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 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:

  • Training course of the WHO CC for HIV Strategic Information. Source: WHO Collaborating Centre for HIV Strategic Information; Copyright: WHO Collaborating Centre for HIV Strategic Information; URL:; License: Creative Commons Attribution (CC-BY).

    HIV Strategic Information in Non-European Union Countries in the World Health Organization European Region: Capacity Development Needs


    Background: Capacity building of the national HIV strategic information system is a core component of the response to the HIV epidemic as it enables understanding of the evolving nature of the epidemic, which is critical for program planning and identification of the gaps and deficiencies in HIV programs. Objective: The study aims to describe the results of the assessment of the needs for further development of capacities in HIV strategic information systems in the non-European Union (EU) countries in the World Health Organization European Region (EUR). Methods: Self-administered questionnaires were distributed to national AIDS programs. The first questionnaire was sent to all countries (N=18) to find out, among other issues, the priority level for strengthening a range of HIV surveillance areas and their key gaps and weaknesses. The second questionnaire was sent to 15 countries to more specifically determine capacities for the analysis of the HIV care cascade. Results: Responses to the first questionnaire were received from 10 countries, whereas 13 countries responded to the second questionnaire. Areas that were most frequently marked as being of high to moderate priority for strengthening were national electronic patient monitoring systems, evaluation of HIV interventions and impact analysis, implementation science, and data analysis. Key weaknesseses were lack of electronic reporting of HIV cases, problems with timeliness and completeness of reporting in HIV cases, under-estimates of the reported number of HIV-related deaths, and limited CD4 count testing at the time of HIV diagnosis. Migrant populations, internally displaced persons, and refugees were most commonly mentioned as groups not covered by surveillance, followed by clients of sex workers and men who have sex with men. The majority of countries reported that they were able to provide the number of people diagnosed with HIV who know their HIV status, which is important for the analysis of cross-sectional and longitudinal HIV care cascades. Ability to report on some of the key impact indicators of HIV programs—viral load suppression and mortality—should be considerably strengthened. Conclusions: The assessment found a substantial need to invest in surveillance capacities, which is a cornerstone in the development of an evidence-informed response to HIV epidemics.

  • Source: The authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Filtering Entities to Optimize Identification of Adverse Drug Reaction From Social Media: How Can the Number of Words Between Entities in the Messages Help?


    Background: With the increasing popularity of Web 2.0 applications, social media has made it possible for individuals to post messages on adverse drug reactions. In such online conversations, patients discuss their symptoms, medical history, and diseases. These disorders may correspond to adverse drug reactions (ADRs) or any other medical condition. Therefore, methods must be developed to distinguish between false positives and true ADR declarations. Objective: The aim of this study was to investigate a method for filtering out disorder terms that did not correspond to adverse events by using the distance (as number of words) between the drug term and the disorder or symptom term in the post. We hypothesized that the shorter the distance between the disorder name and the drug, the higher the probability to be an ADR. Methods: We analyzed a corpus of 648 messages corresponding to a total of 1654 (drug and disorder) pairs from 5 French forums using Gaussian mixture models and an expectation-maximization (EM) algorithm . Results: The distribution of the distances between the drug term and the disorder term enabled the filtering of 50.03% (733/1465) of the disorders that were not ADRs. Our filtering strategy achieved a precision of 95.8% and a recall of 50.0%. Conclusions: This study suggests that such distance between terms can be used for identifying false positives, thereby improving ADR detection in social media.

  • Gay couple enjoying the outdoors. Source: iStock by Getty Images; Copyright: Pekic; URL:; License: Licensed by the authors.

