JMIR Publications

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 2015: 4.532). 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:

  • Source: The authors; URL:; License: Created by the authors.

    Zika in Twitter: Temporal Variations of Locations, Actors, and Concepts


    Background: The recent Zika outbreak witnessed the disease evolving from a regional health concern to a global epidemic. During this process, different communities across the globe became involved in Twitter, discussing the disease and key issues associated with it. This paper presents a study of this discussion in Twitter, at the nexus of location, actors, and concepts. Objective: Our objective in this study was to demonstrate the significance of 3 types of events: location related, actor related, and concept related, for understanding how a public health emergency of international concern plays out in social media, and Twitter in particular. Accordingly, the study contributes to research efforts toward gaining insights on the mechanisms that drive participation, contributions, and interaction in this social media platform during a disease outbreak. Methods: We collected 6,249,626 tweets referring to the Zika outbreak over a period of 12 weeks early in the outbreak (December 2015 through March 2016). We analyzed this data corpus in terms of its geographical footprint, the actors participating in the discourse, and emerging concepts associated with the issue. Data were visualized and evaluated with spatiotemporal and network analysis tools to capture the evolution of interest on the topic and to reveal connections between locations, actors, and concepts in the form of interaction networks. Results: The spatiotemporal analysis of Twitter contributions reflects the spread of interest in Zika from its original hotspot in South America to North America and then across the globe. The Centers for Disease Control and World Health Organization had a prominent presence in social media discussions. Tweets about pregnancy and abortion increased as more information about this emerging infectious disease was presented to the public and public figures became involved in this. Conclusions: The results of this study show the utility of analyzing temporal variations in the analytic triad of locations, actors, and concepts. This contributes to advancing our understanding of social media discourse during a public health emergency of international concern.

  • Public Response to Scientific Misconduct: Assessing Changes in Public Sentiment Toward the Stimulus-Triggered Acquisition of Pluripotency (STAP) Cell Case...


    Background: In this age of social media, any news—good or bad—has the potential to spread in unpredictable ways. Changes in public sentiment have the potential to either drive or limit investment in publicly funded activities, such as scientific research. As a result, understanding the ways in which reported cases of scientific misconduct shape public sentiment is becoming increasingly essential—for researchers and institutions, as well as for policy makers and funders. In this study, we thus set out to assess and define the patterns according to which public sentiment may change in response to reported cases of scientific misconduct. This study focuses on the public response to the events involved in a recent case of major scientific misconduct that occurred in 2014 in Japan—stimulus-triggered acquisition of pluripotency (STAP) cell case. Objectives: The aims of this study were to determine (1) the patterns according to which public sentiment changes in response to scientific misconduct; (2) whether such measures vary significantly, coincident with major timeline events; and (3) whether the changes observed mirror the response patterns reported in the literature with respect to other classes of events, such as entertainment news and disaster reports. Methods: The recent STAP cell scandal is used as a test case. Changes in the volume and polarity of discussion were assessed using a sampling of case-related Twitter data, published between January 28, 2014 and March 15, 2015. Rapidminer was used for text processing and the popular bag-of-words algorithm, SentiWordNet, was used in Rapidminer to calculate sentiment for each sample Tweet. Relative volume and sentiment was then assessed overall, month-to-month, and with respect to individual entities. Results: Despite the ostensibly negative subject, average sentiment over the observed period tended to be neutral (−0.04); however, a notable downward trend (y=−0.01 x +0.09; R ²=.45) was observed month-to-month. Notably polarized tweets accounted for less than one-third of sampled discussion: 17.49% (1656/9467) negative and 12.59% positive (1192/9467). Significant polarization was found in only 4 out of the 15 months covered, with significant variation month-to-month (P<.001). Significant increases in polarization tended to coincide with increased discussion volume surrounding major events (P<.001). Conclusions: These results suggest that public opinion toward scientific research may be subject to the same sensationalist dynamics driving public opinion in other, consumer-oriented topics. The patterns in public response observed here, with respect to the STAP cell case, were found to be consistent with those observed in the literature with respect to other classes of news-worthy events on Twitter. Discussion was found to become strongly polarized only during times of increased public attention, and such increases tended to be driven primarily by negative reporting and reactionary commentary.

