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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, ranked #1 by Clarivate's Journal Impact Factor. 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: picjumbo; Copyright: Viktor Hanacek; URL:; License: Licensed by the authors.

    Google for Sexual Relationships: Mixed-Methods Study on Digital Flirting and Online Dating Among Adolescent Youth and Young Adults


    Background: According to a 2015 report from the Pew Research Center, nearly 24% of teens go online almost constantly and 92% of teens are accessing the internet daily; consequently, a large part of adolescent romantic exploration has moved online, where young people are turning to the Web for romantic relationship-building and sexual experience. This digital change in romantic behaviors among youth has implications for public health and sexual health programs, but little is known about the ways in which young people use online spaces for sexual exploration. An examination of youth sexual health and relationships online and the implications for adolescent health programs has yet to be fully explored. Objective: Although studies have documented increasing rates of sexually transmitted infections and HIV among young people, many programs continue to neglect online spaces as avenues for understanding sexual exploration. Little is known about the online sexual health practices of young people, including digital flirting and online dating. This study explores the current behaviors and opinions of youth throughout online sexual exploration, relationship-building, and online dating, further providing insights into youth behavior for intervention opportunities. Methods: From January through December 2016, an exploratory study titled TECHsex used a mixed-methods approach to document information-seeking behaviors and sexual health building behaviors of youth online in the United States. Data from a national quantitative survey of 1500 youth and 12 qualitative focus groups (66 youth) were triangulated to understand the experiences and desires of young people as they navigate their sexual relationships through social media, online chatting, and online dating. Results: Young people are using the internet to begin sexual relationships with others, including dating, online flirting, and hooking up. Despite the fact that dating sites have explicit rules against minor use, under 18 youth are using these products regardless in order to make friends and begin romantic relationships, albeit at a lower rate than their older peers (19.0% [64/336] vs 37.8% [440/1163], respectively). Nearly 70% of youth who have used online dating sites met up with someone in person (44.78% [30/67] under 18 vs 74.0% [324/438] over 18). Focus group respondents provided further context into online sexual exploration; many learned of sex through pornography, online dating profiles, or through flirting on social media. Social media played an important role in vetting potential partners and beginning romantic relationships. Youth also reported using online dating and flirting despite fears of violence or catfishing, in which online profiles are used to deceive others. Conclusions: Youth are turning to online spaces to build sexual relationships, particularly in areas where access to peers is limited. Although online dating site use is somewhat high, more youth turn to social media for online dating. Sexual relationship-building included online flirting and online dating websites and/or apps. These findings have implications for future sexual health programs interested in improving the sexual health outcomes of young people. Researchers may be neglecting to include social media as potential sources of youth hookup culture and dating. We implore researchers and organizations to consider the relationships young people have with technology in order to more strategically use these platforms to create successful and youth-centered programs to improve sexual health outcomes.

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

    Pneumococcal Vaccination Utilization Among Hispanic Long-Term Colorectal Cancer Survivors: Cross-Sectional Assessment of Claims


    Background: Colorectal cancer (CRC) is the second leading cancer-related cause of death in the United States. However, survivorship has been increasing. Both cancer survivors and underserved populations experience unique health-related challenges and disparities that may exist among long-term CRC survivors as it relates to routine preventive care, specifically pneumococcal (PNM) vaccination. Objective: The aim of this study was to explore the relationship between long-term CRC survival and the receipt of PNM vaccine among Hispanic Medicare recipients compared with non-Hispanic populations. Methods: This study is a cross-sectional analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data examining ethnic differences in the receipt of PNM vaccination among long-term CRC survivors. Multivariable logistic regression models considered Hispanic ethnicity while controlling for sociodemographic characteristics, comorbidity score, age, tumor stage, and SEER registry. Results: Our sample revealed 32,501 long-term CRC survivors, and 1509 identified as Hispanic (4.64%) based on an established SEER algorithm. In total, 16,252 CRC survivors, or 50.00% of our sample, received a PNM vaccination. We found that Hispanic CRC survivors had 10% decreased odds of having received a PNM vaccine compared with non-Hispanic survivors (P=.03). Conclusions: Disparities likely exist in the utilization of PNM vaccination among long-term CRC survivors. Among Medicare beneficiaries, the use of claims data regarding PNM vaccination highlights the relatively poor utilization of guideline-directed preventive care.