    Perceptions of HIV Seriousness, Risk, and Threat Among Online Samples of HIV-Negative Men Who Have Sex With Men in Seven Countries


    Background: Rates of new HIV infections continue to increase worldwide among men who have sex with men (MSM). Despite effective prevention strategies such as condoms and pre-exposure prophylaxis (PrEP), low usage of both methods in many parts of the world hinder prevention efforts. An individual’s perceptions of the risk of acquiring HIV and the seriousness they afford to seroconversion are important drivers of behavioral risk-taking. Understanding the behavioral factors suppressing the uptake of HIV prevention services is a critical step in informing strategies to improve interventions to combat the ongoing HIV pandemic among MSM. Objective: The study aimed to examine cross-national perceptions of HIV/AIDS seriousness, risk, and threat and the association between these perceptions and sociodemographic characteristics, relationships, and high-risk sexual behaviors among MSM. Methods: Participants in Australia, Brazil, Canada, Thailand, South Africa, the United Kingdom, and the United States were recruited for a self-administered survey via Facebook (N=1908). Respondents were asked to rate their perceived seriousness from 1 (not at all serious) to 5 (very serious) of contracting HIV, their perceived risk from 1 (no risk) to 10 (very high risk) of contracting HIV based on their current behavior, and their perception of the threat of HIV—measured as their confidence in being able to stay HIV-negative throughout their lifetimes—on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). Covariates included sociodemographic factors, sexual behavior, HIV testing, drug use, and relationship status. Three ordered logistic regression models, one for each outcome variable, were fit for each country. Results: Contracting HIV was perceived as serious (mean=4.1-4.6), but perceptions of HIV risk (mean=2.7-3.8) and threat of HIV (mean=1.7-2.2) were relatively low across countries. Older age was associated with significantly lower perceived seriousness of acquiring HIV in five countries (Australia: odds ratio, OR 0.97, 95% CI 0.94-0.99; Brazil: OR 0.95, 95% CI 0.91-0.98; Canada: OR 0.96, 95% CI 0.93-0.98; South Africa: OR 0.96, 95% CI 0.94-0.98; United Kingdom: OR 0.95, 95% CI 0.92-0.98). Being in a male-male sexual relationship was associated with significantly lower perceived risk of HIV in four countries (Australia: OR 0.47, 95% CI 0.30-0.75; Canada: OR: 0.54, 95% CI 0.35-0.86; United Kingdom: OR 0.38, 95% CI 0.24-0.60; United States: OR 0.5, 95% CI 0.31-0.82). Drug use in the previous year was associated with greater threat of contracting HIV in two countries (Canada: OR 1.81, 95% CI 1.13-2.91; United Kingdom: OR 1.7, 95% CI 1.06-2.74). Conclusions: Few measures of behavioral or sexual risk-taking were significantly associated with perceived HIV seriousness, risk, or threat across countries. Overall, low levels of reported risk were identified, and results illustrate important gaps in the understanding of risk among MSM across societies that could be addressed through culturally-tailored prevention messaging.

  • Young key populations participating in research. Source: The Authors; Copyright: Youth LEAD; URL:; License: Creative Commons Attribution (CC-BY).

    Ensuring Inclusion of Adolescent Key Populations at Higher Risk of HIV Exposure: Recommendations for Conducting Biological Behavioral Surveillance Surveys


    Ending acquired immune deficiency syndrome (AIDS) depends on greater efforts to reduce new human immunodeficiency virus (HIV) infections and prevent AIDS-related deaths among key populations at highest HIV risk, including males who have sex with males, sex workers, and people who inject drugs. Although adolescent key populations (AKP) are disproportionately affected by HIV, they have been largely ignored in HIV biological behavioral surveillance survey (BBSS) activities to date. This paper reviews current ethical and sampling challenges and provides suggestions to ensure AKP are included in surveillance activities, with the aim being to enhance evidence-informed, strategic, and targeted funding allocations and programs toward ending AIDS among AKP. HIV BBSS, conducted every few years worldwide among adult key populations, provide information on HIV and other infections’ prevalence, HIV testing, risk behaviors, program coverage, and when at least three of these surveys are conducted, trend data with which to evaluate progress. We provide suggestions and recommendations on how to make the case to ethical review boards to involve AKP in surveillance while assuring that AKP are properly protected. We also describe two widely used probability sampling methods, time location sampling and respondent driven sampling, and offer considerations of feature modifications when sampling AKP. Effectively responding to AKP’s HIV and sexual risks requires the inclusion of AKP in HIV BBSS activities. The implementation of strategies to overcome barriers to including AKP in HIV BBSS will result in more effective and targeted prevention and intervention programs directly suited to the needs of AKP.