  • Web-based intervention: Peer-to-peer tailored video message of a peer’s experiences with consistent condom use represents the method of using role models. Source: Figure 2 from JMIR Public Health Surveill 2017;3(2):e20; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    The Use of Intervention Mapping to Develop a Tailored Web-Based Intervention, Condom-HIM


    Background: Many HIV (human immunodeficiency virus) prevention interventions are currently being implemented and evaluated, with little information published on their development. A framework highlighting the method of development of an intervention can be used by others wanting to replicate interventions or develop similar interventions to suit other contexts and settings. It provides researchers with a comprehensive development process of the intervention. Objective: The objective of this paper was to describe how a systematic approach, intervention mapping, was used to develop a tailored Web-based intervention to increase condom use among HIV-positive men who have sex with men. Methods: The intervention was developed in consultation with a multidisciplinary team composed of academic researchers, community members, Web designers, and the target population. Intervention mapping involved a systematic process of 6 steps: (1) needs assessment; (2) identification of proximal intervention objectives; (3) selection of theory-based intervention methods and practical strategies; (4) development of intervention components and materials; (5) adoption, implementation, and maintenance; and (6) evaluation planning. Results: The application of intervention mapping resulted in the development of a tailored Web-based intervention for HIV-positive men who have sex with men, called Condom-HIM. Conclusions: Using intervention mapping as a systematic process to develop interventions is a feasible approach that specifically integrates the use of theory and empirical findings. Outlining the process used to develop a particular intervention provides clarification on the conceptual use of experimental interventions in addition to potentially identifying reasons for intervention failures.

  • Traffic on the highway next to Boston Chinatown. Source: Photo taken by Doug Brugge, one of the co-authors; Copyright: Doug Brugge, one of the co-authors; URL:; License: Permission granted by Doug Brugge..

    Making Air Pollution Visible: A Tool for Promoting Environmental Health Literacy


    Background: Digital maps are instrumental in conveying information about environmental hazards geographically. For laypersons, computer-based maps can serve as tools to promote environmental health literacy about invisible traffic-related air pollution and ultrafine particles. Concentrations of these pollutants are higher near major roadways and increasingly linked to adverse health effects. Interactive computer maps provide visualizations that can allow users to build mental models of the spatial distribution of ultrafine particles in a community and learn about the risk of exposure in a geographic context. Objective: The objective of this work was to develop a new software tool appropriate for educating members of the Boston Chinatown community (Boston, MA, USA) about the nature and potential health risks of traffic-related air pollution. The tool, the Interactive Map of Chinatown Traffic Pollution (“Air Pollution Map” hereafter), is a prototype that can be adapted for the purpose of educating community members across a range of socioeconomic contexts. Methods: We built the educational visualization tool on the open source Weave software platform. We designed the tool as the centerpiece of a multimodal and intergenerational educational intervention about the health risk of traffic-related air pollution. We used a previously published fine resolution (20 m) hourly land-use regression model of ultrafine particles as the algorithm for predicting pollution levels and applied it to one neighborhood, Boston Chinatown. In designing the map, we consulted community experts to help customize the user interface to communication styles prevalent in the target community. Results: The product is a map that displays ultrafine particulate concentrations averaged across census blocks using a color gradation from white to dark red. The interactive features allow users to explore and learn how changing meteorological conditions and traffic volume influence ultrafine particle concentrations. Users can also select from multiple map layers, such as a street map or satellite view. The map legends and labels are available in both Chinese and English, and are thus accessible to immigrants and residents with proficiency in either language. The map can be either Web or desktop based. Conclusions: The Air Pollution Map incorporates relevant language and landmarks to make complex scientific information about ultrafine particles accessible to members of the Boston Chinatown community. In future work, we will test the map in an educational intervention that features intergenerational colearning and the use of supplementary multimedia presentations.