  • Image by Dean Moriarty from Pixabay. Source: Image by Dean Moriarty from Pixabay; Copyright: Dean Moriarty; URL:; License: Public Domain (CC0).

    A Software Tool Aimed at Automating the Generation, Distribution, and Assessment of Social Media Messages for Health Promotion and Education Research


    Background: Social media offers promise for communicating the risks and health effects of harmful products and behaviors to larger and hard-to-reach segments of the population. Nearly 70% of US adults use some social media. However, rigorous research across different social media is vital to establish successful evidence-based health communication strategies that meet the requirements of the evolving digital landscape and the needs of diverse populations. Objective: The aim of this study was to expand and test a software tool (Trial Promoter) to support health promotion and education research by automating aspects of the generation, distribution, and assessment of large numbers of social media health messages and user comments. Methods: The tool supports 6 functions (1) data import, (2) message generation deploying randomization techniques, (3) message distribution, (4) import and analysis of message comments, (5) collection and display of message performance data, and (6) reporting based on a predetermined data dictionary. The tool was built using 3 open-source software products: PostgreSQL, Ruby on Rails, and Semantic UI. To test the tool’s utility and reliability, we developed parameterized message templates (N=102) based upon 2 government-sponsored health education campaigns, extracted images from these campaigns and a free stock photo platform (N=315), and topic-related hashtags (N=4) from Twitter. We conducted a functional correctness analysis of the generated social media messages to assess the algorithm’s ability to produce the expected output for each input. We defined 100% correctness as use of the message template text and substitution of 3 message parameters (ie, image, hashtag, and destination URL) without any error. The percent correct was calculated to determine the probability with which the tool generates accurate messages. Results: The tool generated, distributed, and assessed 1275 social media health messages over 85 days (April 19 to July 12, 2017). It correctly used the message template text and substituted the message parameters 100% (1275/1275) of the time as verified by human reviewers and a custom algorithm using text search and attribute-matching techniques. Conclusions: A software tool can effectively support the generation, distribution, and assessment of hundreds of health promotion messages and user comments across different social media with the highest degree of functional correctness and minimal human interaction. The tool has the potential to support social media–enabled health promotion research and practice: first, by enabling the assessment of large numbers of messages to develop evidence-based health communication, and second, by providing public health organizations with a tool to increase their output of health education messages and manage user comments. We call on readers to use and develop the tool and to contribute to evidence-based communication methods in the digital age.

  • Source: Flickr; Copyright: Fernando; URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Text-Based Illness Monitoring for Detection of Novel Influenza A Virus Infections During an Influenza A (H3N2)v Virus Outbreak in Michigan, 2016:...


