.4%, 118/202): 20 were aged between 0 and 5 years, 95 were aged between 6 and 64 years, and three were aged 65 years or older. Medications were purchased from pharmacies, without medical consultation, in 33.1% (41/124) of reported cases. Medical attention was sought in 27.4% (34/124) of reported cases. The cost of identifying an ILI case was US $6.00. We found a positive correlation (Pearson correlation coefficient=.8) between reported ILI and official surveillance data for noninfluenza viruses from weeks 41 (2016) to 13 (2017). Conclusions: Our system has the potential to serve as a practical complement to respiratory virus surveillance in Guatemala. Its strongest attributes are simplicity, flexibility, and timeliness. The biggest challenge was low enrollment caused by people’s fear of victimization and lack of phone credit. Authorities in Central America could test similar methods to improve the timeliness, and extend the breadth, of disease surveillance. It may allow them to rapidly detect localized or unusual circulation of acute respiratory illness and trigger appropriate public health actions.

  • Source: Flickr; Copyright: John Tann; URL:; License: Creative Commons Attribution (CC-BY).

    Health Information–Seeking Patterns of the General Public and Indications for Disease Surveillance: Register-Based Study Using Lyme Disease


    Background: People using the Internet to find information on health issues, such as specific diseases, usually start their search from a general search engine, for example, Google. Internet searches such as these may yield results and data of questionable quality and reliability. Health Library is a free-of-charge medical portal on the Internet providing medical information for the general public. Physician’s Databases, an Internet evidence-based medicine source, provides medical information for health care professionals (HCPs) to support their clinical practice. Both databases are available throughout Finland, but the latter is used only by health professionals and pharmacies. Little is known about how the general public seeks medical information from medical sources on the Internet, how this behavior differs from HCPs’ queries, and what causes possible differences in behavior. Objective: The aim of our study was to evaluate how the general public’s and HCPs’ information-seeking trends from Internet medical databases differ seasonally and temporally. In addition, we aimed to evaluate whether the general public’s information-seeking trends could be utilized for disease surveillance and whether media coverage could affect these seeking trends. Methods: Lyme disease, serving as a well-defined disease model with distinct seasonal variation, was chosen as a case study. Two Internet medical databases, Health Library and Physician’s Databases, were used. We compared the general public’s article openings on Lyme disease from Health Library to HCPs’ article openings on Lyme disease from Physician’s Databases seasonally across Finland from 2011 to 2015. Additionally, media publications related to Lyme disease were searched from the largest and most popular media websites in Finland. Results: Both databases, Health Library and Physician’s Databases, show visually similar patterns in temporal variations of article openings on Lyme disease in Finland from 2011 to 2015. However, Health Library openings show not only an increasing trend over time but also greater fluctuations, especially during peak opening seasons. Outside these seasons, publications in the media coincide with Health Library article openings only occasionally. Conclusions: Lyme disease–related information-seeking behaviors between the general public and HCPs from Internet medical portals share similar temporal variations, which is consistent with the trend seen in epidemiological data. Therefore, the general public’s article openings could be used as a supplementary source of information for disease surveillance. The fluctuations in article openings appeared stronger among the general public, thus, suggesting that different factors such as media coverage, affect the information-seeking behaviors of the public versus professionals. However, media coverage may also have an influence on HCPs. Not every publication was associated with an increase in openings, but the higher the media coverage by some publications, the higher the general public’s access to Health Library.

  • Source: iStock by Getty Images; Copyright: Bet_noire; URL:; License: Licensed by the authors.

    Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey


    Background: There is a heavy and disproportionate burden of human immunodeficiency virus (HIV) infection among migrant communities living in Europe. Despite this, the published evidence related to HIV testing, prevention, and treatment needs for migrants is sparse. Objective: The aim of this study was to identify the factors associated with access to primary care and HIV testing among migrant groups living in Europe. Methods: A Web-based survey (available in 14 languages) was open to all people aged 18 years and older, living outside their country of birth in the World Health Organization (WHO) European area. Community organizations in 9 countries promoted the survey to migrant groups, focusing on those at a higher risk of HIV (sub-Saharan Africans, Latin Americans, gay or bisexual men, and people who inject drugs). Multivariable analysis examined factors associated with access to primary care and previous history of an HIV test. Results: In total, 559 women, 395 heterosexual men, and 674 gay or bisexual men were included in the analysis, and 68.1% (359/527) of women, 59.5% (220/371) of heterosexual men, and 89.6% (596/664) of gay or bisexual men had tested for HIV. Low perceived risk was the reason given for not testing by 62.3% (43/69) of gay or bisexual men and 83.3% (140/168) of women and heterosexual men who reported never having tested for HIV. Access to primary care was >60% in all groups. Access to primary care was strongly positively associated with living in Northern Europe compared with Southern Europe (women: adjusted odds ratio, aOR 34.56 [95% CI 11.58-101]; heterosexual men: aOR 6.93 [95% CI 2.49-19.35], and gay or bisexual men: aOR 2.53 [95% CI 1.23-5.19]), whereas those with temporary residency permits were less likely to have access to primary care (women: aOR 0.41 [95% CI 0.21-0.80] and heterosexual men: aOR 0.24 [95% CI 0.10-0.54] only). Women who had experience of forced sex (aOR 3.53 [95% CI 1.39-9.00]) or postmigration antenatal care (aOR 3.07 [95% CI 1.55-6.07]) were more likely to have tested for HIV as were heterosexual men who had access to primary care (aOR 3.13 [95% CI 1.58-6.13]) or reported “Good” health status (aOR 2.94 [95% CI 1.41-5.88]). Conclusions: Access to primary care is limited by structural determinants such as immigration and health care policy, which varies across Europe. For those migrants who can access primary care and other health services, missed opportunities for HIV testing remain a barrier to earlier testing and diagnosis for migrants in Europe. Clinicians should be aware of these potential structural barriers to HIV testing as well as low perception of HIV risk in migrant groups.

  • "Take our survey" recruitment image. Source: iStock by Getty Images; Copyright: FGorgun; URL:; License: Licensed by the authors.

    Examining E-Loyalty in a Sexual Health Website: Cross-Sectional Study


    Background: Web-based sexual health resources are typically evaluated in terms of their efficacy. Information is lacking about how sexual health promotion websites are perceived and used. It is essential to understand website use to address challenges with adherence and attrition to Web-based health interventions. An existing theoretical framework for examining loyalty to electronic health (eHealth) interventions has been not yet been applied in the context of sexual health promotion nor has the association between e-loyalty and intended intervention efficacy outcomes been investigated. Objective: The objectives of this study were to investigate users’ loyalty toward a sexual health website (ie, e-loyalty), measure user perceptions of the website, and measure the association between e-loyalty and perceived knowledge increase and intent to change behavior. Methods: Over 4 months, website users (clients and health care providers) participated in an open, online, cross-sectional survey about their user experiences that measured e-loyalty, user perceptions, and intended website efficacy outcomes. Relationships between user perceptions and e-loyalty were investigated using structural equation modeling (SEM). Associations between e-loyalty and website efficacy outcomes were tested using Spearman rank correlation. Results: A total of 173 participants completed user perception questions and were included in the analysis. E-loyalty was high for both clients and providers and was significantly correlated with clients’ perceived knowledge increase (ρ(171)=.30, P<.001), their intent to have safer sex (ρ(171)=.24, P=.01), and their intent to get tested for sexually transmitted infections (ρ(171)=.37, P<.001). The SEM showed that trustworthiness, overall experience, active trust, and effectiveness were directly related to e-loyalty. Finding the website “easy to understand” was significantly related to active trust (ie, participants’ willingness to act upon information presented on the website). Conclusions: E-loyalty may be related to the efficacy of the selected website in improving one’s sexual health and was significantly associated with all three intended knowledge and behavioral outcomes. To increase e-loyalty, trustworthiness and active trust are important user perceptions to deliberately engender. Our findings indicate that understanding a website contributes to active trust, thereby highlighting the importance of considering eHealth literacy in designing health promotion websites. Our study confirms the relevance of e-loyalty as an outcome for evaluating the antecedents of the use and efficacy of online public health interventions across disciplines by adapting and validating an existing e-loyalty framework to the field of sexual health promotion. Our findings suggest that e-loyalty is positively associated with measures of website efficacy, including increased knowledge and intent to change behavior. Longitudinal research with larger samples could further investigate the relationships between e-loyalty, website understandability, and outcomes of online health interventions to determine how the manipulation of website characteristics may impact user perceptions and e-loyalty.

  • Source: Shutterstock; Copyright:; URL:; License: Licensed by the authors.