  • Ticks displayed on finger. Copyright: California Department of Public Health; URL:; License: Creative Commons Attribution (CC-BY).

    Health Care Professionals’ Evidence-Based Medicine Internet Searches Closely Mimic the Known Seasonal Variation of Lyme Borreliosis: A Register-Based Study


    Background: Both health care professionals and nonprofessionals seek medical information on the Internet. Using Web-based search engine searches to detect epidemic diseases has, however, been problematic. Physician’s databases (PD) is a chargeable evidence-based medicine (EBM) portal on the Internet for health care professionals and is available throughout the entire health care system in Finland. Lyme borreliosis (LB), a well-defined disease model, shows temporal and regional variation in Finland. Little data exist on health care professionals’ searches from Internet-based EBM databases in public health surveillance. Objective: The aim of this study was to assess whether health care professionals’ use of Internet EBM databases could describe seasonal increases of the disease and supplement routine public health surveillance. Methods: Two registers, PD and the register of primary health care diagnoses (Avohilmo), were used to compare health care professionals’ Internet searches on LB from EBM databases and national register-based LB diagnoses in order to evaluate annual and regional variations of LB in the whole country and in three selected high-incidence LB regions in Finland during 2011-2015. Results: Both registers, PD and Avohilmo, show visually similar patterns in annual and regional variation of LB in Finland and in the three high-incidence LB regions during 2011-2015. Conclusions: Health care professionals’ Internet searches from EBM databases coincide with national register diagnoses of LB. PD searches showed a clear seasonal variation. In addition, notable regional differences were present in both registers. However, physicians’ Internet medical searches should be considered as a supplementary source of information for disease surveillance.

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

    Determinants of Participants’ Follow-Up and Characterization of Representativeness in Flu Near You, A Participatory Disease Surveillance System


    Background: Flu Near You (FNY) is an Internet-based participatory surveillance system in the United States and Canada that allows volunteers to report influenza-like symptoms using a brief weekly symptom report. Objective: Our objective was to evaluate the representativeness of the FNY population compared with the general population of the United States, explore the demographic and behavioral characteristics associated with FNY’s high-participation users, and summarize results from a user survey of a cohort of FNY participants. Methods: We compared (1) the representativeness of sex and age groups of FNY participants during the 2014-2015 flu season versus the general US population and (2) the distribution of Human Development Index (HDI) scores of FNY participants versus that of the general US population. We analyzed associations between demographic and behavioral factors and the level of participant follow-up (ie, high vs low). Finally, descriptive statistics of responses from FNY’s 2015 and 2016 end-of-season user surveys were calculated. Results: During the 2014-2015 influenza season, 47,234 unique participants had at least one FNY symptom report that was either self-reported (users) or submitted on their behalf (household members). The proportion of female FNY participants was significantly higher than that of the general US population (n=28,906, 61.2% vs 51.1%, P<.001). Although each age group was represented in the FNY population, the age distribution was significantly different from that of the US population (P<.001). Compared with the US population, FNY had a greater proportion of individuals with HDI >5.0, signaling that the FNY user distribution was more affluent and educated than the US population baseline. We found that high-participation use (ie, higher participation in follow-up symptom reports) was associated with sex (females were 25% less likely than men to be high-participation users), higher HDI, not reporting an influenza-like illness at the first symptom report, older age, and reporting for household members (all differences between high- and low-participation users P<.001). Approximately 10% of FNY users completed an additional survey at the end of the flu season that assessed detailed user characteristics (3217/33,324 in 2015; 4850/44,313 in 2016). Of these users, most identified as being either retired or employed in the health, education, and social services sectors and indicated that they achieved a bachelor’s degree or higher. Conclusions: The representativeness of the FNY population and characteristics of its high-participation users are consistent with what has been observed in other Internet-based influenza surveillance systems. With targeted recruitment of underrepresented populations, FNY may improve as a complementary system to timely tracking of flu activity, especially in populations that do not seek medical attention and in areas with poor official surveillance data.