    Background: Rapid reporting of human infections with novel influenza A viruses accelerates detection of viruses with pandemic potential and implementation of an effective public health response. After detection of human infections with influenza A (H3N2) variant (H3N2v) viruses associated with agricultural fairs during August 2016, the Michigan Department of Health and Human Services worked with the US Centers for Disease Control and Prevention (CDC) to identify infections with variant influenza viruses using a text-based illness monitoring system. Objective: To enhance detection of influenza infections using text-based monitoring and evaluate the feasibility and acceptability of the system for use in future outbreaks of novel influenza viruses. Methods: During an outbreak of H3N2v virus infections among agricultural fair attendees, we deployed a text-illness monitoring (TIM) system to conduct active illness surveillance among households of youth who exhibited swine at fairs. We selected all fairs with suspected H3N2v virus infections. For fairs without suspected infections, we selected only those fairs that met predefined criteria. Eligible respondents were identified and recruited through email outreach and/or on-site meetings at fairs. During the fairs and for 10 days after selected fairs, enrolled households received daily, automated text-messages inquiring about illness; reports of illness were investigated by local health departments. To understand the feasibility and acceptability of the system, we monitored enrollment and trends in participation and distributed a Web-based survey to households of exhibitors from five fairs. Results: Among an estimated 500 households with a member who exhibited swine at one of nine selected fairs, representatives of 87 (17.4%) households were enrolled, representing 392 household members. Among fairs that were ongoing when the TIM system was deployed, the number of respondents peaked at 54 on the third day of the fair and then steadily declined throughout the rest of the monitoring period; 19 out of 87 household representatives (22%) responded through the end of the 10-day monitoring period. We detected 2 H3N2v virus infections using the TIM system, which represents 17% (2/12) of all H3N2v virus infections detected during this outbreak in Michigan. Of the 70 survey respondents, 16 (23%) had participated in the TIM system. A total of 73% (11/15) participated because it was recommended by fair coordinators and 80% (12/15) said they would participate again. Conclusions: Using a text-message system, we monitored for illness among a large number of individuals and households and detected H3N2v virus infections through active surveillance. Text-based illness monitoring systems are useful for detecting novel influenza virus infections when active monitoring is necessary. Participant retention and testing of persons reporting illness are critical elements for system improvement.

  • Source: Pixabay; Copyright: truk; URL:; License: Licensed by JMIR.

    Estimation of the Population Size of Men Who Have Sex With Men in Vietnam: Social App Multiplier Method


    Background: Although the prevalence of HIV among men who have sex with men (MSM) in Vietnam has been increasing in recent years, there are no estimates of the population size of MSM based on tested empirical methods. Objective: This study aimed to estimate the size of the MSM population in 12 provinces in Vietnam and extrapolate from those areas to generate a national population estimate of MSM. A secondary aim of this study was to compare the feasibility of obtaining the number of users of a mobile social (chat and dating) app for MSM using 3 different approaches. Methods: This study used the social app multiplier method to estimate the size of MSM populations in 12 provinces using the count of users on a social app popular with MSM in Vietnam as the first data source and a questionnaire propagated through the MSM community using respondent-driven sampling as the second data source. A national estimation of the MSM population is extrapolated from the results in the study provinces, and the percentage of MSM reachable through online social networks is clarified. Results: The highest MSM population size among the 12 provinces is estimated in Hanoi and the lowest is estimated in Binh Dinh. On average, 37% of MSM in the provinces surveyed had used the social app Jack’d in the last 30 days (95% CI 27-48). Extrapolation of the results from the study provinces with reliable estimations results in an estimated national population of 178,000 MSM (95% CI 122,000-512,000) aged 15 to 49 years in Vietnam. The percentage of MSM among adult males aged 15 to 49 years in Vietnam is 0.68% (95% CI 0.46-1.95). Conclusions: This study is the first attempt to empirically estimate the population of MSM in Vietnam and highlights the feasibility of reaching a large proportion of MSM through a social app. The estimation reported in this study is within the bounds suggested by the Joint United Nations Programme on HIV/AIDS. This study provides valuable information on MSM population sizes in provinces where reliable estimates were obtained, which they can begin to work with in program planning and resource allocation.

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

    Improved Real-Time Influenza Surveillance: Using Internet Search Data in Eight Latin American Countries