  • Source: The Authors; Copyright: Jennifer Jabson; URL:; License: Creative Commons Attribution (CC-BY).

    Understanding Health Information Seeking on the Internet Among Sexual Minority People: Cross-Sectional Analysis From the Health Information National Trends...


    Background: Individuals who face barriers to health care are more likely to access the Internet to seek health information. Pervasive stigma and heterosexism in the health care setting are barriers to health care for sexual minority people (SMP, ie, lesbian, gay, and bisexual people); therefore, SMP may be more likely to use the Internet as a source of health information compared to heterosexual people. Objective: Currently, there is a dearth of published empirical evidence concerning health information seeking on the Internet among SMP; the current project addresses this gap. Methods: Data from the 2015 Health Information National Trends Survey Food and Drug Administration Cycle were used to describe and summarize health information seeking among SMP (n=105) and heterosexual people (n=3405). Results: Almost all of the SMP in this sample reported having access to the Internet (92.4%, 97/105). SMP were equally as likely as heterosexual people to seek health information on the Internet (adjusted odds ratio [aOR] 0.94, 95% CI 0.56-1.66) and to report incidental exposure to health information online (aOR 1.02, 95% CI 0.66-1.60). SMP were 58% more likely to watch a health-related video on YouTube than heterosexual people (aOR 1.58, 95% CI 1.00-2.47). Incidental exposure to health information was associated with seeking health information for oneself (aOR 3.87, 95% CI 1.16-14.13) and for someone else (aOR 6.30, 95% CI 2.40-17.82) among SMP. Conclusions: SMP access the Internet at high rates and seek out health information online. Their incidental exposure could be associated with seeking information for self or others. This suggests that online interventions could be valuable for delivering or promoting health information for SMP.

  • U.S. Air Force Senior Airman Brandi Spriggs, 97th Medical Operations Squadron health technician, sets up a dry ice trap to catch mosquitoes. Source: Airman 1st Class Cody Dowell; Copyright: N/A; URL:; License: Public Domain (CC0).

    What Are People Tweeting About Zika? An Exploratory Study Concerning Its Symptoms, Treatment, Transmission, and Prevention


    Background: In order to harness what people are tweeting about Zika, there needs to be a computational framework that leverages machine learning techniques to recognize relevant Zika tweets and, further, categorize these into disease-specific categories to address specific societal concerns related to the prevention, transmission, symptoms, and treatment of Zika virus. Objective: The purpose of this study was to determine the relevancy of the tweets and what people were tweeting about the 4 disease characteristics of Zika: symptoms, transmission, prevention, and treatment. Methods: A combination of natural language processing and machine learning techniques was used to determine what people were tweeting about Zika. Specifically, a two-stage classifier system was built to find relevant tweets about Zika, and then the tweets were categorized into 4 disease categories. Tweets in each disease category were then examined using latent Dirichlet allocation (LDA) to determine the 5 main tweet topics for each disease characteristic. Results: Over 4 months, 1,234,605 tweets were collected. The number of tweets by males and females was similar (28.47% [351,453/1,234,605] and 23.02% [284,207/1,234,605], respectively). The classifier performed well on the training and test data for relevancy (F1 score=0.87 and 0.99, respectively) and disease characteristics (F1 score=0.79 and 0.90, respectively). Five topics for each category were found and discussed, with a focus on the symptoms category. Conclusions: We demonstrate how categories of discussion on Twitter about an epidemic can be discovered so that public health officials can understand specific societal concerns within the disease-specific categories. Our two-stage classifier was able to identify relevant tweets to enable more specific analysis, including the specific aspects of Zika that were being discussed as well as misinformation being expressed. Future studies can capture sentiments and opinions on epidemic outbreaks like Zika virus in real time, which will likely inform efforts to educate the public at large.