Breast cancer awareness sticker. Source:; Copyright: Al Pavangkanan; URL:; License: Public Domain (CC0).

    Using Google Trends Data to Study Public Interest in Breast Cancer Screening in Brazil: Why Not a Pink February?


    Background: One of the major challenges of the Brazilian Ministry of Health is to foster interest in breast cancer screening (BCS), especially among women at high risk. Strategies have been developed to promote the early identification of breast cancer mainly by Pink October campaigns. The massive number of queries conducted through Google creates traffic data that can be analyzed to show unrevealed interest cycles and their seasonalities. Objectives: Using Google Trends, we studied cycles of public interest in queries toward mammography and breast cancer along the last 5 years. We hypothesize that these data may be correlated with collective interest cycles leveraged by national BCS campaigns such as Pink October. Methods: Google Trends was employed to normalize traffic data on a scale from 0 (<1% of the peak volume) to 100 (peak of traffic) presented as weekly relative search volume (RSV) concerning mammography and breast cancer as search terms. A time series covered the last 261 weeks (November 2011 to October 2016), and RSV of both terms were compared with their respective annual means. Polynomial trendlines (second order) were employed to estimate overall trends. Results: We found an upward trend for both terms over the 5 years, with almost parallel trendlines. Remarkable peaks were found along Pink October months— mammography and breast cancer searches were leveraged up reaching, respectively, 119.1% (2016) and 196.8% (2015) above annual means. Short downward RSVs along December-January months were also noteworthy along all the studied period. These trends traced an N-shaped pattern with higher peaks in Pink October months and sharp falls along subsequent December and January. Conclusions: Considering these findings, it would be reasonable to bring Pink October to the beginning of each year, thereby extending the beneficial effect of the campaigns. It would be more appropriate to start screening campaigns at the beginning of the year, when new resolutions are taken and new projects are added to everyday routines. Our work raises attention to the study of traffic data to encourage health campaign analysts to undertake better analysis based on marketing practices.

  • Number of MSM participants in the American Men’s Internet Survey by state, 2015. Source: Figure 1 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: 2015 Key Indicators Report


    The American Men’s Internet Survey (AMIS) is an annual Web-based behavioral survey of men who have sex with men (MSM) living in the United States. This Rapid Surveillance Report describes the third cycle of data collection (September 2015 through April 2016; AMIS-2015). The key indicators are the same as previously reported for AMIS (December 2013-May 2014, AMIS-2013; November 2014-April 2015, AMIS-2014). The AMIS survey methodology has not substantively changed since AMIS-2014. MSM were recruited from a variety of websites using banner advertisements and email blasts. Additionally, participants from AMIS-2014 who agreed to be recontacted for future research were emailed a link to the AMIS-2015 survey. Men were eligible to participate if they were age 15 years and older, resided in the United States, provided a valid US ZIP code, and reported ever having sex with a man. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by participants’ self-reported human immunodeficiency virus (HIV) status. The AMIS-2015 round of data collection resulted in 10,217 completed surveys from MSM representing every US state and Puerto Rico. Participants were mainly non-Hispanic white, older than 40 years, living in the US South, living in urban areas, and recruited from general social networking websites. Self-reported HIV prevalence was 9.35% (955/10,217). Compared to HIV-negative/unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with any male partner in the past 12 months (75.50%, 721/955 vs 63.09%, 5843/9262, P<.001) and more likely to have had anal sex without a condom with a serodiscordant or unknown status partner (34.45%, 329/955 vs 17.07%, 1581/9262, P<.001). The reported use of marijuana and other illicit substances in the past 12 months was higher among HIV-positive participants than HIV-negative/unknown status participants (marijuana use: 24.61%, 235/955 vs 22.96%, 2127/9262; other illicit substance use: 28.59%, 273/955 vs 17.51%, 1622/9262, respectively; both P<.001). Most HIV-negative/unknown status participants (79.11%, 7327/9262) reported ever having a previous HIV test, and 55.69% (5158/9262) reported HIV testing in the past 12 months. HIV-positive participants were more likely to report sexually transmitted infection (STI) testing and diagnosis compared to HIV-negative/unknown status participants (STI testing: 71.73%, 685/955 vs 38.52%, 3568/9262; STI diagnosis: 25.65%, 245/955 vs 8.12%, 752/9262, respectively; both P<.001).