    Background: Novel influenza surveillance systems that leverage Internet-based real-time data sources including Internet search frequencies, social-network information, and crowd-sourced flu surveillance tools have shown improved accuracy over the past few years in data-rich countries like the United States. These systems not only track flu activity accurately, but they also report flu estimates a week or more ahead of the publication of reports produced by healthcare-based systems, such as those implemented and managed by the Centers for Disease Control and Prevention. Previous work has shown that the predictive capabilities of novel flu surveillance systems, like Google Flu Trends (GFT), in developing countries in Latin America have not yet delivered acceptable flu estimates. Objective: The aim of this study was to show that recent methodological improvements on the use of Internet search engine information to track diseases can lead to improved retrospective flu estimates in multiple countries in Latin America. Methods: A machine learning-based methodology that uses flu-related Internet search activity and historical information to monitor flu activity, named ARGO (AutoRegression with Google search), was extended to generate flu predictions for 8 Latin American countries (Argentina, Bolivia, Brazil, Chile, Mexico, Paraguay, Peru, and Uruguay) for the time period: January 2012 to December of 2016. These retrospective (out-of-sample) Influenza activity predictions were compared with historically observed flu suspected cases in each country, as reported by Flunet, an influenza surveillance database maintained by the World Health Organization. For a baseline comparison, retrospective (out-of-sample) flu estimates were produced for the same time period using autoregressive models that only leverage historical flu activity information. Results: Our results show that ARGO-like models’ predictive power outperform autoregressive models in 6 out of 8 countries in the 2012-2016 time period. Moreover, ARGO significantly improves on historical flu estimates produced by the now discontinued GFT for the time period of 2012-2015, where GFT information is publicly available. Conclusions: We demonstrate here that a self-correcting machine learning method, leveraging Internet-based disease-related search activity and historical flu trends, has the potential to produce reliable and timely flu estimates in multiple Latin American countries. This methodology may prove helpful to local public health officials who design and implement interventions aimed at mitigating the effects of influenza outbreaks. Our methodology generally outperforms both the now-discontinued tool GFT, and autoregressive methodologies that exploit only historical flu activity to produce future disease estimates.

  • Two source capture recapture. Source: Image created by the authors; Copyright: The authors; License: Public Domain (CC0).

    Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda


    Background: Key populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers. Objective: The aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda. Methods: We utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis. Results: We estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono. Conclusions: The CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.

  • Source: Freepik; Copyright: prostooleh; URL:; License: Licensed by JMIR.

    An Automated Text-Messaging Platform for Enhanced Retention and Data Collection in a Longitudinal Birth Cohort: Cohort Management Platform Analysis


    Background: Traditional methods for recruiting and maintaining contact with participants in cohort studies include print-based correspondence, which can be unidirectional, labor intensive, and slow. Leveraging technology can substantially enhance communication, maintain engagement of study participants in cohort studies, and facilitate data collection on a range of outcomes. Objective: This paper provides an overview of the development process and design of a cohort management platform (CMP) used in the Newborn Epigenetic STudy (NEST), a large longitudinal birth cohort study. Methods: The platform uses short message service (SMS) text messaging to facilitate interactive communication with participants; it also semiautomatically performs many recruitment and retention procedures typically completed by research assistants over the course of multiple study follow-up visits. Results: Since February 2016, 302 participants have consented to enrollment in the platform and 162 have enrolled with active engagement in the system. Daily reminders are being used to help improve adherence to the study’s accelerometer wear protocol. At the time of this report, 213 participants in our follow-up study who were also registered to use the CMP were eligible for the accelerometer protocol. Preliminary data show that texters (138/213, 64.8%), when compared to nontexters (75/213, 35.2%), had significantly longer average accelerometer-wearing hours (165.6 hours, SD 56.5, vs 145.3 hours, SD 58.5, P=.01) when instructed to wear the devices for 1 full week. Conclusions: This platform can serve as a model for enhancing communication and engagement with longitudinal study cohorts, especially those involved in studies assessing environmental exposures.