    Combining Participatory Influenza Surveillance with Modeling and Forecasting: Three Alternative Approaches


    Background: Influenza outbreaks affect millions of people every year and its surveillance is usually carried out in developed countries through a network of sentinel doctors who report the weekly number of Influenza-like Illness cases observed among the visited patients. Monitoring and forecasting the evolution of these outbreaks supports decision makers in designing effective interventions and allocating resources to mitigate their impact. Objective: Describe the existing participatory surveillance approaches that have been used for modeling and forecasting of the seasonal influenza epidemic, and how they can help strengthen real-time epidemic science and provide a more rigorous understanding of epidemic conditions. Methods: We describe three different participatory surveillance systems, WISDM (Widely Internet Sourced Distributed Monitoring), Influenzanet and Flu Near You (FNY), and show how modeling and simulation can be or has been combined with participatory disease surveillance to: i) measure the non-response bias in a participatory surveillance sample using WISDM; and ii) nowcast and forecast influenza activity in different parts of the world (using Influenzanet and Flu Near You). Results: WISDM-based results measure the participatory and sample bias for three epidemic metrics i.e. attack rate, peak infection rate, and time-to-peak, and find the participatory bias to be the largest component of the total bias. The Influenzanet platform shows that digital participatory surveillance data combined with a realistic data-driven epidemiological model can provide both short-term and long-term forecasts of epidemic intensities, and the ground truth data lie within the 95 percent confidence intervals for most weeks. The statistical accuracy of the ensemble forecasts increase as the season progresses. The Flu Near You platform shows that participatory surveillance data provide accurate short-term flu activity forecasts and influenza activity predictions. The correlation of the HealthMap Flu Trends estimates with the observed CDC ILI rates is 0.99 for 2013-2015. Additional data sources lead to an error reduction of about 40% when compared to the estimates of the model that only incorporates CDC historical information. Conclusions: While the advantages of participatory surveillance, compared to traditional surveillance, include its timeliness, lower costs, and broader reach, it is limited by a lack of control over the characteristics of the population sample. Modeling and simulation can help overcome this limitation as well as provide real-time and long-term forecasting of influenza activity in data-poor parts of the world.

  • Source: Pixabay; Copyright: Edar; URL:; License: Public Domain (CC0).

    Online Influence and Sentiment of Fitness Tweets: Analysis of Two Million Fitness Tweets


    Background: Publicly available fitness tweets may provide useful and in-depth insights into the real-time sentiment of a person’s physical activity and provide motivation to others through online influence. Objective: The goal of this experimental approach using the fitness Twitter dataset is two-fold: (1) to determine if there is a correlation between the type of activity tweet (either workout or workout+, which contains the same information as a workout tweet but has additional user-generated information), gender, and one’s online influence as measured by Klout Score and (2) to examine the sentiment of the activity-coded fitness tweets by looking at real-time shared thoughts via Twitter regarding their experiences with physical activity and the associated mobile fitness app. Methods: The fitness tweet dataset includes demographic and activity data points, including minutes of activity, Klout Score, classification of each fitness tweet, the first name of each fitness tweet user, and the tweet itself. Gender for each fitness tweet user was determined by a first name comparison with the US Social Security Administration database of first names and gender. Results: Over 184 days, 2,856,534 tweets were collected in 23 different languages. However, for the purposes of this study, only the English-language tweets were analyzed from the activity tweets, resulting in a total of 583,252 tweets. After assigning gender to Twitter usernames based on the Social Security Administration database of first names, analysis of minutes of activity by both gender and Klout influence was determined. The mean Klout Score for those who shared their workout data from within four mobile apps was 20.50 (13.78 SD), less than the general Klout Score mean of 40, as was the Klout Score at the 95th percentile (40 vs 63). As Klout Score increased, there was a decrease in the number of overall workout+ tweets. With regards to sentiment, fitness-related tweets identified as workout+ reflected a positive sentiment toward physical activity by a ratio of 4 to 1. Conclusions: The results of this research suggest that the users of mobile fitness apps who share their workouts via Twitter have a lower Klout Score than the general Twitter user and that users who chose to share additional insights into their workouts are more positive in sentiment than negative. We present a novel perspective into the physical activity messaging from within mobile fitness apps that are then shared over Twitter. By moving beyond the numbers and evaluating both the Twitter user and the emotions tied to physical activity, future research could analyze additional relationships between the user’s online influence, the enjoyment of the physical activity, and with additional analysis a long-term retention strategy for the use of a fitness app.