  • A pain in the neck. Source: Wikicommons; Copyright: Simon James; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context

    Authors List:


    Background: In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care and no insurance or compensation system. Objective: The purpose of this infodemiology study was to investigate the global pattern of evolving Internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. Methods: We used the Internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. Results: We found that the search for “whiplash” is strikingly and consistently often associated with the search for “compensation” in countries or cultures with a tort system. Frequent or traumatic painful injuries; diseases or disorders such as arthritis, headache, radius, and hip fracture; depressive disorders; and fibromyalgia were not associated similarly with searches on “compensation.” Conclusions: In this study, we present evidence from the evolving viewpoint of naturalistic Internet search engine analytics that the expectations for receiving compensation may influence Internet search behavior in relation to whiplash injury.

  • Smartphone in use. Source: Reuters; Copyright: Kai Pfaffenbach; License: Public Domain (CC0).

    Tweet for Behavior Change: Using Social Media for the Dissemination of Public Health Messages


    Background: Social media public health campaigns have the advantage of tailored messaging at low cost and large reach, but little is known about what would determine their feasibility as tools for inducing attitude and behavior change. Objective: The aim of this study was to test the feasibility of designing, implementing, and evaluating a social media–enabled intervention for skin cancer prevention. Methods: A quasi-experimental feasibility study used social media (Twitter) to disseminate different message “frames” related to care in the sun and cancer prevention. Phase 1 utilized the Northern Ireland cancer charity’s Twitter platform (May 1 to July 14, 2015). Following a 2-week “washout” period, Phase 2 commenced (August 1 to September 30, 2015) using a bespoke Twitter platform. Phase 2 also included a Thunderclap, whereby users allowed their social media accounts to automatically post a bespoke message on their behalf. Message frames were categorized into 5 broad categories: humor, shock or disgust, informative, personal stories, and opportunistic. Seed users with a notable following were contacted to be “influencers” in retweeting campaign content. A pre- and postintervention Web-based survey recorded skin cancer prevention knowledge and attitudes in Northern Ireland (population 1.8 million). Results: There were a total of 417,678 tweet impressions, 11,213 engagements, and 1211 retweets related to our campaign. Shocking messages generated the greatest impressions (shock, n=2369; informative, n=2258; humorous, n=1458; story, n=1680), whereas humorous messages generated greater engagement (humorous, n=148; shock, n=147; story, n=117; informative, n=100) and greater engagement rates compared with story tweets. Informative messages, resulted in the greatest number of shares (informative, n=17; humorous, n=10; shock, n=9; story, n=7). The study findings included improved knowledge of skin cancer severity in a pre- and postintervention Web-based survey, with greater awareness that skin cancer is the most common form of cancer (preintervention: 28.4% [95/335] vs postintervention: 39.3% [168/428] answered “True”) and that melanoma is most serious (49.1% [165/336] vs 55.5% [238/429]). The results also show improved attitudes toward ultraviolet (UV) exposure and skin cancer with a reduction in agreement that respondents “like to tan” (60.5% [202/334] vs 55.6% [238/428]). Conclusions: Social media–disseminated public health messages reached more than 23% of the Northern Ireland population. A Web-based survey suggested that the campaign might have contributed to improved knowledge and attitudes toward skin cancer among the target population. Findings suggested that shocking and humorous messages generated greatest impressions and engagement, but information-based messages were likely to be shared most. The extent of behavioral change as a result of the campaign remains to be explored, however, the change of attitudes and knowledge is promising. Social media is an inexpensive, effective method for delivering public health messages. However, existing and traditional process evaluation methods may not be suitable for social media.