  • Locations of TripAdvisor-sourced wet markets, with zoomed inset in Southeast Asia. Red circles represent wet markets where visitors reported adverse health events, whereas empty circles denote locations where such reports were lacking. The background country border is sourced from Natural Earth vector data projected in the World Robinson coordinate reference system using Quantum Geographic Information System (QGIS) 2.18.2. Source: Figure 1 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    Wet Markets and Food Safety: TripAdvisor for Improved Global Digital Surveillance


    Background: Wet markets are markets selling fresh meat and produce. Wet markets are critical for food security and sustainable development in their respective regions. Due to their cultural significance, they attract numerous visitors and consequently generate tourist-geared information on the Web (ie, on social networks such as TripAdvisor). These data can be used to create a novel, international wet market inventory to support epidemiological surveillance and control in such settings, which are often associated with negative health outcomes. Objective: Using social network data, we aimed to assess the level of wet markets’ touristic importance on the Web, produce the first distribution map of wet markets of touristic interest, and identify common diseases facing visitors in these settings. Methods: A Google search was performed on 31 food market–related keywords, with the first 150 results for each keyword evaluated based on their relevance to tourism. Of all these queries, wet market had the highest number of tourism-related Google Search results; among these, TripAdvisor was the most frequently-occurring travel information aggregator, prompting its selection as the data source for this study. A Web scraping tool (ParseHub) was used to extract wet market names, locations, and reviews from TripAdvisor. The latter were searched for disease-related content, which enabled assignment of GeoSentinel diagnosis codes to each. This syndromic categorization was overlaid onto a mapping of wet market locations. Regional prevalence of the most commonly occurring symptom group - food poisoning - was then determined (ie, by dividing the number of wet markets per continent with more than or equal to 1 review containing this syndrome by the total number of wet markets on that continent with syndromic information). Results: Of the 1090 hits on TripAdvisor for wet market, 36.06% (393/1090) conformed to the query’s definition; wet markets were heterogeneously distributed: Asia concentrated 62.6% (246/393) of them, Europe 19.3% (76/393), North America 7.9% (31/393), Oceania 5.1% (20/393), Africa 3.1% (12/393), and South America 2.0% (8/393). Syndromic information was available for 14.5% (57/393) of wet markets. The most frequently occurring syndrome among visitors to these wet markets was food poisoning, accounting for 54% (51/95) of diagnoses. Cases of this syndrome were identified in 56% (22/39) of wet markets with syndromic information in Asia, 71% (5/7) in Europe, and 71% (5/7) in North America. All wet markets in South America and Oceania reported food poisoning cases, but the number of reviews with syndromic information was very limited in these regions (n=2). Conclusions: The map produced illustrates the potential role of touristically relevant social network data to support global epidemiological surveillance. This includes the possibility to approximate the global distribution of wet markets and to identify diseases (ie, food poisoning) that are most prevalent in such settings.

  • Source: Flickr; Copyright: Stars Foundation; URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Informing HIV Prevention Programs for Adolescent Girls and Young Women: A Modified Approach to Programmatic Mapping and Key Population Size Estimation


    Background: Standard programmatic mapping involves identifying locations where key populations meet, profiling of these locations (hotspots), and estimating the key population size. Information gained from this method has been used for HIV programming—resource allocation, program planning, service delivery, and monitoring and evaluation—for people who inject drugs, men who have sex with men, and female sex workers (FSWs). With an increasing focus on adolescent girls and young women (AGYW) as a priority population for HIV prevention, programs need to know the location of and how to effectively reach individuals who are at increased risk for HIV but were conventionally considered part of the general population. We hypothesize that AGYW who engage in transactional and casual sex also congregate at sex work hotspots to meet sex partners. Therefore, we adapted the standard programmatic mapping approach to understand the geographic distribution and population size of AGYW at increased HIV risk in Mombasa County, Kenya. Objectives: The objectives are several-fold: (1) detail and compare the modified programmatic mapping approach used in this study to the standard approach, (2) estimate the number of young FSWs, (3) estimate the number of AGYW who congregate in sex work hotspots to meet sex partners other than clients, (4) estimate the overlap in sexual network in hotspots, (5) describe the distribution of sex work hotspots across Mombasa and its four subcounties, and (6) compare the distribution of hotspots that were known to the local HIV prevention program prior to this study and those newly identified. Methods: The standard programmatic mapping approach was modified to estimate the population of young women aged 14 to 24 years who visit sex work hotspots in Mombasa to meet partners for commercial, transactional, and casual sex. Results: We estimated that there were 11,777 FSWs (range 9265 to 14,290) in Mombasa in 2014 among whom 6127 (52.02%) were 14 to 24 years old. The population estimates for women aged 14 to 24 years who engaged in transactional and casual sex and congregated at the hotspots were 5348 (range 4185 to 6510) and 4160 (range 3194 to 5125), respectively. Of the 1025 validated sex work hotspots, 870 (84.88%) were locations also visited by women engaged in transactional and casual sex. Only 47 (4.58%) hotspots were exclusive sex work locations. The geographic and typological distribution of hotspots were significantly different between the four subcounties (P<.001). Of the 1025 hotspots, 419 (40.88%) were already known to the local HIV prevention program and 606 (59.12%) were newly identified. Conclusions: Using the adapted programmatic mapping approach detailed in this study, our results show that HIV prevention programs tailored to AGYW can focus delivery of their interventions to sex work hotspots to reach subgroups that may be at increased risk for HIV.