  • Tech. Sgt. Bryan Gray hands out mosquito nets to a Cham-Muslim woman in a village. Source: Master Sgt. Adam Johnston; Copyright: US Air Force; URL:; License: Creative Commons Attribution (CC-BY).

    Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia


    Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems’ developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of “best practices” but also accelerates global and regional malaria elimination efforts. In this article, Cambodia’s experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination.

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

    How Do You #relax When You’re #stressed? A Content Analysis and Infodemiology Study of Stress-Related Tweets


    Background: Stress is a contributing factor to many major health problems in the United States, such as heart disease, depression, and autoimmune diseases. Relaxation is often recommended in mental health treatment as a frontline strategy to reduce stress, thereby improving health conditions. Twitter is a microblog platform that allows users to post their own personal messages (tweets), including their expressions about feelings and actions related to stress and stress management (eg, relaxing). While Twitter is increasingly used as a source of data for understanding mental health from a population perspective, the specific issue of stress—as manifested on Twitter—has not yet been the focus of any systematic study. Objective: The objective of our study was to understand how people express their feelings of stress and relaxation through Twitter messages. In addition, we aimed at investigating automated natural language processing methods to (1) classify stress versus nonstress and relaxation versus nonrelaxation tweets, and (2) identify first-hand experience—that is, who is the experiencer—in stress and relaxation tweets. Methods: We first performed a qualitative content analysis of 1326 and 781 tweets containing the keywords “stress” and “relax,” respectively. We then investigated the use of machine learning algorithms—in particular naive Bayes and support vector machines—to automatically classify tweets as stress versus nonstress and relaxation versus nonrelaxation. Finally, we applied these classifiers to sample datasets drawn from 4 cities in the United States (Los Angeles, New York, San Diego, and San Francisco) obtained from Twitter’s streaming application programming interface, with the goal of evaluating the extent of any correlation between our automatic classification of tweets and results from public stress surveys. Results: Content analysis showed that the most frequent topic of stress tweets was education, followed by work and social relationships. The most frequent topic of relaxation tweets was rest & vacation, followed by nature and water. When we applied the classifiers to the cities dataset, the proportion of stress tweets in New York and San Diego was substantially higher than that in Los Angeles and San Francisco. In addition, we found that characteristic expressions of stress and relaxation varied for each city based on its geolocation. Conclusions: This content analysis and infodemiology study revealed that Twitter, when used in conjunction with natural language processing techniques, is a useful data source for understanding stress and stress management strategies, and can potentially supplement infrequently collected survey-based stress data.

  • #LiveFitNOLA Twitter chat network map. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Measuring Audience Engagement for Public Health Twitter Chats: Insights From #LiveFitNOLA


    Background: Little empirical evidence exists on the effectiveness of using Twitter as a two-way communication tool for public health practice, such as Twitter chats. Objective: We analyzed whether Twitter chats facilitate engagement in two-way communications between public health entities and their audience. We also describe how to measure two-way communications, incoming and outgoing mentions, between users in a protocol using free and publicly available tools (Symplur, OpenRefine, and Gephi). Methods: We used a mixed-methods approach, social network analysis, and content analysis. The study population comprised individuals and organizations participating or who were mentioned in the first #LiveFitNOLA chat, during a 75-min period on March 5, 2015, from 12:00 PM to 1:15 PM Central Time. We assessed audience engagement in two-way communications with two metrics: engagement ratio and return on engagement (ROE). Results: The #LiveFitNOLA chat had 744 tweets and 66 participants with an average of 11 tweets per participant. The resulting network had 134 network members and 474 engagements. The engagement ratios and ROEs for the #LiveFitNOLA organizers were 1:1, 40% (13/32) (@TulanePRC) and 2:1, −40% (−25/63) (@FitNOLA). Content analysis showed information sharing (63.9%, 314/491) and health information (27.9%, 137/491) as the most salient theme and sub-theme, respectively. Conclusions: Our findings suggest Twitter chats facilitate audience engagement in two-way communications between public health entities and their audience. The #LiveFitNOLA organizers’ engagement ratios and ROEs indicated a moderate level of engagement with their audience. The practical significance of the engagement ratio and ROE depends on the audience, context, scope, scale, and goal of a Twitter chat or other organized hashtag-based communications on Twitter.