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  • Research ethics in digital participatory disease surveillance: Using European Influenzanet Network as an example

    Date Submitted: Dec 10, 2017

    Open Peer Review Period: Dec 12, 2017 - Dec 26, 2017

    Background: Influenzanet was launched in several European countries to monitor influenza-like illness during flu seasons with the help of volunteering participants and web-based technologies. As commo...

    Background: Influenzanet was launched in several European countries to monitor influenza-like illness during flu seasons with the help of volunteering participants and web-based technologies. As commonly the case for developing fields, ethical approaches are not well developed in the collection, processing and analysis of participants’ information. Existing controversies and varying national ethical regulations can thus hamper efficient cross-border research collaboration to the detriment of quality disease surveillance. Objective: The objectives of this study were to characterize current practices on how ethico-legal and social issues (ELSI) pertinent to research ethics are being handled by different Influenzanet country groups, in order to analyze similarities and identify the need for further harmonization of ethical approaches. An ELSI analysis was carried out to suggest ways to strengthen these ethical approaches. Methods: A scoping literature search was carried out on PubMed, Web of Science, Global Digital Library on Ethics and BELIT to identify ELSI for Influenzanet country platforms. Only English-language articles were included, with publication dates from 2003 to 2017. Publications were screened for the application of four well-known bioethics principles in the implementation of country platforms. Additional publications gathered from the Influenzanet Consortium website were screened for ELSI. Country project leaders were contacted for additional information when necessary. Results: 66 and 28 articles were gathered from the literature search and from the Influenzanet website respectively. A total of 23 articles which mentioned ELSI were identified and included in the study. No article has addressed explicitly the ELSI of Influenzanet. Research Ethics Committee (REC) approvals were sought for recruiting participants and collecting their data in 8 out of 11 country platforms and informed e-consent was sought from participants in 10 out of 11 country platforms. Discrepancies between the implementation of informed e-consent and national legislations on privacy and data protection were found for the Danish and Dutch platforms. Personal data protection was ensured throughout the Consortium by data anonymization before processing and analysis, and the use of only aggregated data. Conclusions: Epidemics forecasting activities such as Influenzanet are beneficial. However, its benefits could be further increased through harmonization of data gathering and ethical requirements. This objective is achievable by the Consortium. In this regard, identifying and adopting the strictest ethical requirements used by one platform could help to reach consensus. Additionally, more transparency should be promoted concerning REC-approved research for Influenzanet-like systems. Validity of informed e-consent could also be increased through the provision of a user-friendly and standard information sheet across the Consortium where participants agree to its terms, conditions and privacy policies before being able to fill in the questionnaire. These will help to build trust in the general public while preventing any backdrop in participation, which might be triggered by mediatization and potential exaggeration of risks.

  • Toward simplified and accurate surveys to monitor public health nutrition

    Date Submitted: Nov 30, 2017

    Open Peer Review Period: Dec 5, 2017 - Dec 19, 2017

    Background: Accurately identifying whether an individual's diet is in compliance with national nutritional guidelines requires the collection of a large amount of dietary data. A common method in publ...

    Background: Accurately identifying whether an individual's diet is in compliance with national nutritional guidelines requires the collection of a large amount of dietary data. A common method in public health nutrition is to record every food consumed by an individual, down to an exact weight of the foods. A previous study used the data mining technique of decision trees to find which foods were needed to accurately identify whether individuals were in compliance with the five main guidelines (sodium, saturated fats, sugars, fruit/vegetables, fats). The study, performed in the United Kingdom, found that tracking only 3% of all foods was sufficient to accurately infer compliance. While the possibility of only tracking 3% of the items significantly reduces participation burden, this may be further reduced if items did not need to be weighted exactly. A further reduction in participation burden would lower the costs for monitoring public health nutrition, and may also lower the chance of errors as much less will be required from participants. Objective: We will assess whether national public health nutrition surveys can be further simplified by only recording whether a food was consumed, rather than having to weigh it. Methods: Our data comes from a generalized sample of inhabitants in the United Kingdom, specifically from the National Diet and Nutrition Survey (NDNS) 2008-12. After simplifying food consumptions to a binary value (1 if an individual consumed a food and 0 otherwise), we built and optimized decision trees to find whether the foods could accurately predict compliance with the major five nutritional guidelines. Results: When using decision trees of a similar size to previous studies (i.e., involving as many foods), we were able to correctly infer compliance for the five guidelines with an average accuracy of 80.1%. This is an average increase of 2.5 percentage points over a previous study, showing that further simplifying the surveys can actually yield more robust estimates. When we allowed the new decision trees to use slightly more foods than in previous studies, we were able to optimize the performance with an average increase of 3.1 percentage points. Conclusions: While one may expect a further simplification of surveys to decrease accuracy, our study found that public health dietary surveys can be significantly simplified (from accurately weighing items to simply checking whether they were consumed) while improving accuracy. One possibility is that the simplification reduced noise, and made it easier for patterns to emerge. Using simplified surveys will allow to monitor public health nutrition in a more cost-effective manner, and possibly decrease the number of errors as participation burden is significantly reduced.