  • Young person receives HPV vaccination. Source: Wikimedia Commons; Copyright: CNX OpenStax; URL:; License: Creative Commons Attribution (CC-BY).

    Characterizing Trends in Human Papillomavirus Vaccine Discourse on Reddit (2007-2015): An Observational Study


    Background: Despite the introduction of the human papillomavirus (HPV) vaccination as a preventive measure in 2006 for cervical and other cancers, uptake rates remain suboptimal, resulting in preventable cancer mortality. Social media, widely used for information seeking, can influence users’ knowledge and attitudes regarding HPV vaccination. Little is known regarding attitudes related to HPV vaccination on Reddit (a popular news aggregation site and online community), particularly related to cancer risk and sexual activity. Examining HPV vaccine–related messages on Reddit may provide insight into how HPV discussions are characterized on forums online and influence decision making related to vaccination. Objective: We observed how the HPV vaccine is characterized on Reddit over time and by user gender. Specifically, this study aimed to determine (1) if Reddit messages are more related to cancer risks or sexual behavior and (2) what other HPV vaccine–related discussion topics appear on Reddit. Methods: We gathered all public Reddit comments from January 2007 to September 2015. We manually annotated 400 messages to generate keywords and identify salient themes. We then measured the similarity between each comment and lists of keywords associated with sexual behavior and cancer risk using Latent Semantic Analysis (LSA). Next, we used Latent Dirichlet Allocation (LDA) to characterize remaining topics within the Reddit data. Results: We analyzed 22,729 messages containing the strings hpv or human papillomavirus and vaccin. LSA findings show that HPV vaccine discussions are significantly more related to cancer compared with sexual behavior from 2008 to 2015 (P<.001). We did not find a significant difference between genders in discussions of cancer and sexual activity (P>.05). LDA analyses demonstrated that although topics related to cancer risk and sexual activity were both frequently discussed (16.1% and 14.5% of word tokens, respectively), the majority of online discussions featured other topics. The most frequently discussed topic was politics associated with the vaccine (17.2%). Other topics included HPV disease and/or immunity (13.5%), the HPV vaccine schedule (11.5%), HPV vaccine side effects (9.7%), hyperlinks to outside sources (9.1%), and the risks and benefit of HPV vaccination (8.5%). Conclusions: Reddit discourse on HPV vaccine encompasses a broad range of topics among men and women, with HPV political debates and cancer risk making up the plurality of the discussion. Our findings demonstrated that women and men both discussed HPV, highlighting that Reddit users do not perceive HPV as an issue that only pertains to women. Given the increasing use of social media as a source of health information, these results can inform the development of targeted online health communication strategies to promote HPV vaccination to young adult users of Reddit. Analyzing online discussions on Reddit can inform health communication efforts by identifying relevant, important HPV-related topics among online communities.