  • Part of an advertisement for OutsmartHPV. Source: OutsmartHPV; Copyright: OutsmartHPV; URL:; License: Creative Commons Attribution (CC-BY).

    Recruiting Young Gay and Bisexual Men for a Human Papillomavirus Vaccination Intervention Through Social Media: The Effects of Advertisement Content


    Background: Web-based approaches, specifically social media sites, represent a promising approach for recruiting young gay and bisexual men for research studies. Little is known, however, about how the performance of social media advertisements (ads) used to recruit this population is affected by ad content (ie, image and text). Objective: The aim of this study was to evaluate the effects of different images and text included in social media ads used to recruit young gay and bisexual men for the pilot test of a Web-based human papillomavirus (HPV) vaccination intervention. Methods: In July and September 2016, we used paid Facebook advertisements to recruit men who were aged 18-25 years, self-identified as gay or bisexual, US resident, and had not received HPV vaccine. A 4x2x2 factorial experiment varied ad image (a single young adult male, a young adult male couple, a group of young adult men, or a young adult male talking to a doctor), content focus (text mentioning HPV or HPV vaccine), and disease framing (text mentioning cancer or a sexually transmitted disease [STD]). Poisson regression determined whether these experimental factors affected ad performance. Results: The recruitment campaign reached a total of 35,646 users who viewed ads for 36,395 times. This resulted in an overall unique click-through rate of 2.01% (717/35,646) and an overall conversion rate of 0.66% (241/36,395). Reach was higher for ads that included an image of a couple (incidence rate ratio, IRR=4.91, 95% CI 2.68-8.97, P<.001) or a group (IRR=2.65, 95% CI 1.08-6.50, P=.03) compared with those that included an image of a single person. Ads that included an image of a couple also had a higher conversion rate (IRR=2.56, 95% CI 1.13-5.77, P=.02) than ads that included an image of a single person. Ads with text mentioning an STD had a higher unique click-through rate compared with ads with text mentioning cancer (IRR=1.34, 95% CI 1.06-1.69, P=.01). The campaign cost a total of US $413.72 and resulted in 150 eligible and enrolled individuals (US $2.76 per enrolled participant). Conclusions: Facebook ads are a convenient and cost-efficient strategy for reaching and recruiting young gay and bisexual men for a Web-based HPV vaccination intervention. To help optimize ad performance among this population, researchers should consider the importance of the text and image included in the social media recruitment ads.

  • Young girls with ActiGraph GT9x Link. Source: ActiGraph; URL:; License: Fair use/fair dealings.

    Understanding Environmental and Contextual Influences of Physical Activity During First-Year University: The Feasibility of Using Ecological Momentary...


    Background: It is well established that drastic declines in physical activity (PA) occur during young adults’ transition into university; however, our understanding of contextual and environmental factors as it relates to young adults’ PA is limited. Objective: The purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university. Methods: First-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days. Results: A total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ≥2 days of ≥10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ≥3 days of 3 prompts/day or ≥4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ≥5 days of 4 prompts/day or ≥ 4 days of 5 prompts/day). Conclusions: This study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA.