  • RCGP Research and Surveillance Centre Annual Report 2015-2016: Boys and young male adults have a higher incidence of lower respiratory tract infections and atopic conditions

    Date Submitted: Nov 1, 2017

    Open Peer Review Period: Nov 3, 2017 - Dec 29, 2017

    Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) comprises >150 general practices, with a combined population of >1.5 million, contributing to UK an...

    Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) comprises >150 general practices, with a combined population of >1.5 million, contributing to UK and European public health surveillance and research. Objective: To report gender differences in the presentation of infectious and respiratory conditions in children and young adults Methods: Disease incidence data testing the hypothesis that boys up to puberty present more with lower respiratory tract infection (LRTI) and asthma. Incidence rates were reported for infectious conditions in children and young adults, by gender. We controlled for ethnicity, deprivation, and consultation rates. We report odds ratios (OR) with 95%CI, p-values and probability of presenting. Results: Boys presented more with LRTI, largely due to acute bronchitis. The OR of males consulting was greater across the youngest three age bands (OR 1.59 95%CI 1.35-1.87; OR 1.13 95%CI 1.05-1.21; OR 1.20 95% CI 1.09-1.32). Allergic rhinitis and asthma had a higher OR of presenting in 5-14 year old boys (OR 1.52 95%CI 1.37-1.68; OR 1.31, 95%CI 1.17-1.48). Upper respiratory infection (URTI) and urinary tract infection (UTI) had lower odds of presenting in boys, especially over 15years old. The probability of presenting showed different patterns for LRTI, URTI and atopic conditions. Conclusions: Boys under 15 years old have greater odds of presenting with LRTI and atopic conditions; whereas girls may present more with URTI and UTI. These differences may provide insights into disease mechanisms and for health service planning. Clinical Trial: Not applicable

  • Spatial variation of harmful traditional practices and associated factors among under five children in Dabat District, Northwest Ethiopia

    Date Submitted: Oct 28, 2017

    Open Peer Review Period: Oct 30, 2017 - Dec 25, 2017

    Background: In Ethiopia, evidences show that there are about 140 harmful traditional practices affecting mothers and children. Knowledge of the spatial distribution and characteristics of harmful trad...

    Background: In Ethiopia, evidences show that there are about 140 harmful traditional practices affecting mothers and children. Knowledge of the spatial distribution and characteristics of harmful traditional practices are important for planning effective mitigation activities. Objective: The aim of this study was to identify spatial variations of harmful traditional practices and associated factors among children under age of 5 years at Dabat health and demographic surveillance site (HDSS), in northwest Ethiopia. Methods: A total of 7240 under five children on follow-up in Dabat Health and demographic surveillance site were included in the study. A spatial scan test using SaTScan Version 9.4 was used to identify spatial clusters of harmful traditional practice using a Bernoulli probability model. Results: Nine from ten mothers reported at least one harmful traditional practice on their children. Of harmful traditional practice, Uvelectomy (83.6%) accounted the highest. The frequent practice was found high at Arebur (93%) and Doka (95%) Kebeles. Nine most likely clusters (LLR=17.3, p = .002) of harmful traditional practice were identified. Age and educational level of mothers, access to television and tel-ephone of the household were significantly associated with occurrence of HTPs on children before age of five years. Conclusions: In this study we found out that harmful traditional practice remains one of the major public health problem and have spatial variations in rural community. The younger aged and less educated mothers, and no access to television and telephone in the household were significant predictors of harmful tradi-tional practices to be undergone on children.