  • Example of a Respondent-driven sampling (RDS) Coupon. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Kuantim mi tu (“Count me too”): Using Multiple Methods to Estimate the Number of Female Sex Workers, Men Who Have Sex With Men, and Transgender Women in...


    Background: Female sex workers (FSW), men who have sex with men (MSM), and transgender women (TGW) are at high risk of acquiring HIV in many settings, such as Papua New Guinea (PNG). An understanding of the approximate size of these populations can inform resource allocation for HIV services for FSW, MSM, and TGW. Objective: An objective of this multi-site survey was to conduct updated population size estimations (PSE) of FSW and MSM/TGW. Methods: Respondent-driven sampling (RDS) biobehavioral surveys of FSW and MSM/TGW were conducted in 3 major cities—(1) Port Moresby, (2) Lae, and (3) Mount Hagen—between June 2016 and December 2017. Eligibility criteria for FSW included: (1) ≥12 years of age, (2) born female, (3) could speak English or Tok Pisin (PNG Pidgin), and (4) had sold or exchanged sex with a man in the past six months. Eligibility for MSM/TGW included: (1) ≥12 years of age, (2) born male, (3) could speak English, or Tok Pisin, and (4) had engaged in oral or anal sex with another person born male in the past six months. PSE methods included unique object multiplier, service multiplier, and successive sampling-population size estimation (SS-PSE) using imputed visibility. Weighted data analyses were conducted using RDS-Analyst and Microsoft Excel. Results: Sample sizes for FSW and MSM/TGW in Port Moresby, Lae, and Mount Hagen included: (1) 673 and 400, (2) 709 and 352, and (3) 709 and 111 respectively. Keychains were used for the unique object multiplier method and were distributed 1 week before the start of each RDS survey. HIV service testing data were only available in Port Moresby and Mount Hagen and SS-PSE estimates were calculated for all cities. Due to limited service provider data and uncertain prior size estimation knowledge, unique object multiplier weighted estimations were chosen for estimates. In Port Moresby, we estimate that there are 16,053 (95% CI 8232-23,874) FSW and 7487 (95% CI 3975-11,000) MSM/TGW, approximately 9.5% and 3.8% of the female and male populations respectively. In Lae, we estimate that there are 6105 (95% CI 4459-7752) FSW and 4669 (95% CI 3068-6271) MSM/TGW, approximately 14.4% and 10.1% of the female and male populations respectively. In Mount Hagen, we estimate that there are 2646 (95% CI 1655-3638) FSW and 1095 (95% CI 913-1151) MSM/TGW using service multiplier and successive sampling, respectively. This is approximately 17.1% and 6.3% of the female and male populations respectively. Conclusions: As the HIV epidemic in PNG rapidly evolves among key populations, PSE should be repeated to produce current estimates for timely comparison and future trend analysis.

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    Open Peer Review Period: May 8, 2019 - May 22, 2019

    Background: There is a lack of real-time nationally representative data on severe acute respiratory infections (SARI) in the Netherlands. Objective: This study assessed whether media reports provide r...

    Background: There is a lack of real-time nationally representative data on severe acute respiratory infections (SARI) in the Netherlands. Objective: This study assessed whether media reports provide relevant and timely information for the estimation of trends and impact of influenza in hospitals. Methods: Dutch news articles on influenza in hospitals during the influenza season (week 40 2017 until week 20 2018) were searched in an online media monitoring program (Coosto). Trends in number of weekly articles were compared to trends in five different influenza surveillance systems. A content analysis was performed on a selection of news articles and information on the hospital, department, problem and preventive/response measures were collected. Results: The trend in weekly news articles correlated significantly with the trends in all five surveillance systems. However, the peak in all five surveillance systems preceded the peak in news articles by 5 weeks. Content analysis showed hospitals (n=69) had major capacity problems (n=46, 67%) resulting in admission stops (n=9, 20%), postponement of non-urgent surgical procedures (n=29, 63%) or both (n=8, 17%). Only few hospitals reported the use of point-of-care testing (n=5, 7%) or a separate influenza ward (n=3, 4%) to accelerate clinical management, but most resorted to ad-hoc crisis management (n=34, 49%). Conclusions: Media reports showed that the 2017/2018 caused serious problems in hospitals throughout the country. However, because of the time lag in media reporting, it is not a suitable alternative for near real-time SARI surveillance. A robust SARI surveillance program is important in order to inform decision-making.