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

    Physician’s Perceptions of Telemedicine in HIV Care Provision: A Cross-Sectional Web-Based Survey


    Background: Telemedicine, or electronic interactive health care consultation, offers a variety of benefits to both patients and primary care clinicians. However, little is known about the opinions of physicians using these modalities. Objective: The aim of this study was to examine physician perceptions, including challenges, risks, and benefits of the use of telemedicine in human immunodeficiency virus (HIV) patient care. Methods: A Web-based, self-administered, anonymous, cross-sectional survey was sent to physicians known to be providing medical care to patients living with HIV in Ontario, Canada. Descriptive statistics and frequencies were used to examine physician perceptions and characteristics of participants. Results: Among the 51 invited participants, 48 (94%) completed the survey. Sixty-two percent (29/47) of respondents reported that they used some form of telemedicine to care for HIV patients in their practice. Of the respondents who identified as having used telemedicine in their practice, telephone (86%, 25/29), email (69%, 20/29), and teleconsultation (24%, 7/29) were listed as frequent modalities used. A significant number of physicians (83%, 38/46) agreed that an obstacle to adopting telemedicine is their perception that this modality does not allow for a comprehensive assessment of their patients’ health. In addition, 65% (28/43) of physicians agreed that patients may not feel adequately connected to them as a provider if they used telemedicine. However, 85% (39/46) of respondents believed that telemedicine could improve access and timeliness to care along with increasing the number of times physicians can interact with their patients. Conclusions: From the perceptions of physicians, telemedicine shows promise in the care of patients living with HIV. More than half of the respondents are already using telemedicine modalities. Whereas many physicians are concerned about their ability to fully assess the health of a patient via telemedicine, most physicians do see a need for it—to reduce patient travel times, reduce exposure to stigma, and improve efficiency and timely access to care. Challenges and risks such as technological gaps, confidentiality, and medicolegal concerns must be addressed for physicians to feel more comfortable using telemedicine.

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  • Main effect, buffering effect, and exacerbation effect of positive and negative social relations with fellow church members on depression; Racial and ethnic differences

    Date Submitted: Jun 22, 2017

    Open Peer Review Period: Jun 26, 2017 - Jul 10, 2017

    Background: Religiosity has been shown to be associated with both desired and undesired health outcomes. Objective: Conceptualizing chronic medical conditions as stressors and major depressive disorde...

    Background: Religiosity has been shown to be associated with both desired and undesired health outcomes. Objective: Conceptualizing chronic medical conditions as stressors and major depressive disorder (MDD) as outcome, the current study investigates whether race and ethnicity modify main effect, stress-buffering effect and stress-exacerbation effect of positive and negative social relations with fellow church members on MDD Methods: With a cross sectional design, the current study used data from National Survey of American Life, 2003. Study included 3,570 African American, 1438 Caribbean Blacks and 891 non-Hispanic White adults. Positive (3 items) and negative (3 items) social relation from fellow church members were independent variables, 12 months MDD (CIDI) was outcome, and age, gender, education, marital status, employment, and country region were controlled. Multiple race specific logistic regressions were used to determine main effect, stress-buffering effect and stress-exacerbation effects of positive and negative social relation with fellow church members. Results: Regardless of race and ethnicity, number of chronic medical conditions was positively associated with risk of MDD. Among Caribbean Blacks, positive social support was associated with lower odds of MDD (main effect), while negative social relationship showed stress-exacerbation effect, as the effect of chronic medical condition on depression was larger when negative social interaction was high. Among African Americans and non-Hispanic Whites, positive and negative social relation with church fellows did not show a main effect, stress-buffering effect or stress-exacerbation effect. Conclusions: There are major ethnic differences in role of social relation with fellow church members on depression. In addition, even in one ethnic group, mechanism of the effect of positive and negative social relation with fellow church members is different. While positive relations directly reduce risk of depression, negative social interactions inside church may exacerbate the effect of other stressors on mental health.

  • User Participation and Engagement with the See Me Smoke-Free mHealth App: Results of a Prospective Feasibility Trial

    Date Submitted: Apr 21, 2017

    Open Peer Review Period: May 31, 2017 - Jul 14, 2017

    Background: The See Me Smoke-Free (SMSF) mobile health (mHealth) application (app) was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy throu...