  • TOC image created from the following:
1) "Lessig reading news"
2) "Tea Party Pro Gun Rally"
3) "Rally17.GunControlMarch.WDC.26January2013". Source: 1) Joi Ito 2) Fibonacci Blue 3) Elvert Barnes,; Copyright: Saurabh Rahurkar; URL: 1) 2) 3); License: 1) Creative Commons Attribution 2.0 Generic (CC BY 2.0); 2) Creative Commo
ns Attribution 2.0 Generic (CC BY 2.0); 
3) Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0). 
TOC image is licensed under Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0).

    Using Web-Based Search Data to Study the Public’s Reactions to Societal Events: The Case of the Sandy Hook Shooting


    Background: Internet search is the most common activity on the World Wide Web and generates a vast amount of user-reported data regarding their information-seeking preferences and behavior. Although this data has been successfully used to examine outbreaks, health care utilization, and outcomes related to quality of care, its value in informing public health policy remains unclear. Objective: The aim of this study was to evaluate the role of Internet search query data in health policy development. To do so, we studied the public’s reaction to a major societal event in the context of the 2012 Sandy Hook School shooting incident. Methods: Query data from the Yahoo! search engine regarding firearm-related searches was analyzed to examine changes in user-selected search terms and subsequent websites visited for a period of 14 days before and after the shooting incident. Results: A total of 5,653,588 firearm-related search queries were analyzed. In the after period, queries increased for search terms related to “guns” (+50.06%), “shooting incident” (+333.71%), “ammunition” (+155.14%), and “gun-related laws” (+535.47%). The highest increase (+1054.37%) in Web traffic was seen by news websites following “shooting incident” queries whereas searches for “guns” (+61.02%) and “ammunition” (+173.15%) resulted in notable increases in visits to retail websites. Firearm-related queries generally returned to baseline levels after approximately 10 days. Conclusions: Search engine queries present a viable infodemiology metric on public reactions and subsequent behaviors to major societal events and could be used by policymakers to inform policy development.

  • Image Source: Swedenexpo, via FlickR,, licensed under cc-by.

    Self-Reported Psychosomatic Complaints In Swedish Children, Adolescents, and Young Adults Living in Rural and Urban Areas: An Internet-Based Survey


    Background: Frequencies in reported psychosomatic illnesses have increased in Sweden among children, adolescents, and young adults. Little is known about demographic differences in self-reported psychosomatic complaints, such as between urban and rural areas, and whether surveys launched on the Internet could be a useful method in sampling such data. Objectives: This study examines the connection between psychosomatic illnesses and demographics in Swedish children and youth. The feasibility of using the Internet to gather large amounts of data regarding psychosomatic complaints in this group is another major objective of this study. Methods: A cross-sectional study using 7 validated questions about psychosomatic health, were launched in a controlled way onto a recognized Swedish Internet community site, which targeted users 10 to 24 years of age. The subjects were able to answer the items while they were logged in to their personal domain. The results were analyzed cross-geographically within Sweden. Results: In total, we received 100,000 to 130,000 individual answers per question. Subjects of both sexes generally reported significantly higher levels of self-reported psychosomatic complaints in major city areas as compared with minor city/rural areas, even though the differences between the areas were small. For example, 12.00% (4472/37,265) of females in minor regions reported always feeling tense, compared with 13.80% (3156/22,873) of females in major regions (P<.001). In males, the answer pattern was similar, 16.40% (4887/29,801) in major regions versus 15.60% (2712/17,386) in minor regions, (P=.006). Females reported significantly higher frequencies of psychosomatic complaints than males (P<.001). Conclusions: In subjects aged 10 to 24 years, higher levels of psychosomatic complaints appear to correlate with living in major city areas in comparison with minor city/rural areas. Surveys launched on the Internet could be a useful method in sampling data regarding psychosomatic health for this age group.

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