  • Authors’ reply to JMIR’s and Professor Gunter Eysenbach’s Expression of Editorial Concern, Correction of Conflict of Interest and Affiliation

    Date Submitted: May 4, 2019

    Open Peer Review Period: May 8, 2019 - May 22, 2019

    The authors are postgraduate professionals who are insiders to a complementary-to-medicine healthcare organisation called Universal Medicine. The authors carried out a cross-sectional survey of 400...

    The authors are postgraduate professionals who are insiders to a complementary-to-medicine healthcare organisation called Universal Medicine. The authors carried out a cross-sectional survey of 400+ of the female participants of Universal Medicine and published a protocol paper [3] and a summary paper [4] with the latter showing that these women have well above average mean levels of physical and mental health with some evidence of below average physical and mental health at the start of their participation. The authors declared that they were insiders in their conflict of interest declarations in the paper. A serial objector filed a lengthy complaint with JMIR and others, alleging inadequate disclosure of conflicts of interest by the authors. This complaint combined with an error of JMIR (described below) led to an 8-month investigation by The University of Queensland (UQ) into the lead author, a UQ PhD student. Prior to UQ completing their investigation, i.e. before UQ drew any conclusion, JMIR added a reputation harming Expression of Editorial Concern, Correction of Conflict of Interest and Affiliation to the two published papers. The 8-month investigation by The University of Queensland cleared the lead author of research misconduct. The Expression of Editorial Concern, Correction of Conflict of Interest and Affiliation remains in situ and in essence it continues to allege that there was an undisclosed conflict of interest and some form of wrongdoing or misconduct by the authors. This is completely contrary to the extensive investigation that was conducted by The University of Queensland.

  • Stress among resident doctors in Jordanian teaching hospitals

    Date Submitted: Apr 2, 2019

    Open Peer Review Period: Apr 2, 2019 - May 28, 2019

    Background: Residents doctors in Jordanian hospitals are involved in many clinical and non-clinical tasks that might expose them to various stress factors. High stress and burnout have the potential...

    Background: Residents doctors in Jordanian hospitals are involved in many clinical and non-clinical tasks that might expose them to various stress factors. High stress and burnout have the potential to negatively impact upon work performance and patient care, including medication errors, suboptimal care, clinical errors and patient dissatisfaction. Objective: This study aimed to determine the perceived stress among resident doctors in Jordanian hospitals and its associated risk factors Methods: : A cross-sectional study was conducted among residents in Jordanian hospitals. A cluster sample of five hospitals with residency programs was selected from different health sectors. All residents who were working in the selected hospitals were invited to participate in this study during the period April- July 2017. A total of 555 residents (response rate was 84 %) agreed to participate in this study. The perceived stress scale (PSS) was used for assessment. Results: A total of 398 male and 157 female residents were included in this study. The mean PSS score in this study was 21.6. About 6.7% of the residents had hypertension, 2.7% had diabetes, 3.2% had heart-diseases, and 8.5% were anemic. The majority of respondents complained of back pain 42%, and 29% complained of insomnia. Stress was associated with higher workload, sleep deprivation, and dissatisfaction with the relationships with colleagues, income and the program. In multivariate analysis, the following were significantly associated with stress: female gender, dissatisfaction with working environment, and facing work-related stressors. Conclusions: The majority of resident doctors in Jordanian hospitals suffer from stress. Stress management programs during residency and improving working environment are strongly recommended.