    Background: The See Me Smoke-Free (SMSF) mobile health (mHealth) application (app) was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy through cognitive behavioral techniques and guided imagery audio files addressing smoking, diet, and physical activity. A feasibility trial found associations between SMSF usage and positive treatment outcomes. This paper reports a detailed exploration of program use among those who downloaded the app, and the relationship between program use and treatment outcomes. Objective: To determine whether: 1) participants were more likely to set quit dates, be current smokers, and report higher levels of smoking at baseline than non-participants; 2) participants opened the app and listened to audio files more frequently than non-participants; and 3) participants with more app usage had a higher likelihood of smoking abstinence at follow-up. Methods: The SMSF feasibility trial was a single arm, within-subjects, prospective cohort study with assessments at baseline, 30- and 90-days post-enrollment. The SMSF app was deployed on the Google Play store for download, and basic profile characteristics were obtained for all app installers. Additional variables were assessed for study participants. Participants were prompted to use the app daily during study participation. Crude differences in baseline characteristics between trial participants and non-participants were evaluated using t-tests (continuous variables) and Fisher’s exact tests (categorical variables). Exact Poisson tests were used to assess group-level differences in mean usage rates over the full study period, using aggregate Google Analytics data on participation and usage. Negative binomial regression models were used to estimate associations of app usage with participant baseline characteristics, after adjustment for putative confounders. Associations between app usage and smoking abstinence were assessed using separate logistic regression models for each outcome measure. Results: Participants (n=151) were more likely than non-participants (n=96) to report female gender (P < 0.02) and smoking in the 30 days prior to enrollment (P < 0.0001). Participants and non-participants opened the app and updated quit dates at the same average rate (Rate ratio (RR) 0.98; 95% CI: 0.92, 1.04; P = 0.43), but participants started audio files (RR 1.07; 95% CI: 1.00, 1.13; P < 0.04) and completed audio files (RR 1.11; 95% CI: 1.03, 1.18; P < 0.003) at significantly higher rates than non-participants. Higher app usage among participants was generally associated with increased smoking cessation, and most effect sizes suggested strong associations, though generally without statistical significance. Conclusions: The current study suggests potential efficacy of the SMSF app, as increased usage was generally associated with higher smoking abstinence. A planned randomized controlled trial will assess the SMSF app’s efficacy as an intervention tool to help women quit smoking. Clinical Trial: NCT02972515

  • Low- and No-Cost Strategies to Recruit Women to a Mobile Health Smoking Cessation Trial

    Date Submitted: Jan 19, 2017

    Open Peer Review Period: May 31, 2017 - Jul 14, 2017

    Background: Successful recruitment and retention of adequate numbers of participants to mobile health (mHealth) studies remains a challenge. Given that researchers must decide how to invest limited re...

    Background: Successful recruitment and retention of adequate numbers of participants to mobile health (mHealth) studies remains a challenge. Given that researchers must decide how to invest limited recruitment resources, it is important to identify the most effective recruitment strategies, defined as those that incur low costs relative to participant yield. Objective: The objective of this manuscript is to describe the development and implementation process for the recruitment phase of an mHealth intervention designed to increase smoking cessation among weight-concerned women smokers. These recruitment methods could be applicable across a range of mHealth studies. Methods: Study information was released to the media in multiple phases. First, local city and state media were contacted, followed by national women’s health media, and finally outlets in states with high smoking rates. Stories and mentions resulting from the press releases (earned media) were disseminated via existing department and new study-specific social media accounts. Strategic hashtags were used in Facebook and Twitter posts to connect with broader smoking cessation campaigns. Posts were also made to third-party Facebook smoking cessation communities and Internet classifieds sites. Results: Media coverage was documented across 75 publications and radio/television broadcasts, 35 of which were local, 39 national, and 1 international. Between March 30th and July 31st, 2015, 151 participants were successfully recruited to the study. Conclusions: Leveraging social media, and coordinating with university public affairs offices were effective and low-cost strategies to earn media coverage, and reach potential participants. Clinical Trial: Not Applicable